Promotora models in community health: How much participant contact is needed for dietary change?

Introduction: Entre Familia: Reflejos de Salud was a successful family-based RCT designed to improve dietary practices in a U.S. Latino sample. The intervention involved community health workers (promotoras), an evidence-based strategy for health promotion. The efficacy of the promotora model has been demonstrated, yet data regarding the amount of participant-promotora contact necessary to achieve change is limited. This study used process evaluation data to assess how intervention dose-received influenced dietary change. Methods: Three-hundred and sixty-one families were recruited to participate and were randomized to an intervention or a delayed-treatment control condition. Process evaluation measures such as fidelity and dose delivered were collected throughout the intervention. Immediate post-intervention data collected at 4 months demonstrated significant intervention effects on the mothers' dietary intake Analyses of covariance were performed to determine the presence of a dose-response relationship between minutes of participant-promotora contact and participant dietary change. Results: Mean minutes of contact was 948 (SD=250). Minutes of participant-promotora contact was significantly related to several dietary changes, including the number of times the participant ate outside the home each week (B=-.57, SE=.13, p<.001) and use of behavioral strategies to reduce fat intake (B=-22 (SE=.13), p<.001). Further analysis will explore intervention involvement, including how father and child involvement, influenced change. Conclusion: Data analyses show a clear dose-response relationship between the total time of participant-promotora contact and participant outcomes. These results can inform future interventions on the amount of promotora contact needed to achieve behavior change.