4/26/2013

MakingCulturalAdaptationsto
EvidenceBasedPrograms
BelindaHernandez,PhD,CHES
UTHealth,SchoolofPublicHealth
SanAntonioRegionalCampus
CenterforHealthPromotionandPreventionResearch

Whatdowemeanby
Wh
d
b
adaptation?

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Fidelity

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HowdoIminimize
How
do I minimize
adaptationsand
maintainfidelity?

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ProgramA
StudyPopulation
Age:MiddleSchool
100%Male
100%AfricanAmerican

NOTTHEBEST
NOT
THE BEST
CHOICE

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ProgramB
StudyPopulation
Age:MiddleSchool
44%Hispanic,42%African
American,14%Other
59%Females,41%Males

BETTER
BETTER
CHOICE

SUPPORT

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ToAdaptorNotAdapt?

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Isthechangedueto

U i
UniversalBeliefs
l B li f
CulturalBeliefs
PersonalBeliefs

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Youwanttoimplementasexualhealth
programinyourschooldistrictthatis
composedofpredominatelyHispanic
youth.However,youdonotwantto
h
d
implementtheactivitiesthatdiscuss
condomsandcontraceptivesbecauseyou
fearmostparentsinyourdistrictdonot
support sex education that includes
supportsexeducationthatincludes
informationaboutcondomsand
contraceptives.

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MajorityofParentsSupportTeachingAbstinence
plusCondomsandContraceptives

68%ofHispanicparentsinTexas

74%ofCatholicparentsinTexas

78%ofSpanishspeakingparentsinTexas
Tortolero,S.R.,Johnson,K.,Peskin,M.F.,Cuccaro,P.,Markham,C.M.,Hernandez,B.F.,Addy,R.C.,Shegog,R.,Li,
D.(2011).Dispellingthemyth:Whatparentsreallythinkaboutsexeducationinschools.JournalofApplied
ResearchonChildren:InformingPolicyforChildrenatRisk,2,Article5.

MajorityofParentsSupportTeachingMedically
AccurateInformationonCondoms&
ContraceptivesinMiddleSchoolorEarlier
74%ofHispanicparentsinTexas

65%ofCatholicparentsinTexas

84%ofSpanishspeakingparentsinTexas
Tortolero,S.R.,Johnson,K.,Peskin,M.F.,Cuccaro,P.,Markham,C.M.,Hernandez,B.F.,Addy,R.C.,Shegog,R.,Li,
D.(2011).Dispellingthemyth:Whatparentsreallythinkaboutsexeducationinschools.JournalofApplied
ResearchonChildren:InformingPolicyforChildrenatRisk,2,Article5.

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Youwanttoimplementasexualhealthprogram
inyourcommunitywhichispredominately
Hispanic.Youmustreceiveparentalconsentfor
eachstudenttoparticipateintheprogram,but
youarehavingahardtimereceivingtheconsent
formsfromyouth.Youknowthatthemajority
ofparentsinyourcommunitysupportsexual
healtheducation.Manyoftheparentsinyour
y
p
y
communityspeakSpanishonly.

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CultureattheSurfaceLevel

Language

Visual
Symbols

Examples

Scenarios

Activities

Staff
ff

CultureataDeeperLevel

RiskFactors

Protective
Factors

Values

Beliefs
li f

A i d
Attitudes

Expectations
i

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AdaptationsattheDeepLeveltakes
TimeandResources
Formative Work
FormativeWork
Decide/MakeAdaptations
PilotTest
Implement
Evaluate

CaseStudy#1
OriginalProgram
Studypopulation:AfricanAmericanmales,ages
Study population African American males ages
1114years
Setting:Localschoolsoutsideoftheregular
schoolday
Designedtoaffectknowledge,beliefs,and
intentions related to condom use and sexual
intentionsrelatedtocondomuseandsexual
behaviors
Deliveredthroughgroupdiscussionsand
exercises,videos,games,androleplays

12

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CaseStudy#1
Challenges:
1.Targetpopulation:Latinoyouth
2.Desiretoaddressriskandprotectivefactors
specifictotheLatinoculture DeepLevel

CaseStudy#1
1. FocusgroupswereconductedamongLatina
adolescentsandtheirmothersinthe
d l
t
d th i
th i th
community
2. Reviewedexistingliteratureandresearch
3. Conductedpilotstudyoforiginalprogram
with Latino youth (1318 years)
withLatinoyouth(1318years)
4. FocusgroupswereconductedwithLatino
boysandgirlsafterpilotstudy

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CaseStudy#1
5. Interviewswereconductedwithfacilitators
6. DeepLeveladaptationsmade:
Specificactivitieswerecreatedanddesignedto
identifyculturalvaluesandhowtheyinfluence
sexualdecisionmaking
Activitieswerealsodesignedtoweakenculturally
prescribedbehavioralbeliefsandattitudesthat
fosterunprotectedsexualintercourse

CaseStudy#1
7. SurfaceLeveladaptationsmade:

Titleofprogram
Programlogo
TranslatedactivitiesintoSpanish
UsedLatinofacilitators
Latino images, games, and music were
Latinoimages,games,andmusicwere
incorporatedthroughouttheprogram

8. Conductedevaluationofnewprogramwith
facilitatorsandparticipants

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CaseStudy#2
OriginalProgram
Studypopulation:Latinoadolescents,ages1318
years
Setting:Community
Designedtoincreaseskilllevelandselfefficacyin
communicatingandnegotiatingwithsexual
g
g
g
partnersaboutabstinenceandcondomuse.
Deliveredthroughculturallyrelevantroleplays,
music,videogames,andhandsonpractice

CaseStudy#2
Challenge
1.Setting:Highschoolwithalargenumberof
Latinoyouth

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CaseStudy#2
1. Consultedwiththedevelopersfortraining
andtechnicalassistanceforadaptations
dt h i l i t
f
d t ti
2. AdaptationsMade:
Programwasadjustedtofitschoolschedule 15
45minutesessionsdeliveredover3weeks
g
p
Substituted2songsandreplacedvideo

General
General
Adaptation
Guidelines

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CoreElements

Wh t i B i T ht
WhatisBeingTaught
HowitisTaught
Implementation

GreenLightAdaptations
Changinglanguage
Replacingimagestoshowyouthand
Replacing images to show youth and
familiesthatlooklikeyourtarget
population
Customizeroleplays(e.g.,names)
Makeactivitiesmoreinteractive
Updatingstatistics

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YellowLightAdaptations
Changingsequenceofactivities
Addi
Addingactivitiestoaddressadditional
i ii
dd
ddi i
l
riskorprotectivefactors
Replacingorsupplementingvideos
Modifyingcondomactivities
Modifying condom activities
Implementinginadifferentsetting

RedLightAdaptations
Shorteningaprogram
Reducingoreliminatingactivitiesthatallowfor
personalization or skills practice
personalizationorskillspractice
Removingcondomactivities
Contradicting,competingwith,ordilutingthe
programsgoals
Minimizingoreliminatingstrategiesthat
Minimizing or eliminating strategies that
promoteclassroommanagement
Replacinginteractiveactivitieswithlecturesor
individualwork

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ManyAdaptationKitsAvailable

ProgramsthatWork
AmongLatinoYouth
ChildrensAidsSociety
Carrera Program
Cuidate!
DrawtheLine/Respect
theLine
ItsYourGame:Keepit
R l
Real

SaferChoices
ReducingtheRisk
R d i th Ri k
TeenOutreachProgram

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ProgramsthatWork
AmongLatinoYouth
All4You! foralternative
schools
ProjectTalc foryouth
withparentslivingwith
HIV
Respeto/Proteger for
highriskyoungLatino
parents
pa
e ts
Rikers HealthAdvocacy
Program for
incarceratedyouth

SaferSex clinicbased
Sexual Health and
SexualHealthand
AdolescentRisk
Prevention for
incarceratedyouth
SistersSavingSisters
clinicbased

Questions?
Belinda Hernandez
Belinda.Hernandez@UTH.TMC.EDU

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