A Binational Approach to Cultural Adaptation of the Substance Use Prevention Program, Mantente REAL, for Adolescents in Mexico: Products Developed

The adolescent substance use prevention program keepin’ it REAL has been translated into Spanish for use in several Latin American countries, including Mexico. Recently, a binational team of researchers from the three largest cities in Mexico (Mexico City, Guadalajara, Monterrey) and Arizona State University completed a cultural adaptation process and modified certain aspects of the program in order to enhance the intervention’s cultural fit. This poster will focus on the specific changes incorporated into the updated version.

Data for the cultural adaptation came from a pilot implementation of the original curriculum in all three cities and from a variety of sources: focus groups with students, reflection forms and focus groups with teachers, fidelity observations, and teacher notes written directly in the curriculum workbooks. The binational team analyzed the data through multi-phase coding and comparison of emergent themes. At a weeklong binational team meeting, these themes guided the curriculum adaptation.

Changes to keepin’ it REAL (Mantente REAL in Spanish) consisted of surface structure and deep structure components. Surface structure changes included vocabulary changes, adding visual appeal, hiring a visual designer from Mexico to update the teacher and student manuals, and creating slides to accompany each lesson. Deep structure changes included adding workbook activities that draw on Mexican culture and norms, incorporating specific substance offer scenarios described in the focus groups, and having Mexican youth create new videos to accompany the lessons.

One important deep structure adaptation required lengthening the curriculum from 10 to 12 lessons. Though the core of the lessons remained the same, the team incorporated the themes of violence and gender roles into the lesson activities. Mexican youth identified the changing gender roles and the presence of violence as salient variables in the Mexican context. Violence, or the threat of it, was incorporated into several lessons; for example, de-escalation strategies were mentioned as a method for violence prevention. Gender roles dictate expectations of behavior and communication styles particular to Mexican culture. This was incorporated in several videos, with male and female youth portraying both the drug offeror and the refuser. In the curriculum, the team incorporated gender roles into an activity where individual students partner with an opposite sex classmate and practice saying NO.

The adapted curriculum is currently being used in the randomized control trial funded by NIDA for the Mantente REAL program in Mexico. The iterative approach described above led to a true collaborative effort that the researchers hope is relevant and effective for Mexican-heritage youth substance prevention.