Binational Cultural Adaptation of the Keepin' It Real Substance Use Prevention Program for Adolescents in Mexico

Background & Purpose: Sharp increases in substance use rates among youth and the lack of evidence-based prevention interventions in Mexico are a major concern. A team of investigators from Mexico and the U.S. are actively addressing this gap by culturally adapting keepin’ it REAL (kiR) – a former U.S. SAMHSA model program – for Mexico.  This presentation reports the processes and outcomes of the cultural adaptation of kiR for adolescents in Mexico.

 Methods: Multiple forms of data informed this cultural adaptation, including focus groups with students about gendered and violence experiences with substance use, feedback from teachers who previously implemented the original versions of kiR, lesson fidelity observations, and external expert reviews. The Ecological Validity and Cultural Sensitivity Models were employed to guide the adaptation process. The process encompassed surface structure adaptations, like updating language, graphics, and videos, as well as deep structure adaptation components including cultural norms, attitudes, and beliefs salient among Mexican adolescents.

 Results: Key surface structure adaptations included helping students identify with and engage in curriculum content, enhancing teachers’ experience in facilitating the curriculum, and updating the curriculum to reflect the Spanish language used in Mexico. The deep structure adaptations were made based on focus groups with adolescents. Youth reported receiving alcohol offers from family members, links between substance use and violence, and that shifting gender norms result in more females initiating substance use offers. In the culturally adapted kiR curriculum, changes based on these key surface and deep structure adaptations entailed altering the language and graphics in the original version of kiR to better represent the Mexican context, modifying existing activities and videos to resonate with and appeal to Mexican youth, and adding new activities that reinforce violence prevention and help students navigate risky situations with family members.

 Conclusions & Implications: The adaptation process convened a team of diverse researchers from two countries, and as a result, enabled the team to establish a dynamic to facilitate successful and collaborative school-based prevention research. The adapted version of kiR spans beyond topics of substance use prevention by addressing key salient elements in the lives of Mexican adolescents, such as the role of family members, gender, and violence; all of which were incorporated with input from students, teachers, and researchers. By employing multiple data sources and relying on Mexican partners in this adaptation process, the surface and deep structure adaptations made to the kiR curriculum will increase the chances that kiR will be successful in its new setting and provide an opportunity to extend knowledge and expertise to create a national substance use prevention program for Mexico. The framework and process established by the research team for this adaptation provides a template for others wanting to test prevention interventions outside the U.S. context. This clear, uniform, and established process enables prevention research teams to maintain the core elements of a curriculum while making the necessary adaptations to enhance cultural fit across diverse settings.