Comadres Saludables: A Web-Based Promotora Training Program for Obesity Prevention in Hispanic Women - ABSTRACT
More than two in three (70.2%) U.S. adults are overweight or obese (Body Mass Index (BMI) of ≥ 25).1
Hispanics are 23% more likely to be obese than their White counterparts4, and obesity rates are higher in
Hispanic women than Hispanic men (45% vs. 39.7, respectively).5 Obesity is driven by a variety of social,
physical, and economic factors, but is mainly due to poor diet and physical inactivity.2,7 Hispanics are more
likely than non-Hispanic Whites to engage in these risk behaviors10-13 Given this, most successful interventions
that reduce adiposity indices (e.g. BMI, weight, waist circumference) incorporate both diet and exercise21-23
Nonetheless, most obesity research is based on a general non-Hispanic population. Culturally adapted health
interventions substantially improve the outcomes in minority groups compared to generic programs26-30
including culturally tailored obesity programs for Hispanics.31 Successful obesity interventions for Hispanics
have relied on promotores de salud (also known as community health workers) as key implementers.31
Promotores are effective in delivering obesity interventions 31,37,40,42, however, adequate in-person training of
the promotora is necessary for effective implementation of these interventions. An in-person train-the-trainer
model is a laudable means of investing in promotores and communities, however, there remains barriers to
accessibility of training due to promotores availability, family commitments and associated costs.43,58-60 Our
goal is to develop an effective, accessible, and scalable obesity prevention training program for promotores.
We aim to develop Comadres Saludables, an interactive, web-based (and tablet compatible) promotora
training for obesity prevention in Hispanic women. Comadres Saludables will : 1) combine both theory and
evidence-based practices to provide promotores with the knowledge and skills required to effectively
implement an obesity intervention for Hispanic women; and 2) provide promotores with interactive mHealth
tools to enhance implementation with Hispanic populations. The training program will aim to increase
knowledge and skills by incorporating interactive activities such as interactive quizzes, exercises, video role-
playing scenarios, and tools. A booster module aimed at providing continuous support and education for
promotores will also be included in the program. Lastly, interactive mHealth tools will be accessible to
promotores to aid in implementation and fidelity monitoring.
In Phase I, with input from focus groups and our expert consultants, ISA staff will develop and pilot test
Comadres Saludables, a prototype promotora training program for obesity prevention. Community Action
Corporation of South Texas (CACOST) will provide ISA with an Advisory Committee that will participate in a
focus group and aid in the iterative process of developing the prototype. In addition, CACOST will help us
recruit certified promotores from the area. Certified promotores will participant in both the focus groups and
pilot testing of the prototype. For Phase I, the Introduction, Nutrition, and Exercise modules will be
substantially developed, and the remaining modules will be partially developed with sufficient material to
provide users with a sense of what the fully developed program will contain. During Phase I, we will work with
our software contractor, the Redmon Group (RGI) to develop a prototype program guided by input from our
expert consultants, advisory committee, and focus groups. After the completion of our prototype, our team of
expert consultants will conduct a final review of the program. We will then complete the pilot testing of the
prototype with the original participants from the focus groups. To move to Phase II, there must be an 80%
error-free rate and no critical errors in the usability portion of pilot testing. In addition, feasibility testing mean
ratings of 3.5 or higher will have to be received across the proposed prototype items and Comadres Saludables
must be rated as preferable to comparable NHLBI training materials47 on 75% of the dimensions. We believe
that feasibility and appeal of the program concept will be achieved by using these two rigorous criteria.
