Merrill Katherine G, Fuentes Jacqueline, Merrill Jamison, DeCelles Jeff, Silva Jacqueline, Sedeño Angela, Salgado Susana, Vargas Sara, Cano Jennifer K, Nabor Veronica, Rodriguez Laura, Melgoza Vanessa, Mora Corin, Baumann Ana A, Guastaferro Kate, Donenberg Geri R
Center for Dissemination and Implementation Science, University of Illinois Chicago, Chicago, IL, United States.
Floreciendo Community Advisory Council, Chicago, IL, United States.
Front Public Health. 2025 Feb 19;13:1501757. doi: 10.3389/fpubh.2025.1501757. eCollection 2025.
Adaptation is widely recognized as important when interventions are to be delivered in new settings or with new populations. However, there are gaps in the literature on how adaptations are carried out and documented. IMARA is a 12-h evidence-based sexual health intervention for Black teens and their mothers, designed for delivery over two days. We present our systematic process of adapting IMARA for Latinas to produce the ("Blooming") program for Latina teens (14-18 years old) and their female caregivers (e.g., mothers, sisters).
Using a community-based participatory research (CBPR) approach, we carried out a qualitative study that included 7 focus groups: 4 with staff from community partner organizations ( = 29), 2 with Latina teens (14-18 years) ( = 11), and 1 with female caregivers ( = 5). We also conducted seven key informant interviews with experts in sexual health and Latina health. We used Escoffery's recommended steps to guide our adaptation process. Data were thematically coded and adaptations documented using the FRAME for reporting modifications to evidence-based interventions.
Informed by the data, we grouped IMARA content into four sessions for Floreciendo, each with unique curricular content and designed to be delivered in two hours (eight hours total): (1) Foundations in Sexual Risk Prevention; (2) Condoms and Contraception; (3) Family Strengthening; and (4) Gender and Relationships. We documented adaptations made for each session. For example, participants emphasized unplanned pregnancy as an important issue facing Latina teens. In response, we added an activity providing hands-on experience with contraceptive methods. Participants also highlighted how gender norms and family expectations in Latine culture shape Latina teens' sexual and reproductive health practices. We therefore developed activities and opportunities for discussion addressing these cultural influences. We removed IMARA activities considered of lower priority (e.g., portrayal of women in the media).
This study addresses gaps in the literature by reporting in detail the adaptations we made to an evidence-based intervention using qualitative methods. The four curriculum sessions we generated through our adaptation process will form the basis of the intervention components we will test in future work using the multiphase optimization strategy (MOST) framework.
当干预措施要在新环境中或针对新人群实施时，适应性调整被广泛认为是很重要的。然而，关于如何进行和记录适应性调整的文献存在空白。IMARA是一项针对黑人青少年及其母亲的为期12小时的循证性健康干预措施，设计为分两天进行。我们展示了将IMARA改编为适合拉丁裔的系统性过程，以产生针对拉丁裔青少年（14 - 18岁）及其女性照顾者（如母亲、姐妹）的“绽放”（“Blooming”）项目。
采用基于社区的参与性研究（CBPR）方法，我们开展了一项定性研究，包括7个焦点小组：4个与社区合作伙伴组织的工作人员进行（n = 29），2个与拉丁裔青少年（14 - 18岁）进行（n = 11），1个与女性照顾者进行（n = 5）。我们还对性健康和拉丁裔健康领域的专家进行了7次关键 informant访谈。我们使用埃斯科费里推荐的步骤来指导我们的改编过程。对数据进行主题编码，并使用FRAME记录改编情况，以报告对循证性干预措施的修改。
根据数据，我们将IMARA的内容分为“绽放”项目的四个部分，每个部分都有独特的课程内容，设计为两小时完成（总共八小时）：（1）性风险预防基础；（2）避孕套与避孕；（3）家庭强化；（4）性别与关系。我们记录了每个部分所做的改编。例如，参与者强调意外怀孕是拉丁裔青少年面临的一个重要问题。作为回应，我们增加了一项提供避孕方法实践经验的活动。参与者还强调了拉丁文化中的性别规范和家庭期望如何塑造拉丁裔青少年的性健康和生殖健康行为。因此，我们开发了针对这些文化影响的活动和讨论机会。我们删除了IMARA中被认为优先级较低的活动（例如，媒体中女性的形象描绘）。
本研究通过详细报告我们使用定性方法对循证性干预措施所做的改编，填补了文献中的空白。我们通过改编过程生成的四个课程部分将构成我们未来使用多阶段优化策略（MOST）框架进行测试的干预组件的基础。
