School-Based Healthy Relationship Promotion: Hispanic Youth Perspectives of the "Fourth R"

Background: The “Fourth R: Strategies for Healthy Youth Relationships” is a 21-lesson skills-based curriculum which aims to prevent violence, substance abuse, and risky sexual behavior. A randomized control trial demonstrated short- and long-term reductions in physical dating violence and increased condom use among Canadian youth (Wolfe et al., 2009). There were also sustainable reductions in violent delinquency for youth with maltreatment histories (Crooks et al., 2007; 2011), as well as improved peer resistance skills involving scenarios of substance use, bullying, and risky sex (Wolfe et al., 2012). Having implemented and evaluated the Fourth R among majority Hispanic youth in a U.S.-Mexico border state, we qualitatively assessed how these students perceived the curriculum.

Methods: Twenty four mixed-sex focus groups (98 youth; 65 female) were conducted with high school students following receipt of the curriculum as part of their health class. Youth were asked what they had learned, what skills they could demonstrate, recommendations for curriculum improvement, and dissemination questions. Skill demonstration was explored by asking students to respond to two vignettes (i.e., how they would help a friend or family member who was stressed; how they would respond to a friend getting bullied). A thematic template approach (Brooks et al., 2015) was utilized for analysis. This approach specifies categories a priori, which in this study were based on our focus group questions, while also allowing substantial flexibility for emergent themes and subthemes. Qualitative rigor was enhanced via inter-rater reliability (k=.97), researcher triangulation, and negative case analysis (Lietz & Zayas, 2010).

Results: All respondents stated that they have or would tell a friend about taking the Fourth R curriculum, and discussed a number of personal benefits to having participated. Student responses to the stress and bullying scenarios reflected an ability to assess the situation, listen and offer relevant coping skills, and directly intervene or seek additional help. Negative case analyses demonstrated that a few youth had not learned to respond in a healthy manner to bullying, suggesting further curricular enhancement, increased dosage, or booster sessions. Recommendations for program improvement included more in-depth coverage of specific content areas; namely, many had already experienced suicidality, risky sexual behavior, pregnancy, and drug use and felt that they could benefit by further processing these experiences.

Conclusions: This study responds to a lack of published research concerning students’ perspectives of the Fourth R. As the program now serves various regions and countries, these perceptions are particularly important to improve treatment receipt and transferability. We found that youth enjoyed the Fourth R and found it applicable to their lives. Student perspectives also, however, offer suggestions as to why significant changes have not been consistently demonstrated across all curricular aims (e.g., peer violence; Wolfe et al., 2009). Further, some of the skills taught encourage youth to seek additional help, whereby school personnel are often not visible or available to youth (Rueda & Fawson, 2018). Cultural considerations (e.g., familism) surfaced which suggest additional adaptations in order for the curriculum to be efficacious and strengths-driven for Hispanic youth populations.