A study of employees at organizations connected to the Ecuadorian Social Security Institute (IESS) in Loja demonstrates why cultural adaptation of this kind of intervention needs to consider a population's real living and working conditions in addition to its habits.
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 the course of 16 weeks. By reformulating 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.
In addition to showing decreases in body fat, waist circumference, and body mass index, participants who finished the program dropped an average of 0.84 kilos, or 1.06% of their body weight. Additionally, the percentage of those who engaged in moderate or high levels of physical activity rose.
These modifications, however, were insufficient to demonstrate that the program outperformed standard treatment. Both body weight and diabetes risk, as determined by the FINDRISC score, did not significantly differ between the two groups when baseline differences were taken into account.
Additionally, only 11.46% of participants lost at least 5% of their body weight, falling short of the initial program's clinical goal.
This result implies that increasing an intervention's accessibility does not always imply that it is administered at a dosage high enough to provide all of its anticipated benefits.
The program had to be modified to fit 58 institutions' operating environments. Nevertheless, the biggest obstacles to remain enrolled were work obligations and trouble attending weekend sessions. Just 42.19% of the 274 workers who were first included in the intervention program, attended six or more of the ten sessions, and 82 did not finish the final assessments.
The diabetes risk score, muscle mass, visceral fat, adherence to the Mediterranean diet, and sedentary behavior did not show any statistically significant changes.
However, one outcome was particularly noteworthy: the group that got the intervention saw a greater drop in systolic blood pressure. 3.34 millimeters of mercury was the adjusted difference when compared to the control group. This outcome persisted in a different statistical analysis, although it became less strong when the researchers employed estimate techniques to take participant dropouts into consideration. Because of this, the authors believe it to be a promising signal that has to be verified in longer trials with higher participant retention. "This experience demonstrates that cultural adaptation must design an intervention that is 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 twelve months, mixing in-person and virtual sessions, and monitoring blood pressure as an early sign of success.
Translational Behavioral Medicine
Experimental study
People
Effectiveness of a culturally adapted group-based lifestyle intervention in reducing cardiovascular risk factors in a high-risk Latin American population
29-Jul-2026