Mediators and Moderators of the Effectiveness of a Community Health Worker Intervention That Improved Dietary Outcomes in Pregnant Latino Women

Abstract

Background Pregnancy is an opportune time to initiate diabetes prevention strategies for minority and underserved women, using culturally tailored interventions delivered by community health workers (CHWs). A community-partnered randomized controlled trial (RCT) with pregnant Latina women resulted in significantly improved vegetable, fiber, added sugar, and total fat consumption compared to a minimal intervention (MI) group. However, studying RCT intervention effects alone does not explain the mechanisms by which the intervention was successful or help identify which participants may have benefitted most. Purpose To improve the development and targeting of future CHW interventions for high-risk pregnant women, we examined baseline characteristics (moderators) and potential mechanisms (mediators) associated with these dietary changes. Methods Secondary analysis of data for 220 Latina RCT participants was conducted. A linear regression with effects for intervention group, moderator, and interaction between intervention group and moderator was used to test each hypothesized moderator of dietary changes. Sobel-Goodman mediation test was used to assess mediating effects on dietary outcomes. Results Results varied by dietary outcome. Improvements in vegetable consumption were greatest for women who reported high spousal support at baseline. Women younger than age 30 were more likely to reduce added sugar consumption than older women. Participants who reported higher baseline perceived control were more likely to reduce fat consumption. No examined mediators were significantly associated with intervention effects. Conclusion Future interventions with pregnant Latinas may benefit from tailoring dietary goals, to consider age, level of spousal support, and perceived control to eat healthy.

Barriers and Facilitators to Improve Fruit and Vegetable Intake Among WIC-Eligible Pregnant Latinas: An Application of the Health Action Process Approach Framework

“…These findings are consistent with studies showing that familial social support encourages healthier eating among pregnant Latinas. 23–25 High spousal social support improved vegetable intake among pregnant Latinas 24 , and encouraged optimal health behaviors, including a healthy diet, among low-income pregnant/postpartum Latinas. 23 Similarly, pregnant adolescent Latinas were found to have good eating habits if they had a family support system that provided care, attention, and buffered them from life stressors.…”

Prediction of Postpartum Weight in Low-Income Mexican-Origin Women From Childhood Experiences of Abuse and Family Conflict

“…Adults abused as children may lack skills to develop and maintain healthy relationships, or may experience a continuation of abuse in their intimate relationships (31–32, 41–43). Following the birth of a baby, supportive relationships can improve adherence to healthy diet and exercise (51); the lack of support may exert the opposite effect, challenging efforts to obtain or maintain a healthy weight. Relatively high levels of partner support were reported by women in the current study, consistent with cultural values of familism in low-acculturated Mexican-origin families.…”

“…In contrast, lack of social support has been cited as a barrier to postpartum weight loss in low-income women (50). Among pregnant Latina women, partner support helps promote healthier dietary and exercise practices (51). …”

Can the Theory of Planned Behavior predict dietary intention and future dieting in an ethnically diverse sample of overweight and obese veterans attending medical clinics?

“…For example, a recent TPB study with pregnant Latino women determined that women with higher baseline social support showed greater improvement in healthy eating (Shah, Keiffer, Choi, Schuman, & Heisler, 2015). Given the gravity of the obesity challenge worldwide, it is important to continue investigating factors involved in the initiation and maintenance of weight loss behaviors, with some additional focus on older medical patients, military veterans, males, ethnic/racial minorities (or all of the above) as priorities.…”