Integrating an Evidence-Based Preventive Intervention in Chilean Communities Based on Community Level Risk

Introduction: In Latin American countries, including Chile, the availability of evidence based interventions (EBIs) is virtually non-existent. Most of the existing registries of EBIs for the prevention of substance use and sexual risk behaviors such as Blueprints for Healthy Youth Development consist of interventions developed specifically for and evaluated with U.S. populations. No such registries of EBIs developed and/or evaluated in Latin America. Unfortunately, community data to help guide the selection and implementation of EBIs in Chile is just as lacking. The purpose of this study was to: 1) assess risk factors in three communities in Chile and 2) describe the process by which Familias Unidas was selected as the EBI to be implemented in the three target communities in Chile.

Methods:2,147 youth (M age = 14; SD = 2.01) living in three communities completed a Spanish Language culturally adapted version of the self-reported Communities That Care survey. These surveys assessed family (e.g. family conflict, Poor family management), community (e.g. community disorganization, low neighborhood attachment), and school level (e.g. low commitment to school) risk factors. To select the intervention to be implemented, 12 registries of EBIs were reviewed, including 11 registries from the U.S. (e.g., BluePrints) and one from Spain. Additionally, San Carlos de Maipo Foundation staff called community-based organizations to inquire which interventions they were implementing at their sites/in their community.

Results: The results from the youth surveys suggest that family and community level risk factors were the most prevalent across all three target communities. Specifically, family level risk factors identified as highly elevated included parent favorable attitudes towards drug use and community level risk factors identified as highly elevated included community disorganization. Unfortunately, none of the 35 Chilean preventive interventions reviewed targeted family or community level risk factors. Moreover, none of the Chilean interventions reviewed had measures of adherence to program fidelity nor showed significant impact on the outcomes of interest. After reviewing the data registries, 18 EBIs developed specifically for Hispanics were identified. Of these, 3 targeted family level risk factors. Familias Unidas was selected because of its impact on both substance use and sexual risk behaviors.

Conclusions: There is a lack of preventive interventions shown to be efficacious and effective in Chile.  As such, it is of utmost importance to develop a registry of EBIs for Chile. To develop this necessary evidence, it is important to evaluate, through rigorous study designs, preventive interventions in Chile. Moreover, interventions to be evaluated can be and should be based on the risks of the community.