Assessing the Feasibility, Acceptability, and Utility of Mantente Real (keepin' it REAL), a School-Based Substance Use Prevention Program Culturally Adapted for Mexico

Background and Purpose: Rigorous assessment of the social validity of behavioral interventions is especially important when they are developed through cultural adaptation of existing EBIs and applied to a new population. This presentation reports on the social validity of Mantente REAL, an adapted version of the school-based keepin’ it REAL substance use prevention program, that was culturally tailored for early adolescents in urban areas of Mexico. We assessed the feasibility, acceptability, and utility of the adapted intervention as perceived by various stakeholders, including some comparisons of assessments of the adapted and unadapted versions of the intervention.

Methods: Qualitative and quantitative data came from a randomized controlled trial of Mantente REAL (MREAL) using a population-based sample of 36 public middle schools in Mexico’s three largest cities (Mexico City, Guadalajara, Monterrey). Schools were randomly assigned to 1) the culturally adapted version for Mexico (MREAL), 2) the original intervention from the USA (keepin’ it REAL [kiR]) translated into Spanish, or 3) a control condition (treatment as usual). MREAL was culturally adapted to represent the gendered and violence-influenced social contexts where Mexican youth are exposed to drugs. Data were collected from 7^th grade student participants in MREAL and kiR at a posttest (n = 3,607); from focus groups with teachers who implemented MREAL (n = 9); and in-depth interviews with principals and assistant principals after the implementation of kiR or MREAL (n = 18). We assessed feasibility on multiple criteria (fit to institutional goals, cost and resource implications, implementation characteristics, practicality, and fidelity). Acceptability was measured on criteria such as satisfaction, comfort with topics and activities, understanding of content, and willingness to use the intervention in the future. Utility was assessed on knowledge gained, applicability and authenticity of content, and impact on participants.

Results: Administrators and students reported that the MREAL and kiR interventions were feasible to implement in the Mexican context, and MREAL teachers agreed. Implementation fidelity was equally high for both the MREAL and kiR manualized interventions. Teachers reported high acceptability of and satisfaction with the MREAL curriculum and the program overall, and perceived it as a useful and applicable program to prevent risk behaviors in their students. Students, however, reported higher acceptability and utility of MREAL than of kiR: they were more satisfied, they reported gaining more knowledge, finding it more acceptable, applicable, and authentic, and they discussed the program with more of their family and friends. Implementation problems included large classes, student absences, and audio-visual equipment.

Conclusions and Implications: Findings demonstrated the feasibility of engaging classroom teachers to implement manualized prevention programs in Mexico, and documented the importance of cultural adaptation as a means to increase students’ identification with and acceptability of efficacious school-based interventions. Long-standing engagement with Mexican prevention researchers at each study site helped ensure that the curriculum design and implementation efforts were practical, useful, and suitable to the institutional and cultural environment of Mexico. The findings have potential generalizability to other middle- and lower-income countries who may benefit from cultural adaptation of efficacious interventions for their populations.