JMIR Publications

ABSTRACT

Background:

Taking evidence-based interventions to scale is a challenge for prevention science. Mighty Girls is an evidence based, sexual health intervention program that combines classrooms sessions with novel, cutting-edge technology (digital puppetry). The program was developed for 7th grade Latinas, but US school and community demographics rarely allow interventions targeting a single ethnic group. Additionally, digital puppetry is costly to scale up, and parent disapproval often prevents successful dissemination of adolescent sexual health programs. Intervening steps along the scaling up pathway are needed to adapt the program prior to scaling-up for dissemination.

Objective:

Create a multicultural adaptation of the Mighty Girls program that uses a less costly-to-disseminate cell phone app, and is acceptable to parents of 7th grade girls.

Methods:

This study used a 3-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (non-probability), sampling of low-income, multicultural, urban metropolitan groups (7th grade girls, their parents) within Central Florida. Phase 1 involved 2 videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (n=14), and a second serving as a one group, pre-test, post-test pilot study (n=23). Phase 2 developed a narrative cell phone app prototype and subjected it to usability testing (n=25). App usability and engagement were assessed qualitatively (observation, focus group, open ended question) and quantitatively. Phase 3 used focus groups to assess parent support for the program (n=6). Qualitative data were analyzed using descriptive content analysis. Quantitative data were analyzed using descriptive statistics and paired t-tests.

Results:

Qualitative findings supported classroom sessions being multicultural, and identified simple changes to improve engagement and learning. Quantitative findings from the second classroom session implementation pilot study indicated a significant pre-post difference in intention to delay sexual intercourse (P=.04). App usability and appeal was supported by a System Usability Scale score of 76 (exceeding 68, industry standard) and 83% (20/24) of participants agreeing they would recommend the app to friends. Parents (mothers) expressed only positive regard for program goals and classroom session and app activities.

Conclusions:

This study adapted Mighty Girls into an engaging, easier-to-disseminate, multicultural program, Mighty Teens, that uses a narrative generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. The study also provided evidence of preliminary effectiveness of Mighty Teens classroom sessions. Sampling method and sample size were appropriate for adaptation, but research involving a more representative U.S. sample is needed to confirm multicultural fit, parent receptivity, and program effectiveness. Study implications include integrating app use throughout the classroom sessions to build narrative generating skills across the program, increasing the number of narratives produced which in turn should increase the program’s behavior change potency.