Older Adults' Perceptions of a Church-Based Social Marketing Initiative to Prevent Falls Through Balance and Strength Classes.

Despite evidence that balance and strength training and other multicomponent exercise classes reduce the risk and rate of falls and fall-related injuries, few older adults participate. To increase uptake of balance- and strength-based fall-prevention classes, we designed and implemented a social marketing program, delivered through churches. Diverse stakeholders in this social marketing initiative included class participants, instructors, church leaders and members, and public health and recreation partners. We used interpretive description to explore perceptions of the social marketing messages and the barriers and facilitators older church members encountered to balance-class enrollment and adherence. The results were three practical, clinically relevant thematic summaries of older adults' experience. The marketing initiative succeeded in helping older adults hear about the classes, decide whether classes fit their lifestyle and needs, and continue attendance.

Understanding fall meaning and context in marketing balance classes to older adults.

This study explored older, community-dwelling adults' attitudes and values about proposed church-delivered balance classes for fall prevention. Community observation, group interviews with stakeholders, key informant interviews, and focus groups with church members ≥ 60 years of age were analyzed in two ways: first for inductive themes expressing community sentiment about fall prevention for older adults, then for content useful in creating locally tailored social marketing messages. Four themes expressed perceptions of fall-prevention programming: de-emphasizing fall risk and emphasizing strength and independence, moving older adults out of their "comfort zones" to join classes, identifying relationships to support fall-prevention activities, and considering gender-based differences in approaches to fall prevention. A content analysis of the same dataset yielded information about preferred places in the community, promotion through churches, a tolerable price, and the balance class product itself. The qualitative results will inform the social marketing program to increase intervention delivery success.

Healthcare providers' perceptions of the factors contributing to infant obesity in a low-income Mexican American community.

PURPOSE: To examine healthcare professionals' perceptions of Mexican American infant feeding practices and obesity. DESIGN AND METHODS: Five provider focus groups (n = 38 providers) were conducted in two agencies in the Denver area on the topic of contributors to childhood obesity in the Mexican American community. RESULTS: Healthcare providers believe obesity in Mexican American infants is related to: (a) a chubby baby being a healthy baby, (b) introducing complementary foods early, (c) extended family members' infant feeding practices, (d) offering infants high-calorie foods, and (e) prolonged bottle feeding and sweet beverages. Providers reported ambivalence regarding their role in addressing infant obesity. PRACTICE IMPLICATIONS: Healthcare providers working with Mexican American families should deliver consistent, culturally specified messages regarding infant feeding and activity practices.

Using focus groups to develop a culturally competent diabetes self-management program for Mexican Americans.

PURPOSE: The purpose of this study was to describe factors that facilitate or hinder diabetes self-management and elicit participants' preferences and recommendations about the essential components of a culturally competent diabetes self-management program. METHODS: Latino patients with type 2 diabetes and their family caregivers were interviewed in focus groups. Four focus groups consisted of patients, and 2 groups consisted of family caregivers for a total of 40 participants. Participants were assigned to groups based on break characteristics of gender and preferred language. RESULTS: "Being in the dark" emerged as an important concern, and patient respondents wanted timely access to information that they deemed understandable about how to manage their diabetes. Family members' support and understanding were crucial in maintaining lifestyle changes. Patient and family caregiver participants wanted a self-management program to incorporate information on how to modify traditional foods, home remedies, and stress management. Preferences for information delivery included group didactic and interactive sessions, written information, and videotapes. Higher technology strategies using computers were not seen as useful. CONCLUSIONS: Culturally competent diabetes self-management for Latinos should incorporate the family and include techniques for stress management as well as diet modification. Information delivery should include a variety of techniques.

Early infant feeding decisions in low-income Latinas.

Breastfeeding rates remain low, especially among low-income minority women. The objective of this qualitative study was to assess barriers to breastfeeding and reasons for combination feeding among low-income Latina women and their families. Meetings were held with key informants to inform the sampling plan and develop questions for focus groups. Data were collected from eight qualitative focus groups with primiparous mothers postpartum, mothers breastfeeding at 4 to 6 months, mothers formula feeding at 4 to 6 months, grandmothers and fathers, and 29 individual interviews with formula- and combination-feeding mothers. Transcripts of focus groups and interviews were content coded and analyzed for thematic domains and then compared for concurrence and differences. Four main domains with 15 categories were identified: (a) Best of both: Mothers desire to ensure their babies get both the healthy aspects of breast milk and "vitamins" in formula. (b) Breastfeeding can be a struggle: Breastfeeding is natural but can be painful, embarrassing, and associated with breast changes and diet restrictions. (c) Not in Mother's Control: Mothers want to breastfeed, but things happen that cause them to discontinue breastfeeding. (d) Family and cultural beliefs: Relatives give messages about supplementation for babies who are crying or not chubby. Negative emotions are to be avoided so as to not affect mother's milk. Those counseling Latina mothers about infant feeding should discourage and/or limit early supplementation with formula, discuss the myth of "best of both," understand the fatalism involved in problem-solving breastfeeding issues, and enlist the altruism embedded in the family unit for support of the mother-infant pair.