Implementing Pequeños Cambios Diarios: Culturally Tailored Nutrition Counseling to Improve Waist to Height Ratio and Self-Efficacy in Hispanic Women
Year: 2026
Type: dissertation
Study design: Clinical Trial
Abstract: Background: Hispanic women experience disproportionately high rates of insulin resistance (IR), metabolic syndrome (MetS), and related cardiometabolic complications, yet they remain underrepresented in early screening and prevention initiatives. Central adiposity and obesity-related risks are disproportionately high, with a (91%) increase in all-cause mortality risk in Hispanic and Latino adults, especially among women. This disparity underscores the urgency of identifying more sensitive, economical, and tailored educational resources in Federally Qualified Health Centers (FQHCs), where health inequities are most pronounced. Traditional primary care screening relies heavily on body mass index (BMI) and serum markers; however, BMI does not adequately capture central adiposity and fails to identify metabolically at-risk individuals. Emerging evidence suggests that the waist-to-height ratio (WHtR) is a sensitive and practical anthropometric indicator of cardiometabolic risk. Central obesity measures are strongly associated with mortality among Hispanic and Latino adults, particularly women, compared to BMI alone. Similarly, it is reported that stronger associations between WHtR and full cardiometabolic risk exist than those between BMI and full cardiometabolic risk. These findings supported integrating WHtR into routine screening to improve early risk identification in high-risk populations. Objectives: The purpose of the Pequeños Cambios Diarios quality improvement project was to implement culturally tailored nutrition counseling in an FQHC to improve WHtR and self-efficacy for healthy lifestyle behaviors among Hispanic women aged 35–65 years with BMI ≥25 kg/m². Methods: This quasi-experimental, single-site pilot project used a pre-test/post-test design over an 8-week period. Ten eligible participants with a BMI ≥25 kg/m² were recruited from a primary care clinic serving a predominantly Hispanic population. Participants with elevated BMI received culturally tailored counseling, which emphasized small lifestyle modification changes to promote a focus on waist circumference (WC) rather than a weight scale. WHtR, in which values ≤0.5 indicate increased cardiometabolic risk, was measured at baseline and at 8 weeks post-intervention as the primary outcome measure. Self-efficacy for healthy meal planning and dietary behaviors was measured at baseline and at 8 weeks using a validated Self-Efficacy Scale for Health Meals questionnaire. Results: The Wilcoxon Signed-Rank Test was carried out for primary outcome measures for completed cases (N = 8). There was statistically significant improvement in self-efficacy total score between baseline (Median) = 31.00, and post-intervention (Median = 42.50), Z = -2.316, p = .021, and a large effect size (r = 0.82), suggesting significant positive change. There were no statistically significant changes in WHtR from baseline (Median = 0.78) to post-intervention (Median = 0.80), Z = -0.254, p = .799, r = 0.09. Conclusions: Introducing culturally tailored nutrition counseling and support to Hispanic women with a BMI ≥25 kg/m² in a primary care setting was a feasible and effective intervention in promoting self-efficacy. Post-intervention self-efficacy scores increased, suggesting greater participant confidence in healthy meal planning and dietary behaviors after completing the program. Unchanged WHtR from baseline to 8 weeks in the majority of participants in the 8-week intervention period could have been insufficient to create biological change due to short time frame.
Author: Mexicano, Elvia
Institution: University of California, Los Angeles
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7213488357