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Although Latino men have the highest prevalence (45%) of obesity among all men in the United States, traditional weight loss interventions have not effectively engaged this hard-to-reach and diverse group. Offering choices among technology-mediated weight loss interventions may offer advantages.
The aim of this study is to examine Latino men’s preferences among 3 weight loss intervention options. We also examined whether attendance in group sessions (videoconference and in person) and weight loss differed according to intervention choice.
Latino men (n=200; mean age 47.3, SD 11.8 years) participated in a comparative effectiveness trial based on primary care and were randomized to receive the 1-year HOMBRE (Hombres con Opciones para Mejorar su Bienestar para Reducir Enfermedades Crónicas; English translation: Men With Options to Improve Their Well-being and Reduce Chronic Disease) intervention. HOMBRE is a weight loss intervention that offers 3 delivery options. During an orientation session, a trained bilingual coach helped men select 1 of the 3 intervention options that differed in coach, peer support, and available language. We used canonical discriminant analysis to assess multivariate associations of demographic, clinical, employment, cultural, and technology use and access factors with men’s intervention choices. We used generalized linear models to estimate weight loss at 6, 12, and 18 months for men in each intervention option.
Among Latino men, 28% (56/200) chose videoconference groups, 31% (62/200) chose web-based videos, and 41% (82/200) chose in-person groups. The canonical discriminant analysis identified 1 orthogonal dimension that distinguished between men who chose an in-person group and men who chose web-based videos. Men who were older, spoke Spanish, and did not use a computer frequently had a higher probability of choosing in-person groups versus web-based videos. For men who selected a group delivery option, 86.9% (107/123) attended ≥25% of the sessions, 83.7% (103/123) attended ≥50% of the sessions, and 73.2% (90/123) attended ≥75% of the sessions, with no differences by type of group (videoconference or in person). Men who chose videoconference and in-person group sessions lost significantly more weight at 6 months (both
There were significant differences according to demographic, employment, cultural, and technology use factors between men who chose 1 of the 3 intervention options. Men who chose one of the group-based options (videoconference or in person) lost significantly more weight than those who chose web-based videos. Providing options that accommodate the diversity of Latino men’s preferences is important for increasing engagement in behavioral interventions.
ClinicalTrials.gov NCT03092960; https://clinicaltrials.gov/ct2/show/NCT03092960
Obesity is a major contributor to the leading causes of death among all men in the United States, such as heart disease, cancer, and type 2 diabetes [
Technology, including web-based and smartphone apps, offers opportunities for extending the reach and engagement of behavioral lifestyle interventions to priority populations such as Latino men. Technology can help overcome prevalent barriers to engaging in interventions because of competing priorities from family, inflexible work schedules, and unreliable transportation. In addition, technology-mediated approaches became essential during the COVID-19 pandemic, when in-person meetings were not allowed or encouraged. Latinos increasingly have access to technology in general and smartphones specifically, which makes this a promising approach to maximize reach and engagement in this population [
The HOMBRE (Hombres con Opciones para Mejorar su Bienestar para Reducir Enfermedades Crónicas; English translation: Men With Options to Improve Their Well-being and Reduce Chronic Disease) trial was designed to compare a culturally adapted behavioral lifestyle intervention for Latino men with minimal-intensity control. The culturally adapted behavioral lifestyle intervention offered men 3 options for engaging in the intervention sessions: coach-facilitated group sessions using web-based videoconferencing, prerecorded videos of group sessions available on the web, and coach-facilitated group sessions in person. The 3 choices differed in the used technology, the level of coach and peer support, and language options. The goal of this study is to examine Latino men’s preferences among the 3 intervention options according to demographic, clinical, employment, cultural, and technology use and access factors. We also examined whether attendance (for the videoconference and in-person groups) and weight loss differed among the intervention options. Understanding Latino men’s preferences according to key baseline characteristics can inform future implementation of technology-based interventions for this high-priority population.
The institutional review board for Sutter Health, Northern California, and Stanford University approved the study. All participants provided written informed consent. The trial protocol has been previously published [
A total of 424 Latino men who had a BMI of ≥27 kg/m2 and ≥1 cardiometabolic risk factor (high waist circumference, high triglycerides, high blood pressure, high fasting plasma glucose, or low high-density lipoprotein cholesterol) were enrolled in the HOMBRE trial following a multistep process, as described in the trial protocol [
The HOMBRE intervention was based on the Group Lifestyle Balance (GLB) intervention, a group-based adaptation of the original Diabetes Prevention Program intervention [
Session delivery options in the HOMBRE (Hombres con Opciones para Mejorar su Bienestar y Reducir Enfermedades Crónicas) intervention.
Characteristics | Videoconference | Web-based videos | In person |
Description |
A bilingual, bicultural coach facilitated weekly sessions on a videoconferencing platform (Zoom) |
Men were given access to prerecorded web-based videos of coach-facilitated group sessions |
A bilingual, bicultural coach facilitated weekly sessions at the clinic where men were recruited |
Coach support |
Coach-facilitated sessions Feedback from the coach on diet and physical activity monitoring |
Self-directed sessions Option to contact the coach for feedback on diet and physical activity monitoring |
Coach-facilitated sessions Feedback from the coach on diet and physical activity monitoring |
Peer support |
Support from other members of the group |
No peer support |
Support from other members of the group |
Frequency of sessions |
Weekly |
Self-paced; weekly recommended |
Weekly |
Language |
English or Spanish per preference |
English with Spanish subtitles |
English or Spanish per preference |
In addition to the differences in delivery, the 3 intervention options differed in level and type of coach feedback (
Following randomization, all participants attended an in-person group orientation session. Trained health coaches offered the orientation sessions in English and Spanish at different times of the day throughout the 2 weeks following randomization to accommodate all participants. Group sessions were designed for approximately 10 participants but could accommodate varying sizes as needed. Participants were encouraged to bring their partners and other family members to the orientation session with the purpose of increasing understanding and social support among family members. Group orientation sessions followed a standardized protocol that featured a didactic component to provide information on the background and goals of the intervention and a small group discussion component specific to their randomization arm. The goal of the small group discussion for the HOMBRE arm was to support men in making a choice among the 3 intervention options. The small group discussion included 3 components to support men in making a choice: (1) description of the 3 intervention choices provided by a health coach, (2) a worksheet that helped men reflect on each of the 3 options, and (3) a small group discussion on the pros and cons of each option. The worksheet prompted men to think about whether they liked participating in groups, the degree to which they would like support from a coach, their comfort with new technologies, and their availability for attending regular weekly sessions. In the small group, the coach asked men to discuss the pros and cons of each option to assist them in considering the choices. At the end of the session, men were asked to make their choice, given their intervention materials, and assisted with using the activity tracker and other technologies based on their choice.
The intervention participants’ initial choices of intervention delivery were used to group them into the 3 options (videoconference, web-based videos, and in person). The participants were allowed to change their choice within 4 weeks. However, none of the participants elected to change. Coaches could transfer patients from the videoconference or in-person groups to the web-based videos if they did not attend the first 4 sessions; 15 men (n=11, 73% from the videoconferencing group and n=4, 27% from the in-person group) were transferred to the web-based videos group.
Baseline characteristics included demographic (eg, age, income, education, marital status, and household size) and clinical characteristics (eg, weight, waist circumference, blood pressure, depression symptoms, quality of life, and sleep function), employment (eg, employment status and occupation), cultural characteristics (eg, language, acculturation, and health literacy), and technology use and access. Weight, waist circumference, and blood pressure were measured in duplicate according to standard protocols [
We used 2 steps to identify the different profiles of demographic, clinical, employment, cultural, and technology use and access characteristics based on their choice of delivery options. First, we performed a bivariate analysis to choose a set of candidate variables. Second, we conducted multivariate analysis based on the variables identified in the bivariate analysis to derive the baseline characteristic profiles that significantly differentiated the men who chose 1 of the 3 intervention delivery options [
Percentages and means and SDs were used to describe the baseline characteristics among HOMBRE intervention participants overall and by intervention delivery option chosen. We used the Fisher least significant difference method [
Canonical discriminant analysis was used to derive linear combinations of the baseline characteristic profiles that significantly differentiated the men who chose 1 of the 3 intervention delivery options. Canonical discriminant analysis is a multivariate dimension reduction technique that derives a linear combination of explanatory variables that has the highest possible multiple correlation with the groups of a classification variable. The dimension defined by the linear combination is the first canonical dimension. This maximum multiple correlation is called the first canonical correlation. The coefficients of the linear combination are the canonical coefficients. The second canonical dimension is obtained by finding the linear combination with the next highest possible multiple correlation with the groups that is uncorrelated with the first canonical dimension. The process of extracting canonical dimensions can be repeated until the number of canonical dimensions equals the number of original variables or the number of groups minus 1, whichever is smaller. We included only the baseline characteristics with
We used generalized linear models to compare weight loss among men in different intervention options at 6, 12, and 18 months after randomization. We examined weight according to the men’s initial and final intervention choices. Weight was measured by trained study staff at baseline. Weight was measured using a standard calibrated scale at baseline and 18 months at local clinic sites according to standard protocol [
Session attendance was calculated for weekly sessions and monthly phone calls combined and separately in the videoconference and in-person groups, excluding the 15 participants who were transferred to the web-based video option. Session attendance was then compared between the videoconference and in-person groups using Student
All analyses were conducted using SAS version 9.4 (SAS Institute Inc). Statistical significance was defined as
As shown in
Baseline characteristics overall and by initial choice of intervention delivery (N=200).
Characteristic | All | Videoconference (n=56) | Web-based videos (n=62) | In-person group (n=82) | |||||||||
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Age (years), mean (SD) | 47.3 (11.8) | 45.6 (10.9)a | 45.4 (11.4)a | 50.0 (12.3)b | .03 | |||||||
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.02 | |||||||||||
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<75,000 | 49 (29.3) | 8 (16)a | 14 (25.9)a,b | 27 (42.9)b |
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75,000-<150,000 | 53 (31.7) | 17 (34)a | 17 (31.5)a,b | 19 (30.2)b |
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≥150,000 | 65 (38.9) | 25 (50)a | 23 (42.6)a,b | 17 (27)b |
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.03 | |||||||||||
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High school, GEDc, or less | 45 (23.1) | 7 (12.7)a | 12 (19.7)a,b | 26 (32.9)b |
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Some college | 49 (25.1) | 12 (21.8)a | 19 (31.1)a,b | 18 (22.8)b |
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College graduate | 58 (29.7) | 17 (30.9)a | 21 (34.4)a,b | 20 (25.3)b |
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More than college | 43 (22.1) | 19 (34.5)a | 9 (14.8)a,b | 15 (19)b |
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.07 | |||||||||||
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Married or living with a partner | 156 (79.6) | 38 (69.1) | 52 (83.9) | 66 (83.5) |
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Single, separated, divorced, or widowed | 40 (20.4) | 17 (30.9) | 10 (16.1) | 13 (16.5) |
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.51 | |||||||||||
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1-2 | 13 (6.8) | 4 (7.3) | 4 (6.7) | 5 (6.6) |
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3 | 35 (18.3) | 10 (18.2) | 10 (16.7) | 15 (19.7) |
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4 | 44 (23) | 19 (34.6) | 10 (16.7) | 15 (19.7) |
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5 | 49 (25.7) | 10 (18.2) | 18 (30) | 21 (27.6) |
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≥6 | 50 (26.2) | 12 (21.8) | 18 (30) | 20 (26.3) |
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BMI (kg/m2), mean (SD) | 33.1 (5.2) | 33.7 (5.7) | 32.6 (5.4) | 33.0 (4.6) | .48 | |||||||
|
Weight (kg), mean (SD) | 101.5 (33.7) | 102.7 (22.3) | 96.7 (17.3) | 104.3 (46.8) | .39 | |||||||
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Waist circumference (cm), mean (SD) | 109.5 (12.3) | 111.0 (14.0) | 106.8 (11.8) | 110.6 (11.2) | .11 | |||||||
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Number of metabolic risks, mean (SD) | 2.0 (0.9) | 1.9 (0.9) | 2.0 (0.8) | 2.0 (0.9) | .62 | |||||||
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SBPd (mm Hg), mean (SD) | 122.4 (12.2) | 121.2 (13.9) | 121.5 (11.2) | 123.9 (11.6) | .36 | |||||||
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DBPe (mm Hg), mean (SD) | 78.6 (9.4) | 78.1 (10.0) | 79.2 (9.0) | 78.5 (9.4) | .81 | |||||||
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PHQ-9f score (n=196), mean (SD) | 3.5 (3.7) | 3.6 (4.2) | 3.6 (3.3) | 3.2 (3.7) | .72 | |||||||
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.63 | |||||||||||
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No problems | 170 (86.7) | 50 (90.9) | 52 (83.9) | 68 (86.1) |
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Slight problems | 16 (8.2) | 5 (9.1) | 5 (8.1) | 6 (7.6) |
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Moderate problems | 8 (4.1) | 0 (0) | 4 (6.5) | 4 (5.1) |
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Severe problems | 2 (1) | 0 (0) | 1 (1.6) | 1 (1.3) |
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Extreme problems | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
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.64 | |||||||||||
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No problems | 193 (98.5) | 54 (98.2) | 62 (100) | 77 (97.5) |
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Slight problems | 2 (1) | 1 (1.8) | 0 (0) | 1 (1.3) |
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Moderate problems | 1 (0.5) | 0 (0) | 0 (0) | 1 (1.3) |
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Severe problems | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
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Extreme problems | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
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.68 | |||||||||||
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No problems | 171 (87.2) | 50 (90.9) | 51 (82.3) | 70 (88.6) |
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Slight problems | 19 (9.7) | 4 (7.3) | 8 (12.9) | 7 (8.9) |
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Moderate problems | 6 (3.1) | 1 (1.8) | 3 (4.8) | 2 (2.5) |
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Severe problems | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
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Extreme problems | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
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.15 | |||||||||||
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No problems | 103 (52.6) | 25 (45.5) | 29 (46.8) | 49 (62) |
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Slight problems | 69 (35.2) | 26 (47.3) | 23 (37.1) | 20 (25.3) |
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Moderate problems | 20 (10.2) | 4 (7.3) | 8 (12.9) | 8 (10.1) |
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Severe problems | 4 (2) | 0 (0) | 2 (3.2) | 2 (2.5) |
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Extreme problems | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
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.73 | |||||||||||
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No problems | 147 (75) | 40 (72.7) | 46 (74.2) | 61 (77.2) |
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Slight problems | 35 (17.9) | 9 (16.4) | 12 (19.4) | 14 (17.7) |
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Moderate problems | 13 (6.6) | 5 (9.1) | 4 (6.5) | 4 (5.1) |
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Severe problems | 1 (0.5) | 1 (1.8) | 0 (0) | 0 (0) |
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Extreme problems | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
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Obesity-related problem raw score (n=196), mean (SD) | 0.8 (0.7) | 0.9 (0.8) | 0.8 (0.7) | 0.7 (0.7) | .29 | |||||||
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PROMISh sleep disturbance T score (n=196), mean (SD) | 47.3 (8.9) | 47.7 (9.1) | 48.8 (7.5) | 45.8 (9.7) | .13 | |||||||
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PROMIS sleep impairment T score (n=195), mean (SD) | 47.5 (9.2) | 48.4 (9.4) | 48.2 (8.8) | 46.3 (9.3) | .34 | |||||||
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.24 | |||||||||||
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Employed | 167 (86.1) | 51 (92.7) | 55 (88.7) | 61 (79.2) |
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Unemployed | 5 (2.6) | 1 (1.8) | 1 (1.6) | 3 (3.9) |
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Other (homemaker, student, retired, and disabled or not able to work) | 22 (11.3) | 3 (5.5) | 6 (9.7) | 13 (16.9) |
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.18 | |||||||||||
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0 to <5 | 15 (8) | 2 (3.8) | 3 (4.9) | 10 (13.5) |
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5 to <30 | 9 (4.8) | 2 (3.8) | 2 (3.3) | 5 (6.8) |
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30 to <50 | 95 (50.5) | 26 (49.1) | 30 (49.2) | 39 (52.7) |
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≥50 | 69 (36.7) | 23 (43.4) | 26 (42.6) | 20 (27) |
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.04 | |||||||||||
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Mostly sitting or standing | 128 (68.8) | 44 (81.5)a | 39 (67.2)a,b | 45 (60.8)b |
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Mostly walking or heavy work | 58 (31.2) | 10 (18.5)a | 19 (32.8)a,b | 29 (39.2)b |
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.02 | |||||||||||
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White collar | 108 (71.1) | 39 (86.7)a | 33 (68.8)b | 36 (61)b |
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Blue collar | 44 (29) | 6 (13.3)a | 15 (31.3)b | 23 (39)b |
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<.001 | |||||||||||
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English | 142 (71) | 48 (85.7)a | 61 (98.4)j | 33 (40.2)b |
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Spanish | 58 (29) | 8 (14.3)a | 1 (1.6)j | 49 (59.8)b |
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Acculturation score, mean (SD) | 3.4 (0.9) | 3.7 (0.6)a | 3.6 (0.7)a | 3.1 (1.0)b | <.001 | |||||||
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Health literacy score, mean (SD) | 4.4 (1.9) | 5.0 (1.5)a | 4.5 (1.9)a,b | 4.0 (2.0)b | .004 | |||||||
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.02 | |||||||||||
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Adequate literacy | 147 (73.5) | 49 (87.5)a | 47 (75.8)a,b | 51 (62.2)b |
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Possibility of limited literacy | 31 (15.5) | 4 (7.1)a | 8 (12.9)a,b | 19 (23.2)b |
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High likelihood (≥50%) of limited literacy | 22 (11) | 3 (5.4)a | 7 (11.3)a,b | 12 (14.6)b |
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aDifferent superscripts denote statistically significant differences.
bDifferent superscripts denote statistically significant differences.
cGED: General Educational Development.
dSBP: systolic blood pressure.
eDBP: diastolic blood pressure.
fPHQ-9: Patient Health Questionnaire-9.
gEQ-5D-5L: EuroQol 5-dimension 5-level.
hPROMIS: Patient-Reported Outcome Measurement System.
iLanguage that the patient preferred for the intervention.
jDifferent superscripts denote statistically significant differences.
Baseline technology use and access overall and by initial choice of intervention delivery (N=184).
Characteristic | All, |
Videoconference (n=54), |
Web-based videos (n=55), |
In-person group (n=75), |
||||||||
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.01 | |||||||||||
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Yes | 165 (89.7) | 54 (100)a | 50 (90.9)b | 61 (81.3)b |
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No | 18 (9.8) | 0 (0)a | 5 (9.1)b | 13 (17.3)b |
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Declined to state | 1 (0.5) | 0 (0)a | 0 (0)b | 1 (1.3)b |
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.51 | |||||||||||
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Yes | 179 (97.3) | 54 (100) | 53 (96.4) | 72 (96) |
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No | 4 (2.2) | 0 (0) | 2 (3.6) | 2 (2.7) |
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Declined to state | 1 (0.5) | 0 (0) | 0 (0) | 1 (1.3) |
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.43 | |||||||||||
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Yes | 18 (9.8) | 3 (5.6) | 9 (16.4) | 6 (8) |
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No | 160 (87) | 50 (92.6) | 44 (80) | 66 (88) |
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I’m not sure | 1 (0.5) | 0 (0) | 0 (0) | 1 (1.3) |
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Declined to state | 5 (2.7) | 1 (1.9) | 2 (3.6) | 2 (2.7) |
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.07 | |||||||||||
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Yes | 139 (75.5) | 48 (88.9) | 39 (70.9) | 52 (69.3) |
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No | 44 (23.9) | 6 (11.1) | 16 (29.1) | 22 (29.3) |
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Declined to state | 1 (0.5) | 0 (0) | 0 (0) | 1 (1.3) |
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.21 | |||||||||||
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Yes | 30 (16.3) | 4 (7.4) | 8 (14.6) | 18 (24) |
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No | 149 (81) | 49 (90.7) | 46 (83.6) | 54 (72) |
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I’m not sure | 1 (0.5) | 0 (0) | 0 (0) | 1 (1.3) |
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Declined to state | 4 (2.2) | 1 (1.9) | 1 (1.8) | 2 (2.7) |
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.09 | |||||||||||
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Yes | 173 (94) | 53 (98.2) | 52 (94.6) | 68 (90.7) |
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No | 5 (2.7) | 1 (1.9) | 3 (5.5) | 1 (1.3) |
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I’m not sure | 5 (2.7) | 0 (0) | 0 (0) | 5 (6.7) |
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Declined to state | 1 (0.5) | 0 (0) | 0 (0) | 1 (1.3) |
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.002 | |||||||||||
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Never | 12 (6.5) | 0 (0)a | 2 (3.6)b | 10 (13.3)b |
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Rarely | 15 (8.2) | 0 (0)a | 6 (10.9)b | 9 (12)b |
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Sometimes | 7 (3.8) | 0 (0)a | 2 (3.6)b | 5 (6.7)b |
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Often | 26 (14.1) | 7 (13)a | 9 (16.4)b | 10 (13.3)b |
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Very often | 124 (67.4) | 47 (87)a | 36 (65.5)b | 41 (54.7)b |
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|
.003 | |||||||||||
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Never | 13 (7.1) | 0 (0)a | 4 (7.3)a,b | 9 (12)b |
|
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Rarely | 15 (8.2) | 1 (1.9)a | 2 (3.6)a,b | 12 (16)b |
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Sometimes | 31 (16.9) | 7 (13)a | 14 (25.5)a,b | 10 (13.3)b |
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Often | 29 (15.8) | 11 (20.4)a | 7 (12.7)a,b | 11 (14.7)b |
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Very often | 96 (52.2) | 35 (64.8)a | 28 (50.9)a,b | 33 (44)b |
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|
.01 | |||||||||||
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Never | 38 (20.7) | 7 (13)a | 8 (14.6)a,b | 23 (30.7)b |
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Rarely | 44 (23.9) | 7 (13)a | 15 (27.3)a,b | 22 (29.3)b |
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Sometimes | 34 (18.5) | 15 (27.8)a | 9 (16.4)a,b | 10 (13.3)b |
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Often | 24 (13) | 7 (13)a | 7 (12.7)a,b | 10 (13.3)b |
|
||||||
|
Very often | 43 (23.4) | 18 (33.3)a | 16 (29.1)a,b | 9 (12)b |
|
||||||
|
Declined to state | 1 (0.5) | 0 (0)a | 0 (0)a,b | 1 (1.3)b |
|
||||||
|
.22 | |||||||||||
|
Never | 6 (3.3) | 0 (0) | 2 (3.6) | 4 (5.3) |
|
||||||
|
Rarely | 4 (2.2) | 0 (0) | 1 (1.8) | 3 (4) |
|
||||||
|
Sometimes | 19 (10.3) | 2 (3.7) | 8 (14.6) | 9 (12) |
|
||||||
|
Often | 22 (12) | 6 (11.1) | 5 (9.1) | 11 (14.7) |
|
||||||
|
Very often | 132 (71.7) | 46 (85.2) | 39 (70.9) | 47 (62.7) |
|
||||||
|
Declined to state | 1 (0.5) | 0 (0) | 0 (0) | 1 (1.3) |
|
||||||
|
.10 | |||||||||||
|
Never | 11 (6) | 0 (0) | 2 (3.6) | 9 (12) |
|
||||||
|
Rarely | 20 (10.9) | 8 (14.8) | 2 (3.6) | 10 (13.3) |
|
||||||
|
Sometimes | 30 (16.3) | 8 (14.8) | 11 (20) | 11 (14.7) |
|
||||||
|
Often | 41 (22.3) | 11 (20.4) | 16 (29.1) | 14 (18.7) |
|
||||||
|
Very often | 80 (43.5) | 27 (50) | 23 (41.8) | 30 (40) |
|
||||||
|
Declined to state | 2 (1.1) | 0 (0) | 1 (1.8) | 1 (1.3) |
|
||||||
|
.31 | |||||||||||
|
Never | 4 (2.2) | 0 (0) | 2 (3.6) | 2 (2.7) |
|
||||||
|
Rarely | 5 (2.7) | 0 (0) | 1 (1.8) | 4 (5.3) |
|
||||||
|
Sometimes | 14 (7.6) | 1 (1.9) | 5 (9.1) | 8 (10.7) |
|
||||||
|
Often | 36 (19.6) | 12 (22.2) | 10 (18.2) | 14 (18.7) |
|
||||||
|
Very often | 122 (66.3) | 41 (75.9) | 36 (65.5) | 45 (60) |
|
||||||
|
Declined to state | 3 (1.6) | 0 (0) | 1 (1.8) | 2 (2.7) |
|
||||||
|
.10 | |||||||||||
|
Never | 9 (4.9) | 0 (0) | 3 (5.5) | 6 (8) |
|
||||||
|
Rarely | 16 (8.7) | 5 (9.3) | 2 (3.6) | 9 (12) |
|
||||||
|
Sometimes | 32 (17.4) | 6 (11.1) | 14 (25.5) | 12 (16) |
|
||||||
|
Often | 43 (23.4) | 13 (24.1) | 11 (20) | 19 (25.3) |
|
||||||
|
Very often | 82 (44.6) | 30 (55.6) | 25 (45.5) | 27 (36) |
|
||||||
|
Declined to state | 2 (1.1) | 0 (0) | 0 (0) | 2 (2.7) |
|
||||||
|
.13 | |||||||||||
|
Strongly disagree | 2 (1.1) | 1 (1.9) | 0 (0) | 1 (1.3) |
|
||||||
|
Disagree | 8 (4.4) | 1 (1.9) | 3 (5.5) | 4 (5.3) |
|
||||||
|
Neither agree nor disagree | 12 (6.5) | 0 (0) | 6 (10.9) | 6 (8) |
|
||||||
|
Agree | 62 (33.7) | 15 (27.8) | 16 (29.1) | 31 (41.3) |
|
||||||
|
Strongly agree | 99 (53.8) | 37 (68.5) | 30 (54.6) | 32 (42.7) |
|
||||||
|
Declined to state | 1 (0.5) | 0 (0) | 0 (0) | 1 (1.3) |
|
||||||
|
.49 | |||||||||||
|
Strongly disagree | 5 (2.7) | 1 (1.9) | 2 (3.6) | 2 (2.7) |
|
||||||
|
Disagree | 7 (3.8) | 0 (0) | 2 (3.6) | 5 (6.7) |
|
||||||
|
Neither agree nor disagree | 14 (7.6) | 2 (3.7) | 4 (7.3) | 8 (10.7) |
|
||||||
|
Agree | 58 (31.5) | 16 (29.6) | 18 (32.7) | 24 (32) |
|
||||||
|
Strongly agree | 99 (53.8) | 35 (64.8) | 29 (52.7) | 35 (46.7) |
|
||||||
|
Declined to state | 1 (0.5) | 0 (0) | 0 (0) | 1 (1.3) |
|
||||||
|
.12 | |||||||||||
|
Strongly disagree | 5 (2.7) | 1 (1.9) | 1 (1.8) | 3 (4) |
|
||||||
|
Disagree | 5 (2.7) | 0 (0) | 1 (1.8) | 4 (5.3) |
|
||||||
|
Neither agree nor disagree | 10 (5.4) | 0 (0) | 4 (7.3) | 6 (8) |
|
||||||
|
Agree | 57 (31) | 13 (24.1) | 18 (32.7) | 26 (34.7) |
|
||||||
|
Strongly agree | 106 (57.6) | 40 (74.1) | 31 (56.4) | 35 (46.7) |
|
||||||
|
Declined to state | 1 (0.5) | 0 (0) | 0 (0) | 1 (1.3) |
|
aDifferent superscripts denote statistically significant differences.
bDifferent superscripts denote statistically significant differences.
cDSL: digital subscriber line.
Participants in the 3 intervention delivery options had similar clinical characteristics (eg, BMI, blood pressure, depression symptoms, and overall and obesity-specific quality of life) but differed significantly according to demographic, employment, cultural, and technology use factors (
Canonical discriminant analysis identified 1 orthogonal dimension representing statistically significant combinations of the baseline characteristics. The canonical variates of this single dimension explained 41% of the total variance of the choice of 3 intervention delivery options. Participants electing the in-person and web-based video options had the most extreme mean scores (0.98 vs −0.89;
Standardized coefficients from canonical discriminant analysis for individual baseline characteristics of participants in the HOMBRE (Hombres con Opciones para Mejorar su Bienestar para Reducir Enfermedades Crónicas) intervention (N=175)a.
Characteristic | Dimension 1b coefficients | |||
|
||||
|
Age | 0.33 | ||
|
|
|||
|
|
Some college | 0.03 | |
|
|
College graduate | 0.12 | |
|
|
More than college | 0.10 | |
|
|
|||
|
|
Married or living with another person | −0.22 | |
|
||||
|
Waist circumference | 0.11 | ||
|
Sleep disturbance T score | −0.20 | ||
|
||||
|
|
|||
|
|
Mostly sitting or standing | 0.23 | |
|
|
Mostly walking or heavy work | 0.15 | |
|
||||
|
|
|||
|
|
Spanish | 1.03 | |
|
Short Acculturation Scale for Hispanics | 0.09 | ||
|
Health literacy score | 0.00 | ||
|
||||
|
|
|||
|
|
Yes | 0.15 | |
|
|
|||
|
|
Yes | 0.13 | |
|
|
|||
|
|
Yes | 0.09 | |
|
|
|||
|
|
Often or very often | −0.27 | |
|
|
|||
|
|
Often or very often | −0.08 | |
|
|
|||
|
|
Often or very often | −0.06 | |
|
|
|||
|
|
Often or very often | 0.03 | |
|
|
|||
|
|
Often or very often | −0.01 | |
|
|
|||
|
|
Agree or strongly agree | −0.08 | |
|
|
|||
|
|
Agree or strongly agree | 0.13 |
aResults based on 175 HOMBRE intervention participants who had complete data for all baseline characteristics used in the canonical discriminant analysis.
bDimension 1: canonical function
cGED: General Educational Development.
dDSL: digital subscriber line.
Compared with men who initially chose web-based videos, those who initially chose videoconference and in-person group sessions lost significantly more weight at 6 months (mean −3.9, SD 6.1 kg for videoconference and mean −4.3, SD 5.3 kg for in-person vs mean −0.3, SD 3.7 kg for web-based videos;
Weight change by initial and final choice of intervention delivery (N=200).
Weight changea | Initial intervention choice, mean (SD) | Final intervention choice, mean (SD) | |||||
|
Videoconference (n=56) | Web-based videos (n=62) | In-person group (n=82) | Videoconference (n=45) | Web-based videos (n=77) | In-person group (n=78) | |
Weight change at 6 months from baseline (kg) | −3.9 (6.1)b | −0.3 (3.7) | −4.3 (5.3)b | −4.8 (5.7)b | −0.4 (4.3) | −4.4 (5.3)b | |
Weight change at 12 months from baseline (kg) | −3.4 (7.9) | −1.0 (4.8) | −4.1 (6.0)c | −4.5 (8.0)c | −0.6 (4.8) | −4.2 (6.1)c | |
Weight change at 18 months from baseline (kg) | −3.8 (8.4)d | −0.9 (4.6) | −3.3 (6.0)d | −4.8 (8.6)c | −0.8 (4.6) | −3.2 (6.2)d |
aElectronic health record–abstracted and self-reported weights were used for 6 and 12 months, and study-measured, electronic health record–abstracted, and self-reported weights were used for 18 months.
bSignificant difference at
cSignificant difference at
dSignificant difference at
There was no significant difference (
Session attendance among participants in the web-based and in-person groupsa (N=123).
Group | Number of total sessions attended (including makeup sessions, out of 21 sessions), mean (SD) | Number of weekly core sessions attended (including makeup sessions, out of 12 sessions), mean (SD) | Number of monthly contacts received (including makeup sessions, out of 8 calls), mean (SD) | |||
Overall (in person and videoconference) | 16.5 (6.5) | N/Ab | 10.1 (3.8) | N/A | 5.4 (3.1) | N/A |
Videoconference | 17.9 (4.7) | .07 | 10.9 (2.6) | .07 | 5.9 (2.6) | .13 |
In person | 15.7 (7.3) | .07 | 9.7 (4.3) | .07 | 5.1 (3.3) | .13 |
aA total of 15 participants who were transferred to the web-based video option after not attending in-person or videoconference sessions were excluded.
bN/A: not applicable.
This study found that, when provided with a choice on how to engage in a weight loss intervention, 28% (56/200) of men chose videoconference groups, 31% (62/200) chose web-based videos, and 41% (82/200) chose in-person groups. There were significant differences in demographic, employment, cultural, and technology use and access factors among men who chose 1 of the 3 different options. For example, men who chose web-based videoconference groups were more likely to be younger, have higher income and education, have a white-collar type of job, prefer English, be more acculturated, have higher health literacy, have access to a computer, and have higher technology skills (eg, computer, email, and video chat app use) compared with men who chose in-person groups. Our multivariate analysis distinguished most significantly between those who chose in-person groups versus those who chose web-based videos. Men who were older, spoke Spanish, and did not use a computer frequently had a higher probability of choosing in-person groups versus web-based videos. In terms of weight loss, men who chose the videoconference and in-person group sessions lost more weight than those who chose web-based videos.
Similar to this study, Piatt et al [
These findings have important implications for translation to practice, especially given the COVID-19 pandemic, which has made technology-mediated options necessary in the short term and possibly more common in the long term. The fact that 59% (118/200) of Latino men in this study preferred a technology-mediated option (ie, videoconference or web-based videos) suggests that these can be acceptable delivery formats for chronic disease prevention programs for this important high-risk population. This is consistent with previous literature indicating that Latinos are comfortable with technology and open to technology-mediated interventions [
These findings demonstrate that Latino men from lower socioeconomic backgrounds may need additional support for accessing and using technology-mediated interventions. Technology use and access differ along socioeconomic lines in the United States, including among Latinos, with lower socioeconomic-level subgroups having less reliable access to technology than their higher socioeconomic-level counterparts [
The findings from the HOMBRE trial may be specific to the type of technology-mediated interventions offered. The 2 technology-mediated options included smartphone apps for tracking diet and physical activity and either videoconferencing or web-based videos for the intervention sessions. Preferences may vary according to the type of technology used in the intervention. Other technologies such as SMS text messaging, social media, and digital voice assistants may be appealing to other groups of Latino men. For example, Latino migrant farm workers have high (81%-97%) access to mobile phones and prefer talking and SMS text messaging using their phones [
This study has several limitations. First, all the technology use data were self-reported. Participants may have reported answers regarding their prior and current use of technology that they may have perceived as desirable [
In conclusion, this study revealed that among a diverse group of Latino men recruited from primary care, 28% (56/200) chose videoconference groups, 31% (62/200) chose web-based videos, and 41% (82/200) chose in-person groups. Differences in demographic, employment, cultural, and technology use factors distinguished between men who chose each of the options, suggesting that when offering interventions in diverse groups of Latino men, choice of delivery may be recommended. We also found that men attending either of the group-based options (videoconference and in-person) lost more weight than men who chose the web-based videos.
Group Lifestyle Balance
Hombres con Opciones para Mejorar su Bienestar para Reducir Enfermedades Crónicas
The Patient Centered Outcomes Research Institute funded the study (AD 15-1503-29190), and the funder had no role in the review or approval of the manuscript for publication.
All authors conceptualized and designed the study. NL and LX conducted the statistical analysis with input from LGR and JM. All authors interpreted the data. LGR drafted the manuscript. All authors critically revised the manuscript for important intellectual content. LGR, NL, LX, and JM obtained funding. LGR had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
None declared.