Assigment .Apa seven . All instructions attached.

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Capstone Part II: Review of Literature

Erika Brito

Florida National University

MSN Capstone Project

Dr. Carmen Lazo

October 3, 2026

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Capstone Part II: Review of Literature

Obesity is a chronic disease with clinical and economic impact in United States.

According to CDC surveillance data, at least 35% of Hispanic adults were obese in 33

geographic areas with adequate data for 2022-2024 (Centers for Disease Control and Prevention

[CDC], 2025). In 2019, obesity related $173 billion in direct medical costs, and adults with

obesity incurred $1861 per year in excess medical costs (CDC, 2026). These findings provide

evidence to reinforce primary-care interventions. The PICOT is aimed at the topic of low-income

Hispanic adults age 18-64 years with obesity in a community clinic in Hialeah, FL. The practice

change includes 12-week nurse led bilingual education on nutrition, portion control, physical

activity and weight management.

Primary research supports multicomponent lifestyle interventions, although weight-loss

magnitude and sustainability differ. Tsai et al. (2021) conducted a PROPEL randomized clinical

trial to examined intensive lifestyle intervention within primary care among adults with obesity

from a racially diverse, low-income population. Participants received behavioral support and

follow-up. The study showed that intensive lifestyle treatment can be delivered as a component

of primary care and can provide benefits for weight and cardiometabolic outcomes (Tsai et al.,

2021). This evidence is relevant as the proposed intervention focuses on repeated primary-care

contact. However, the population was not specifically Hispanic, limiting cultural applicability.

Evidence from Hispanic populations provides stronger support for cultural and linguistic

adaptation. Rosas et al. (2022) conducted a randomized clinical trial (RCT) to assess the

HOMBRE intervention with 424 Latino men who had overweight or obesity and cardiovascular

risk factors. The culturally adapted intervention was delivered either in person or online or

through self-directed instruction. The primary outcome at 18 months did not differ significantly

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between groups. However, exploratory analyses showed greater weight loss at six and 12

months. There was a positive correlation between attendance and weight loss (Rosas et al.,

2022). This result indicates possibilities and limitations. Cultural adaptation alone may not

ensure sustained weight loss.

Garcia et al. (2022) studied a culturally and gender-sensitive intervention for Hispanic

men with overweight and obesity that lasted 12 weeks. It consisted of personalized counseling,

calorie targets, activity and technology-enabled self-monitoring. Sixteen of the 18 participants

went through the intervention, experiencing a mean weight loss of 4.7 kg at 12 weeks.

Technology adherence was modest, and participants reported literacy and internet barriers

(Garcia et al., 2022). The findings are valid to the project as it is not supported by costly

technologies. Direct bilingual education can help to lower digital access barriers.

A group based COMIDA lifestyle intervention was studied in Mexican American adults.

Of the 129 overweight or obese, 17% lost at least 5% of their body weight at the 6-month follow-

up. In addition, participants reported improvements in their dietary habits, such as eating more

fruits and vegetables and reducing their consumption of sweets and fried foods (Leng et al.,

2022). These results support dietary interventions and familiarity with foods. Clinically

significant weight loss was variable, however. Continued behavioral support remains important.

Cifuentes et al. (2023) examined a 12-week phenotype-specific intervention for adults

who were obese. Participants receiving the tailored intervention lost an average of 7.4 kg

compared with 4.3 kg among those receiving standard lifestyle intervention. This difference was

statistically significant. The study was not randomized or conducted at multiple centers,

however, and may not be generalized (Cifuentes et al., 2023). The results are valid for setting

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individual goals and barriers but have not been determined to be equally effective for low-

income Hispanic adults.

Griauzde et al. (2024) assessed a primary care-based weight navigation program that

referred patients with obesity to weight-management consultation and treatment. The study

demonstrates the effectiveness of structured obesity management in Primary care. Its

multidisciplinary structure differs from the proposed nurse-led intervention, but it reinforces

integrating weight management into routine clinical care.

Krishnasamy et al. (2024) performed a randomized controlled pilot study with 88 adults

who had obesity. Significant weight loss was also reported at 16 weeks in the intervention group

(2.58 kg), in comparison to the general care group (0.38 kg), and in other parameters, including

weight, waist circumference, BMI, and cholesterol (Krishnasamy et al., 2024). The study was

done in India, but it shows that nurses can provide structured behavioral interventions to manage

weight. Generalizability is restricted to Hialeah because of differences in setting and population.

A nurse practitioner-guided behavioral counseling program involving 36 adults with

overweight or obesity used biweekly counseling for 10 weeks. The participants showed weight

loss, waist circumference reduction, better blood pressure, quality of life, and exercise self-

efficacy (Onyegasi et al., 2023). The small sample and short duration limit generalizability.

However, the results validate APRN leadership for assessment, education, goal setting,

monitoring, and referral.

Noreik and Madigan (2021) examined primary care referral to online weight-

management programmes in a randomized controlled trial. Although different from the proposed

face-to-face bilingual model, the study reinforces primary-care engagement. Hesseldal et al.

(2022) reported that a primary care-based lifestyle coaching program resulted in more weight

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loss at 12 months than standard care. The intervention group achieved a weight loss of about 4.5

kg, whereas the control group lost just 1.5 kg. These results justify structured follow-up but

indicate that longer follow-up programs need resources.

From the literature, it is evident that effective interventions have been found to

incorporate elements such as nutrition education, physical activity, behavior goals, self-

monitoring, and follow-up. In Hispanic interventions, language, cultural food, social support, and

mode of delivery have been highlighted. Variation exists in terms of intensity, duration,

technology application, target population, and outcomes. While some studies have revealed

substantial weight loss, there are other studies where minimal or no difference has been

observed. HOMBRE has revealed that culturally-tailored care may bring about early success but

does not necessarily guarantee superiority (Rosas et al., 2022). This intervention supports

measuring weight change rather than assuming cultural adaptation will automatically produce

weight loss.

The proposed practice change supports evidence from culturally responsive,

multicomponent, behavioral interventions in children of color with evidence-based practice. The

primary aim is to see if weight changes can be found at 12 weeks after bilingual nurse-led

education for low-income Hispanic adults with obesity. Additional objectives are to improve

access to nutrition and physical activity education and establish a process for screening,

education, monitoring, and referral. Bilingual materials, affordable food strategies, realistic

goals, and nurse follow-up address financial, transportation, language, food-access, and

technology barriers.

The evidence also identifies important limitations. Weight loss is not consistently

maintained, compliance is not always high and culturally individualized programme is not

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always effective. A few studies were conducted in small samples or on selected populations.

Physical activity should be tailored to each person due to differences in health and functional

capacity. The APRN should conduct the screening of participants, offer suitable guidance for the

activities, follow-up progress, and recommend patients to a more specialized evaluation. The

intervention should not be expected to produce weight loss, but rather enhancement in quality of

the intervention.

Overall, there is literature that backs structured primary-care interventions for obesity.

Studies including Hispanic adults, culturally adapted interventions, primary-care delivery and

nurse-led counseling have the highest level of relevance. The evidence does not support the

conclusion of a single uniform intervention for all Hispanic adults. Instead, it supports

combining nutrition, physical activity, behavioral goals, cultural adaptation, and follow-up. For

Hialeah, bilingual APRN-led education provides a practice change that directly addresses the

PICOT population, intervention, comparison, and 12-week outcome.

Conclusion

Obesity is an issue that should be addressed in low-income Hispanic adults. This 12-week

bilingual nurse-led educational intervention program will focus on nutrition, portion control,

exercise, and reasonable weight-management goals. The APRN has ample evidence on the role

of nurses in assessing obesity, educating on lifestyle changes, setting goals, monitoring progress,

and follow-up. The safety of participants will be ensured through personalized recommendations

for exercise, assessment of their health and functional status, and referral where further

assessment is needed. The project will also ensure that an institutional IRB or quality

improvement determination is obtained prior to implementation. Pender’s Health Promotion

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Model and Lewin’s Change Theory will guide behavior change and practice improvement within

the primary care setting.

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References

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Centers for Disease Control and Prevention (CDC). (2025). Adult obesity prevalence maps.

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maps.html

Cifuentes, L., Ghusn, W., Feris, F., Campos, A., Sacoto, D., De la Rosa, A., McRae, A., Rieck, T.,

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