Adapting an Evidence-Based Family-Centered Substance Use and Sexual Risk Behavior Intervention for Obesity Prevention in Hispanic Adolescents

Introduction: Although strong evidence supports the efficacy of family-centered interventions for preventing and reducing adolescent problem behaviors (e.g., substance use), family-centered approaches are much less common in obesity prevention. This paper describes the process of adapting Familias Unidas, a parent-centered intervention shown to be efficacious and effective in preventing or reducing substance use and sexual risk behaviors in Hispanic adolescents, for obesity prevention.

Methods: A multidisciplinary team including the Familias Unidas developers and experts in obesity, exercise physiology, dietetics, and the local county parks system provided input for changes to the content and structure of Familias Unidas. Qualitative data were also obtained from Hispanic parents (n=39, 95% female) and adolescents (n=39; 64% female; 41% immigrants; M_age=13 years) through a series of focus groups conducted before, during, and after an initial pilot test of Familias Unidas adapted for obesity prevention. Sessions were audio-taped, transcribed, and coded by independent pairs of raters. A general inductive approach was used to derive themes and a content analysis was conducted using QSR Nvivo 10. Refinements to the intervention were made accordingly.

Results: Themes to emerge from the focus groups conducted before the pilot test indicated families would benefit from 1) exposure to diverse types of physical activities within the context of a fun, engaging environment; 2) communication strategies for shared parent-adolescent decision making around physical activity and diet; 3) greater nutrition education and skill building; and 4) increased opportunities to share healthy activities as a family. Parents who participated in the pilot test described enjoying the hands on nutrition activities, reported improvements in family communication, and suggested the health and wellness focus be made clearer. Adolescents stated they wanted their parents be more involved in physical activity opportunities.

Conclusions: The adapted intervention maintains fidelity to Familias Unidas core theoretical elements (e.g., family functioning) and overall structure (8 group sessions, 4 family visits) yet includes the following obesity-specific adaptations: 1) parent content focused on physical activity and quality dietary intake; 2) adolescent participation in physical activity sessions led by park coaches during parent group sessions; and 3) joint parent-adolescent participation in diet and physical activity skill-building activities (e.g., cooking class, family obstacle course). An ongoing study is examining the relative efficacy of the adapted intervention compared to community practice in improving the physical activity and diet of 280 Hispanic adolescents and their parents.