Systematic review of behavioural interventions with culturally adapted strategies to improve diet and weight outcomes in African American women

Abstract

Behavioral interventions incorporating features that are culturally salient to African-American women have emerged as one approach to address the high rates of obesity in this group. Yet, the systematic evaluation of this research is lacking. This review identified culturally-adapted strategies reported in behavioral interventions using a prescribed framework and examined the effectiveness of these interventions for diet and weight outcomes among African-American women. Publications from January 1, 1990 through December 31, 2012 were retrieved from four databases, yielding 28 interventions. Seventeen of 28 studies reported significant improvements in diet and/or weight change outcomes in treatment over comparison groups. The most commonly identified strategies reported were ‘socio-cultural’ (reflecting a group’s values and beliefs) and ‘constituent-involving’ (drawing from a group’s experiences). Studies with significant findings commonly reported ‘constituent-involving’ strategies during the formative phases of the intervention. Involving constituents early on may uncover key attributes of a target group and contribute to a greater understanding of the heterogeneity that exists even within racial/ethnic groups. Available evidence does not, however, explain how culturally-adapted strategies specifically influence outcomes. Greater attention to defining and measuring cultural variables and linking them to outcomes or related mediators are important next steps.

Community-based participatory research to design a faith-enhanced diabetes prevention program: The Better Me Within randomized trial

“…The purpose of the focus groups was to determine the perspectives of church leaders and church members on the relationship between faith and health, as well as, weight loss and maintaining a healthy lifestyle, to guide the development of a faith-enhanced lifestyle program. Gathering input directly from community members, in addition to community leaders, has been shown to improve the outcomes of behavioral interventions [10]. Using directed content analysis [21] to group participant statements, the following broad categories were identified: 1) Connections between faith beliefs and health, 2) Attitudes, values and motivations for weight management, 3) Hurdles to healthy weight, and 4) Elements for successful weight loss.…”

“…Due to the growing health disparities and reduced effectiveness of health promotion programs such as the DPP in AA communities, culturally relevant enhancements to evidence-based approaches need to be tested with rigorous study designs to inform public and population health approaches [3, 10]. With rising chronic disease rates and healthcare costs, practical and sustainable programs need to be evaluated.…”

“…Further, a review of DPP program translations for AA found reduced effectiveness; approximately half of the expected weight loss from the original study [3]. Taken together, more research is needed to develop effective enhancements to health programs for AA [9, 10]. …”

Culturally Tailored Nutrition Education Interventions: Why Focus on African American Women?

“…AA women are often underrepresented in behavioral weight loss intervention trials or outcome results are not reported by ethnicity or gender [11], plus the lack of a consistent theoretical framework, has made very challenging to establish comparisons across studies [11,12]. Also, it is important to underscore the fact that a greater percentage of AA population lives below the federal poverty line (24.7%) compared to Americans overall; which puts them at a disadvantage when participating in interventions that address only individual health behavior change, because participants who have more choices regarding their environment are at an advantage [11].…”

Refining a Church-Based Lifestyle Intervention Targeting African-American Adults at Risk for Cardiometabolic Diseases: A Pilot Study

“…The majority of the church-based programs showed improved risk factor outcomes [17]. Effect size has varied, for example, ranging from 1.1 to 6.1 kg among males [18] [19]. Emerging evidence suggests that mindfulness practice can help to curb obesity-related behaviors and therefore would be beneficial for weight management [20].…”