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. 2023;3(1):16-30.
doi: 10.1007/s43477-022-00070-3. Epub 2023 Jan 9.

The Pre-implementation Process of Adapting a Culturally Informed Stress Reduction Intervention for Native American Head Start Teachers

Deborah H Wilson  1 , Katie E Nelson  1 , Ashley Gresh  1 , Adriann Ricker  1 , Shea Littlepage  2 , Lydia Koh Krienke  1   2 , Teresa N Brockie  1
Affiliations

The Pre-implementation Process of Adapting a Culturally Informed Stress Reduction Intervention for Native American Head Start Teachers

Deborah H Wilson et al. Glob Implement Res Appl. 2023.

Abstract

Head Start is a federally funded program for children (3-5 years) from low-income families. In the Fort Peck Native American Reservation, tribal Head Start teachers have reported high stress in supporting children experiencing adverse childhood experiences. Thus, we adapted the Little Holy One intervention (ClinicalTrials.gov: NCT04201184) for the teachers' context and culture to enhance psychological health and well-being. Within a participatory framework, the eight-step ADAPT-ITT methodology was used to guide the adaptation process: assessment; decision; adaptation; production; topical experts; integration; training; and testing. For Step 1, we purposive sampled 27 teachers, ancillary staff, and parents to understand teachers' stress, support mechanisms, and interest in an intervention via focus groups (n = 9) and individual interviews (n = 18). Qualitative data underscored teachers' experiences of stress, depression, and need for support (Step 1). Iterative feedback from a tribal advisory board and Little Holy One designers rendered selection of five lessons (Step 2, 5), which were adapted for the teachers via theater testing (Step 3, 4). Community capacity assessment revealed their ability to implement the intervention (Step 6). Testing of this adapted intervention in a feasibility trial (steps 7, 8) will be reported in a future publication. A rigorous systematic process within a participatory framework allowed intervention adaption based on community input. Leveraging "culture as treatment" may be useful for enhancing psychological health outcomes for Native Americans who historically underutilize existing psychological services.

Supplementary information: The online version contains supplementary material available at 10.1007/s43477-022-00070-3.

Keywords: Community-based participatory research; Cultural safety; Native American; Process evaluation.

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Conflict of interest statement

Conflict of interestThe authors declare that they have no financial or non-financial competing interests.Ethical approval and consent to participateThe study was authorized by the Fort Peck Executive Board through Tribal Resolution (Resolution #30-348-2020-03). All study team members have completed required training on human subjects’ research, conflicts of interest, and health privacy issues. Study team members completed consent with all participants prior to the start of data collection, which included consent to publication of findings. Human subjects review was conducted by the Fort Peck Tribal IRB (September 2020) and Johns Hopkins School of Medicine IRB (IRB00252294). Any modifications to study protocols were submitted to both IRBs for approval prior to implementation. Fort Peck Tribal IRB reviews all manuscripts prior to publication.

Figures

Fig. 1
Fig. 1
Logic model depicting cultural psychological intervention for tribal head start teachers
Fig. 2
Fig. 2
How CBPR and ADAPT-ITT inform and enhance each other
See this image and copyright information in PMC

References

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