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Use of Web-Based Parent–Adolescent Health Promotion Program Among Puerto Ricans

Villarruel, Antonia M.; Varas-Díaz, Nelson; Hanlon, Alexandra; Betancourt, Elba; Lozano, Alicia J.; DiNapoli, Lucia

doi: 10.1097/NNR.0000000000000306

Background Despite positive attitudes of Latinos using the Internet and the increased availability of health information resources, few studies have been conducted that examine actual use and barriers to web-based health information.

Objective The aim of this study was to examine whether select sociodemographic factors and technology factors (e.g., computer and Internet access) predicted use of a web-based, parent–adolescent sexual communication program or a physical activity program, entitled Cuídalos, among Puerto Rican parents.

Methods This study uses data from a randomized controlled trial designed to examine the long-term effectiveness of Cuídalos. Parents were recruited from community-based and school sites throughout Puerto Rico and randomly assigned to a web-based, parent–adolescent sexual communication (n = 245) or a physical activity (n = 247) program. Parents were instructed to complete the two-session program within 1 week and had access to the program for a period of 3 months. Outcomes in this secondary analysis were the number of log-ins and self-reported access during the 3-month period. Reasons for not accessing the program after the 3-month period were assessed.

Results Self-reported access after completion of the Cuídalos program and the actual number of log-ins over the intervention period were low. There were no statistically significant differences in the number of log-ins between parents who accessed Cuídalos during the 3-month time frame and those who did not (p = .28). Logistic regression analyses demonstrated that the odds of accessing Cuídalos during the 3-month period was 72% higher (OR = 1.72, 95% CI [1.08, 2.75]) among parents with a high school education or less, as compared to parents with a college education (p = .02). Similarly, Poisson regression model results indicated that, with every year increase in age, the expected number of log-ins increased by 1% (RR = 1.01, 95% CI [1.00, 1.02]); compared to those who accessed the program at home, the expected number of log-ins ranged from 10% to 27% lower for parents accessing elsewhere. Reasons for not accessing the program during the 3-month period included not having easy access to a computer (n = 134, 48.6%), or they did not know how to access the program again (n = 56, 20.3%).

Discussion Despite the availability of web-based and e-health resources, further research is needed to identify how to facilitate greater access and actual use of digital health resources by Latinos. This is an important effort in order to prevent a widening health equity gap caused by a lack of access and use of digital health resources.

Antonia M. Villarruel, PhD, is Professor and Margaret Bond Simon Dean of Nursing, University of Pennsylvania School of Nursing, Philadelphia.

Alexandra Hanlon, PhD, is Research Professor of Nursing, University of Pennsylvania School of Nursing, Philadelphia.

Alicia J. Lozano, MS, is Statistical Analyst, University of Pennsylvania School of Nursing, Philadelphia.

Lucia DiNapoli, MES, is Director, University of Pennsylvania School of Nursing, Philadelphia, PA.

Nelson Varas-Díaz, PhD, is Professor, Global and Sociocultural Studies, Florida International University, Miami.

Elba Betancourt, PhD, Researcher, Institute for Psychological Research, Universidad del Este, Carolina, Puerto Rico.

Accepted for publication May 16, 2018.

The authors acknowledge the National Institutes of Health (R01NRO13505) supported this study. In addition, the National Institute of Drug Abuse (K02DA035122) supported Dr. Nelson Varas-Díaz.

The authors would like to thank their communities and the parents and adolescents who participated in the study for their support.

The research reported here was conducted within the guidelines for research ethics. The Institutional Review Boards at the University of Puerto Rico, University of Michigan, and University of Pennsylvania approved the study.

Trial Registration: NCT03063385; Registration September 2012,

The authors have no conflicts of interest to report.

Corresponding author: Antonia M. Villarruel, PhD, RN, FAAN, University of Pennsylvania School of Nursing, 418 Curie Blvd., Claire M. Fagin Hall, Room 430, Philadelphia, PA, 19104-4217 (e-mail:

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