An APRN-led intervention helps identify individual barriers to obesity prevention in Black women to aid in patient education and management. Obesity risk and stress assessment counseling should be integrated into APRNs obesity tool kit and used consistently in the care of Black women, said study author Jasmine A. Berry, DNP, APRN, FNP-C, of Atlanta ID Group in a poster session at the inaugural conference of DNPs of Color, held virtually October 23, 2021.
“Black women are not a monolith,” Dr Berry said in an interview. “Successful interventions to eradicate an epidemic birthed almost 30 years ago depend on an understanding and reverence that Black culture and traditions are webbed into daily interactions affecting one’s thoughts, beliefs, and actions. This collective approach must involve government agencies, research institutions, community leaders, and the Black community.”
Obesity rates among Black women are disproportionally higher than any other sex or race in the US, explained Dr Berry. “Health care providers, specifically APRNs, are vital to understanding and developing appropriate interventions for this public health issue,” Dr Berry said.
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Study Design
The study was designed to assess the effectiveness of an APRN-led intervention to identify factors influencing excess weight and obesity in Black women and to provide individualized education on health habits and attitudes using the teach-back method.
A total of 29 Black women were recruited from a local predominantly Black church in Atlanta, GA. Of these, 20 Black women aged 18 to 45 years (mean age, 32.7 years) completed the entire intervention, Dr Berry said in an interview. The mean BMI was 39.7 and 50% were diagnosed with a chronic disease (eg, hypertension, hyperlipidemia, type 2 diabetes, polycystic ovary syndrome, and pre-diabetes). The vast majority of participants held a college or graduate-level degree (55% graduate degree, 35% bachelor/associate degree, 5% doctorate or professional degree) and 50% earned more than $75,000 annually (30% ≥$100,000, 20% ≥$75,000-$100,000).
The intervention consisted of 4 weekly 1-hour educational sessions held via Zoom addressing the following topics:
- Chronic Diseases and Obesity: How Are They Related
- Physical Activity and What it Looks Like
- Nutrition in the Black Community
- Mental Health and Emotional Triggers: Can This Contribute to Obesity?
Sessions concluded with a 5- to 10-minute teach-back session to ensure participants understood and retained the information. At baseline, the participants completed a demographic survey and Readiness to Change Questionnaire (RCQ). The RCQ was repeated within 1 week of completion of the sessions.
Individualized, Multifactorial Barriers to Obesity Prevention Found
The intervention confirmed that barriers to obesity prevention are individualized and multifactorial, Dr Berry said. Common barriers in this group of upper-middle-class Black women include stress, social support, income and educational attainment, and groups/group dynamics.
“What was found throughout the sessions was that women gravitated toward the group format because social support is a huge component for Black women and the Black community,” Dr Berry told us. “It is a shared space with like-minded individuals, who share the same culture and tradition; this atmosphere allows the women to be transparent and vulnerable without having to first explain why they may engage in certain habits or ways of thinking.”
In this cohort, BMI was significantly correlated with education and income level (P <0.05). Additionally, ANOVA analysis was used to examine if there were any associations between education level and BMI as literature constantly cites a lower education level is associated with obesity; however, Dr Berry hypothesized this would not be the case given the small sample size. As expected, ANOVA analysis showed no statistically significant differences in BMI when compared across education level (P =0.299) or income levels (P =0.446).
The findings from paired-sample t test revealed no significant change between pre-RCQ and post-RCQ after the 4-week intervention. Although there was no statistically significant change, 3 participants (15%) improved from the stage of contemplation to action. Small sample size and high attrition (32%) most likely contributed to the lack of significance, Dr Berry explained.
“Since the questionnaire could not assess more than 1 habit contributing to obesity, participants were asked about their current engagement in physical activity on a weekly basis,” Dr Berry explained. In both the pre- and postintervention survey, 75% of the participants stated they engaged in physical activity at least once during the week and 25% stated they did not currently engage in physical activity weekly. Reasons cited for not engaging in physical activity were “lack of motivation,” “poor time management,” “I left the gym due to COVID and haven’t found anything I like yet,” and “I am a mom and lack support right now.”
Study limitations include the small sample size, convenience sampling, short project timeline, and COVID-19 restrictions.
The next steps in this research are to recreate the group format setting using the teach-back method with community leaders and health ministries as well as in health care settings, Dr Berry said. Additionally, APRNs should integrate health literacy on obesity into the assessment of Black women and lobby for updated health policies, social justice measures, and quality health care for Black women, Dr Berry concluded.
Reference
Berry JA. Project B.L.A.C.K. Barriers lifted after cultivating knowledge assessing barriers to obesity prevention in Black women using the teach-back method. Poster presented at: DNPs of Color Virtual Conference 2021; October 23, 2021.
