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SMARTGoal.docx

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SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County

Mirlenys Diaz

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice-

Dr. Nora Hernandez-Pupo

June 11, 2026

SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County

Adult obesity is a major public health concern in the United States, notably in susceptible communities such as Miami-Dade County. Obesity is a risk factor for hypertension, type 2 diabetes mellitus, cardiovascular disease, stroke and some malignancies Recent national data indicate that adult obesity is still relatively prevalent, with 40.3% of people in the United States classed as obese during August 2021 through August 2023 (Emmerich et al., 2024). This is particularly relevant for low-income Hispanic adults, where social determinants of health, including food insecurity, limited access to healthy foods, transportation barriers, low health literacy, and decreased access to safe environments for physical activity, may negatively influence weight management (Washington et al., 2023). Therefore, a culturally relevant nurse-led health promotion intervention is needed to improve the obesity-related markers in this community.

This plan has the SMART aim of: Low-income Hispanic adults with obesity in Miami-Dade County who participate in a nurse-led health promotion program will have an average of 3%-5% reduction in body weight within 12 weeks, show improvement in BMI trends, increase moderate physical activity to at least 150 minutes per week, and improve nutrition knowledge scores by 20%. The outcomes will be measured by weekly weight tracking, activity logs, and pre/post nutrition questionnaires. The objective is SMART in that it describes the population, the intervention, the outcomes, the methods of measurement and the period of assessment.

Specific

It is specific since the target population is low-income Hispanics with obesity in Miami-Dade County. The intervention will be a 12-week, nurse-leaded intervention including culturally appropriate nutrition teaching, physical activity counseling, weekly weight monitoring and motivational support. This cohort was chosen because Hispanic people in low-income regions may face more difficulties in preventing and managing obesity, such as food instability, limited access to preventive care, and environmental factors that hinder healthy lifestyle habits (Washington et al., 2023). What is the role of nurse-led education in improving obesity outcomes in low-income Hispanic adults? This is a very important question in graduate level. Nurse-led education may improve results by increasing understanding of the hazards of obesity, enhancing self-management skills and promoting realistic behavior change. Furthermore, a community health worker intervention using motivational interviewing found positive changes in weight-related outcomes among Hispanic adults (Brown et al., 2022), which supports the use of culturally relevant counseling in this approach.

Measurable

The aim is measurable . It contains clear signals to monitor progress. Primary objectives will be body weight, BMI trends, weekly minutes of physical activity and nutrition knowledge scores. Body weight will be measured weekly and trends in BMI from baseline to week 12 will be investigated. Physical activity will be monitored using activity diaries by participants and nutrition knowledge will be assessed using pre and after intervention questionnaires. The second question at the graduate level is: What are the best measured outcomes that show short-term progress in obesity management? Clinical and behavioural change (e.g. body weight, BMI, waist circumference, physical activity levels and dietary knowledge) are useful markers. The use of measurable outcomes in this health promotion program is confirmed by the findings of Zeb et al. (2024), who found improvement in body weight, BMI and waist circumference in community-based obesity treatments.

Achievable

The target is achievable because the expected results are realistic to achieve within a 12-week period. A reasonable target for a short-term health promotion strategy that does not involve unsafe or excessive eating habits is an average weight loss of 3% to 5% body weight. The method will focus on making little changes to lifestyle, such adopting healthier food choices, controlling portion sizes, walking more, or doing moderate activity, and assessing yourself often. Practical strategies that can be utilized in a community setting include weekly education sessions, activity records, nutrition questionnaires and weight monitoring. Motivational interviewing also allows participants to uncover personal barriers, increase self-confidence, and generate realistic action plans. The technique suits the specified group. Brown et al. (2022) revealed that motivated interviewing helps in obesity-related behavior change in Hispanic adults.

Relevant

This purpose is relevant because it is directly related to the promotion of health, prevention of chronic diseases and advanced nursing practice. Advanced practice nurses are trained to evaluate health risks, educate patients, coordinate care, and advocate for vulnerable populations. This intervention has particular relevance in Miami-Dade County, where many low-income Hispanic residents may face cultural, economic and environmental barriers to healthy living. The Health Belief Model supports this hypothesis. The model explains how perceived vulnerability, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy influence health behavior. Training based on the Health Belief Model and social support increased physical activity among overweight women (Faghih et al., 2024). Therefore, this approach can allow the nurse to help the participants to identify the dangers of obesity and to adopt healthy practices.

Time-Bound

The goal has a time frame since it will be finished and evaluated in 12 weeks. Week 1 will include a baseline measurement of body weight, BMI, activity level and dietary information.

Weeks 2-11 Participants will get weekly teaching, counseling and monitoring. The last data collection will be in week 12 and outcomes will be compared to base line A third graduate level concern is how can advanced practice nurses help in maintaining lifestyle change after the 12-week intervention has been completed? Instructing participants on setting personal goals, tracking weight and activity, planning affordable meals, utilizing community resources, and following through with care will help participants reach their sustainability goals.

At the conclusion of this study, it is confirmed that obesity among low-income Hispanic adults in Miami-Dade County is a local public health issue that requires prioritized action. This group is constrained by social environmental barriers. The culturally adapted, nurse-led SMART goal intervention proposed in this study is clear, measurable, and evidence-based, and can turn generalized public health concerns into actionable, on-the-ground efforts. Led and implemented by advanced practice nurses through health education, motivational support, and continuous assessment, this intervention is expected to improve weight-related outcomes and support the development of long-term healthy behaviors.

References

Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2022). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing. American journal of health promotion : AJHP, 36(2), 259–268. https://doi.org/10.1177/08901171211049679

Emmerich, S. D., Fryar, C. D., Stierman, B., & Ogden, C. L. (2024). Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023. National Center for Health Statistics. https://doi.org/10.15620/cdc/159281

Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial. Frontiers in public health, 12, 1250152. https://doi.org/10.3389/fpubh.2024.1250152

Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in access and quality of obesity care. Gastroenterology Clinics of North America, 52(2), 429–441. https://doi.org/10.1016/j.gtc.2023.02.003

Zeb, A., Sivarajan Froelicher, E., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis. Iranian journal of nursing and midwifery research, 29(1), 16–22. https://doi.org/10.4103/ijnmr.ijnmr_120_22

HealthPromotionProposalPart14.docx

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Adult Obesity in Miami-Dade County

Mirlenys Diaz

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice-

Dr. Nora Hernandez-Pupo

May 30, 2026

Adult Obesity in Miami-Dade County

Obesity in adults is a major public health problem in Miami-Dade County and the United States. During August 2021 through August 2023, the prevalence of obesity among adults in the United States reached 40.3%, with no significant difference between men and women, and prevalence was higher among adults aged 40 to 59 compared to other age groups (Emmerich et al., 2024). Nationwide, in 2023, all states and territories in the United States had an obesity prevalence of more than 20% with the South reporting obesity prevalence of 35% (CDC, 2024). This burden is particularly high in low-income, Hispanic communities, such as the communities throughout Miami Dade County, Florida, which are affected by multiple structural inequities that increase the risk of chronic disease. The proposed health promotion program will consist of a structured 12-week nutrition education and physical activity counseling program in the community with a measurable goal of decreasing mean Body Mass Index (BMI) by 5% of adult Hispanic residents of Miami Dade County at the end of the intervention.

Globally, obesity continues to be a major public health concern. In 2022, 1 in 8 people worldwide were living with obesity, and approximately 890 million adults had obesity (World Health Organization, 2025). In the United States, adult obesity prevalence reached 40.3% during August 2021 through August 2023 (Emmerich et al., 2024). Locally, Miami-Dade County reported that 61.9% of adults were overweight or obese during 2017–2019, showing the continued need for community-based obesity prevention strategies in this population (Miami-Dade Matters, n.d.).

Vulnerable Population

Low-income Hispanic adults living in Miami-Dade County is the vulnerable population for this proposal. Socio-economic, cultural and environmental factors contribute to this population's increased risk of obesity. Minority families, specifically non-Hispanic African American and Hispanic families, are more likely to experience food insecurity, which makes it difficult to adhere to a particular diet, and low-income minority families face a number of other challenges such as chronic stress and poor access to quality foods, including vegetables, fruits and lean meats (Washington et al., 2023). In addition to these structural disadvantages, there are also poor access to physical activity resources. Low-income families may not have access to safe spaces for physical activity or may have transportation barriers that limit access to grocery stores with healthier food options, while financial insecurity can have a negative effect on health behaviors.

Another set of risk factors are those associated with access to health care and acculturation stress. Risk factors that contribute to the obesity disparities within Hispanic communities include low high school completion rates, low employment rates, higher rates of food insecurity, higher availability of poor-quality foods, low availability of convenient physical activity spaces, targeted marketing of poor food choices, and low access to healthcare providers or community-based organizations to support self-management (Levi et al., 2020). The combination of these vulnerabilities makes low-income Hispanic adults in Miami-Dade one of the most vulnerable populations for obesity and related comorbidities, and therefore a population in need of targeted, culturally competent health promotion efforts.

Review of Literature

Interventions that include culturally appropriate education, physical activity promotion, and motivational interviewing have been shown to have measurable impacts on BMI and body fat percentage in low-income Hispanic adults with obesity. Brown et al. (2022) performed a quasi-experimental study to determine if Hispanic adults who participated in the Healthy Fit intervention with supplemental motivational interviewing (MI) had more significant reductions in body composition than those who received the standard intervention. Of the 656 baseline participants, intervention participants had 2.13 times higher odds of weight loss and 2.59 times higher odds of decreased body fat percentage, and the average amount of weight lost for the MI group was 1.23 kg over 12 months. The study found that a community health worker approach that incorporates MI is a viable, cost-effective strategy for incremental change in diet and physical activity behavior in Hispanic communities, thus establishing a solid evidence base for replication in Miami-Dade.

Zeb et al. (2024) reviewed the literature on community-based obesity interventions and their effects on body weight, BMI, and waist circumference. The study validated that obesity prevention and management can be achieved by healthy diet, exercise and lifestyle modification provided by community-based programs. Structured community programs with multiple behavior change components were consistently found to have positive effects on BMI and waist circumference, supporting the proposed design of intervention for the target population in Miami-Dade County.

Strengths and Weaknesses of Sources

There are several strengths and limitations in the literature reviewed for this proposal. The strengths of the Brown et al. (2022) study are that it was conducted specifically with a Hispanic adult population, employed a validated intervention framework (Healthy Fit), and reported very precise and measurable outcomes on BMI and Body Fat Percentage at a 12-month follow-up. However, because of its quasi-experimental design, causal inferences are limited, and there is a high attrition rate of 46%, which may limit the generalizability of the findings.

The Zeb et al. (2024) meta-analysis is more generalizable since it incorporates several community-based studies, but its inclusion of international studies also leads to some differences in socioeconomic and healthcare systems that may not apply to a Miami-Dade community. Despite the limitations, however, both sources are peer reviewed, published in reputable indexed journals and offer empirical data, well identified methodologies, and sampling procedures that meet rigorous standards of scientific credibility and applicability to the proposed health promotion program.

Theoretical Framework

The Health Belief Model (HBM) is chosen as the guiding theoretical framework for this health promotion proposal. The HBM proposes that individuals are more likely to engage in health-promoting behaviors when they perceive themselves as susceptible to a condition, believe the condition is serious, perceive benefits to taking action, and experience few barriers to doing so.The HBM can be used as a framework to guide the design of health promotion and disease prevention interventions by identifying the factors that influence behavioral intentions for weight management in adults (Vo & Le, 2025). Its constructs reflect the challenges that low-income Hispanic adults experience in Miami-Dade, including low perceived susceptibility for obesity-related comorbidities and high structural barriers to healthy behavior.

Using the HBM, the proposed program will address perceived susceptibility through targeted health screening, perceived severity through diabetes and cardiovascular risk education, perceived benefits through culturally appropriate nutrition and exercise, and barriers through transportation assistance and Spanish language resources. Interventions informed by the HBM that involve social support and education have been shown to have a considerable positive impact on physical activity and weight-related outcomes for overweight adults (Faghih et al., 2024). The HBM therefore offers a sound and action-oriented approach to design, implement and assess this community-based obesity program in Miami-Dade County.

References

Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2021). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing. American Journal of Health Promotion, 36(2), 089011712110496. https://doi.org/10.1177/08901171211049679

CDC. (2024, September 12). New CDC Data Show Adult Obesity Prevalence Remains High. CDC Newsroom. https://www.cdc.gov/media/releases/2024/p0912-adult-obesity.html

Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. (2024). Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023. Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023, 508(508). https://doi.org/10.15620/cdc/159281

Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial. Frontiers in Public Health, 12(12). https://doi.org/10.3389/fpubh.2024.1250152

Petersen, R., Pan, L., & Blanck, H. M. (2020). Racial and Ethnic Disparities in Adult Obesity in the United States: CDC’s Tracking to Inform State and Local Action. Preventing Chronic Disease, 16(16). https://doi.org/10.5888/pcd16.180579

Vo, T. T., & Le, Q.-D. (2025). Application of the health belief model to study weight management behavioral intentions among adults in Ho Chi Minh City, Vietnam: a cross-sectional study. BMC Public Health, 25(1). https://doi.org/10.1186/s12889-025-23637-9

Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in Access and Quality of Obesity Care. Disparities in Access and Quality of Obesity Care, 52(2), 429–441. https://doi.org/10.1016/j.gtc.2023.02.003

Zeb, A., Froelicher, E. S., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis. Iranian Journal of Nursing and Midwifery Research, 29(1), 16. https://doi.org/10.4103/ijnmr.ijnmr_120_22