Using CBPR to Adapt a Culturally-grounded Prevention Curriculum for Urban America

利用 CBPR 为美国城市调整基于文化的预防课程

• 批准号: 8149895
• 负责人: Stephen S. Kulis
• 金额: $ 37.74万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8149895
• 关键词: AIDS/HIV problem; Address; Adolescent; Adult; Adverse effects; Affect; Affective; Age; Alcohol or Other Drugs use; American Indians; Americas; Arizona; Build-it; Child; Child health care; Cognitive; Coitus; Collaborations; Communication; Communities; Control Groups; Development; Education; Educational Curriculum; Educational Intervention; Educational process of instructing; Ensure; Evaluation; Face; Family; Family health status; Family member; Feedback; Feeling; Focus Groups; Functional disorder; Future; Generations; Goals; Healed; Health; Health Promotion; Indian reservation; Individual; Intervention; Knowledge; Language; Lead; Life; Methodology; Methods; Modeling; Modification; Morbidity - disease rate; National Center on Minority Health and Health Disparities; Not Hispanic or Latino; Outcome; Parenting Education; Parenting behavior; Parents; Participant; Pathway interactions; Personal Satisfaction; Population; Poverty; Pre-Post Tests; Prevention; Prevention approach; Prevention program; Preventive Intervention; Primary Prevention; Principal Investigator; Public Health; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Infrastructure; Research Methodology; Reservations; Resources; Risk; Risk Behaviors; Risk Factors; Rural; Services; Sexual Partners; Source; Stress; Substance abuse problem; System; Target Populations; Testing; Translational Research; Treatment Efficacy; United States Indian Health Service; Youth; adolescent substance abuse; adolescent substance use; base; behavioral health; community based participatory research; design; early onset; evidence base; experience; healing; health disparity; help-seeking behavior; high risk sexual behavior; improved; informant; innovation; intervention effect; member; migration; minimal risk; mortality; next generation; parent-child communication; parental involvement; parental monitoring; peer; pregnant; prevent; programs; public health relevance; skills; social; staff intervention; theories; urban Native American; urban area

DESCRIPTION (provided by applicant): American Indian (AI) families now living in urban areas experience disproportional health disparities associated with substance abuse and risky sexual behavior but few evidence-based prevention approaches exist to prevent, reduce and eliminate health disparities among this rapidly growing population. Family disruption, stresses related to poverty and rural-to-urban migration, and loss of cultural and social connections frequently operate as pathways to adverse health outcomes among AI families. By strengthening family functioning (parental involvement, family support, parental monitoring, and parent-child communication), a parenting intervention can help parents strengthen culturally relevant parenting skills that are consistent with promoting their children's health and well-being, and help them serve as direct sources of influence in reducing their children's risk of substance use and risky sexual behavior. The proposed study draws upon the project team's research, conducted at an NCMHD Center of Excellence, on the social determinants of AI families' behavioral health, their salient risk and resiliency factors, culturally appropriate strategies for resisting risk behaviors, and systematic methods for culturally adapting prevention programs. The aims of the study are to create and test a culturally grounded parenting intervention for urban AI families through a modification of an existing prevention program, Families Preparing the Next Generation (FPNG). The adaptation will employ a Cultural Adaptation Model for adapting programs for new target populations in ways that increase cultural fit while maintaining fidelity to core components of the original program. The intervention will be adapted, piloted, evaluated, culturally validated, revised accordingly, and tested in a randomized control trial (RCT) involving 600 families (300 intervention, 300 control) in partnership with the three largest urban Indian centers in Arizona. Ecodevelopmental Theory provides the framework for identifying parental, family, peer, community and cultural influences on youths' substance use and risky sexual behavior. CBPR methods will be used to adapt the intervention, using feedback from focus groups of urban AI parents, AI professionals and prevention experts, and through close collaboration between the designers of the original intervention and staff of the urban Indian centers, thus increasing the capacity of those centers to provide future parenting interventions. In addition to testing the intervention's efficacy, we will assess whether and how the participants' connection to native culture and identity influences the interventions effects, and whether changes in overall family functioning lead to specific parenting practices directed at reducing their children's risk behaviors. These models and theory can inform the design and implementation of more effective, culturally relevant interventions. The resulting prevention intervention will address the needs of an under-served group severely affected by health disparities, strengthen families and help them to avoid familial and individual dysfunction, and advance knowledge on effective translational research strategies for adapting prevention interventions for ethnically diverse families. PUBLIC HEALTH RELEVANCE: The proposed study responds to a need, identified by urban Indian coalitions in Arizona and across the nation, for innovative culturally grounded prevention program adaptation for urban American Indian (AI) families. Public health efforts to address unacceptably high levels of substance use and risky sexual behavior among urban AI youth can be advanced through the creation of an intervention that focuses on effective parenting strategies tailored to the cultural and social forces that urban AI families face. The CBPR methodology of the study not only integrally involves community partners and community members in the design and testing of the intervention, it builds institutional capacity for sustaining the development and delivery of this and similarly designed culturally grounded prevention interventions.

描述（由申请人提供）：现在居住在城市地区的美国印第安人（AI）家庭经历了与药物滥用和危险性行为相关的不成比例的健康差异，但几乎没有基于证据的预防方法来预防，减少和消除这一快速增长的人口中的健康差异。家庭破裂，与贫困和农村到城市的移民有关的压力，以及文化和社会联系的丧失经常成为AI家庭不良健康结果的途径。通过加强家庭功能（父母参与、家庭支持、父母监督和亲子沟通），父母干预可以帮助父母加强与促进子女健康和福祉相一致的文化相关的父母技能，并帮助他们在减少子女使用药物和危险性行为的风险方面发挥直接影响力。拟议的研究借鉴了项目团队在NCMHD卓越中心进行的研究，研究AI家庭行为健康的社会决定因素，其突出的风险和弹性因素，抵制风险行为的文化适当策略，以及文化适应预防计划的系统方法。该研究的目的是通过修改现有的预防计划，为城市AI家庭创建和测试基于文化的育儿干预，家庭准备下一代（FPNG）。适应将采用文化适应模型，以增加文化适应的方式，同时保持对原始计划核心组成部分的忠实性，使计划适应新的目标人群。该干预措施将进行调整，试点，评估，文化验证，相应修订，并在一项涉及600个家庭（300个干预，300个对照）的随机对照试验（RCT）中进行测试，该试验与亚利桑那州三个最大的城市印第安人中心合作。生态发展理论为确定父母、家庭、同伴、社区和文化对青少年物质使用和危险性行为的影响提供了框架。CBPR方法将用于调整干预措施，利用城市AI父母，AI专业人员和预防专家的重点群体的反馈，并通过原始干预措施的设计者与城市印度中心工作人员之间的密切合作，从而提高这些中心提供未来育儿干预措施的能力。除了测试干预措施的有效性，我们还将评估参与者与本土文化和身份的联系是否以及如何影响干预措施的效果，以及整体家庭功能的变化是否会导致针对减少儿童风险行为的具体育儿实践。这些模型和理论可以为设计和实施更有效的、与文化相关的干预措施提供信息。由此产生的预防干预措施将满足受健康差距严重影响的服务不足群体的需求，加强家庭并帮助他们避免家庭和个人功能障碍，并促进对有效转化研究战略的了解，以适应不同种族家庭的预防干预措施。 公共卫生关系：这项拟议的研究回应了亚利桑那州和全国各地的城市印第安人联盟确定的一个需求，即为城市美国印第安人（AI）家庭制定创新的基于文化的预防计划。解决城市人工智能青少年中不可接受的高水平物质使用和危险性行为的公共卫生工作可以通过创建一种干预措施来推进，该干预措施侧重于针对城市人工智能家庭面临的文化和社会力量的有效育儿策略。该研究采用的社区伙伴关系和社区重建方法不仅使社区伙伴和社区成员参与干预措施的设计和测试，而且还建立了机构能力，以持续发展和提供这种和类似设计的基于文化的预防干预措施。