Assigment .Apa seven . All instructions attached.

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Capstone Part I: PICOT Assignment

Erika Brito

Florida National University

MSN Capstone Project

Dr. Carmen Lazo

September 18, 2026

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Introduction and Significance of the Practice Problem

Obesity is a serious chronic disease problem that has negative consequences for physical

and social health, health-care utilization, and health-care costs. The disease is linked to

cardiovascular disease, decreased physical functioning, musculoskeletal complications, certain

cancers, Type 2 diabetes and hypertension (CDC 2025). Across the nation, 40.3% of U.S. adults

were at risk of having obesity, with 9.4% having severe obesity during August 2021-2023

(Emmerich et al., 2024). CDC surveillance data also show that Hispanic adults are impacted; at

least 35% of adult Hispanics are obese in 33 geographic areas for which there is adequate data

for 2022–2024 (CDC, 2024). The results highlight the need for interventions aimed at weight

management that are culturally and linguistically accessible.

Obesity also has significant economic impacts. Health care for obesity is expensive for

patients and the health care system. In 2019 dollars, adults with obesity had $1,861 more in

annual medical expenses than adults with healthy weight. Excess costs for adults suffering for

severe obesity were $3,097 per person. This represents almost $173 billion in 2019 dollars

(CDC, 2024) in medical costs. Additionally, Cawley et al. (2021) further showed that the burden

of obesity to direct medical costs in the United States is substantial. Although a reliable obesity-

specific healthcare cost for ZIP code 33012 is not available, local socioeconomic conditions

justify examining the issue in this population. Hialeah is mostly Hispanic, and culturally

responsive care is relevant to the proposed project because there is a large Hispanic population

within ZIP code 33012.

The intervention that is being proposed is bi-lingual nurse led, 12-week-long nutrition,

portion control, physical activity, and realistic weight management education. The purpose is to

determine whether the intervention produces measurable weight loss among low-income

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Hispanic adults with obesity receiving care in a community primary care clinic in Hialeah. The

proposed outcome is a change in body weight from baseline to the completion of 12 weeks. This

objective is measurable and realistic for a semester-long quality improvement project.

PICOT Question

The PICOT question is: In low-income Hispanic adults between 18 and 64 years of age

with obesity who receive primary care at a community clinic in Hialeah, Miami-Dade County

(P), how does a nurse-led bilingual education program addressing healthy nutrition and physical

activity (I), compared with participants’ baseline weight before the intervention (C), affect

weight loss (O) over 12 weeks (T)?

The population will consist of adults 18 to 64 years of age who self-identify as Hispanic,

have a BMI of at least 30 kg/m², receive care at the selected community clinic, and meet the

clinic’s income-related eligibility criteria. The intervention will consist of structured nurse-led

education provided in English and Spanish. Education will address affordable healthy food

selection, portion control, culturally familiar foods, increased physical activity, goal setting, and

strategies for overcoming common barriers. The comparison will use each participant’s baseline

weight as the preintervention reference point. Although this is not a separate control group, the

preintervention measurement will allow the project to determine whether weight changes occur

following implementation. The outcome will be change in weight measured in pounds or

kilograms, with measurements collected at baseline and during follow-up. The intervention will

continue for 12 weeks.

Vulnerable Population and Setting

The population selected would be the low-income Hispanic adults with obesity getting

primary care in the City of Hialeah, specifically in the 33012 ZIP code. The population is

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vulnerable because obesity risk and weight-management behaviors are influenced by

socioeconomic conditions, access to nutritious foods, transportation, health education, language,

and opportunities for physical activity. A study of Latinx adults in Florida found that financial

constraints, not having access to nutritious food, and a lack of culturally sensitive education were

significant obstacles to preventing obesity and diabetes (Martin et al., 2022). Social determinants

of health are strongly associated with obesity, and cumulative socioeconomic disadvantage can

increase obesity risk and severity (Philip et al., 2025).

Local data should be used with caution. In 2023, there were approximately 30.9% adults

in the Hialeah community considered obese with a 95% confidence interval from 26.2% to

35.9%, in 2017. Thus, any estimate available locally should not be read as implying that Hialeah

has a greater obesity prevalence than the United States as a whole. Instead, the proposed project

will focus specifically on a clinically identified high-risk population of low-income Hispanic

adults with BMI of at least 30 kg/m². A baseline review of deidentified clinic data will determine

the number and percentage of eligible patients and provide a clinic-specific measure of need.

Change is important because obesity can negatively influence physical mobility,

emotional health, risk for chronic disease and health care usage. The population may also

experience difficulty following conventional weight-management programs when educational

materials do not reflect cultural foods, language preferences, family practices, or financial

realities. According to Garcia et al. (2026), culturally tailored interventions among Hispanic

populations frequently feature bilingual delivery, culturally adapted food choices, peer and

family support, and adjusted educational materials.

Evidence-Based Intervention and Literature Review

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Research shows the efficacy of interventions that incorporate nutrition, physical exercise,

behavior modification, and follow-up. In addition, nurses are in the best position to conduct such

interventions as the role of primary care nurses encompasses assessment, education, goal setting,

monitoring, supportive care, and follow-up (Piwowarczyk et al., 2024). Nurses are involved in

education, counseling, psychological support, health advocacy, and intervention for obesity

management.Cultural adaptation is especially relevant to the proposed population. A recent

systematic review of behavioral weight-management interventions for Hispanic men found that

interventions frequently incorporated linguistic access and social or family support. Reported

weight changes ranged from weight gain to losses of approximately 6.3 kg (Flaxman et al.,

2024). Research involving Hispanic women also demonstrates benefits from culturally tailored

lifestyle interventions. When programs use bilingual and bicultural delivery, culturally modified

materials, traditional Hispanic foods, and peer participation (Garcia et al., 2026).

The proposed intervention will therefore avoid presenting weight management as a

simple matter of individual choice. Instead, nurses will assess barriers and work with participants

to establish achievable goals. Nutrition education will include affordable food substitutions and

portion control rather than requiring expensive specialty foods. Physical activity education will

focus on practical exercises that can be done safely in the participant’s environment. Follow-up

sessions each week will help maintain the activity, recognize barriers, and motivate the

individual to continue being active.

This approach is feasible for the advanced practice nurse because it can easily be

included in the daily routine of primary care services without any specialized and costly

equipment. The necessary resources are: bilingual educational brochures, weight scales, BMI

calculators, forms, educational materials, and about 15 to 30 minutes each session. The estimated

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project budget can remain modest, consisting primarily of printing, educational materials, staff

preparation, and participant tracking. The clinic can establish an initial project budget of

approximately $300 to $500, depending on existing equipment and printing resources. No

additional medication or specialized technology is required.

Implementation Timeline

The project will take place within 16 weeks. In weeks 1 and 2, the APRN will get

organizational approval for the project, recruit the eligible participants, analyze baseline data

from the clinics and develop bilingual materials. In week 3, staff and participant recruitment will

be done. From weeks 4 to 15, there will be the 12-week intervention program. Week 16 will

involve final weight measurement, data analysis, evaluation of outcomes, and preparation of

recommendations for continued practice. The primary outcome will be the difference between

baseline weight and weight at 12 weeks.

Theoretical Nursing Framework

The theoretical framework that supports the project is Pender’s Health Promotion Model.

This model focuses on individual attributes and experiences, perceived benefits and barriers,

self-efficacy, interpersonal influences, situational influences, and commitment to act (Rojas-

Torres et al., 2025). The above concepts can easily apply to the chosen target population as

Hispanic adults living below the poverty line might face such barriers as economic, cultural,

linguistic, environmental, and motivational barriers to healthy behavior.

In the case of this project, the nurse will use the above model by assessing the perceived

barriers, confidence, culture food preference, readiness for change, and available resources of the

participants. Then, the education will be tailored according to the above assessment results. The

individuals will set weekly nutritional and physical activity goals, monitor their weight, and get

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encouragement from the nurse. The model therefore connects the population’s needs with the

intervention and expected outcome.

Lewin’s Change Theory will provide a complementary framework for implementing the

practice change. The unfreezing stage will involve reviewing baseline obesity data, educating

staff, and explaining the need for improved weight-management support. The changing stage

will involve implementation of the bilingual 12-week intervention, participant education, goal

setting, weight monitoring, and follow-up. The refreezing stage will involve reviewing outcomes

and determining whether successful educational procedures can become part of routine clinic

practice. Change models can support structured preparation, implementation, stakeholder

engagement, and sustainability in healthcare improvement.

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References

Cawley, J. (2021). Direct medical costs of obesity in the United States and the most populous

states. Journal of Managed Care & Specialty Pharmacy, 27(3), 354–366.

https://doi.org/10.18553/jmcp.2021.20410

CDC. (2024). Adult obesity prevalence maps. CDC. https://www.cdc.gov/obesity/data-and-

statistics/adult-obesity-prevalence-maps.html

CDC. (2025, January 28). High blood pressure facts. High Blood Pressure.

https://www.cdc.gov/high-blood-pressure/data-research/facts-stats/index.html

Centers for Disease Control and Prevention. (2024, May 14). Adult obesity facts. CDC.

https://www.cdc.gov/obesity/adult-obesity-facts/index.html

Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. L. (2024, September). Obesity and severe

obesity prevalence in adults: United States, August 2021–August 2023. CDC. CDC.Gov.

https://www.cdc.gov/nchs/products/databriefs/db508.htm

Flaxman, H. R., Hernandez, N. G., Critelli, B., Chong, B. K., Sadowska, K., Pain, K., &

Gonzalez, C. J. (2024). Behavioral weight management interventions for hispanic men in

the United States: A systematic review. American Journal of Men’s Health, 18(5).

https://doi.org/10.1177/15579883241290344

Garcia, A. V., Falls, E., Dodge, E., & Aboul-Enein, B. H. (2026). The impact of culture in weight

loss intervention effectiveness among hispanic American women with overweight or

obesity: A systematic scoping review. Hispanic Health Care International : The Official

Journal of the National Association of Hispanic Nurses, 24(3), 153–171. PubMed

Central. https://doi.org/10.1177/15404153251383131

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Martin, M. P., Obioha, C. U., Gaikwad, S., Padron-Monedero, A., Pino, M. J. Del, Curtis, D., &

Villalba, K. (2022). Perceptions, awareness, and barriers to care regarding obesity and

diabetes among latinx in Miami and Escambia, Florida: A qualitative geographical

comparative study. Journal of Global Health Reports, 6, e2022003.

https://doi.org/10.29392/001c.30829

Philip, J., Hagan, K., Shahid, I., Chang, R., Prakash, S., Friedman, M., Titus, A., Harun Kundi,

Amin, Z., Javed, U., Avenatti, E., Sadeer Al-Kindi, Nasir, K., & Javed, Z. (2025).

Unfavorable social determinants of health and obesity. JACC Advances, 4(11), 102154–

102154. https://doi.org/10.1016/j.jacadv.2025.102154

Piwowarczyk, E., MacPhee, M., & Howe, J. (2024). Nurses’ role in obesity management in

adults in primary healthcare settings worldwide: A scoping review. Healthcare, 12(17),

1700. https://doi.org/10.3390/healthcare12171700

Rojas-Torres, I. L., Garizábalo Dávila, C. M., Ruidíaz Gómez, K. S., Fernández Aragón, S. P.,

Perea-Rojas, D. M., Rodelo Olmos, G. M., & Liñán Meléndez, N. I. (2025).

Effectiveness of Nola Pender’s health promotion model: A comprehensive approach for

enhancing healthy behaviors and quality of life in adults. International Journal of

Environmental Research and Public Health, 22(10), 1506.

https://doi.org/10.3390/ijerph22101506