Prevalent obesity rates among Hispanics, especially women, continue to increase at a rapid rate as compared to other ethnic groups. The U.S. Department of Health and Human Services Office of Minority Health estimates that 78.8 percent of Hispanic American women are overweight or obese, as compared to 64 percent of non-Hispanic white women, placing them at higher risk for development of diabetes, cardiovascular disease, cancer and other health conditions.
The alarming statistics prompted Dr. Sarah Watts, assistant professor in the College of Nursing, to undertake a study to engage and train stakeholders to participate in patient-centered research to reduce obesity in Hispanic women. “Addressing this problem is challenging due to lack of resources and research, especially in the rural South,” Watts said.
Dr. Sarah Watts
Watts serves as the principal investigator in the project, funded by the Patient-Centered Outcomes Research Institute. Members of the research group include Dr. Mayra Rodriguez, chair for preventive medicine and public health at Edward Via College of Osteopathic Medicine, or VCOM, who serves as research partner, Dr. Surachat Ngorsuraches (Harrison College of Pharmacy) as engagement partner, Dr. Johnny Stackhouse (VCOM) as healthcare provider partner and Carmen Gonzalez (St. Mary of the Mission Catholic Church, Opelika, Ala.) as patient partner.
According to Rodriguez, few studies have seen improved long-term health outcomes for Hispanic women. “There is little evidence that any effort has been placed to engage the Hispanic population in the research process. More than ever, there is a need for patient-centered outcomes research.
“For vulnerable people living in rural areas, access to proper nutrition is one of the main barriers leading to poor health outcomes. In addition to the health deficit, differences in language, education and culture contribute as social factors that make it challenging to conduct research in the population,” Rodriguez added.
The team was interested in working with Hispanic women because of their unique and important role in family dynamics and as part of the overall culture. “Women often do most of the meal planning in this culture — grocery shopping, meal prepping and feeding their families daily. They share and pass on recipes to the next generation. For these reasons, women play a valuable role in affecting health outcomes in the Hispanic population,” Rodriguez said.
Dr. Mayra Rodriguez, VCOM
“During planning meetings for a local Hispanic health fair, the importance of focusing on research questions that were important to these women and developing interventions tailored to their culture was realized,” Watts said. “It was recognized that by engaging the stakeholders — Hispanic women and their families, Hispanic community leaders, and their health care providers — it would enable us to more successfully identify and address the barriers and challenges frequently faced to reduce obesity among Hispanic women. To accomplish this, we realized that an infrastructure must be established with the mission of conducting future patient-centered outcomes research/comparative effectiveness research, or PCOR/CER.
“Reducing obesity and maintaining a healthy weight cannot be successfully accomplished without lifestyle changes. Targeted interventions considered culturally acceptable among Hispanic women are necessary and warranted to improve the quality of diet to reduce obesity and improve health outcomes. Their behaviors and habits can greatly impact those of their families and communities. Therefore, engaging Hispanic women early in the research process could be the key to reduce barriers, overcome challenges and identify interventions and solutions to address obesity among this population,” Watts added.
The proposed project will train stakeholders from Lee County, Ala., to engage in designing and promoting future PCOR/CER in the rural South. After participating in training workshops, stakeholders will participate in brainstorming sessions and establish the research community, which will serve as the infrastructure for PCOR/CER once the project ends.
“The project is the initial step in an overarching effort to develop patient-centered research for obesity problems in this target population in the rural South,” said Watts.
With insight and collaboration from the research community, we hope to be able to design a future study that addresses health issues important to the women and includes research approaches that engage participants and reduce dropout, which in turn improves rigor of the study. Using the approach of training and engaging patients early in the research process could lead to the development of interventions that are effective and impactful.
“Few research efforts have trained the patients and put them in the ‘driver’s seat’ to guide the direction of the research. Our team hopes that we can work together to solve real-world problems and improve the health outcomes of Hispanic women,” she added.
Rodriguez’s research focus is on assessing stressors in communities and vulnerable populations. “I am interested in interventions that can help improve healthcare outcomes. This study allows our team to work closely with Hispanic community members and clinicians and create an inter-collaborative group focused on improving health outcomes,” she added.
Watts, who worked as an emergency and critical care nurse before entering academia, recognized there was a better way to improve patients’ health outcomes. “Much of my research now focuses on improving collaboration among interprofessional teams and providing targeted interventions to promote wellness among individuals. I am optimistic that our work in wellness can lead to an improved healthcare culture where patients are given tools early on to make better decisions for their health,” Watts added.
“Nurses comprise the largest component of the healthcare workforce and spend more time with patients or clients than any other professionals,” said Dr. Pao-Feng Tsai, associate dean for research at the College of Nursing. “We understand that in many cases only holistic care that involves patients and family to make lifestyle changes can result in better health outcomes in the patient population. In this regard, nurses are in a unique position to promote and make changes to the health care system.
“Research studies that do not take the patients’ and families’ perspectives into consideration tend to fail. With the engagement of these stakeholders to build a better research infrastructure, this research team will be able to design a future study that is considered a priority and important in this population, leading to better participation and outcomes,” Tsai added.