The socioecological model levels, behavior change mechanisms, and behavior change techniques to improve accelerometer-measured physical activity among Hispanic women: a systematic review.

Abstract

Background: Interventions to increase and maintain Hispanic women's moderate-to-vigorous physical activity (MVPA) are lacking. Socioecological models hypothesize that MVPA participation is influenced by factors at multiple levels of the environment (i.e., intrapersonal, interpersonal, organizational, neighborhood, policy). These factors, including behavior change mechanisms (BCM), are targeted with behavior change techniques (BCT) delivered through interventions to improve MVPA participation. However, the specific factors and BCT that positively influence Hispanic women's MVPA remain unknown.

Purpose: Synthesize existing literature to determine the socioecological model levels, BCM, and BCT that significantly increased Hispanic women's accelerometer-measured MVPA.

Methods: Databases (PubMed, CINAHL, Scopus, Cochrane Library and PsychINFO) were searched using key terms ((Hispanic women) OR (Hispanic OR Mexican American OR Latina OR Latinx) AND (female) AND (exercise OR physical activity)) without date or geographic limitations in March 2023. Peer-reviewed studies published in English that tested interventions to increase Hispanic women's accelerometer-measured MVPA were included. Two authors extracted data, a narrative synthesis was conducted, and a conceptual model of a multilevel MVPA intervention was proposed.

Results: Nine unique interventions were identified with four studies providing additional findings (N = 13). Studies were conducted in the United States and totaled 2,303 Hispanic women (M = 28.4-44.6 years). Self-efficacy (intrapersonal level) and family participation (interpersonal level) were the only BCM that mediated MVPA post-intervention. Half of the studies targeting the organizational (n = 3/6) and 83.3% (n = 5/6) targeting the neighborhood levels demonstrated significant improvements in MVPA. BCT targeting confidence, goals, and problem-solving at the intrapersonal level, partner support and childcare barriers at the interpersonal level, and physical activity access with methods to overcome weather and safety barriers at the neighborhood level significantly improved MVPA post-intervention. None of the interventions tested for longer-term (i.e., > 9-months post-intervention) MVPA change.

Conclusions: Interventions to increase Hispanic women's accelerometer-measured MVPA in the shorter-term should be developed to include BCT to increase self-efficacy (intrapersonal level) and family participation (interpersonal level) and identify physical activity opportunities/access (neighborhood level), including BCT to overcome safety and weather barriers. Future research is needed to confirm these findings and determine the socioecological levels, BCM, and BCT to maintain Hispanic women's MVPA in the longer term.

Trial registration: The 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was followed for this systematic review. The protocol for this systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42021285063.