Physical activity and healthy eating serve as a mantra for health promotion, but for people living in impoverished colonias communities along the U.S. border with Mexico, a simple walk around the block can prove daunting. Becky Keele, PhD, PHCNS-BC, RN, associate professor at the New Mexico State University School of Nursing in Las Cruces, aims to reduce health disparities related to overweight and obesity by promoting physical activity and healthy eating.
“I’ve always been interested in health promotion,” Keele said. “And I’ve always been passionate about this population and their needs.”
Keele has received several grants to fund her work in colonias communities, unincorporated settlements, which often lack basic infrastructure, such as sewer and public water, sidewalks and paved roads, parks and grocery stores. Almost all residents are Mexican-Americans.
“When they are trying to make do, physical activity and eating healthy may be a low priority,” Keele said.
Award funds study
A 2014 National Institutes of Health IDeA Networks of Biomedical Research Excellence program award allowed her to conduct a pilot study working with families of preschool-age children, with a family caretaker, to promote physical activity. She is analyzing data for the work completed in May 2015.
“All of the families showed progress with their actual family activity,” Keele said. She noted many of the women in the community suffered from depression, but their affect began to change. Toward the end, they were taking more pride in their appearance and seemed happier and more positive.
The pilot began with focus groups to determine if the residents considered obesity a problem, which they did, and factors they thought contributed. Residents reported the convenience of fast food, preferences for fried food, safety concerns associated with walking and competing family obligations. Nine families agreed to participate in the study.
A promotora, a trained, lay community health worker who lives and knows the community, completed most of the five monthly home visits, since she spoke Spanish and had already established a trust relationship with the people. Each month, the study leaders assessed physiologic measures, current activities, those activities they liked and did not enjoy and the family members’ exercise motivation. The team used that information to develop ideas to promote exercise and discussed them with the family.
“We negotiated and came up with a plan each was able to go forward with,” Keele said. “We tried to start where they were.”
Undergraduates participate in study
A group of four undergraduate community health students participated in the study and learned about the project. During their clinical, the students conducted a literature review to learn about the community, observed and documented their experiences during the home visits and met weekly with Randee Greenwald, PhD(c), FNP-BC, assistant professor of Community Health Nursing at New Mexico State University.
“It was a great opportunity for students to be part of a research project,” Greenwald said. “Without research you cannot move the profession forward.”
Greenwald also mentioned that students observing the difficulties rural, poor people have in implementing things many Americans take for granted, such as safely walking around their neighborhood and easy access to healthy foods, creates a different perspective and opens students’ eyes to the need to tailor such guidance to the audience.
Starting with small steps
Most of the participants were not exercising at all when the pilot started, so Keele focused on small steps to get them moving. Sometimes that was parking a little farther from the store or taking the steps rather than the elevator. Then the team would build on that at the next home visit, during which participants also received an incentive — a pedometer, an exercise ball, a stretch band — and education in using the devices.
Keele tailored the program to each person’s needs, including finding an exercise plan for a long-distance truck driver. She found the families liked dancing, walking and competitive sports. The team also provided suggestions for healthier eating, such as baking rather than frying foods. At the end of the study, Keele gave each family a fruit and vegetable basket, and the promotora created healthy recipes to use in preparing the foods in the basket.
“They did make an effort, committed to us and stuck with it,” Keele said. “They were so appreciative of what we did to help them.”
[accordion title=”Program earns PCORI grants” load=”hide”]In addition to receiving a National Institutes of Health IDeA Networks of Biomedical Research Excellence grant, Becky Keele, PhD, PHCNS-BC, New Mexico State University School of Nursing associate professor, has secured Tier 1 and Tier 2 Pipeline to Proposal funding awards from the Patient-Centered Outcomes Research Institute.
With the first $14,000 award, Keele created a community alliance work group composed of business, health and educational leaders and families living in the colonias to develop goals and objectives and brainstorm solutions to identified issues. The second $25,000 grant, now underway, continues to build engagement and community participation and develop research questions. In Tier 3, the research proposal would be created. Keele plans to apply for the Tier 3 grant.
“The idea is community engagement and helping people decide for themselves the issues and strategies to resolve those issues,” Keele said.
Keele expects the findings from her INBRE study will prove helpful to the PCORI group in developing strategies that will work in the community.[/accordion]