Culturally Appropriate Nutrition Communication for Mexican American Women

Study Overview
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Brief Summary
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A randomized controlled trial to test the effects of culturally appropriate nutrition communication for Mexican American women.

Detailed Description
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An unbalanced randomized controlled trial with pre-test and immediate post-test was employed to test the effects of different types of message features and appeals. The study was conducted online with Mexican American women aged 18-29 years old. Messages focused on sugary beverage consumption and the main outcomes were acceptance and receptivity to the message (i.e., perceived effectiveness), perceptions of social norms, and knowledge. The investigators also measured a number of hypothesized mediators and moderators of the effects.

Official Title
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Culturally Appropriate Nutrition Communication for Mexican American Women: A Randomized Controlled Trial

Conditions
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Obesity, Lifestyle Risk Reduction, Nutrition Poor, Chronic Disease, Cancer, Breast

Intervention / Treatment
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* Other: Health Communication


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Self-identify as Latina/x or Hispanic Self-identify as a woman Self-reported as being of age between 18-29 years Undergraduate students enrolled in SONA at UC Merced Exclusion Criteria: - Not Mexican American

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 29 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Rewind the Future<br>Fear appeal, video message to reduce sugar consumption or risk death | Other: Health Communication<br>* Spoken word poems set to images performed by youth who wrote the poems. Videos were produced by The Bigger Project and were posted publicly to the Bigger Picture Project website and YouTube. Duration of videos ranges from 2 minutes to 6 minutes.<br>|
| Experimental: Hear No<br>Video of spoken word poem from The Bigger Picture project, Hear No by Joshua Merchant; images of African-American male poet interspersed with images of environment | Other: Health Communication<br>* Spoken word poems set to images performed by youth who wrote the poems. Videos were produced by The Bigger Project and were posted publicly to the Bigger Picture Project website and YouTube. Duration of videos ranges from 2 minutes to 6 minutes.<br>|
| Experimental: The Longest Mile<br>Video of spoken word poem from The Bigger Picture Project, The Longest Mile by Tassiana Willis; images of African-American female poet interspersed with images of environment | Other: Health Communication<br>* Spoken word poems set to images performed by youth who wrote the poems. Videos were produced by The Bigger Project and were posted publicly to the Bigger Picture Project website and YouTube. Duration of videos ranges from 2 minutes to 6 minutes.<br>|
| Experimental: A Taste of Home<br>Video of spoken word poem from The Bigger Picture Project, A Taste of Home by Monica Mendoza; images of Hispanic female poet interspersed with images of environment | Other: Health Communication<br>* Spoken word poems set to images performed by youth who wrote the poems. Videos were produced by The Bigger Project and were posted publicly to the Bigger Picture Project website and YouTube. Duration of videos ranges from 2 minutes to 6 minutes.<br>|
| Experimental: Lost in Translation<br>Video of spoken word poem from The Bigger Picture Project, Lost in Translation by Yosimar Reyes; images of Hispanic male poet interspersed with images of environment | Other: Health Communication<br>* Spoken word poems set to images performed by youth who wrote the poems. Videos were produced by The Bigger Project and were posted publicly to the Bigger Picture Project website and YouTube. Duration of videos ranges from 2 minutes to 6 minutes.<br>|
| Experimental: Bottled Up<br>Video of spoken word poem from The Bigger Picture Project, Bottled Up by Eileen Torrez; images of Hispanic female poet interspersed with images of environment | Other: Health Communication<br>* Spoken word poems set to images performed by youth who wrote the poems. Videos were produced by The Bigger Project and were posted publicly to the Bigger Picture Project website and YouTube. Duration of videos ranges from 2 minutes to 6 minutes.<br>|
| Experimental: The Corner<br>Video of spoken word poem from The Bigger Picture Project, The Corner by Jose Vadi; images of Hispanic male poet interspersed with images of environment | Other: Health Communication<br>* Spoken word poems set to images performed by youth who wrote the poems. Videos were produced by The Bigger Project and were posted publicly to the Bigger Picture Project website and YouTube. Duration of videos ranges from 2 minutes to 6 minutes.<br>|
| Experimental: Thin Line<br>Video of spoken word poem from The Bigger Picture Project, Thin Line by Ivori Holson; images of African-American female poet interspersed with images of environment | Other: Health Communication<br>* Spoken word poems set to images performed by youth who wrote the poems. Videos were produced by The Bigger Project and were posted publicly to the Bigger Picture Project website and YouTube. Duration of videos ranges from 2 minutes to 6 minutes.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perceived effectiveness | Perceived effectiveness of the message is known to affect intention to engage in a given health behavior. Therefore, perceived effectiveness of the stimuli was assessed as a proxy measure for intention to reduce sugary beverage consumption using a 5-point, 13-item Likert scale with responses ranging from Strongly Agree=5 to Strongly Disagree=1. This scale comprised 3 subscales namely (1) Message Acceptance - 2 items, (2) Argument Strength - 4 items, (3) Personalized Perceived Effectiveness - 7 items. Greater scores on this scale represented greater levels of perceived effectiveness of the message. | Immediately post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Identification with the message | responses ranging from Strongly Agree=5 to Strongly Disagree=1. Two sample items from the scale are, During viewing, I felt I could really get inside the person's head, and At key moments in the video, I felt I knew exactly what they were going through. Greater scores on this scale represent greater degree of identification with the character in the video. | Immediately post-intervention | 
| Activation of social justice values | Activation of social justice values was measured using a 5-point, 2-item Likert scale with responses ranging from Strongly Agree=5 to Strongly Disagree=1. The two items are, The message made me think that when I choose to eat healthy, I'm helping to make the world a better place and The message made me think that when I eat healthy, I'm doing my part to protect people who are being manipulated by sugary beverage companies. Greater scores on this scale represent greater levels of activation of social justice values. | Immediately post-intervention | 
| Sugary beverage related media literacy | Sugary beverage related media literacy was measured using a 5-point, 8-item Likert scale with responses ranging from Strongly Agree=5 to Strongly Disagree=1. This scale measured how much the participants understood the ways in which sugary beverage industry used media to influence and manipulate their sugary beverage consumption behaviors. Some sample items are as follows: Certain sugary drink brands are designed to appeal to people like me, Sugary drink ads show a healthy lifestyle to make people forget about the health risks, such as weight gain and diabetes and Sugary drink ads link drinking these beverages to things people want, like love, good looks, and power. Greater scores on this scale represent greater levels of sugary beverage media literacy. | Pre-test and Immediately post-intervention | 
| Public health literacy | Public health literacy is defined here as an understanding of the social determinants of health. This was measured using a 5-point and 7-item Likert scale with responses ranging from Strongly Agree=5 to Strongly Disagree=1. The seven items measured opinions about how much different external factors affect health because these best reflected an understanding of the social determinants of health: (1) money, (2) education, (3) safe and affordable housing, (4) early childhood experiences, and (5) government policies and programs (6) lifestyle choices and (7) consequences of system failure on the under-resourced. Greater scores on this scale represented greater levels of public health literacy. | Pre-test and Immediately post-intervention | 
| Empowerment | Empowerment to engage in civic action was measured using a two-item index that assessed the perceived effectiveness of engaging in civic actions. Each question was a 4-point Likert item with responses ranging from Very Effective=4 to Very Ineffective=1. The two items were as follows, How effective would it be to boycott sugary beverages as a way to convince corporations to stop pushing sugar to my community? and How effective would it be to use social media to convince corporations to stop pushing sugar to vulnerable groups?. Greater scores on this index represented greater levels of efficacy to engage in civic action. | Pre-test and Immediately post-intervention | 
| Beverage knowledge | Knowledge increases self-efficacy and empowers people to make better health choices for themselves and knowledge of the negative consequences of a given health behavior increases the intention to reduce that behavior. Therefore, better knowledge of the negative consequences of sugary beverage consumption directly impacts both individual level sugary beverage consumption as well as social level psychological empowerment to advocate for reduction in sugary beverage consumption at the community level. A sugary beverage knowledge scale comprised 6 true or false items adapted from multiple studies. The statements were as follows: Excessive sugar consumption causes, (1) health problems (2) weight gain (3) dental caries (4) diabetes (5) cancer and (6) heart disease. Greater scores on this scale represented greater levels of sugary beverage knowledge. | Pre-test and Immediately post-intervention | 
| Engagement | Engagement with the message was assessed with 2 items from the Narrative Transportation Scale (Green et al.). | Immediately post-intervention | 
| Similarity | Perceived similarity of the participant with the main character (poet/speaker) in the video was assessed with a 2-item scale adapted from Cohen and colleagues (2018). | Immediately post-intervention | 
| Elaboration | Elaboration of the message arguments was assessed using a 4-point scale created by Kahlor and colleagues (2003) and a 3-point sugar-specific elaboration scale created by Dixon and colleagues (2015). | Immediately post-intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Latinx, sugar sweetened beverages, Health Communication, Values-based messages, Latinas, Hispanic, Experiment, Message testing, tailoring