Familias Unidas for Health and Wellness: Adapting an Evidence-Based Substance Use and Sexual Risk Behavior Intervention for Obesity Prevention in Hispanic Adolescents

Abstract

We describe the adaptation of Familias Unidas, an evidence-based substance use and sexual risk behavior intervention, for obesity prevention in Hispanic adolescents. Intervention developers and experts in pediatric obesity, exercise physiology, dietetics, and the local parks system provided input for changes. Hispanic families also provided input through a series of 21 focus groups conducted before, during, and after an initial pilot test of the adapted intervention. After transcribing audiotaped sessions, we used a general inductive approach and Dedoose qualitative software to derive themes. Results indicated the need for improved health-related family functioning, enhanced nutrition education and skill building, increased family engagement in physical activity, and stronger links between family and environmental supports. Parents who participated in the pilot test expressed high enthusiasm for hands-on nutrition training and reported improvements in family functioning. Adolescents liked outdoor physical activities but wanted parents to be more engaged in joint physical activity sessions. The adapted intervention maintains fidelity to Familias Unidas' core theoretical elements and overall structure, but also includes content focused on physical activity and nutrition, adolescent participation in physical activity sessions led by park coaches, and joint parent-adolescent participation in physical activity and nutrition skill-building activities.

Results of a Family-Based Intervention Promoting Healthy Weight Strategies in Overweight Hispanic Adolescents and Parents: An RCT

“…This study used an RCT design to evaluate the relative efficacy of FUHW among a sample of 280 Hispanic overweight and obese adolescents and their primary caregivers compared with prevention as usual. 28 Study staff recruited participants beginning in 2015. Adolescents and their primary caregiver were eligible to participate in the study if the Hispanic adolescent: (1) was a student in the 7th/8th grade, (2) had a BMI ≥85th percentile adjusted for age and sex, (3) lived with an adult primary caregiver willing to participate in the 2-year study, and (4) had plans to remain a resident of the geographic study catchment area (i.e., South Florida) during the study period.…”

“…The process of adapting Familias Unidas, an intervention targeted toward reducing substance use and sexual risk behaviors, to target obesogenic behaviors has been described in detail elsewhere. 28 The adapted intervention, FUHW, was developed with the input from experts in pediatric obesity, exercise physiology, dietetics, and nutrition, such that these experts provided intervention modifications aligned with existing evidence-based physical activity curriculums. The research team also adapted the intervention through an iterative process based on input from Hispanic adolescents and parents who participated in a series of focus groups conducted before, during, and after an initial pilot test of the adapted intervention.…”

Predictors of Participant Attendance Patterns in a Family-Based Intervention for Overweight and Obese Hispanic Adolescents

“…A recent review of barriers and facilitators to initial and continued attendance in community-based lifestyle programs for overweight and obese youth concluded that a family-centered approach (where both parents and youth attend sessions), practical sessions (e.g., hands on cooking activities and physical activity), and social interaction and support were important factors influencing continued attendance [ 67 ]. All of these characteristics are central to the present intervention and were previously endorsed by those participating in the initial pilot/feasibility study as important features of the program [ 45 ]. Specifically, parents described feeling engaged by intervention content and social connections, reported enjoying hands-on nutrition training activities, perceived improvements in family cohesion, and described the intervention social climate as being very positive.…”

“…Familias Unidas for Health and Wellness was adapted from an evidence-based intervention for Hispanic adolescents (“Familias Unidas”) shown to be efficacious and effective in preventing and reducing substance use and sexual risk behaviors in Hispanic adolescents across four randomized controlled trials [ 49 , 50 , 51 ]. The adaptation process is described in detail elsewhere [ 45 ]. Briefly, intervention developers and experts in pediatric obesity, exercise physiology, dietetics, and the local parks system provided input for changes.…”

“…In the context of a culturally relevant family-based obesity prevention intervention for Hispanic adolescents known as Familias Unidas for Health and Wellness [ 45 ], the aims of the current study were to: (1) identify subgroups of participant attendance patterns, and (2) examine the role of individual (i.e., adolescent gender, parent education, annual household income, adolescent and parent weight status and healthy lifestyle behaviors), family dynamics (i.e., positive parenting, parent-adolescent communication), and cultural variables (i.e., acculturation, Hispanicism, Americanism) in distinguishing attendance patterns. We hypothesized that multiple attendance patterns would emerge from our data and that families with the following characteristics at baseline would be most likely to consistently attend intervention sessions: female adolescent gender, higher parent education, higher annual household income, lower parent and adolescent weight status, healthier adolescent and parent lifestyle behaviors, more positive parenting, better parent-adolescent communication, and less acculturation.…”