The Binational Cultural Adaptation Process of Keepin’ It REAL for Use in Mexico: Processes and Lessons Learned.

Introduction: Sharp increases in substance use rates among youth and the lack of evidence based prevention interventions in Mexico are a major concern in both Mexico and the US. A team of investigators from both countries are actively addressing this gap and have jointly secured support from NIDA in 2015 to culturally adapt keepin’ it REAL (KiR) for Mexico. The main hypothesis guiding the study is that a culturally adapted version of KiR will be more efficacious in Mexico than the exiting linguistically only adapted version. This poster reports on the processes and activities applied to conduct the cultural adaption.

Approach:Phase 1. One school in each study site (Guadalajara, Mexico City and Monterrey) piloted the original kiR and gathered different forms of data, including data from adolescents. Data included: 1) pre and post-test surveys, 2) feedback forms after each lesson, 3) transcripts from discussion groups at the end of each lesson, and 4) transcripts of focus groups about gendered experiences with substance use offers, violence, and appropriate drug resistance strategies. Teachers also completed feedback forms after each lesson and then met in focus groups to discuss the manual and to make recommendations. The binational team entered, transcribed and analyzed all data to inform the adaptation.

Phase 2. The investigators from both countries met for a week to incorporate the feedback from the quantitative and qualitative data, applying learning and cultural adaptation theories and following the aims of the adaptation process. Group discussions focused on what, why and how to make the necessary cultural adaptations while maintaining KiR’s core elements. The team worked in small groups to comb through kiR activities and present proposed changes the whole group. The entire team weighed in on all recommendations, applying their expertise in Mexican culture and prevention science, before approving changes.

Phase 3. The final phase of the adaption spanned three months and entailed additional reviews among team members and dozens of drafts. Regional experts at each site reviewed the new curriculum and offered cognitive adaptation suggestions. The team integrated the feedback of the outside experts and reviewed the curriculum once more before declaring it final.

Discussion: The research team began testing the efficacy of the newly Mantente REAL (KiR) curriculum in the three cities in Mexico in summer 2017 with the participation of more than 8,000 7^th graders and their teachers. This study is advancing knowledge about cultural adaptation and efficacious prevention approaches for Mexican-heritage youth on both sides of the US-Mexico border.