The Parenting in 2 Worlds Project: CBPR with Urban American Indian Families

Introduction:

The Parenting in 2 Worlds (P2W) project is developing and testing a culturally grounded parenting program specifically tailored to the social and cultural worlds of urban American Indian (AI) families. The program addresses the disproportional health disparities associated with substance abuse and risky sexual behavior experienced by AI families living in urban areas. To improve family functioning, the P2W parenting intervention is designed to help parents strengthen culturally relevant parenting skills, promote their children's health and well-being, and reduce their children’s risk of substance use and risky sexual behavior. The intervention is grounded conceptually in Ecodevelopmental Theory and 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.

Methods:

P2W was created through adaptation of an existing program, Families Preparing the New Generation (FPNG), following a Cultural Adaptation Model (Castro, Barrera, & Martinez, 2004) for modifying programs for new target populations. The model increases cultural fit while maintaining fidelity to core components of the original program. The intervention was adapted, piloted, evaluated, culturally validated, and revised accordingly in partnership with the three largest urban Indian centers in Arizona. CBPR was employed to adapt the intervention, using feedback from focus groups of urban AI parents, AI professionals and prevention experts, and close collaboration between the designers of the original intervention and staff community members from the urban Indian centers. P2W is now being tested in a randomized control trial with 600 families. In addition to tests of intervention efficacy, we will assess whether participants’ connection to native culture and identity influences the program’s effects, and whether changes in family functioning lead to specific parenting practices directed at reducing their children’s risk behaviors.

Results:

An overview of the CBPR process for informing the cultural adaptation of the program will be presented, along with key changes in curriculum content. Preliminary findings from a pilot test which show significant improvements in family functioning and parent-child communication will also be presented.

Conclusions:

CBPR approaches and cultural program adaptation models are essential for the design and implementation of more effective, culturally relevant interventions for the majority of AI families who now live in urban areas. The P2W intervention addresses the needs of an under-served group severely affected by health disparities.