Cultural adaptation of ‘Healthy Dads, Healthy Kids’ for Hispanic families: applying the ecological validity model

Abstract

Background: Healthy Dads Healthy Kids (HDHK) is a unique lifestyle obesity intervention for fathers and children that demonstrated weight loss among the fathers and behavior change among fathers and children in Australia. The program is gender-tailored to specifically target fathers for weight loss and 5-12 year old children for obesity prevention. The aim of this formative study was to examine an Expert Panel's and Hispanic Family Panel's perceptions about the program and suggestions for the cultural adaptation of HDHK for Hispanic families in southwestern US. Methods: Forty-four Hispanic participants (22 fathers, 13 mothers and 9 children) made up the Family Panel. They participated in 1-5 study contacts (focus groups, online survey, and/or interviews). The scripts and qualitative guides assessed participants' perceptions of the HDHK content and material using the Ecological Validity Model. Studies were conducted in English or Spanish, depending on the preference of the participant. Focus groups and interviews were audio-recorded, transcribed, translated, and thematically coded. Findings were reviewed with the Expert Panel who helped inform the cultural adaptation. Results: 80% of parents were foreign-born, 57% spoke only Spanish at home, and 60% did not graduate from high school. Several themes emerged to inform the cultural adaptation of the program. Parents agreed with the HDHK goals and recommended the program place greater emphasis on parenting and limiting children's screen time. Some mothers and fathers wanted greater mother engagement. Weekly videos and a Facebook group emerged as favorite alternative options to engage mothers. Greater promotion of familism (inclusion and impact on whole family) was recommended for the program goals and activities. Gender roles for mothers and fathers, and differences in how fathers interact with male and female children, emerged and should be considered in program activities. Several barriers to father engagement surfaced, including lack of time due to work schedules, physically demanding jobs, concerns of caring for children without mother, fathers' current fitness/weight, and lack of knowledge of how to eat more healthfully. The reading level of the HDHK materials was too high for some parents. Conclusion: Findings from these formative qualitative studies informed the cultural adaptation of HDHK for Hispanic families, to account for literacy level, cultural values, and barriers to participation and engagement.

Family-Based Obesity Prevention Interventions among Hispanic Children and Families: A Scoping Review

“…Additionally, investigators should consider the evaluation of additional family-level contextual factors that may impact obesity-related outcomes and behaviors [ 56 ]. For example, O’Connor et al, assessed family functioning as it has been shown that improving a family’s ability to work and communicate together can improve the family’s ability to participate and make changes to health behaviors as a family unit [ 58 , 59 ]. Similar reviews of family-based obesity prevention strategies have also reported that studies to date do not adequately examine how family factors mediate treatment effects [ 36 , 37 ].…”

“…Thus, intervention strategies should consider the SDoH that may limit disease prevention opportunities and health behaviors that may be leveraged or addressed within interventions to increase engagement and adherence [ 64 ]. About half of the articles included in this review addressed SDoH through content focused on determinants such as immigration stress and access to care or by having research staff call families to discuss barriers to program participation, language barriers, and acculturation [ 58 , 65 , 66 , 67 ]. For example, Crespo et al used group sessions with promotoras and clinic providers to improve patient-provider communication and address barriers to care [ 67 ].…”

Contribution of food groups to energy, grams and nutrients-to-limit: the Latin American Study of Nutrition and Health/Estudio Latino Americano de Nutrición y Salud (ELANS)

“…In the past years, the adaption of existing evidencebased tools to different realities have received greater attention (39,40) . When the ELANS started, an expertise panel provided guidance to evaluate diet and other lifestyle behaviours for policy-making.…”

Latino Fathers as Catalistas (Agents of Change): Strategies to Support Latino Fathers in Childhood Obesity Prevention

“…Currently, O'Connor and colleagues 30,31 are leading a translation of the Healthy Dads, Healthy Kids (HDHK) program for Latino fathers and their children in Houston, Texas. Morgan et al 26,27 originally developed HDHK as an obesity treatment program for predominantly White fathers and their children in Australia and demonstrated success in efficacy and effectiveness trials.…”

“…Although adapting a program can be difficult, their HDHK translation will generate valuable insights for supporting and sustaining behavior change with Latino fathers. 30,31…”