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Randomized Controlled Trial
. 2024 Feb 20:11:1269390.
doi: 10.3389/fpubh.2023.1269390. eCollection 2023.

Lessons learned by adapting and implementing LUCHA: a deep-structure culturally tailored healthy eating randomized pilot intervention for ethnic-diverse Latinos

Josiemer Mattei  1 , Areli Caballero-González  1 , Ana Maafs-Rodríguez  1   2 , Amelia Zhang  1 , H June O'Neill  2 , Cristina Gago  1   2
Affiliations
Randomized Controlled Trial

Lessons learned by adapting and implementing LUCHA: a deep-structure culturally tailored healthy eating randomized pilot intervention for ethnic-diverse Latinos

Josiemer Mattei et al. Front Public Health. .

Abstract

Objectives: To report the adaptation and implementation of LUCHA (Latinos United for a Culturally Healthy Alimentation), a pilot intervention to improve dietary quality and behaviors (primary outcomes) of Latinos in Massachusetts, US, and the lessons learned during the process, including disruptions during the COVID-19 pandemic, to help shape future programs.

Methods: The cultural adaptation process was pre-planned using a framework, grounded in the Theory of Reasoned Action/Planned Behavior, and informed by formative mixed-methods research. A projected 75 self-identifying Latino adults (25-65y) were recruited with community-wide strategies and randomized to receive, in parallel, daily healthy eating text messages for 2 months, reinforced for 2 subsequent months, to either control (i.e., surface-level messages based on USDA MyPlate in Spanish), or intervention (i.e., deep-structure messages). The intervention messages were ethnically tailored to Caribbean or non-Caribbean heritages specifically, grounded in entrenched cultural attitudes, norms, and preferences. Trained research assistants administered questionnaires and clinical measurements at baseline, 2-months, and 4-months, in person (pre-pandemic) or via online video calls (at-pandemic). Clinicaltrials.gov registration #NCT04724382.

Results: LUCHA faced challenges and opportunities that conveyed lessons for future cultural adaptation and implementation of healthy eating programs. Recommendations are provided to improve digital programs for diverse ethnicities, such as widening language capabilities in texting services, using familiar video call applications, and instructing participants to measure their own clinical metrics at home using guided standardized protocols.

Conclusion: Tailoring nutrition programs with deep-structure cultural messages is essential when promoting healthy eating in diverse Latino heritages. LUCHA can inform programs for similar ethnic groups.

Keywords: cultural adaptation; cultural tailoring; deep structure; ethnic minorities; nutrition education.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Factors for the deep-structure cultural adaptation process of healthy eating messages for Latinos, following the Framework for Reporting Adaptations and Modifications-based Implementation Strategies (with permission from Wiltsey-Stirman).
Figure 2
Figure 2
Protocol flowchart of Latinos United for a Culturally Healthy Alimentation: a pilot intervention of deep-structure culturally-adapted vs. surface-level healthy eating messages for Latinos in Massachusetts, US.
Figure 3
Figure 3
Recommendations for cultural adaptation of text-message-based behavioral programs for ethnic groups.
See this image and copyright information in PMC

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