Cultural adaptation strengthens cardiovascular disease and diabetes prevention strategies in Latin America
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A study of employees at organizations connected to the Ecuadorian Social Security Institute (IESS) demonstrates why cultural adaptation of this type of intervention must consider a population's real living and working conditions in addition to its habits.
A total of 192 employees participated in "Transform Your Life with Daily Changes," a modified version of the Diabetes Prevention Program (DPP) created by the U.S. Centers for Disease Control and Prevention, over 16 weeks. By reducing the number of sessions from 22 to 10 and adding regional cuisine and recipes, group activities and workplace visits, the curriculum was adapted to the Ecuadorian setting. The research is published in the journal Translational Behavioral Medicine.
In addition to decreases in body fat, waist circumference and body mass index, participants who finished the program lost an average of 0.84 kilograms (1.85 pounds), or 1.06% of their body weight. The percentage of those who engaged in moderate or high levels of physical activity also rose.
These modifications, however, were insufficient to demonstrate that the program outperformed standard treatment. Body weight and diabetes risk, as determined by the FINDRISC score, did not differ significantly between the two groups after baseline differences were taken into account.
Additionally, only 11.46% of participants lost at least 5% of their body weight, falling short of the original program's clinical goal.
This result implies that increasing an intervention's accessibility does not always mean it is administered at a dosage high enough to provide all its anticipated benefits.
The program had to be modified to fit the operating environments of 58 institutions. Nevertheless, the biggest obstacles to remaining enrolled were work obligations and difficulty attending weekend sessions. Just 42.19% of the 274 workers initially included in the intervention program attended six or more of the 10 sessions, and 82 did not complete the final assessments.
The diabetes risk score, muscle mass, visceral fat, adherence to the Mediterranean diet and sedentary behavior did not show statistically significant changes.
However, one outcome was particularly noteworthy: The group that received the intervention saw a greater drop in systolic blood pressure. The adjusted difference was 3.34 millimeters of mercury compared with the control group.
This outcome persisted in a different statistical analysis, although it became less pronounced when the researchers used estimation techniques to account for participant dropouts. Because of this, the authors consider it a promising signal that must be verified in longer trials with higher participant retention.
"This experience demonstrates that cultural adaptation must produce an intervention compatible with work schedules, bring part of the sessions to the workplace and use foods available in Ecuador, even though we did not observe the expected effect on every indicator, while also being balanced with enough time and intensity to result in long-lasting change," the authors observed.
For comparable programs in other Latin American nations, the authors suggest extending the intervention to nine to 12 months, combining in-person and virtual sessions, and monitoring blood pressure as an early sign of success.
Publication details
Rosario Suárez et al, Effectiveness of a culturally adapted group-based lifestyle intervention in reducing cardiovascular risk factors in a high-risk Latin American population, Translational Behavioral Medicine (2026). DOI: 10.1093/tbm/ibag038
Journal information: Translational Behavioral Medicine
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Preventive medicineEndocrinologyCardiologyCommon illnesses & PreventionHealthy livingWeight managementFitness & Physical activity Provided by Universidad Tecnica Particular de Loja Who's behind this story?
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