Using Photovoice to Examine and Initiate Youth Empowerment in Community-Based Programs: A Picture of Process and Lessons Learned

Photovoice is a creative, participatory action research method that puts cameras in the hands of people whose voice is often hushed by the power elite, such as youth, to document issues and concerns as perceived by that group. Adult society provides youth few opportunities to positively influence the laws and regulations that govern their lives or the policies of programs in which they participate. Communitybased programs are one channel for youth to gain skills and opportunities for changing the community context in which they live. Mechanisms to facilitate youth empowerment in these programs, however, are currently vague and imprecise. Photovoice was implemented in two community-based youth programs in South Carolina to examine and initiate youth empowerment in those communities. This article details the process and lessons learned from conducting Photovoice with youth in out-of-school, community-based youth program settings. While roadblocks appeared for both the youth researchers and the universitybased investigative team, the Photovoice method was embraced by the youth who participated in the research process. Some challenges the investigative team experienced for implementation included geographic distance between the Photovoice project facilitator and the youth, challenges of working with youth and their competing commitments, an uncertainty of youth expectations, and underestimation of time and other resources

Promotoras’ Current Lifestyle Behavior and the Influence on Body Composition and Physical Function

PURPOSE: A significant public health problem is the increased quantity of time spent sedentary. Although promotoras, Spanish for community health workers, are being utilized to promote health behaviors along the South Texas-Mexico Rio Grande Valley (RGV) border region, Latinas are among the most physically inactive and obese segment of the US population. The purpose of this study was to identify the current lifestyle behaviors impact on body composition and physical functioning. METHODS: We conducted an analysis of the recorded body position (sitting, standing and recumbent) from an accelerometer versus the percentage of body fat and the estimated cardiorespiratory function recorded from the Jurca non-exercise test on 17 promotoras. Anthropometric measures included: body fatness and body composition. Participants wore an accelerometer for one week. Descriptive statistics were performed on all variables. RESULTS: Our participants averaged 40.0 ± 7.1% body fat. Cardiorespiratory capacity was 26.0 ± 9.1 VO2/kg/min. The accelerometer recorded 59% in sitting activity. A correlation of sitting and standing versus % body fat was performed with results as (p=.668) and (p=.773) respectively. A correlation of the data for sitting and standing versus estimated cardiorespiratory function was performed with results as (p=.672) and (p=.689) respectively. A correlation was performed on recumbent position versus the performance of a 2 min step test resulting in (p=.701). CONCLUSION: By understanding promotoras physical activity, an idea of the lifestyle of this population can be obtained and improved. To diminish sedentary behavior, the most rudimentary method would be to decrease sitting and laying down

The Effects of Language Barriers on Physical Activity of “Promotora” Community Health Care Workers in the South Texas-Mexico Border Region

PURPOSE: The Rio Grande Valley (RGV) is not only characterized by elevated school drop-out rates, poverty and unemployment, but also physical inactivity, obesity as well as language barriers. The purpose of this study was to assess the agreement between commonly used self-reported methods compared with objectively measured physical activity amongst community health worker; promotoras. METHODS: Our cross-sectional study, 17 promotoras (adult Latinas) capable of engaging in moderate-vigorous PA. We conducted anthropometric assessments (body mass index (BMI), body fatness (%)), assessed PA (accelerometry, and Jurca non-exercise test), and measured self-reported PA behaviors. RESULTS: Promotoras BMI were similar to other Latina women in the United States and averaged 40.0 ± 7.1 % body fat. More than half of our sample were either overweight or obese. Promotoras also exhibited a low estimated cardiorespiratory capacity of 26.0 ± 9.1 VO2/kg/min from the Jurca non-exercise test which was also significantly correlated with measured accelerometry activity. All tests were assessed using Spearman correlation analyses at a significance level of .05. CONCLUSION: Since some of the greatest health disparities occur among those who do not speak English as a first language; improvements in language barriers may enable Latinas to obtain, process and understand basic health and physical activity information and services needed to make appropriate health decisions. This study provides insight on the effect language barriers may have on Latina’s health outcomes in the RGV

Mixed-methods assessment of barriers to physical activity for middle school Latina girls

Meeting physical activity guidelines is associated with positive mental, physical, and social health. However, most adolescent girls do not meet the recommended level of physical activity, with Latina girls even less likely than white girls to do so. Partnership for Girls (PG) sought to improve physical activity (PA) and reduce sedentary behaviors to prevent obesity and obesity-related health disparities among low-income Latina adolescent girls attending Westside San Antonio schools. This study utilizes mixed-methods data—qualitative formative assessments with parents of adolescent girls to gain further insight on the PA needs of Latina girls, and standard quantitative survey assessments to examine barriers and facilitators to PA from the perspective of the Latina girls. Results from the parent focus groups identify safety, cost, and neighborhood structure, such as traffic, as salient barriers to physical activity. In alignment with the focus groups, the feasibility study found that the middle school Latinas’ neighborhood environment was a major barrier to physical activity. Policymakers and planners must address the structural obstacles, such as neighborhood structure and safety concerns, to address physical activity disparities among Latina middle school girls

A Randomized Trial of a Diet and Exercise Intervention for Overweight and Obese Women from Economically Disadvantaged Neighborhoods: Sisters Taking Action for Real Success (STARS)

Background - Lower socioeconomic status at both the individual and neighborhood level is associated with increased health risks. Weight loss can reduce this risk, but few high quality weight loss studies target this population. Objectives - STARS tests a culturally-appropriate, group-based behavioral and social support intervention on body weight and waist circumference in women from financially disadvantaged neighborhoods. Design - A stratified (by BMI) randomized trial. Randomization to group was generated by a random numbers table with allocation concealment by opaque envelopes. Methods - Participants 25-50 years who had a BMI ≥ 25 kg/m2 and a waist circumference ≥ 88 cm were recruited from 18 census tracts in Columbia, SC with high rates of poverty between November 2008 and November 2010. All participants received a dietary and exercise counseling session. Intervention participants then receive 16 theoretically-based and tailored weekly group sessions followed by 8 weeks of telephone maintenance counseling. Control participants receive 16 weekly health education mailings. Measurements correspond to baseline, post-group intervention, and post-telephone counseling, and for intervention participants, after a 12-week no-contact period. Measurement staff was blinded to group assignment. Results - Participants (N=155; n=80 intervention, n=75 minimal intervention control) were primarily African American (86.5%) and averaged 38.9 years with a mean BMI of 40.1 kg/m2 and waist circumference of 115.4 cm. Food insecurity was reported by 43% of participants. Summary - STARS targeted an underserved population with an innovative, tailored, and theoretically-grounded, group-based intervention followed by telephone maintenance. If effective, the approach has the potential to be feasible and cost-effective for community delivery

Influence of Fitness on Stress Reactivity as Measured with the Trier Social Stress Test

PURPOSE: Psychosocial stress is associated with multiple health complaints which a higher cardiorespiratory fitness may reduce stress reactivity. A higher level of fitness may assist in the reduction of stress-related risk factors. Limited studies have investigated the health and cortisol response of promotoras’ (Latina community health educators) physical activity (PA) behaviors along the South Texas Mexico Border Region. The aim of this study was to assess the associations of promotoras’ fitness on stress reactivity in promotoras. METHODS: 17 promotoras’ anthropometric measures (body mass index (BMI)), were assessed before performing Trier Social Stress Test (TSST). Salivary cortisol was collected before, 10-minutes, 25-minutes, and 40-minutes post TSST via passive drool method. Self-report PA included Jurca non-exercise assessment of cardiorespiratory capacity. Promotoras also performed a 2-minute step test. All tests were assessed using Spearman correlation analyses at a significance level of .05. RESULTS: Participants’ average BMI was high (31.4±7.18 kg/m²); 76.5% were overweight or obese, 30% very or extremely obese. Physical functioning levels were low (cardiorespiratory capacity 26.0±9.1 VO2/kg/min; step test 77.4 steps/2-minutes). Salivary cortisol levels revealed significant increase at the onset of the TSST and remained significantly elevated at 10-minutes post TSST. In comparison to baseline, cortisol levels remained elevated at 25-minutes and 40-minutes post TSST. CONCLUSION: Low levels of cardiorespiratory fitness and high BMI’s may have resulted in a slower cortisol recovery time after placing the body under stress in promotoras. Regular physical activity and fitness may attenuate response to psychosocial stress and enable promotoras to achieve a healthier lifestyle

Physical Fitness and Energy Balance Activity of “Promotora” Community Health Care Workers in the South Texas-Mexico Border Region

PURPOSE: Latinas along the U.S.-Mexico border are among the most physically inactive and obese segment of the U.S. population. There is widespread recognition of the cultural appropriateness of promotoras (community health workers) in health education among Latino communities. METHODS: We conducted a cross-sectional study with 17 promotoras who reside/work in the region to investigate their physical fitness and energy balance behaviors. Promotoras completed physical testing and self-report on physical activity and dietary behaviors. Participants wore an accelerometer for one week. In addition, the validity of an activity self-report instrument to assess cardiorespiratory fitness was tested. RESULTS: Participants’ average body mass index (BMI) was high (31.4±7.18 kg/m²); 76.5% were overweight or obese, 30% very or extremely obese. Physical functioning levels were low (cardiorespiratory capacity 26.0±9.1 VO2/kg/min; step test 77.4 steps/2-minutes). Objectively measured moderate-vigorous PA (114.6 ± 87.0 minutes/week) was less than PA recommendations. Accelerometry activity significantly correlated with self-report (r = 0.71, p=0.009). Participants self-reported consuming 1889.2±492.8 kCal/day. CONCLUSION: Promotoras’ energy balance behaviors were similar to women where they reside/work. Promotoras engaging in health-promoting behaviors may enhance their effectiveness as change agents in the communities they serve

Juntos y Saludables: Outcomes of a peer led approach to obesity prevention for Head Start

Purpose: The purpose of this study was to evaluate Juntos y Saludables (Get Healthy Together), a multi-component obesity prevention pilot tailored for Mexican American Head Start children (ages 3-5). For the parent education component, researchers trained seven peer parent educators to deliver health information via afterschool parent education sessions. When parents attended the sessions, they received a take-home bag with a book and family activity to promote physical activity in the home. Method: Parent intercept interviews, focus groups, and questionnaires were collected (average 80% participation rate). Results: Average participation rate at the parent education sessions was 46% and rates varied between 34% (61 parents) and 53% (94 parents). More parents in the intervention school reported that their child ate fruit at least 3 times (83.5% versus 79.17%), ate in front of the television less than three times (70.87% versus 49.38%) during the typical week and more parents reported that their child watched 2 hours or less of television each day (73.79% versus 13.19%), compared to the comparison school. 81% of parents interviewed correctly identified the program name. On average, parents could recall almost 3 (M=2.94, SD=1.92) of the 8 key messages without a prompt and about 6 (M=5.91, SD=1.88) when prompted. Messages recalled the most, without a prompt, included (1) preschoolers need 60 minutes of physical activity each day, and (2) children who get all five servings of fruits and vegetables each day are more likely to get the nutrients they need. In the focus group, parents reported that they enjoyed the peer-led session format and session scheduled time. Conclusion: Results suggest that peer-led approaches can be highly effective with parents, especially when addressing childhood obesity prevention

Lessons Learned from Juntos Y Saludables Peer-Led Parent Education

Purpose: The objective of this study was to assess the quality of training received by peer educators in the Juntos y Saludables (Get Healthy Together) program. Juntos y Saludables is a multi-component childhood obesity prevention program for Head Start. Method: This study applied the peer led education approach to provide parents with education regarding healthy growth among their children. Seven parents were recruited through teachers, other parents, and the Parent Leadership Institute at a local Head Start center. Faculty and graduate assistants from local universities provided training to the parent educators in both English and Spanish. Training sessions were conducted the week of each new parent education session, with one booster training after spring break (7 training sessions in total). The parent educators were trained to: (1) encourage the Head Start parents to participate in the sessions, (2) explain the health messages, and (3) answer any questions the parents had. A focus group was conducted at the end of the program, with all seven parent educators, to assess their feedback about the training they received. Results: The peer parent educators reported that they became educators to improve children’s health. They were satisfied with the training methods and felt that they learned a lot of information regarding nutrition and physical activity recommendations for their children. They also reported feeling comfortable delivering health information to other parents. Parent educators appreciated that they could work together (e.g., in bilingual pairs) to provide the health education to parents in both English and Spanish. The peer parent education training session attendance was high-71% and greater. Conclusions: Most peer parent educators felt comfortable and confident delivering the material as the program progressed. Earlier training might assist the parent educators to have greater familiarity with content prior to the first session. Educators also created strategies to deal with situations that arose during the sessions (e.g. crowd control, parents requesting extra bags). Future training can include suggested strategies to handle similar situations