Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 E. 17th Avenue, Aurora, CO, 80045, USA.
National Native Children's Trauma Center, University of Montana, 32 Campus Drive, 028 McGill Hall, Missoula, MT, 59812, USA.
Prev Sci. 2019 Oct;20(7):1136-1146. doi: 10.1007/s11121-019-01036-y.
Initiation of substance use often occurs earlier among American Indian (AI) youth than among other youth in the USA, bringing increased risk for a variety of poor health and developmental outcomes. Effective prevention strategies are needed, but the evidence base remains thin for this population. Research makes clear that prevention strategies need to be culturally coherent; programs with an evidence base in one population cannot be assumed to be effective in another. However, guidance on effective adaptation is lacking. This paper reports on cultural adaptation of an evidence-based program utilizing the multiphase optimization strategy (MOST) framework embedded within a community-engaged process to evaluate intervention components. The Strengthening Families Program for Parents and Youth 10-14 was adapted to become the Thiwáhe Gluwáš'akapi Program for American Indian youth and families. Three program components were evaluated for their effectiveness with regard to outcomes (youth substance use, theoretical mediators of program effects on substance use, and program attendance) in a sample of 98 families (122 youth and 137 adults). Consistent with the MOST framework, the value of components was also evaluated with regard to efficiency, economy, and scalability. Expanding on the MOST framework for cultural adaptation, we also considered the results of the MOST findings regarding the acceptability of each component from the perspectives of community members and participants. The promise of a strategic component-based approach to adapting evidence-based interventions is discussed, including the benefits of engaging community to ensure relevance and considering both cultural and scientific rationale for each component to enhance impact.
物质使用的开始通常发生在美国印第安人(AI)青年中比在美国的其他青年中更早,从而增加了各种不良健康和发育结果的风险。需要有效的预防策略,但针对该人群的证据基础仍然薄弱。研究清楚地表明,预防策略需要具有文化一致性;不能假设在一个人群中具有证据基础的计划在另一个人群中有效。但是,缺乏有效的适应指导。本文报告了利用多阶段优化策略(MOST)框架嵌入社区参与过程中,对基于证据的计划进行文化适应的情况,以评估干预措施的组成部分。加强家庭计划(Strengthening Families Program)已被改编为针对美国印第安青年及其家庭的 Thiwáhe Gluwáš'akapi 计划。在一个由 98 个家庭(122 名青年和 137 名成年人)组成的样本中,对三个计划组成部分在以下方面的有效性进行了评估:青年物质使用,对物质使用产生影响的计划理论媒介,以及计划参与度。与 MOST 框架一致,还根据效率,经济性和可扩展性对组件的价值进行了评估。在 MOST 框架的基础上进行扩展,我们还从社区成员和参与者的角度考虑了 MOST 调查结果中关于每个组件可接受性的结果。讨论了一种基于战略组件的方法来调整基于证据的干预措施的前景,包括通过让社区参与来确保相关性,并考虑每个组件的文化和科学依据,以提高影响力。