Formative evaluation of a home-focused intervention designed to reduce heart disease risk in urban Mexican Americans

Background: Despite increasing recognition of the importance of environmental cues for stimulating food choice behavior, little attention has been paid to re-engineering the home environment to support health education-triggered improvements in food choices. Low-income, urban Mexican Americans are particularly appropriate targets for such an intervention because of their disproportionately high risk of lifestyle-induced heart disease.

Methods: Ten stakeholder interviews, two focus groups and a 10-participant abbreviated pilot randomized controlled trial were conducted following initial design of a 16-session, promotor-led health promotion program. The program, conducted in Spanish, was designed to help residents of East L.A. make changes to their refrigerator contents, pantry holdings and countertop food selections such that their first food choice would be a healthy choice. The program also encouraged more physical activity.

Results: Participants acknowledged that much of East L.A. was a “food desert” that encouraged consumption of sugary drinks and nutrient-poor foods. They nonetheless endorsed incremental changes to their home environment to get them to eat better and exercise more, including use of the food plate approach to nutrition education. They also endorsed involving the faith community in advocating for healthier, safer neighborhoods but were unenthusiastic about using social media for health promotion.

Conclusions: Stakeholders approved a multisession coaching intervention that applies the traffic light diet approach and myplate.gov messaging to prioritizing food choices in the kitchen but were culturally conflicted about seeking alternatives to sugary drinks for guests. They were enthusiastic about involving promotores as lifestyle change coaches and welcomed home visits.