Table 1 Comparison between Pisando Fuerte and Stepping On
Stepping On | Pisando Fuerte | Rationale for adaptation | |
|---|---|---|---|
Language | English | Spanish | Hispanic/Latino older adults preferred Spanish. |
Reading level of program | 8th Grade | Leader’s manual: 8th Grade Handouts: 3rd Grade | Hispanic/Latino older adults in the study had low educational attainment. |
Requirements to be a leader | (1) Background as an allied health professional (RN, PT, PTA, OT, social worker) or fitness expert; (2) Experience facilitating an adult self-management program; (3) Professional experience working with older adults [21]. | (1) Professional experience working with Hispanic/Latino older adults (2) Background as allied health professional, fitness expert, community health worker, health educator, promotor(a), or equivalent experience. | Recruiting for leaders was difficult, few active health professionals are from a Hispanic/Latino background AND fluent in Spanish. Community organizations did not have staff with the required characteristics, and they could not assure sustainability of the program without the changes. |
Number of sessions | 7 session (2 h each) | 8 sessions (2.5 h each) | During pilot, sessions lasted longer than expected. |
Sessionsa | - Strength and balance exercises - Use of assistive devices - Preventing falls indoor/outdoor - Vision & footwear - Medications & sleep habits - Bone Health | - Strength and balance exercises - Use of assisted devices - Preventing falls indoor/outdoor - Vision & footwear - Medications & sleep habits - Bone Health - How to talk to your doctor? – Modified | The session about “how to talk to your doctor” was modified per stakeholder input to add more emphasis on the importance to voice concerns to health professionals; and how to address barriers. |
Use of weights for exercise | Mandatory | Optional | Cost of the weights is prohibitive to the organizations and participants, and cultural barriers would reduce use. |
Guest Experts | In person visits from guest experts. | If guest experts are not fluent in Spanish, leaders could use any of the following: - Invite an English speaker guest expert and use an interpreter to deliver the information - Use pre-recorded videos with Spanish-speaking guest experts, and bring an English speaker for questions & answers, with an interpreter to facilitate discussion. | It was a challenge to identify and bring bilingual guest experts to participate in the sessions. These modifications assure that the key elements of the program are maintained. |
Other | - Inclusion of Hispanic/Latinos cultural values - Created a resource book for leaders on how to find resources in your community. - Supporting materials (e.g. Presentations, Handouts) included more pictures, and stories were adapted to be culturally appropriate - Participants were asked to share information with family members and family members were invited to the last session | These changes assured acceptability of the program by increasing fun, build trust in leaders, increase involvement of family members, and facilitated participation during sessions. |