Cultural adaptation of 'Healthy Dads, Healthy Kids' for Hispanic families: Applying the ecological validity model

Authors: O'CONNOR, TERESIA - Children'S Nutrition Research Center (CNRC); PEREZ, ORIANA - Children'S Nutrition Research Center (CNRC); BELTRAN, ALICIA - Children'S Nutrition Research Center (CNRC); COLON GARCIA, ISABEL - Children'S Nutrition Research Center (CNRC); ARREDONDO, ELVA - San Diego State University; PARRA-CARDONA, RUBEN - University Of Texas At Austin; CABRERA, NATASHA - University Of Maryland; Thompson, Deborah - Debbe; BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC); MORGAN, PHILIP - University Of Newcastle

Submitted to: International Journal of Behavioral Nutrition and Physical Activity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/27/2020
Publication Date: 4/21/2020
Publication URL: https://handle.nal.usda.gov/10113/6893789
Citation: O'Connor, T.M., Perez, O., Beltran, A., Colon Garcia, I., Arredondo, E., Parra-Cardona, R., Cabrera, N., Thompson, D.J., Baranowski, T., Morgan, P.J. 2020. Cultural adaptation of 'Healthy Dads, Healthy Kids' for Hispanic families: Applying the ecological validity model. International Journal of Behavioral Nutrition and Physical Activity. 17:52. https://doi.org/10.1186/s12966-020-00949-0.
DOI: https://doi.org/10.1186/s12966-020-00949-0

Interpretive Summary: Hispanic children and adults experience significant health disparities for obesity and associated medical conditions. It is generally agreed that to effectively prevent obesity among children, parents should be engaged. To date, fathers have been minimally targeted or engaged in efforts to prevent children from developing obesity, despite fathers having important influences on children's physical activity and eating behaviors. One program, Healthy Dads Healthy Kids (HDHK), has successfully engaged Australian fathers in a weight management program for the men and obesity prevention for their children. This manuscript describes formative qualitative studies to inform a cultural adaption of HDHK for Hispanic fathers and their children. An expert panel of researchers and a family panel of Hispanic parents and some of their children (22 fathers, 13 mothers and 9 children) were convened. The family panel took part in 1-5 study contacts, such as focus groups, an online survey, and/or interviews, to provide feedback and suggestions on how to best culturally adapt the program for Hispanic families in this region. Several themes emerged to inform the adaptation of the program. Parents agreed with the original HDHK goals and recommended the program place greater emphasis on parenting and limiting children's screen time. Some mothers and fathers wanted mothers to be included more in the program. Weekly videos and a Facebook group emerged as favorite alternative options to engage mothers. Greater promotion of familism (inclusion and impact on whole family) was recommended for the program goals and activities. Gender roles for women and men in families, and differences in how fathers interact with sons and daughters, emerged and should be considered in program activities. Several barriers to father engagement surfaced, including lack of time due to work schedules, physically demanding jobs, concerns of fathers' current fitness/weight and caring for children without mother, and lack of knowledge of how to eat more healthfully. The reading level of the HDHK materials was too high for some parents. Findings from these formative qualitative studies informed the cultural adaptation of HDHK for Hispanic families, to account for literacy level, cultural values, and barriers to participation and engagement. The adapted program will be tested in a feasibility trial.

Technical Abstract: Healthy Dads Healthy Kids (HDHK) is a unique lifestyle obesity intervention for fathers and children that demonstrated weight loss among the fathers and behavior change among fathers and children in Australia. The program is gender-tailored to specifically target fathers for weight loss and 5–12'year old children for obesity prevention. The aim of this formative study was to examine an Expert Panel's and Hispanic Family Panel's perceptions about the program and suggestions for the cultural adaptation of HDHK for Hispanic families in southwestern US. Forty-four Hispanic participants (22 fathers, 13 mothers and 9 children) made up the Family Panel. They participated in 1–5 study contacts (focus groups, online survey, and/or interviews). The scripts and qualitative guides assessed participants' perceptions of the HDHK content and material using the Ecological Validity Model. Studies were conducted in English or Spanish, depending on the preference of the participant. Focus groups and interviews were audio-recorded, transcribed, translated, and thematically coded. Findings were reviewed with the Expert Panel who helped inform the cultural adaptation. 80% of parents were foreign-born, 57% spoke only Spanish at home, and 60% did not graduate from high school. Several themes emerged to inform the cultural adaptation of the program. Parents agreed with the HDHK goals and recommended the program place greater emphasis on parenting and limiting children’s screen time. Some mothers and fathers wanted greater mother engagement. Weekly videos and a Facebook group emerged as favorite alternative options to engage mothers. Greater promotion of familism (inclusion and impact on whole family) was recommended for the program goals and activities. Gender roles for mothers and fathers, and differences in how fathers interact with male and female children, emerged and should be considered in program activities. Several barriers to father engagement surfaced, including lack of time due to work schedules, physically demanding jobs, concerns of caring for children without mother, fathers' current fitness/weight, and lack of knowledge of how to eat more healthfully. The reading level of the HDHK materials was too high for some parents. Findings from these formative qualitative studies informed the cultural adaptation of HDHK for Hispanic families, to account for literacy level, cultural values, and barriers to participation and engagement.