Wilson Deborah H, Nelson Katie E, Gresh Ashley, Ricker Adriann, Littlepage Shea, Krienke Lydia Koh, Brockie Teresa N
School of Nursing, Johns Hopkins University, 525 N Wolfe St., Baltimore, MD 21205 USA.
Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 N. Washington St. 4th Floor, Baltimore, MD 21231 USA.
Glob Implement Res Appl. 2023;3(1):16-30. doi: 10.1007/s43477-022-00070-3. Epub 2023 Jan 9.
Head Start is a federally funded program for children (3-5 years) from low-income families. In the Fort Peck Native American Reservation, tribal Head Start teachers have reported high stress in supporting children experiencing adverse childhood experiences. Thus, we adapted the intervention (ClinicalTrials.gov: NCT04201184) for the teachers' context and culture to enhance psychological health and well-being. Within a participatory framework, the eight-step ADAPT-ITT methodology was used to guide the adaptation process: assessment; decision; adaptation; production; topical experts; integration; training; and testing. For Step 1, we purposive sampled 27 teachers, ancillary staff, and parents to understand teachers' stress, support mechanisms, and interest in an intervention via focus groups ( = 9) and individual interviews ( = 18). Qualitative data underscored teachers' experiences of stress, depression, and need for support (Step 1). Iterative feedback from a tribal advisory board and designers rendered selection of five lessons (Step 2, 5), which were adapted for the teachers via theater testing (Step 3, 4). Community capacity assessment revealed their ability to implement the intervention (Step 6). Testing of this adapted intervention in a feasibility trial (steps 7, 8) will be reported in a future publication. A rigorous systematic process within a participatory framework allowed intervention adaption based on community input. Leveraging "culture as treatment" may be useful for enhancing psychological health outcomes for Native Americans who historically underutilize existing psychological services.
The online version contains supplementary material available at 10.1007/s43477-022-00070-3.
“启智计划”是一项由联邦政府资助的针对低收入家庭3至5岁儿童的项目。在福特佩克印第安人保留地，部落“启智计划”教师报告称，在支持经历过不良童年经历的儿童时压力很大。因此，我们根据教师的背景和文化对干预措施（ClinicalTrials.gov：NCT04201184）进行了调整，以促进心理健康和幸福感。在参与式框架内，采用八步ADAPT-ITT方法指导调整过程：评估；决策；调整；制作；主题专家；整合；培训；测试。第一步，我们有目的地抽取了27名教师、辅助人员和家长，通过焦点小组（9个）和个人访谈（18个）了解教师的压力、支持机制以及对干预措施的兴趣。定性数据突出了教师的压力、抑郁经历以及对支持的需求（第一步）。部落咨询委员会和设计者的反复反馈促成了五节课的选定（第二步、第五步），并通过戏剧测试对这些课程进行了教师适应性调整（第三步、第四步）。社区能力评估显示了他们实施干预措施的能力（第六步）。在可行性试验中对这种适应性干预措施的测试（第七步、第八步）将在未来的出版物中报告。参与式框架内严格的系统流程使干预措施能够根据社区意见进行调整。利用“文化即治疗”可能有助于改善美洲原住民的心理健康状况，他们在历史上对现有心理服务的利用率较低。
在线版本包含可在10.1007/s43477-022-00070-3获取的补充材料。
