JMIR Publications

ABSTRACT

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.