UK Nursing Researchers Use ‘Familismo’ to Engage Hispanics in Healthy Behaviors

LEXINGTON, Ky. (March 31, 2017) — In Hispanic culture, “familismo” is an expression of family loyalty. Members of traditional Hispanic households prioritize the well-being of the family over individual wellness and self-care.

Health interventions empower individuals to change behaviors, which requires putting personal wellness first. Hispanics experience a higher risk of cardiovascular disease (CVD) and type 2 diabetes as they age and acculturate to the American diet. Both diseases are associated with lifestyle factors, but intervention researchers have found lifestyle changes are difficult to sustain long-term.

In a pilot study, Gia Mudd-Martin, a researcher in the University of Kentucky College of Nursing, gathered information from members of the local Hispanic community to learn about cultural facilitators of risk reduction behaviors. Respondents indicated a family member’s participation in an intervention might encourage the adoption of a new healthy behavior and increase the likelihood of long-term adherence. The feedback from the community prompted Mudd-Martin to design a study around the Hispanic concept of “familismo,” using dyadic family partnerships to engage Hispanic individuals in CVD and diabetes prevention measures.

Mudd-Martin recently received a $2.6 million grant from the National Institute of Nursing Research (NINR) and the Office of Behavioral and Social Sciences Research (OBSSR) to study a dyad-focused intervention aimed at reducing the risk of CVD and type 2 diabetes in Hispanic communities. The study’s title, Corazón de la Familia, translates to “Heart of the Family.” The researchers hope incorporating a family member component, as requested by participants in the pilot study, will increase engagement and adherence to lifestyle changes, such as improving diet and increasing physical activity.

Guided by principles of community-based participatory research, in this randomized controlled trial Hispanic family member dyads are randomly assigned to one of two intervention groups. In the individualized group, family members will participate in sessions where they learn about biological and behavioral risk factors for diabetes and CVD, such as consumption of foods that are high in sodium and sugar and sedentary lifestyle. In the dyad-focused condition, family members receive health risk information as well as social support skills to encourage their partner’s lifestyle modification. Researchers will disseminate the intervention to Hispanic families in Kentucky through collaborative partnerships with the Lexington/Fayette County Promotores de Salud (Community Health Workers) program and the North Central Area Health Education Center.

The research team will collect data to measure each individual’s level of engagement in the intervention, as well as the level of support they received from their partner. They will also analyze whether social support and a partner’s engagement in the intervention influenced the other member’s level of engagement and lifestyle change. They will examine intervention effects on such biological measures as body mass index and blood pressure as well as on behavioral measures such as nutritional patterns, physical activity and tobacco use.

“Part of our hypothesis is that people might need more social support,” Mudd-Martin said. “Our pilot participants thought if another family member was involved in the intervention, they would first of all be able to implement those changes, and then be able to sustain them as well.”

The study is in the recruitment phase. Mudd-Martin, who worked as a public health nurse with  Hispanic communities in Kentucky before entering academia, said the research responds to needs and preferences voiced by participants. The dyad intervention involves two family members, improving the likelihood that health behaviors will spread to other members of the households as well.

“I would like to see the outcome of type 2 diabetes and cardiovascular disease risk reduction in the Hispanic community, and to be able to extend that benefit beyond the individual to family members,” Mudd-Martin said.

Mudd-Martin is joined by UK College of Nursing co-investigators Terry Lennie, Misook Chung,. Debra Moser and Mary Kay Rayens on this study.