How Mighty Girls Became the Mighty Teens: Using Multi-Cultural Adaptation and App Development to Take an Evidenced-Based Intervention to Scale (Preprint)

BACKGROUND Taking evidence-based interventions to scale is a primary challenge for prevention science. Adapting an intervention to be multi-cultural is a useful pathway for scaling up interventions, particularly those that are school based. So too is finding simpler but powerful technological components to reduce overall cost without jeopardizing effectiveness. Mighty Girls is a sexual pressure resistance program developmentally and culturally tailored for 7th grade Latinas. The program combines classroom sessions with an interactive videogame that reinforces program concepts. However, both the exclusive focus on Latinas and game cost (currently relies on digital puppetry by trained inter-actors) limit dissemination. OBJECTIVE Create a multi-cultural program that uses a narrative phone app to reinforce program concepts and build resistance skills. Specific, adaptation goals included: (1) modify classroom lessons; (2) conduct a pilot study to evaluate feasibility and preliminary efficacy of classroom lessons; (3) develop a narrative app to reinforce curriculum content and build resistance skills; (4) conduct usability test of the app; and (5) assess parents’ views of lesson content and activities, and the app as well as their supervision of child's cell phone use. METHODS Consultation with 4 adult key informants, and a series of research activities involving 7th grade girls attending either a “development school” (n=14) or “pilot study school” (n=23), and parents (n=6) addressed adaptation goals. Activities included: focus groups, pilot study (one group pre-test post-test design), and usability testing. Pilot study self-report measures assessed resistance self-efficacy and intentions, and sexual intentions (including intention to delay intercourse). Usability testing self-report measures included the System Usability Scale (SUS), adapted for use with an app and for teens, an open-ended question soliciting suggestions for improving usability, and a 5-item Like scale for assessing engagement. RESULTS Qualitative analyses of interviews, focus groups, and responses to open-ended questions supported multicultural content, and identified simple changes to improve engagement and learning. These changes were supported by quantitative findings from the pilot study school. Preliminary program effectiveness was supported by a significant pre-post difference in intention to delay sexual intercourse (P=.04). A SUS score of 76 (exceeding 68, industry standard) and a “liking” score of 3.2 on a 4-point scale (SD=.60) supported usability and appeal. CONCLUSIONS Our multi-step adaptation process resulted in a multicultural program that is now paired with an app with good usability and engagement properties. Pilot study findings provided preliminary support for program effectiveness. Modifications identified for the app will be addressed in building out of the app as we move toward commercialization and are expected to increase intervention potency. The resulting program is suitable for universal uptake due to its focus on sexual pressure resistance rather than abstinence or comprehensive sex education.

Preventing Conflicts Between Nurses and Families of a Multi-ethnic Patient Population During Critical Medical Situations in a Hospital

Introduction: Little is known about how to avoid intercultural nurse–family conflicts in critical care settings. In this article, strategies are discussed that may be useful to prevent or mitigate intercultural nurse–family conflicts during critical medical situations in hospital. Method: Strategies are based on an ethnographic study by Van Keer et al., other literature, and expert opinion. Results: Sufficient structural measures are needed. First, institutions must create appropriate ward policies, such as including nurses in end-of-life communication. Second, nurses should be coached in the workplace. Third, institutions must provide adapted, visual, ward information to families. Additionally, education and research are needed. These measures should be actively stimulated by nurse managers and reflect a multicultural program supported by the hospital. Discussion: Intercultural nurse–family conflict prevention or mitigation should take into account organizational aspects, on hospital units and in hospital as a whole, and the crucial role of education and research.

INTEGRASI DAN ADAPTASI SOSIAL MIGRANT DI KOREA SELATAN

<p>South Korea is a country which is gradually facilitating incoming groups of migrants with different approaches including the social aspect of it. This literature reviews that the three biggest migrant groups in South Korea: foreign brides, migrant workers, and international students have major problem in the process of social integration in South Korean society. Therefore, different efforts in social welfare focusing in multicultural program are provided to each category of migrant that also differs depending on the needs of one another. Foreign brides receive the most attention compared to other groups covering programs such as facilities, services, and multicultural programs. Regardless the problems faced by foreign brides, they receive different programs including treatment recovery program, counseling, legal and medical aid. Meanwhile, migrant workers is not included within the long term strategy of the government therefore the coverage is less than foreign brides. Lastly, international students are considered as the group of educated migrants in which the programs are mainly covered by their respective institutions. </p>