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Intervention IP-127: "Every Little Step Counts": A Community-Based Lifestyle Intervention for Diabetes Prevention and Quality of Life Improvement in Latino Adolescents with Obesity
Summary
This health intervention was a culturally tailored, community-based diabetes prevention program for Latino adolescents with obesity that combined weekly family-centered nutrition and health education classes, supervised exercise sessions three times per week, behavior-change strategies such as goal setting and self-monitoring, and ongoing social and emotional support. The findings suggest that culturally relevant, family-focused lifestyle interventions can effectively improve both metabolic and psychosocial health among Latino youth at high risk for type 2 diabetes.
Overview
To evaluate short‑ and long‑term effects of a culturally grounded, community‑based lifestyle intervention on insulin sensitivity and quality of life in Latino adolescents with obesity.
Research-Tested — Interventions with strong methodological rigor that have demonstrated short-term or long-term positive effects on one or more targeted health outcomes to improve minority health and/or health disparities through quantitative measures; Studies have a control or comparison group and are published in a peer-review journal; No pilot, demonstration or feasibility studies.
Intervention Details
Both Community and Academic/Clinical Researchers
Citations:
-
Soltero EG, Olson ML, Williams AN, Konopken YP, Castro FG, Arcoleo KJ, Keller CS, Patrick DL, Ayers SL, Barraza E, Shaibi GQ. Effects of a Community-Based Diabetes Prevention Program for Latino Youth with Obesity: A Randomized Controlled Trial. Obesity (Silver Spring, Md.). 2018 Dec;26(12):1856-1865. Epub 2018 Nov 14. PubMed
PubMed Central DOI
Relevance: Main Intervention
Yes
The Diabetes Prevention Program (DPP)
https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp
Citations:
-
Diabetes Prevention Program (DPP) Research Group. The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes care. 2002 Dec;25(12):2165-71. PubMed PubMed Central DOI
Yes
Contact Information
Arizona State University
https://sirc.asu.edu/every-little-step-counts-efficacy-trial
Results
Improve minority health or the health of other populations with health disparities (e.g. rural populations, populations with low SES)
Insulin sensitivity and weight-specific quality of life.
BMI percentile (BMI%), waist circumference, and percent body fat.
Significant short-term increases in total weight-specific QoL were observed among INT youth (from 63.9 ± 2.9 to 79.6 ± 2.2; P < 0.001) but not in COMP youth (from 64.6 ± 3.1 to 67.1 ± 2.8; P > 0.05), and the between-group difference in change at 3 months was significant (∆ = 13.1; P < 0.001). Furthermore, within- and between-group differences in total weight-specific QoL were maintained at 12 months (∆ = 13.0; P < 0.001). All subdomains of weight-specific QoL were significantly increased in the short and long term among INT youth compared with COMP youth (all P ≤ 0.002). Significant short-term increases in insulin sensitivity were observed among INT youth (from 1.8 ± 0.1 to 2.2 ± 0.1; P < 0.01) in contrast with COMP youth who did not change (1.7 ± 0.2 to 1.7 ± 0.1; P > 0.05). The between-group difference in change at 3 months was significant (∆ = 0.37; P < 0.05). By 12 months, there were no significant within- or between-group effects on insulin sensitivity (∆ = 0.21; P > 0.05).
Latent-change modeling was used to assess changes in insulin sensitivity and QoL across T1 (pretest), T2 (posttest), and T4 (12 months) among randomized youth. Latent-change models adjust for measurement error and reduce estimate bias and allow for the simultaneous assessment of changes between INT and COMP groups from T1 to T2 and from T1 to T4.
Yes
Evaluations and Assessments
Yes
Process Evaluation: Mediation analysis examined the mechanisms by which the intervention led to improvements in outcomes.
Demographic and Implementation Description
Obesity, Type 2 Diabetes
Hispanic or Latino
Racial and Ethnic Minority Populations
Adolescents (10 - 17 years)
Socio-demographics / Population Characteristics
Urban / Inner City
Unspecified
Arizona
Unspecified
Minority Health and Health Disparities Research Framework
| Levels of Influence | |||||
|---|---|---|---|---|---|
| Individual | Interpersonal | Community | Societal | ||
| Determinant Types | Biological | ✔ | |||
| Behavioral | ✔ | ✔ | ✔ | ||
| Physical / Built Environment | ✔ | ||||
| Sociocultural Environment | ✔ | ✔ | ✔ | ||
| Health Care System | ✔ | ✔ | ✔ | ||
Community Involvement
The community's role in different areas of the Intervention (Choices are "No Role", "Participation", and "Leadership"):
Participation
Participation
Participation
Leadership
Participation
Participation
Participation
Participation
Characteristics and Implementation
Behavior Change
Primary Prevention
Local Community (e.g. Barbershops, Beauty / Hair Salon, Laundromats, Food Markets, Community Centers)
In-person
Community Health Worker/Promoters, Health Educator, YMCA Fitness Instructors
Conceptual Framework
Social Cognitive / Social Learning Theory
Social Ecological Model
Implementation
Individual Randomized Controlled Trial/Comparative (requires random assignment, a control/comparison group, and pre and post intervention outcome assessments)
160
136
2012
2016
Intervention Exposures
1-3 months
Weekly
More than 10 Sessions
1-2 Hours
Group (e.g. Community leaders)
Grade 6-7
Adaptations and Modifications
| Intervention Elements | Modified |
|---|---|
| Content |
Yes |
| Context |
Yes |
| Implementation |
Yes |
| Funding |
Yes |
| Organization |
Yes |
| Participants |
Yes |
| Providers |
Yes |
| Sociopolitical |
No |
| Stages of Occurrence | Yes |
Modification Details
| Explanation | |
|---|---|
| Content | |
|
Adding Elements, Tailoring |
The intervention curriculum was tailored to the priority population. |
| Context | |
|
Format, Personnel, Population, Setting |
The intervention was delivered in the community, by the community, and for the community. |
| Implementation | |
|
Delivery, Study Design |
Community stakeholders within the partnership have worked to develop a diabetes-prevention program that integrates Latino cultural values such as familismo (familism) and respeto (respect). The construct of familismo is leveraged by encouraging the entire family, including extended members living in the household, to attend the program and make healthy lifestyle changes as a family. The construct of respeto is leveraged to discuss roles and responsibilities of parents and children for making decisions about health, modeling healthy behaviors, selecting, preparing, and consuming healthy foods, communicating within and outside of the family, and honoring traditional gender roles as well as cultural and religious celebrations. The program is delivered by bilingual and bicultural health educators who appreciate the cultural norms within the local community and use examples from their lives to establish rapport, foster dialogue, and discuss challenges and opportunities around health. |
| Funding | |
|
Federal Government |
The research was supported by the NIMHD. |
| Organization | |
|
Availability of Staffing / Technology / Space, Culture / Climate / Leadership Support, Location |
The intervention was delivered at a local YMCA. |
| Participants | |
|
Ethnicity, Race, None |
The Diabetes Prevention Program (DPP) demonstrated that comprehensive lifestyle intervention that includes nutrition education, physical activity, and behavior change strategies can prevent or delay the onset of T2D in adults with prediabetes. The DPP has been successfully adapted for a variety of adult populations (e.g., elderly, minority, pregnant women). This intervention adapts the DPP to specifically focus on a pediatric Hispanic and Latino population. |
| Providers | |
|
Ethnicity, Training / Skills |
The intervention was delivered by bilingual/bicultural health educators and trainers. |
| Stages of Occurrence | |
|
Implementation, Planning/Pre-implementation/Pilot |
This study adapted the DPP by tailoring the implementation to Latino youth and families in a community setting. Specifically by providing both parents and youth with the skills and resources needed to support behavior change. At the community level, this study adapted the DPP's implementaiton by bringing together key clinical and community partners with strong ties to the Latino community. |
Impact, Lessons, Components
Not Tested
Being culturally grounded and integrating family support.
Lessons Learned
Sustaining improvements in cardiometabolic risk factors may require longer duration and higher intensity interventions.
Insights Gained During Implementation
| Insight Category | Insight Description |
|---|---|
| Transportation | Family's needed help with transportation to attend intervention sessions. |
Intervention Components
Yes
No
Products, Materials, and Funding
| Used for Implementation | Needed for Sustainability | |
|---|---|---|
| Expertise | ||
|
Clinical Care |
Yes | Yes |
| Partnerships | ||
|
Community groups (e.g. faith-based organizations, barbershops, beauty-salons, laundromats, food markets, community centers, cultural associations, tribal groups) |
Yes | Yes |
| Funding Sources | ||
|
Public funding (e.g., federal, state or local government) |
Yes | Yes |
Product/Material/Tools
| Tailored For Language | Language(s) if other than English | Material | |
|---|---|---|---|
| Outreach/Recruitment Tools | |||
|
Publicity Materials (e.g. Posters, Flyers, Press Releases) |
Yes |
Spanish |
Attachment available for request at the bottom of the page. |
|
Videos |
No |
https://youtu.be/aGe5DnFZFrE?si=9TxkTz8e7C_KqDq4
|
|
| Participant Educational Tools | |||
|
Brochures/Factsheets/Pamphlets |
No |
https://www.norc.org/content/dam/norc-org/pdfs/ELSC%20Handouts.pdf
|
|
| Measurement Tools | |||
|
Not available |
No |
These materials are not available. |
|
Implementation Materials and Products
| Material | |
|---|---|
| Implementation/Delivery Materials | |
|
Guidebooks/Workbooks/Participant Manual |
https://www.norc.org/content/dam/norc-org/pdfs/ELSC%20Handouts.pdf
|
|
Coordinator or Facilitator’s Guides |
https://www.norc.org/content/dam/norc-org/pdfs/ELSC%20Session%20Materials.pdf
|
| Implementation/Output Materials | |
| No Implementation/Output Materials provided. | |
Articles Related to Submitted Intervention
| Article | |
|---|---|
| Reports/Monographs | |
| No Reports/Monographs provided. | |
| Additional Articles | |
|
Evaluation |
https://pubmed.ncbi.nlm.nih.gov/33949215/
|
|
Moderating factors |
https://pubmed.ncbi.nlm.nih.gov/32072749/
|
|
Methodology |
https://pubmed.ncbi.nlm.nih.gov/32939893/
|
Materials Available for Request
- ELSC Flyer Full page ASU 7.3.4.pdf