Educational Interventions to Promote Healthy Nutrition and Physical Activity Among Older Chinese Americans: A Cluster-Randomized Trial

摘要

Objectives. To evaluate the efficacy of an in-language intervention of 2 lectures plus printed materials versus printed materials alone on knowledge and adherence to nutrition and physical activity guidelines among older Chinese Americans in San Francisco, California. Methods. From August 2010 to September 2013, we randomized 756 Chinese Americans aged 50 to 75 years to either lectures plus print (n?=?361) or print (n?=?357). Clusters were the participants recruited by each lay health worker. Intervention outcomes were changes in knowledge of recommended vegetable intake, fruit intake, and physical activity level and adherence to those recommendations from pre- to 6 months postintervention. Results. The retention rate was 99%. At baseline, knowledge and adherence to recommendations were low. Print yielded increases in knowledge of recommended vegetable intake and physical activity level and adherence to fruit intake and physical activity recommendations. Lectures plus print had significant increases in all 6 outcomes. In multivariable models, lectures plus print was superior to print for knowledge of vegetable (adjusted odds ratio [AOR]?=?12.61; 95% confidence interval [CI]?=?6.50, 24.45) and fruit (AOR?=?16.16; 95% CI?=?5.61, 46.51) intake recommendations and adherence to vegetable intake recommendations (AOR?=?5.53; 95% CI?=?1.96, 15.58). Conclusions. In-language print materials, alone and combined with lectures, increased nutrition and physical activity knowledge and behaviors among older Chinese Americans. Asian Americans constitute the fastest growing racial/ethnic group in the United States. 1 The largest group is Chinese, 69% of whom are immigrants and 46% of whom have limited English proficiency (LEP). 2 Chinese Americans have low physical activity levels 3,4 and eat less than the recommended amounts of vegetables and fruits. 5 Thus, they may have an increased risk of chronic diseases, such as obesity, cancer, diabetes mellitus, and cardiovascular disease. 6–11 Improving healthy nutrition and physical activity (NPA) is a public health priority in this rapidly growing population. Culturally relevant and linguistically appropriate interventions targeting Chinese Americans are needed because many have LEP and low levels of health literacy, 12–14 but there is a lack of rigorous research on interventions to address NPA among Asian Americans in general and Chinese Americans in particular. A systematic review of lifestyle interventions for Asian Americans found only 7 randomized control trials (RCTs), only 2 of which had a sample size of more than 100. 14 Previous NPA interventions in Asian Americans have focused on print- 15 or lecture-based education alone. 16,17 There has been no RCT that compared an NPA lecture–based intervention to NPA printed materials among Asian Americans. Through a community-based participatory research partnership formed by an academic medical center, an undergraduate university, and a Chinese community–based organization in San Francisco, California, we developed a lecture-based intervention and print materials to deliver culturally relevant, in-language NPA messages. Using a cluster RCT design, we aimed to compare the effects of this lecture-based intervention combined with Chinese-language written materials with those of Chinese-language written materials only in a sample of older Chinese American immigrants.