Cultural adaptation of two school-based smoking prevention programs among adolescents in Bogotá, Colombia

• In Event: Health promotion interventions involving children and adolescents: what works, for whom, and under which circumstances ?

Abstract

Intervention strategies for smoking prevention among adolescents are a public health challenge, which is even greater in low and middle-income countries (LMICs) since local evidence is limited and rates of smoking remain high (U.S. Department of Health and Human Services, 2012; World Health Organization, 2015). Adolescence is the most critical life stage for tobacco consumption due to (1) young peoples' susceptibility to social influence (Vitória et al., 2011); (2) 90% of smokers start smoking before they are 19 years old (Bonnie et al., 2015); and (3) adolescence smoking is associated also with risky and violent behaviours (U.S. Department of Health and Human Services, 2012). Evidence-based interventions for preventing tobacco consumption among adolescents could be transferred to LMIC settings but only after appropriate cultural adaptation. This study aims to record the process of the cultural adaptation of two school-based smoking prevention programs to be implemented in Bogotá, Colombia.
Both interventions have been shown to be effective for preventing smoking onset among school children (Campbell et al., 2008; Thurston et al., 2019), but are based on different behavioural change strategies.
A recognised heuristic framework guided the cultural adaption process through five stages (Barrera & Castro, 2013, 2006). We used a concurrent nested mixed-methods study to test the adaptation. The qualitative analysis was performed using thematic analysis guided by the Framework to report adaptation and modifications-expanded (FRAME) (Wiltsey Stirman et al., 2013, 2019). For the quantitative data, we conducted a descriptive analysis of the baseline sociodemographic characteristics and a repeated-measures analysis clustered within the class to identify changes of knowledge of smoking after the interventions, as an expected short-term outcome.
In total, eight schools participated in Bogotá, including 893 pupils participated (482 in ASSIST program and 411 in Dead Cool program). We analysed 37 diary files, 3 focus groups from students and 11 focus group and interviews from individual practitioners.
Contextual, content, training, and implementation modifications were made to address cultural factors, to maintain fidelity and increase the engagement of pupils. Modifications incorporated the suggestions of stakeholders, the original developers and local community members, taking into account the feasibility of delivering the programs. The fidelity assessment from the original developers had a positive score for both prevention programs. Furthermore, the trial indicated that participants were engaged with the programs. ASSIST schools [OR=2.00 (1.21‒3.30); p=0.007] and Dead Cool schools [OR=1.77 (1.13‒2.77); p=0.013] were more likely to increase the knowledge of smoking after the intervention compared to the baseline measurement.
Our findings highlight the importance of incorporating different roles in the cultural adaptation process and collaborative research. Involving stakeholders, original developers and community members in the cultural adaptation of evidence-based interventions is essential to ensure good fit with the local context, to maintain program fidelity, and to increase the feasibility. (Laird et al., 2020; Movsisyan et al., 2019; Bulthuis et al., 2019; Laird et al., 2020). This study provide evidence-based strategies to promote awareness of tobacco control within school environments in Colombia, contributing to the global effort towards tobacco control.

Authors

• Sharon Sanchez, Universidad de los Andes (Uniandes)
  Presenting Author

• Luis Fernando Arias, University of Los Andes
  Non-Presenting Author

• Joaquin Jaramillo, University of Los Andes
  Non-Presenting Author

• Jennifer Murray, Queen's University Belfast
  Non-Presenting Author

• Ruth Hunter, Queen's University Belfast
  Non-Presenting Author

• Blanca Llorente, Fundación Anáas
  Non-Presenting Author

• Linda Bauld, University of Edinburgh
  Non-Presenting Author

• Sally Good, Evidence to Impact
  Non-Presenting Author

• Judith West, Cancer Focus Northern Ireland
  Non-Presenting Author

• Frank Kee, Queen's University Belfast
  Non-Presenting Author

• Olga L Sarmiento, University of Los Andes
  Non-Presenting Author