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: 8306593
• 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/8306593
• 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）：目前居住在城市地区的美洲印第安人 (AI) 家庭经历着与药物滥用和危险性行为相关的不成比例的健康差异，但很少有基于证据的预防方法可以预防、减少和消除这一快速增长的人口中的健康差异。家庭破裂、与贫困和从农村到城市的人口流动相关的压力以及文化和社会联系的丧失常常成为人工智能家庭产生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），育儿干预可以帮助父母加强与文化相关的育儿技能，这些技能与促进孩子的健康和福祉相一致，并帮助他们成为降低孩子吸毒和危险性行为风险的直接影响源。拟议的研究借鉴了项目团队在 NCMHD 卓越中心进行的研究，内容涉及人工智能家庭行为健康的社会决定因素、其显着风险和弹性因素、文化上适当的抵制风险行为的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“为下一代做好准备的家庭”（FPNG），为城市人工智能家庭创建并测试一种基于文化的育儿干预措施。改编将采用文化适应模型，以增加文化契合度的方式调整节目以适应新的目标人群，同时保持对原始节目核心组成部分的忠实度。该干预措施将与亚利桑那州三个最大的城市印第安人中心合作，进行调整、试点、评估、文化验证、相应修订，并在涉及 600 个家庭（300 个干预组、300 个对照）的随机对照试验 (RCT) 中进行测试。生态发展理论提供了一个框架，用于识别父母、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。 CBPR 方法将用于调整干预措施，利用城市人工智能父母、人工智能专业人员和预防专家焦点小组的反馈，并通过原始干预措施的设计者和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之外，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导致旨在减少孩子危险行为的特定养育做法。这些模型和理论可以为更有效、与文化相关的干预措施的设计和实施提供信息。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，并增进对有效转化研究策略的了解，以适应不同种族家庭的预防干预措施。 公共卫生相关性：拟议的研究响应了亚利桑那州和全国各地的城市印第安人联盟确定的需求，即针对城市美洲印第安人 (AI) 家庭进行基于文化的创新预防计划。通过制定干预措施，重点关注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，可以推进公共卫生工作，解决城市人工智能青少年中令人难以接受的高水平药物使用和危险性行为问题。该研究的 CBPR 方法不仅让社区合作伙伴和社区成员完整地参与干预措施的设计和测试，还建立了机构能力，以维持这种和类似设计的基于文化的预防干预措施的开发和实施。