Arredondo EM, Elder JP, Haughton J, Slymen DJ, Sallis JF, Perez LG, Serrano N, Parra MT, Valdivia R, Ayala GX. (2017). Fe en Acción: Promoting Physical Activity Among Churchgoing Latinas. American Journal of Public Health, 107 (7), 1109-1115.
Designed to increase physical activity among Latina adults, this church-based intervention is delivered by promotoras who lead physical activity classes, conduct motivational interviewing calls, mail monthly educational handouts, and coordinate environmental improvement projects. The study showed an increase in physical activity.
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Currently in the United States, 47% of Hispanics/Latinos are considered obese, and 54% are physically inactive, rates that exceed those among non-Hispanic Whites. Exercise and a balanced diet can contribute to a healthy weight and reduce the risks of health-related conditions associated with obesity, including heart disease, stroke, type 2 diabetes, and certain types of cancer.
Physical activity guidelines recommend that adults engage in a weekly minimum of 150 minutes of moderate-intensity aerobic activity (e.g., brisk walking, dancing) or 75 minutes of vigorous-intensity aerobic activity (e.g., jogging, swimming laps) along with muscle-strengthening activities at least 2 days each week, with adjustments made for older adults with chronic health conditions and a low level of fitness. Interventions that are designed to increase physical activity among Hispanic women (Latinas) are needed.
Faith in Action (Fe en Acciόn) is a 2-year, church-based intervention that promotes physical activity among Hispanic women (Latinas). Faith in Action is based on the ecological framework for health behaviors. This framework, which recognizes the importance of creating socially and physically supportive environments to successfully change behavior, targets multiple levels of influence: the individual, interpersonal, organizational, and environmental. Following this model, the program includes activities at each of the ecological levels to effect change in physical activity.
Faith in Action is tailored to the culture and faith of participants, integrating culturally relevant content (e.g., foods, music) and elements of faith, including those that reinforce health messages (e.g., the body is the temple of God). The intervention uses trained promotoras (lay health educators from the local community) to deliver each of the program’s activities over the 2-year period:
-- Physical activity classes: Each week, promotoras (i.e., community health workers) lead six hour-long physical activity classes (two walking groups, two cardio-dance classes, and two strength-training classes). Promotoras begin each class by leading a prayer and end each class by discussing a monthly health handout (described below). To encourage participation, promotoras take attendance in class and then call participants not present to encourage them to attend future classes. Small incentives are distributed.
-- Motivational interviewing calls: Promotoras conduct up to six 30-minute motivational interviewing calls with each participant across the 2-year period. Facilitated with the use of a guide, the calls aim to assess participants’ frequency and duration of physical activity and barriers to being active as well as to identify strategies to overcome those barriers.
-- Monthly educational handouts: Participants receive monthly evidence-based educational handouts in the mail. The handouts address topics related to physical activity (e.g., benefits, guidelines, strategies for overcoming barriers, injury prevention), healthy eating and portion control, healthy goals, and proper hydration. Each handout includes bible verses and the current physical activity class schedule.
-- Environmental improvement projects: To encourage physical activity, promotoras facilitate improvements to pedestrian environmental features on church grounds and neighborhoods. The promotoras conduct a walkability audit to assess, for example, sidewalk conditions, street lighting, and the presence of trees and plants. Based on this assessment, church members collaboratively select environmental targets and projects to address these targets, and they and other community members help complete the projects. Promotoras plan meetings, develop action plans and reports, and take “before” and “after” pictures.
Community Preventive Services Task Force Finding
-- 3–4 months to recruit promotoras and participants
-- 24 hours for initial promotora training and 16 hours for training on making environmental changes
-- 6 hours weekly to deliver the six physical activity classes
-- 30 minutes for promotoras to facilitate each motivational interviewing call (up to six calls over 2 years per participant)
-- Time to prepare and mail monthly mailings
-- Time for promotoras to oversee the environmental improvement projects
The intervention is intended for Latinas aged 18–65 years.
This intervention is intended to be implemented in church-based settings.
Required resources to implement the program include the following:
-- Implementation Protocol
-- Training Manual (English)
-- Training Manual (Spanish); Contact the developer for availability information.
For costs associated with this program, please contact the developer, Elva Arredondo. (See products page on the EBCCP website for developer contact information.)
About the Study
A randomized controlled trial compared the intervention with an alternative intervention among churchgoing Latinas. Sixteen churches in San Diego, California, were randomized to either the intervention group or to a comparison group offering a cancer screening intervention. Churches were recruited from a list of Catholic churches offering Spanish-language mass that was provided by the Catholic Diocese of San Diego. Churches were eligible to participate in the study if they had at least 200 Latino families attending and were willing to be randomized and to provide space for study activities. Participants were eligible to enroll if they self-identified as Latina, were between the ages of 18 and 65 years, attended the church at least four times a month for any reason, lived within 15 minutes of the church (driving), had reliable transportation to get to the church, did not identify barriers to attend activities at the church, planned to attend the church for the next 24 months, did not attend other churches enrolled in the study, did not have a condition that would preclude them for being active, and were inactive (defined as getting less than 250 minutes of accelerometer assessed MVPA per week).
The comparison condition, also based on the ecological framework and delivered by promotoras, focused on cancer screening for breast, cervical, colorectal, and skin cancer. Participants received a 6-week workshop with weekly classes of 1.5–2 hours each, class reminder calls, up to six motivational interviewing calls over 2 years, and increased access to health care. Over the 2-year study period, promotoras repeated the workshop, so the series was offered by each church at least six times per year.
The study enrolled 436 Latinas, 217 in the intervention group and 219 in the comparison group. The average age of participants was 44.4 years, and the average time living in the United States was 21 years; 90.8% were born in Mexico. Most participants (77.3%) were married or lived as married, and 65.8% were employed. The average body mass index (BMI) was 30.3 kg/m², and the average waist circumference was 94.9 cm. At baseline, there were no significant differences between groups in the primary outcomes.
The main outcome—moderate to vigorous physical activity (MVPA)—was measured with an accelerometer at baseline and 12-month follow-up. At each timepoint, participants attended two appointments. During the first appointment, research assistants measured height, weight, waist circumference, and fitness (3-minute step test). At this time, participants were given an accelerometer to wear for a minimum of 12 hours per day for 7 days. Seven to 10 days later, participants attended a second appointment to return the accelerometer and complete self-report instruments. The accelerometer data included data from 5 valid days (valid days are a minimum of 10 hours per day) with at least one weekend day. Each minute of data was counted, and MVPA was defined as 2020 counts per minute or more.
Secondary outcomes—self-reported leisure-time MVPA, BMI, and use of behavioral strategies for engaging in physical activity—were also assessed at baseline and 12-month follow-up. Self-reported physical activity was measured using the World Health Organization’s Global Physical Activity Questionnaire. It assesses frequency, duration, and intensity level of physical activity in three domains: occupational, transport-related, and leisure time. BMI was calculated by research assistants using the averages from two measurements of height and weight. Use of behavioral strategies (e.g., setting physical activity goals, going to the gym) for physical activity was measured through a survey designed for the purposes of this study.
Although the study (like the intervention) was 2 years in duration, the documents included in this review described only 12-month outcomes because 24-month outcomes were not yet available.
- From baseline to 12-month follow-up, the intervention group had a greater increase than the comparison group in accelerometer-based MVPA (p=.03).
- From baseline to 12-month follow-up, relative to the comparison group, the intervention group had an increase in self-reported leisure time MVPA (p=.003), decrease in BMI (p=.04), and increase in use of behavioral strategies for engaging in physical activity (p<.001).
- Among intervention group participants, greater class attendance was associated with a significant increase in self-reported leisure-time MVPA (p<.001) and decrease in waist circumference (p=.02).
Arredondo EM, Haughton J, Ayala GX, Slymen DJ, Sallis JF, Burke K, Holub C, Chanson D, Perez LG, Valdivia R, Ryan S, Elder J. (2015). Fe en Accion/Faith in Action: Design and implementation of a church-based randomized trial to promote physical activity and cancer screening among churchgoing Latinas. Contemporary Clinical Trials, 45, 404-415.