Fidelity of Familias Unidas in Ecuador: A Report and Comparison to a U.S. Effectiveness Trial

Introduction: When an evidence-based intervention is adapted or disseminated to a different culture or country, it is critical to monitor intervention fidelity. Monitoring fidelity is comprised of two components: 1) interventionist’s adherence to the core components of the intervention, and 2) clinical competence of the interventionist to actively engage and retain participants.  Familias Unidas, a family-based intervention for U.S. Hispanic adolescents, has demonstrated efficacy and effectiveness in preventing and reducing adolescent conduct disorders, substance use and risky sexual behaviors. In collaboration with the Universidad Catolica Santiago de Guayaquil, Familias Unidas was recently adapted and implemented for dissemination in Ecuador. Interventionists (“facilitators”) in Ecuador were trained on how to deliver the 12-week manualized intervention. To assure proper delivery of the Familias Unidas intervention, fidelity ratings and clinical supervision with the trained facilitators in Ecuador were conducted. Methods: Fidelity was measured for each intervention session on standardized rating forms that list: 1) adherence items on a dichotomous scale (yes/no), and 2) clinical competence items and overall session quality on a Likert scale (0- Bad, 6-Excellent). The rating forms have been used in past Familias Unidas efficacy and effectiveness trials. Each intervention session was videotaped and rated by a trained research team member and clinical supervisor. Summary statistics of facilitator fidelity to the intervention’s parent-only group sessions will be presented. To assess whether the intervention was delivered with fidelity across populations, ratings will be compared to those of the Familias Unidas effectiveness trial in the U.S. Results: Across all parent-only group sessions delivered in Ecuador, 95.4% of the adherence items were reported as complete, and 4.6% of the adherence items were not (e.g., “facilitator practices with the parent how to speak to their adolescent about risky sexual behavior” and “facilitator provides parents with information about school resources”). The average overall competence rating was 3.45 (SD= 2.00). Amongst the competence items, “utilizing participatory learning strategies” was rated the highest on average (5.04,SD=0.84). The average overall session quality of group sessions was 4.37(SD=0.86). Further descriptive analyses of the Ecuador trial and comparison to the U.S. effectiveness trial will be presented. Conclusions: The findings suggest that facilitators in Ecuador are adhering well to the intervention and are clinically engaging the families. These findings demonstrate the achievability of training researchers and clinicians in Latin American countries to adapt, deliver and adhere to core components of an evidence-based intervention protocol from the U.S. Further results will demonstrate whether there is a statistically significant difference in fidelity between the Familias Unidas trial in Ecuador and the Familias Unidas effectiveness trial in the U.S.  If fidelity is similar across populations, this may have larger implications for the feasibility of intervention dissemination to other Latin American countries or cities in the U.S.