Cultural Adaptation of Legacy for ChildrenTM for Latino Communities: Qualitative Results of the Feasibility Evaluation (OK UCEDD/LEND)

November 4, 2015

Cultural Adaptation of Legacy for ChildrenTM for Latino Communities:
Qualitative Results of the Feasibility Evaluation
Lana Beasley*, Jane F. Silovsky, Hannah Espeleta*, Angela Harnden, Zohal Heidari,
La Chanda Stephens-Totimeh, Irma Esparza, Sandra DeLoera, Byron Holzberger
University of Oklahoma Health Sciences Center,
[Oklahoma Center for Learning and Leadership, UCEDD/LEND
and the Center on Child Abuse and Neglect]
*Oklahoma State University

Legacy for Children^TM (Legacy) is an evidence-based parenting program focused on strengthening the parent-child relationship, promoting children's health and socio-emotional development, and improving mother's social support. It is a group-based program for mothers and their babies: the Tulsa, Oklahoma community is implementing the Legacy UCLA curriculum, which begins prenatally and is offered through the first three years. In recognition of the need for culturally congruent services, the Legacy for Children^TM program was translated and culturally adapted for Spanish-speaking mothers and their infants. This study examined the cultural adaptations and logistical supports needed for successful implementation with Spanish-speaking mothers.  This report summarizes the results of the qualitative feasibility evaluation of the cultural congruency of the Legacy for Children^TM program. 

Methods include purposive sampling used with participants including Latina bi-lingual providers (N=14) and supervisors (N=5) of local home-based parenting programs (Healthy Families, Parents as Teachers, and SafeCare®).  A total of 19 participants were in focus groups with 2-3 participants per group. The purpose of the semi-structured guide was to assess provider opinions on the cultural congruency of the Legacy for Children^TM curriculum, potential barriers of the program, and recommendations for successful enrollment and engagement of Latina mothers.

Qualitative data analysis of the transcriptions was conducted using NVivo 10 software. A template approach (Patton, 2002) was used to identify broad themes within all provider and supervisor focus group data. An ethnographic approach was taken to the qualitative analyses of these focus groups to gain an understanding of the perceptions of Latino providers and supervisors of the adapted Legacy for Children^TM curriculum.

Overall, focus group results indicated that there are many strengths of the Legacy for Children^TM program. Positive aspects of Legacy included content, approach, pace, topics, structure, social engagement of mothers to reduce social isolation, understandable curriculum, and step-by-step approach.  The results noted that the program and curriculum appeared to be an appropriate fit for Spanish-speaking mothers with infants.  The goal for social connection among the mothers was noted as a particular strength for immigrant mothers. Revisions recommended were: a) minor edits to translation, b) lowering reading level in specific portions throughout material, c) addition of visual images and pictures representative of Latinos and Latino culture, d) addition of traditional songs, and e) provision of audio recordings of songs. 

Themes emerged from the focus groups regarding best practices in identifying, recruiting, and approaching Latina mothers as well as key engagement strategies. Participants provided suggestions for the best places to recruit Latina mothers with locations including child-related settings, settings with high-risk mothers and settings central to the Latino community.  In regards to recruiting and approaching Latina mothers, participants suggested utilizing fliers, newspapers, radio, and television programs to aid in community awareness.  Additionally, it was recommended that recruitment materials be eye-catching, easy to read, and include pictures of Latino infants/children and families. Finally, participants suggested that the person recruiting potential participants be Spanish-speaking and ideally, Latina. The presence and approach of the recruiter were considered crucial for engagement. Specifically, recruiters need to be enthusiastic in their approach and well informed on the program and how it will be helpful for the mothers and their baby. 

Recommendations were provided for engaging Latina mothers in a group-based, long-term parenting program. Participants made suggestions for both initial engagement in the program and sustained engagement to program completion. Provision of transportation and child care were both determined as necessary to aid in both initial and sustained engagement. Focus group participants also suggested providing reminder calls and letters about the session dates and times to aid in participant engagement. See Table 1 for additional recommendations regarding initial and sustained engagement.

Participants were all in agreement that they would recommend the Legacy for Children^TM program to Latino families. Reasons for recommending the program included the benefits of the program to families, the easy-to-follow curriculum approach, the high quality relevant information provided, having a longer commitment to the family, the mother-focus, the enjoyable approach for the mother and infant, and the social support for the mothers.  Results support the translation and adaptation of the Legacy for Children^TM for mothers who are Spanish-speaking.  Direct evaluation of feasibility and acceptability of the program as well as outcomes for mothers and children would be an important next step.

Acknowledgements

This evaluation project was made possible by the Cooperative Agreement Number 5 U38 OT 000140-03 funded by the Centers for Disease Control and Prevention as a sub award from the Association of University Centers on Disabilities. This study was conducted in collaboration with Adriane Griffen, Director of Public Health at the Association for University Centers on Disabilities (AUCD), with Lara Robinson, Jennifer Kaminski, Sophie Hartwig, Angelika Claussen and Lauren Forbes from the Centers on Disease Control and Prevention, and with Amanda Morris, Amy Treat, Amy Huffer, and Kelly Stiller Titchener of Oklahoma State University.  We would like to thank the supervisors and providers at the Latino Community Development Agency for their support.

For Questions Contact:
Jane F. Silovsky, Ph.D.
Professor of Pediatrics
Center on Child Abuse and Neglect
University of Oklahoma Health Sciences Center
940 NE 13th Street; SE 4900 Nicholson Tower; Oklahoma City, OK 73104
(405) 271-8858
[email protected];

 

 Table 1. Strategies to Improve Initial and Sustained Engagement

Initial Engagement	Sustained Engagement
Children excited to participate in the activities	Certificates/Acknowledgements when completing blocks*
Connections made with other families, mothers	End of session potluck/party
Fun atmosphere	Newsletter
Provide transportation	Referrals to other resources during breaks
Provide referrals, resources	Relationships with other families
Reminders	Reminders (phone calls, post cards)
Respectful environment	Seeing results, learning from the program
Small incentives	Small incentives or gifts (i.e. an agenda, planner)
Balanced group dynamics	Communication during breaks
Flexibility with schedule	Home visits during breaks
Including fathers in ancillary activities	Group leader characteristics
Socializing with other groups
Utilizing activities to interact with women
Encourage mothers to be in contact between sessions
Encourage mothers to speak in group (i.e. discussion leaders) Provide food

Note: "Initial engagement" refers to getting a family initially involved in the first block*, while "sustained engagement" refers to keep mothers involved throughout the three years, and consistently returning after breaks.

*Mothers attend sessions in 10-week blocks with 6-week breaks in between sessions.