EVERFI Webinar: Adapting sexual assault prevention to reach diverse students

74
Do we have to start from scratch? Using the ADAPT-ITT model to make culturally-relevant adaptations to pre-existing sexual violence interventions

Transcript of EVERFI Webinar: Adapting sexual assault prevention to reach diverse students

Do we have to start from scratch?Using the ADAPT-ITT model to make culturally-relevant adaptations to pre-existing sexual violence interventions

• Discusstheprosandconsofadaptingpre-existingevidence-basedinterventions

• DescribetheADAPT-ITTmodel

• Discussacasestudy:AdaptingRelationshipRemix

• Summarizehowthismodelmaybeusefulindifferentcampuspreventioncontexts

Objectives

• SarahRominski– UniversityofMichiganMedicalSchool,DepartmentofOB/GYN

• EugeneDarteh– UniversityofCapeCoast,DepartmentofPopulationHealth

• Akua O.Britwum– UniversityofCapeCoast,DirectoroftheCentreforGenderResearch,

Advocacy,andDocumentation• UniversityofMichiganSexualAssaultPrevention&

AwarenessCenter(SAPAC)&Sexperteam• UniversityofCapeCoastResearchAssistants• UniversityofMichiganStudents

ResearchTeam&Partners

ADAPTATIONWhydowecareaboutadaptation?

• Theworldishometoadiversegroupofindividualsthatallhaveintersectingcharacteristicsthatmakethemunique.

• Therearealsonumerousinterventionsthatalreadyexistrelatedtosexualviolenceandprimaryprevention.

• Yetweknowthattheseinterventionsarenotonesizefitsall!

Whyshouldweconsideradaptation?

Pros&ConsofAdaptinganInterventionPros Cons

Savestime Missoutoncommunityactivism/supportfortheintervention?

Savesmoney Willitbetailoredtotheneedsofthecontext/culture/populationIamworkingwith?

Consistencyininterventionsacrossculturesandcontexts

Consistencyininterventionsacrossculturesandcontexts

Italreadyhasanestablishedevidencebase

Don’tknowifitwasthebestoptionforyourcontext/culture/population.Mightbebasedonoutdatedevidenceandsituations.

ASystematicProcessforAdaptingEvidence-BasedInterventions

• TheADAPT-ITTModel:– Systematicframeworkforadaptingevidence-basedinterventions– Introducedin2008forHIVinterventions– PrimarybeenusedforHIVinterventions– Hasbeenusedtoadaptinterventionsto:

• Newlocations• Newculturalcontexts• Newpopulations

Wingood,G.M.,&DiClemente,R.J.(2008).TheADAPT-ITTmodel:anovelmethodofadaptingevidence-basedHIVInterventions. JAIDSJournalofAcquiredImmuneDeficiencySyndromes, 47,S40-S46.

TheADAPT-ITTModelTheADAPT-ITTframeworkinvolveseightssteps:1) Assessmentoftheprioritiesofthenewpopulation2) Decisionsonwhetherornottoadapttheinterventionandwhatcontenttoadapt3) Administrationoftheintervention4) Productionofanadaptedversionoftheintervention5) Topicalexpertsassistintheadaptationprocess6) Integrationoffeedbackfromthetopicalexpertsintotheadaptedintervention7) Trainingstudentstoimplementtheadaptedintervention8) Testingtheadaptedintervention.

Wingood,G.M.,&DiClemente,R.J.(2008).TheADAPT-ITTmodel:anovelmethodofadaptingevidence-basedHIVInterventions. JAIDSJournalofAcquiredImmuneDeficiencySyndromes, 47,S40-S46.

AnAppliedExample:RelationshipTidbits

RelationshipTidbits

ADAPT-ITT

RELATIONSHIPREMIXUniversityofMichigan’sPrimaryPreventionProgram

WhatisRelationshipRemix?• PrimarypreventioninterventiondevelopedattheUniversityof

Michiganin2011byagroupofstudentsandstafffromhousing,SAPAC,andSexperteam.

• Deliveredasaninteractivein-persontraining(1.5hourslong)tofirstyearstudentsbypeerswithafocusonhealthyrelationshipsandconsent,usingavalues-basedframework.

Bonar,E.,Rider-Milkovich,H.,&Cunningham,R.(underreview).Initialevaluationofacampussexualassaultpreventionprogramforfirst-yearcollegestudents.JournalofAmericanCollegeHealth.

BuildingBlocksCurriculum• Curriculumisorganizedtobefacilitatedbytwostudents

– OnestudentisgenerallyavolunteerwiththeSexualAssaultPreventionandAwarenessCenter(SAPAC)

– Theotherstudentisgenerallyavolunteerwiththestudentsexualhealthgroup,Sexperteam

• Workthroughthecurriculumwitheachtopicareabuildingonthepreviouscontent

• Deliveredwithinresidenthallsasaninteractiveandrequiredprogram

• 10Buildingblocks1. Creatingasafeandwelcomingspace2. Thinkingaboutourvalues3. Decision-makingfromourownvaluesystem4. Developingrelationshipskills5. Communication6. Genderequality7. Consent8. Makingchoicesaboutsex9. Sexualharassment10. Campusresources

BuildingBlocks

Title MainActivities

1 Creatingasafeandwelcomingspace

Participantsidentifyideastocreate asafespaceduringthetraining(i.e.,confidentiality,nojudgment)

2 Thinkingaboutourvalues

Participantsidentifyvaluesimportanttothem usingaworksheet&thendiscusswhyitisimportanttothinkaboutourvalues

3 Decision-makingfromourownvaluesystem

Participantsthinkabout theirvaluesandhowtheyupholdthemorwhathappenswhenpeopledonotactinaccordwiththeirvalues

4 Developingrelationshipskills

Fourquadrantsexercise– participantsuseaworksheettoidentifyEssential,Tolerable,Deal-Breaker,andBonuscharacteristicsinarelationship

5 Communication 20questionsgame

6 Consent Discussconsent (focusonconsentwithalcoholuse);Practicegivingandreceivingconsent

7 Makingchoicesaboutsex

Discussionaboutthehealthconsequences ofbeinginasexualrelationship(i.e.,pregnancy,STIs)

8 Sexualharassment Reviewthedefinitionsofsexualassault (terminologyusedattheUniversityofCapeMichigan)aswellascoercion.Studentsareaskedtocreateacasetodiscusswheresexualharassmenthasoccurred.

9 Campusresources Discussresourcesavailableoncampus

DataonRelationshipRemix• Overthelast5years,morethan18,000studentshavereceivedthe

RelationshipRemix trainingattheUniversityofMichigan.

• Arecentanalysisof2,305studentswhohadthetrainingin2015notedthatimmediatelyafterreceivingRelationshipRemix,studentshadsignificantchangesin:–Values-baseddecisionmaking

–Knowinghowtoaskforconsent–Relationshipcommunicationskills

Christensen,R.(2016,June).RelationshipRemixinyearfive:Anassessmentoffirst-yearstudents’pre-workshop,post-workshop,andsix-monthfollow-upquestions.AnnArbor,MI:UniversityofMichiganCommunityMatters.

RELATIONSHIPTIDBITSUniversityofCapeCoast’sPrimaryPreventionProgram

ProjectBackground

• Sexualassaultisasignificantchallengeforuniversitiesworldwide,affectingthehealthandacademicsuccessofstudents

• SexualviolencepreventionprogramsarecommonatuniversitiesintheUnitedStates

• Theseprogramsarenon-existentinGhana

CulturalContext• GhanaislocatedinWestAfricaandis

borderedbytheIvoryCoast,BurkinaFaso,Togo,andtheGulfofGuinea.

• ItwashometotheBritishGoldCoast,whereanumberoftradingpostswereestablishedforthetradingofgoodsandeventuallypeople.

• TheUniversityofCapeCoast wasestablishedin1962.

TheBeginningoftheProject

• StudybyDrs.EugeneDarteh&SarahRominski

- GeneralsurveyofsexualandreproductivehealthofUniversityofCapeCoaststudents

- DatacollectedbetweenJanuaryandMarch,2015

- Residentialstudents

- Self-administered,tabletcomputer-based

Results• Sample:556males,480females

• Significantlymorefemalesthanmalesreporttheywere“notatallwilling”thefirsttimetheyhadsex(41.9%vs.14.5%).

• Significantlymorefemalesthanmalesreporthavingeverbeenforcedintohavingsex(21%vs.9.9%).

• 126(26.3%)femalesand91(16.5%)maleshavehadsexeitherbecausetheywereforcedorcoerced,orwhentheywere“notatallwilling”.

Conclusions

Furtherworkisneededtoinvestigatethisphenomenonandtodevelopinterventionstopreventsexualcoercionamongthispopulation.

InstitutionalSupportforSexualViolenceResponse&Prevention

• In2013theUniversityofCapeCoastestablishedtheCentreforGenderResearch,Advocacy,andDocumentation(CEGRAD)inresponseto:– Poorpost-assaultcarefromstudents– Demandsforsexualviolenceprevention

• TheyrevisedtheirSexualHarassmentpolicyin2015;theterm“sexualharassment”encompassesallformsofunwantedsexualcontact(verbalorphysical).

TheNeed• Therewasarecognizedneedforprimarypreventionbuttheinfrastructuredid

notexistattheUniversityofCapeCoast.• AfterdiscussionsbetweenUniversityofMichiganandUniversityofCapeCoast

faculty,thedecisionwasmadetoattempttoadaptRelationshipRemixusingasystematicprocesstomakeitculturallyandcontextuallyapplicable.

• TheteamdecidedtousetheADAPT-ITTframeworktoguidethisprocess

Wingood,G.M.,&DiClemente,R.J.(2008).TheADAPT-ITTmodel:anovelmethodofadaptingevidence-basedHIVInterventions. JAIDSJournalofAcquiredImmuneDeficiencySyndromes, 47,S40-S46.

Date ADAPT-ITT ProcessFebruary2016 Assessment 4FGDs(2withmen,2withwomen;n=26)todiscussissuesaroundsexualrelationships&violence

February2016 Assessment 20cognitiveinterviewstovalidatetheIllinoisRapeMythAcceptanceScale,theGenderEquityMen’sScale,andtheSexualRelationshipPowerScale

March–April2016 Decisions BasedoninformationgatheredfromtheFGDs,thefirstroundofrevisionstotheinterventionincluded:•Additionofvictimblamingscenarios•Removalofmuchofthefocusonalcohol•Additionof“ConsentasTea”video•Additionofacontentareafocusedongenderequality

April2016 Administration Betatestingconductedwith6groups(2withmen,2withwomen,2withmenandwomencombined;n=76)toadministertherevisedprogram

June2016 Production Productionofdraft#1oftherevisedprogram

July2016 TopicalExperts Draft#1reviewedwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)

July– August2016 Decisions#2 Basedonassessment,administration,anddiscussionwithtopicalexperts,asecondroundofrevisionswasundertaken(Draft#2).Revisionsincluded:•Replacedtwoactivitiesfocusedoncommunicationandgenderequality•Addedadditionalcontentonvictimblaming

September2016 Administration#2 Betatestingrepeatedwith6groups(3withmen,3withwomen;n=57)

October2016 Production#2 ProductionofDraft#2oftherevisedcurriculum

October–November2016 TopicalExperts#2 Reviewedcontentwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)forasecondtime

November2016 Integration Resultsofbetatestingsessions,meetingswithtopicalexperts,&readabilitytestintegrated

March2017 Training MastertrainersinGhanaparticipatedinFacilitator’sTrainingProgramtoreceiveinformationabouttrainingfuturepeerfacilitatorsandhelpcreatethemanualizedFacilitator’sTrainingGuide

August2017 Testing Inprogress– testingofthefinalprogramasadministeredbytrainedpeerfacilitators

Date ADAPT-ITT ProcessFebruary2016 Assessment 4FGDs(2withmen,2withwomen;n=26)todiscussissuesaroundsexualrelationships&violence

February2016 Assessment 20cognitiveinterviewstovalidatetheIllinoisRapeMythAcceptanceScale,theGenderEquityMen’sScale,andtheSexualRelationshipPowerScale

March–April2016 Decisions BasedoninformationgatheredfromtheFGDs,thefirstroundofrevisionstotheinterventionincluded:•Additionofvictimblamingscenarios•Removalofmuchofthefocusonalcohol•Additionof“ConsentasTea”video•Additionofacontentareafocusedongenderequality

April2016 Administration Betatestingconductedwith6groups(2withmen,2withwomen,2withmenandwomencombined;n=76)toadministertherevisedprogram

June2016 Production Productionofdraft#1oftherevisedprogram

July2016 TopicalExperts Draft#1reviewedwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)

July– August2016 Decisions#2 Basedonassessment,administration,anddiscussionwithtopicalexperts,asecondroundofrevisionswasundertaken(Draft#2).Revisionsincluded:•Replacedtwoactivitiesfocusedoncommunicationandgenderequality•Addedadditionalcontentonvictimblaming

September2016 Administration#2 Betatestingrepeatedwith6groups(3withmen,3withwomen;n=57)

October2016 Production#2 ProductionofDraft#2oftherevisedcurriculum

October–November2016 TopicalExperts#2 Reviewedcontentwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)forasecondtime

November2016 Integration Resultsofbetatestingsessions,meetingswithtopicalexperts,&readabilitytestintegrated

March2017 Training MastertrainersinGhanaparticipatedinFacilitator’sTrainingProgramtoreceiveinformationabouttrainingfuturepeerfacilitatorsandhelpcreatethemanualizedFacilitator’sTrainingGuide

August2017 Testing Inprogress– testingofthefinalprogramasadministeredbytrainedpeerfacilitators

AssessmentGoals

• Completedtheassessmentphaseto“learn”aboutsexualviolenceatUniversityofCapeCoastinGhana

• WentinwiththeideathatwemightbeabletoadaptRelationshipRemixbutthatadditionalinformationwasneededfirst

• Neededtoidentifymeasurementtools

AssessmentMethods• Conductedfoursemi-structuredfocusgroups(genderseparated)to

discuss:– SexualRelationships– SexualViolence

• Conducted20cognitiveinterviewstodetermineifthefollowingevaluationmeasureswerecontextuallyandculturallyappropriate:– IllinoisRapeMythAcceptanceScale– modified(McMahon&Farmer,2011)

– GenderEquitableMenScale(GEM)(Pulerwitz&Barker,2008)– SexualRelationshipPowerScale(SRPS)(Pulerwitz,Gortmaker,&DeJong,2000)

McMahon,S.,&Farmer,G.L.(2011).Anupdatedmeasureforassessingsubtlerapemyths. SocialWorkResearch, 35(2),71-81.Pulerwitz,J.&Barker,J.(2008).MeasuringattitudestowardgendernormsamongyoungmeninBrazil:DevelopmentandpsychometricevaluationoftheGEMscale.MenandMasculinities,10(3),322-338.doi:10.1177/1097184X06298778Pulerwitz,J.,Gortmaker,S.L.&DeJong,W.(2000).MeasuringsexualrelationshippowerinHIV/STDresearch.SexRoles,42(7),637-660.doi:10.1023/A:1007051506972

AssessmentResults

Themesthatemergedincluded:1) Communicationusingbodylanguageandactions2) Expectationofabstinencebeforemarriageespeciallyforwomen3) Genderedpowerdifferentialsinrelationships4) Nomeansyes5) Somedegreeofviolenceandcontrolisacceptedinmarriages6) Alcoholisnotaprecipitatingfactorinsexualviolence.

Date ADAPT-ITT ProcessFebruary2016 Assessment 4FGDs(2withmen,2withwomen;n=26)todiscussissuesaroundsexualrelationships&violence

February2016 Assessment 20cognitiveinterviewstovalidatetheIllinoisRapeMythAcceptanceScale,theGenderEquityMen’sScale,andtheSexualRelationshipPowerScale

March–April2016 Decisions BasedoninformationgatheredfromtheFGDs,thefirstroundofrevisionstotheinterventionincluded:•Additionofvictimblamingscenarios•Removalofmuchofthefocusonalcohol•Additionof“ConsentasTea”video•Additionofacontentareafocusedongenderequality

April2016 Administration Betatestingconductedwith6groups(2withmen,2withwomen,2withmenandwomencombined;n=76)toadministertherevisedprogram

June2016 Production Productionofdraft#1oftherevisedprogram

July2016 TopicalExperts Draft#1reviewedwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)

July– August2016 Decisions#2 Basedonassessment,administration,anddiscussionwithtopicalexperts,asecondroundofrevisionswasundertaken(Draft#2).Revisionsincluded:•Replacedtwoactivitiesfocusedoncommunicationandgenderequality•Addedadditionalcontentonvictimblaming

September2016 Administration#2 Betatestingrepeatedwith6groups(3withmen,3withwomen;n=57)

October2016 Production#2 ProductionofDraft#2oftherevisedcurriculum

October–November2016 TopicalExperts#2 Reviewedcontentwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)forasecondtime

November2016 Integration Resultsofbetatestingsessions,meetingswithtopicalexperts,&readabilitytestintegrated

March2017 Training MastertrainersinGhanaparticipatedinFacilitator’sTrainingProgramtoreceiveinformationabouttrainingfuturepeerfacilitatorsandhelpcreatethemanualizedFacilitator’sTrainingGuide

August2017 Testing Inprogress– testingofthefinalprogramasadministeredbytrainedpeerfacilitators

DecisionsGoals

• ThesecondphaseoftheADAPT-ITTprocessinvolvesidentifyingevidence-basedinterventionsthatmaybesuitableforadoptionoradaptationtothenewculturalcontext.

• Weenteredtheprocesswithapotentialinterventioninmind,RelationshipRemix.

DecisionsMethods

• UtilizedatacollectedduringtheassessmentphasetomakedecisionsontheinitialchangesneededtoadaptRelationshipRemix.

• Wealsomadedecisionsonwhetherornotourevaluationmeasureswereappropriateandhowtheyneededtobemodified.

DecisionsResults• WeusedinformationfromtheFGDstobegintoculturallyadapt

RelationshipRemixtotheGhanaiancontextbyshiftingthefocusfromalcohol-facilitatedsexualassaulttorecognizingandeventuallyreducinggenderinequality.

• Basedonthecognitiveinterviews:– TwoquestionswereremovedfromtheGEM– OneitemwasremovedfromthemodifiedIRMA– TerminologywaschangedinthemodifiedIRMAtomakethemmore

culturallyappropriate(i.e.‘slut’changedto‘flirt’).

Date ADAPT-ITT ProcessFebruary2016 Assessment 4FGDs(2withmen,2withwomen;n=26)todiscussissuesaroundsexualrelationships&violence

February2016 Assessment 20cognitiveinterviewstovalidatetheIllinoisRapeMythAcceptanceScale,theGenderEquityMen’sScale,andtheSexualRelationshipPowerScale

March–April2016 Decisions BasedoninformationgatheredfromtheFGDs,thefirstroundofrevisionstotheinterventionincluded:•Additionofvictimblamingscenarios•Removalofmuchofthefocusonalcohol•Additionof“ConsentasTea”video•Additionofacontentareafocusedongenderequality

April2016 Administration Betatestingconductedwith6groups(2withmen,2withwomen,2withmenandwomencombined;n=76)toadministertherevisedprogram

June2016 Production Productionofdraft#1oftherevisedprogram

July2016 TopicalExperts Draft#1reviewedwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)

July– August2016 Decisions#2 Basedonassessment,administration,anddiscussionwithtopicalexperts,asecondroundofrevisionswasundertaken(Draft#2).Revisionsincluded:•Replacedtwoactivitiesfocusedoncommunicationandgenderequality•Addedadditionalcontentonvictimblaming

September2016 Administration#2 Betatestingrepeatedwith6groups(3withmen,3withwomen;n=57)

October2016 Production#2 ProductionofDraft#2oftherevisedcurriculum

October–November2016 TopicalExperts#2 Reviewedcontentwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)forasecondtime

November2016 Integration Resultsofbetatestingsessions,meetingswithtopicalexperts,&readabilitytestintegrated

March2017 Training MastertrainersinGhanaparticipatedinFacilitator’sTrainingProgramtoreceiveinformationabouttrainingfuturepeerfacilitatorsandhelpcreatethemanualizedFacilitator’sTrainingGuide

August2017 Testing Inprogress– testingofthefinalprogramasadministeredbytrainedpeerfacilitators

AdministrationGoals

• Thethirdphaseinvolvesadministering,orpre-testing,theinterventionwiththetargetaudienceinordertoascertainfeedbackontheformat,content,andattitudesabouttheintervention.– Thisisoftendonewiththeoriginalintervention,butcanalsobedone

withsomeminorchangestotheintervention.

AdministrationMethods• Studentparticipantswererecruitedforbetatestingusing

announcementsandsnowballsampling.• Inclusioncriteriaincludedbeing:

1) ResidentialstudentattheparticipatingUniversityinGhana2) AbletospeakandreadEnglish3) > 18yearsold.

• TheGhanaianresearchassistantsdeliveredtheadaptedinterventioningroupsettingswithobservationbytheGhanaianandUnitedStatesresearchers.

AdministrationResults

• Thefirstadministrationofthebeta-testlastedbetween111and178minutes.

• Participantshaddifficultycompletingsomeoftheactivitiesincludedintheintervention,andthefacilitatorsfelttheinterventionwastoolengthy

AdministrationResults

• MaleparticipantshadsignificantlyimprovedscoresinthemodifiedIRMA(ahigherscoreisassociatedwithlessrapemythacceptance).– Eachsub-scaleofthemodifiedIRMA(‘sheaskedforit’,‘hedidn’t

meanto’,‘itwasn’treallyrape’,‘shelied’)alsoshowedsignificantimprovementamongthemaleparticipants.

• BothmaleandfemaleparticipantsdemonstratedimprovementinendorsementofgenderequalityasmeasuredbytheGEMbetweenthepre- andpost-intervention,althoughnotallsub-scaleschanged.

ResultsfromAdministration

0

10

20

30

40

50

60

70

80

Pre Post Pre Post

RMA GEM

Female

Male66.5(5.0)

76.2(8.1)

p<.01

20Questions:WhatHappenedinGhana?

• Theyhadneverplayed20questions

• Theyweretryingtothinkofthe“bestfood”foradesertisland.Whatwouldlastalongtime?Whatwouldbefilling?

• Theconceptofdirectcommunicationwascompletelylost….

MessageRelay:WhatHappenedinGhana?

• TheyLOVEDthisactivity!

• Itwasfun,interactive,andgoteveryoneoutoftheirseats.

• MosteducationinGhanausestheBritishsystemsotheyarenotusedtomoreinteractivetechniques.

• Theconceptofdirectcommunicationwaseasilyobserved.

Date ADAPT-ITT ProcessFebruary2016 Assessment 4FGDs(2withmen,2withwomen;n=26)todiscussissuesaroundsexualrelationships&violence

February2016 Assessment 20cognitiveinterviewstovalidatetheIllinoisRapeMythAcceptanceScale,theGenderEquityMen’sScale,andtheSexualRelationshipPowerScale

March–April2016 Decisions BasedoninformationgatheredfromtheFGDs,thefirstroundofrevisionstotheinterventionincluded:•Additionofvictimblamingscenarios•Removalofmuchofthefocusonalcohol•Additionof“ConsentasTea”video•Additionofacontentareafocusedongenderequality

April2016 Administration Betatestingconductedwith6groups(2withmen,2withwomen,2withmenandwomencombined;n=76)toadministertherevisedprogram

June2016 Production Productionofdraft#1oftherevisedprogram

July2016 TopicalExperts Draft#1reviewedwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)

July– August2016 Decisions#2 Basedonassessment,administration,anddiscussionwithtopicalexperts,asecondroundofrevisionswasundertaken(Draft#2).Revisionsincluded:•Replacedtwoactivitiesfocusedoncommunicationandgenderequality•Addedadditionalcontentonvictimblaming

September2016 Administration#2 Betatestingrepeatedwith6groups(3withmen,3withwomen;n=57)

October2016 Production#2 ProductionofDraft#2oftherevisedcurriculum

October–November2016 TopicalExperts#2 Reviewedcontentwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)forasecondtime

November2016 Integration Resultsofbetatestingsessions,meetingswithtopicalexperts,&readabilitytestintegrated

March2017 Training MastertrainersinGhanaparticipatedinFacilitator’sTrainingProgramtoreceiveinformationabouttrainingfuturepeerfacilitatorsandhelpcreatethemanualizedFacilitator’sTrainingGuide

August2017 Testing Inprogress– testingofthefinalprogramasadministeredbytrainedpeerfacilitators

Production• Theproductionphaseinvolvescreating

thematerialsneededfortheintervention.• Inthisparticularstudy,materialsincluded

aFacilitator’sManualtomaintainfidelityaswellasaFacilitator’sTrainingGuide.

• Thesematerialsweredevelopedbasedontheoriginalcontentfrom RelationshipRemix aswellastheresultsfromthefirstthreephases.

Date ADAPT-ITT ProcessFebruary2016 Assessment 4FGDs(2withmen,2withwomen;n=26)todiscussissuesaroundsexualrelationships&violence

February2016 Assessment 20cognitiveinterviewstovalidatetheIllinoisRapeMythAcceptanceScale,theGenderEquityMen’sScale,andtheSexualRelationshipPowerScale

March–April2016 Decisions BasedoninformationgatheredfromtheFGDs,thefirstroundofrevisionstotheinterventionincluded:•Additionofvictimblamingscenarios•Removalofmuchofthefocusonalcohol•Additionof“ConsentasTea”video•Additionofacontentareafocusedongenderequality

April2016 Administration Betatestingconductedwith6groups(2withmen,2withwomen,2withmenandwomencombined;n=76)toadministertherevisedprogram

June2016 Production Productionofdraft#1oftherevisedprogram

July2016 TopicalExperts Draft#1reviewedwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)

July– August2016 Decisions#2 Basedonassessment,administration,anddiscussionwithtopicalexperts,asecondroundofrevisionswasundertaken(Draft#2).Revisionsincluded:•Replacedtwoactivitiesfocusedoncommunicationandgenderequality•Addedadditionalcontentonvictimblaming

September2016 Administration#2 Betatestingrepeatedwith6groups(3withmen,3withwomen;n=57)

October2016 Production#2 ProductionofDraft#2oftherevisedcurriculum

October–November2016 TopicalExperts#2 Reviewedcontentwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)forasecondtime

November2016 Integration Resultsofbetatestingsessions,meetingswithtopicalexperts,&readabilitytestintegrated

March2017 Training MastertrainersinGhanaparticipatedinFacilitator’sTrainingProgramtoreceiveinformationabouttrainingfuturepeerfacilitatorsandhelpcreatethemanualizedFacilitator’sTrainingGuide

August2017 Testing Inprogress– testingofthefinalprogramasadministeredbytrainedpeerfacilitators

TopicalExperts

• Workingwithtopicalexpertscomprisesthefifthphase.

• Topicalexpertsareidentifiedbasedonthetypeofintervention,whodevelopedtheintervention,andthecontexttowhichtheinterventionisbeingadapting.

• Shouldbeabletogivefeedbackontheformat,content,&typesofmaterialsdevelopedduringtheADAPT-ITTprocess.

TopicalExperts• Ourtopicalexpertsincluded:

– StaffmembersofthesexualassaultcenterandwellnesscenterattheUniversityofMichiganwhichoriginallydevelopedtheinterventionforconsistencyofmainmessages(i.e.,values,healthyrelationships)

– CEGRADattheUniversityofCapeCoastforcultural&contextualapplicability.

Date ADAPT-ITT ProcessFebruary2016 Assessment 4FGDs(2withmen,2withwomen;n=26)todiscussissuesaroundsexualrelationships&violence

February2016 Assessment 20cognitiveinterviewstovalidatetheIllinoisRapeMythAcceptanceScale,theGenderEquityMen’sScale,andtheSexualRelationshipPowerScale

March–April2016 Decisions BasedoninformationgatheredfromtheFGDs,thefirstroundofrevisionstotheinterventionincluded:•Additionofvictimblamingscenarios•Removalofmuchofthefocusonalcohol•Additionof“ConsentasTea”video•Additionofacontentareafocusedongenderequality

April2016 Administration Betatestingconductedwith6groups(2withmen,2withwomen,2withmenandwomencombined;n=76)toadministertherevisedprogram

June2016 Production Productionofdraft#1oftherevisedprogram

July2016 TopicalExperts Draft#1reviewedwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)

July– August2016 Decisions#2 Basedonassessment,administration,anddiscussionwithtopicalexperts,asecondroundofrevisionswasundertaken(Draft#2).Revisionsincluded:•Replacedtwoactivitiesfocusedoncommunicationandgenderequality•Addedadditionalcontentonvictimblaming

September2016 Administration#2 Betatestingrepeatedwith6groups(3withmen,3withwomen;n=57)

October2016 Production#2 ProductionofDraft#2oftherevisedcurriculum

October–November2016 TopicalExperts#2 Reviewedcontentwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)forasecondtime

November2016 Integration Resultsofbetatestingsessions,meetingswithtopicalexperts,&readabilitytestintegrated

March2017 Training MastertrainersinGhanaparticipatedinFacilitator’sTrainingProgramtoreceiveinformationabouttrainingfuturepeerfacilitatorsandhelpcreatethemanualizedFacilitator’sTrainingGuide

August2017 Testing Inprogress– testingofthefinalprogramasadministeredbytrainedpeerfacilitators

RoundTwo:Decisions,Administration,Production,&TopicalExperts

Sincewewereadaptingtonewlocation,culture,andacontextthathadneverhadaprimarypreventioninterventionwefoundaneedtorepeatcertain

portionsoftheADAPT-ITTprocess

RoundTwoResults• Changestotheprogrambasedonroundtwoactivitiesincluded:

1) ReplacingtwoactivitiesthatdidnotworkintheGhanaianculturalcontextfocusedoncommunicationandgenderequality

2) Addingadditionalcontentonvictimblaming(e.g.,acausesofrapeactivity).

RoundTwoAdministration• Smallnumberofparticipants(n=57)• 56%(14/25)offemalesreportedbeingthevictimofatleastoneform

ofsexualassault• SignificantimprovementinoverallGEM(andtwosubscales)and

modifiedIRMA(allsubscales)• SignificantdifferencesinmodifiedIRMAbetweengenders(maleshave

higherlevelsofRMAthanfemales,asinotherlocations)• Significantlydifferentlevelsofchangebetweengenders(femaleshada

biggerchangeintheGEMandRMA)

ResultsfromRoundTwoAdministration

0

10

20

30

40

50

60

70

80

90

100

Pre Post Pre Post

RMA GEM

Female

Male71.9(15.7)

85.8(14.9)

59.9(5.6)

62.0(5.8)

p<.001

p<.001

66.5(5.0)

76.2(8.1)

p<.01

IntegrationGoals&Methods• Theintegrationphaseinvolvesincorporatingchangesbasedonthe

firstfivephasesthatresultinanadaptedinterventionsuitableforpilottesting.

• Theintegrationphasetookintoconsiderationtheresultsoftheassessment,bothadministrations(beta-testing),andconsultationwithtopicalexpertstocreatethefinalFacilitatorManualfortheGhanaiancontext.

• Atthistime,readabilitytestingwasalsoperformedusingtheFlesch-Kincaidreadabilitytest.

IntegrationResults• IntegrationresultedinafullymanualizedversionofRelationship

Tidbits,whichwasreadyforthenextstepsoffacilitatortrainingandpilottesting.

• SinceRelationshipsTidbitsisaninteractive,peer-deliveredintervention,ourteambelievestheremaybefuturechangestothemanual.

• ThecurrentinterventionhasundergonearigorousadaptationprocessandcurrentreadabilitytestresultsindicateaFlesch-KincaidGradeLevelof8.4,whichwouldbeappropriateforanincominggroupofuniversitystudents.

Date ADAPT-ITT ProcessFebruary2016 Assessment 4FGDs(2withmen,2withwomen;n=26)todiscussissuesaroundsexualrelationships&violence

February2016 Assessment 20cognitiveinterviewstovalidatetheIllinoisRapeMythAcceptanceScale,theGenderEquityMen’sScale,andtheSexualRelationshipPowerScale

March–April2016 Decisions BasedoninformationgatheredfromtheFGDs,thefirstroundofrevisionstotheinterventionincluded:•Additionofvictimblamingscenarios•Removalofmuchofthefocusonalcohol•Additionof“ConsentasTea”video•Additionofacontentareafocusedongenderequality

April2016 Administration Betatestingconductedwith6groups(2withmen,2withwomen,2withmenandwomencombined;n=76)toadministertherevisedprogram

June2016 Production Productionofdraft#1oftherevisedprogram

July2016 TopicalExperts Draft#1reviewedwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)

July– August2016 Decisions#2 Basedonassessment,administration,anddiscussionwithtopicalexperts,asecondroundofrevisionswasundertaken(Draft#2).Revisionsincluded:•Replacedtwoactivitiesfocusedoncommunicationandgenderequality•Addedadditionalcontentonvictimblaming

September2016 Administration#2 Betatestingrepeatedwith6groups(3withmen,3withwomen;n=57)

October2016 Production#2 ProductionofDraft#2oftherevisedcurriculum

October–November2016 TopicalExperts#2 Reviewedcontentwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)forasecondtime

November2016 Integration Resultsofbetatestingsessions,meetingswithtopicalexperts,&readabilitytestintegrated

March2017 Training MastertrainersinGhanaparticipatedinFacilitator’sTrainingProgramtoreceiveinformationabouttrainingfuturepeerfacilitatorsandhelpcreatethemanualizedFacilitator’sTrainingGuide

August2017 Testing Inprogress– testingofthefinalprogramasadministeredbytrainedpeerfacilitators

• 10Buildingblocks1. Creatingasafeandwelcomingspace2. Thinkingaboutourvalues3. Decision-makingfromourownvaluesystem4. Developingrelationshipskills5. Communication6. Genderequality7. Consent8. Makingchoicesaboutsex9. Sexualharassment10. Campusresources

BuildingBlocks

Title MainActivities

1 Creatingasafeandwelcomingspace

Participantsidentifyideastocreate asafespaceduringthetraining(i.e.,confidentiality,nojudgment)

2 Thinkingaboutourvalues

Participantsidentifyvaluesimportanttothem usingaworksheet&thendiscusswhyitisimportanttothinkaboutourvalues

3 Decision-makingfromourownvaluesystem

Participantsthinkabout theirvaluesandhowtheyupholdthemorwhathappenswhenpeopledonotactinaccordwiththeirvalues

4 Developingrelationshipskills

Fourquadrantsexercise– participantsuseaworksheettoidentifyEssential,Tolerable,Deal-Breaker,andBonuscharacteristicsinarelationship

5 Communication Telephonegametoillustratetheneed foropenandhonestcommunication6 Genderequality Readahandoutongenderequalityandshareastoryin groupsabouthowtheyhave

personallynoticedtheirgenderimpacttheirlife7 Consent ConsentasTeavideo,casestudieswherestudentsdeterminewhetherornotconsent

hasbeengarnered,practicegivingandreceivingconsent8 Makingchoicesabout

sexDiscussionaboutthehealthconsequences ofbeinginasexualrelationship(i.e.,pregnancy,STIs)

9 Sexualharassment Reviewthedefinitionsofsexualharassment (terminologyusedattheUniversityofCapeCoast)aswellascoercion.Studentsareaskedtocreateacasetodiscusswheresexualharassmenthasoccurred.

10 Campusresources Discussresourcesavailableoncampus

Date ADAPT-ITT ProcessFebruary2016 Assessment 4FGDs(2withmen,2withwomen;n=26)todiscussissuesaroundsexualrelationships&violence

February2016 Assessment 20cognitiveinterviewstovalidatetheIllinoisRapeMythAcceptanceScale,theGenderEquityMen’sScale,andtheSexualRelationshipPowerScale

March–April2016 Decisions BasedoninformationgatheredfromtheFGDs,thefirstroundofrevisionstotheinterventionincluded:•Additionofvictimblamingscenarios•Removalofmuchofthefocusonalcohol•Additionof“ConsentasTea”video•Additionofacontentareafocusedongenderequality

April2016 Administration Betatestingconductedwith6groups(2withmen,2withwomen,2withmenandwomencombined;n=76)toadministertherevisedprogram

June2016 Production Productionofdraft#1oftherevisedprogram

July2016 TopicalExperts Draft#1reviewedwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)

July– August2016 Decisions#2 Basedonassessment,administration,anddiscussionwithtopicalexperts,asecondroundofrevisionswasundertaken(Draft#2).Revisionsincluded:•Replacedtwoactivitiesfocusedoncommunicationandgenderequality•Addedadditionalcontentonvictimblaming

September2016 Administration#2 Betatestingrepeatedwith6groups(3withmen,3withwomen;n=57)

October2016 Production#2 ProductionofDraft#2oftherevisedcurriculum

October–November2016 TopicalExperts#2 Reviewedcontentwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)forasecondtime

November2016 Integration Resultsofbetatestingsessions,meetingswithtopicalexperts,&readabilitytestintegrated

March2017 Training MastertrainersinGhanaparticipatedinFacilitator’sTrainingProgramtoreceiveinformationabouttrainingfuturepeerfacilitatorsandhelpcreatethemanualizedFacilitator’sTrainingGuide

August2017 Testing Inprogress– testingofthefinalprogramasadministeredbytrainedpeerfacilitators

TrainingGoals• Stepseveninvolvestrainingthosewhowillbeinvolvedwith

administeringtheinterventionormaintainingfidelity.• Inourproject,thisinvolvedtrainingagroupof“MasterTrainers”that

couldadministertheprogramandtrainfuturepeerfacilitators.

• Additionally,becausethisisapeer-deliveredinterventionitwasimportantforustohavestudentsinvolvedinthetrainingprocess.

TrainingMethods• TrainingManualwasdevelopedforall“MasterTrainers”

• AgroupofsixstudentstraveledtoGhanawithustoconductthetraining

• Workshops– EachworkshopwasdevelopedbyoneUMorUCCstudent– Theyweredesignedtobe1-1.5hourslong– Theywereallinteractiveandfun!

TrainingTopics

• BackgroundonSexualViolenceintheUS• BackgroundonSexualViolenceinGhana• SexualHealth&TechniquestoEducate

Others• Self-Reflection&IdentificationofBiases• FacilitationSkillsforMasterTrainers• Redirection&HandlingDifficultQuestions• Self-Care

FeedbackonTraining• GhanaianStudentssaid:

“Itwassonicetogetthetrainingfromstudentsourownageinsteadofhavinganadulttellyouwhatyouaresupposedtodo.”

• UniversityofMichiganstudentssaid:“Itwasthewarmestandmostfulfillingtripofmycollegecareer.IgainedsomuchfrombeinginaplacesovastlydifferentfromAmerica.IlearnedalotaboutmyselfandthelensthroughwhichIviewtheworld.Itwasthekindofinfluentialtripthatwillshapethepublichealthandcommunityeducation

workIdointhefuture.” – BrianaSanders

Date ADAPT-ITT ProcessFebruary2016 Assessment 4FGDs(2withmen,2withwomen;n=26)todiscussissuesaroundsexualrelationships&violence

February2016 Assessment 20cognitiveinterviewstovalidatetheIllinoisRapeMythAcceptanceScale,theGenderEquityMen’sScale,andtheSexualRelationshipPowerScale

March–April2016 Decisions BasedoninformationgatheredfromtheFGDs,thefirstroundofrevisionstotheinterventionincluded:•Additionofvictimblamingscenarios•Removalofmuchofthefocusonalcohol•Additionof“ConsentasTea”video•Additionofacontentareafocusedongenderequality

April2016 Administration Betatestingconductedwith6groups(2withmen,2withwomen,2withmenandwomencombined;n=76)toadministertherevisedprogram

June2016 Production Productionofdraft#1oftherevisedprogram

July2016 TopicalExperts Draft#1reviewedwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)

July– August2016 Decisions#2 Basedonassessment,administration,anddiscussionwithtopicalexperts,asecondroundofrevisionswasundertaken(Draft#2).Revisionsincluded:•Replacedtwoactivitiesfocusedoncommunicationandgenderequality•Addedadditionalcontentonvictimblaming

September2016 Administration#2 Betatestingrepeatedwith6groups(3withmen,3withwomen;n=57)

October2016 Production#2 ProductionofDraft#2oftherevisedcurriculum

October–November2016 TopicalExperts#2 Reviewedcontentwithtopicalexperts(GhanaianandUnitedStatessexualassaultcenters)forasecondtime

November2016 Integration Resultsofbetatestingsessions,meetingswithtopicalexperts,&readabilitytestintegrated

March2017 Training MastertrainersinGhanaparticipatedinFacilitator’sTrainingProgramtoreceiveinformationabouttrainingfuturepeerfacilitatorsandhelpcreatethemanualizedFacilitator’sTrainingGuide

August2017 Testing Inprogress– testingofthefinalprogramasadministeredbytrainedpeerfacilitators

Testing• Currentlyinprogress

• Willevaluatethefinalversionoftheadaptedprogramasadministeredbythetrainedpeerfacilitators

• Willpreparetheprogramforscale-uptotheentireUniversityofCapeCoaststudentpopulation

LongTermGoal

DecreasesexualviolenceperpetrationatUCCandenableallstudentstoengageinhealthy,satisfyingrelationshipsbasedontheirvalues

Howwillwedothat?

• HaveamanualizedversionofRelationshipTidbits thatincludesa:– FacilitatorManual– Facilitator’sTrainingGuide

• RelationshipTidbitswillbedeliveredtoallincomingstudentsattheUniversityofCapeCoast

• BegintousetheadaptationprocesstoadaptRelationshipRemix tootheruniversitiesinGhanaandthroughoutsub-SaharanAfrica

LessonsLearned• Adaptingcontenttonewlocationsand/or

populationsrequiresengaginginanongoing,iterativeprocess

• Workingwith thetargetpopulationisessential.Wecannotmakeassumptions.Thetargetpopulationknowsbest.

• Youareneverdone.Youarealwayslearningfromthepopulation,thedeliveryofthecontent,andnewindividuals.Itisimportanttoincorporatethisnewlearningintoyourfacilitationskills.

AnAlternativeExample:MKit

AdaptingaWebApptoaNewPopulation

Date ADAPT-ITT ProcessAugust2016 Community

EngagementMetwithTechnicalExpertiseGrouptointroducetheWebApp,getbuyin,anddiscussADAPT-ITTprocess.Theyprovidedfeedbackonthefocusgroupandinterviewprocess.

November2016–February2017

Assessment Students: 7FGDstodiscussissuesaroundhealthyrelationshipsandsexualviolence.Totalnumberofparticipants:43Faculty&Staff: 3FGDs&1individualinterviewtodiscussissuesaroundhealthyrelationshipsandsexualviolence.Totalnumberofparticipants:16

March2017 Decisions Basedontheinformationgatheredinthefocusgroupdiscussion,madedecisionson:1)Editingpre-existingtiles2)Replacingtiles

April2017 Administration Theatertestingusingcognitiveinterviewsdoneinsmallgroups(2-3people)withcampusorganizations(n=44)

May2017 CommunityEngagement

MembersoftheTechnicalExpertiseGrouprevisedsomeofthekey“tiles”

June-August2017 Production ProductionoftherevisedWebAppbymytechpartners

August-September2017

TopicalExperts RevisedWebAppiscurrentlybeingreviewedbyfourtopicalexperts(whowerenotinvolvedintheWebAppdevelopment)includingasexualviolenceexpert,primarypreventionexpert,studentexpert,andtechnologyexpert

August-September2017

CommunityEngagement

TheTechnicalExpertiseGrouphasanopportunitytoreviewthebetaversionoftheWebApp

September2017 Integration ResultsofbetatestingwillbeintegratedintobetaversionofWebApp

September2017 Training RelationshipRemixfacilitatorsaretrainedtoadvertisetheWebApp

September2017–April2018

Testing Pilottestwith300students

ComparingRelationshipTidbits &MKit

• UsedtheADAPT-ITTprocess

• Adaptedtoanewcultureandcontext

• Intendedtobeaprimarypreventionintervention

• Script-basedinterventiondeliveredbypeerfacilitators

• UsedtheADAPT-ITTprocess

• Adaptedtoanewpopulationwithanewfocus

• Intendedtobeareinforcementtoalreadyexistingprimarypreventioninterventions

• WebApptechnologybasedintervention

PuttingitTogether:WhatwilltheADAPT-ITTprocesslooklikeinyourcontexts?

WheremighttheADAPT-ITTprocessbeuseful?

• CommunityorCommuterColleges

• TechnicalSchools

• InternationalStudentPrograms

• CollegesorUniversitieswithmultiplecampusesthatservedifferentstudentspopulations

• Non-traditionalStudents

KeystoaSuccessfulAdaptation• Knowyourpopulation

– WespentthemajorityofourtimegettingtoknowGhanaianstudentsandhowtheyunderstandandviewsexualviolence.

• Engageyourcommunity– Student,Organization,orCommunityAdvisoryBoard

• Thinkaboutyourtimeline– Whenarestudentsoncampusandavailable?– Whatisrealisticgivenyourworkload?

KeystoaSuccessfulAdaptation• Buildateam

– Doyouneedcampusadministratorstohelppromotetheprogram?– Doyouneedresearcherstohelpevaluatedata?– Doyouneedtoinvolvefacilitiesorcampushousingtologistically

enabletheprogram?– Doyouneedatechnologypartner?

• Identifyfinancialsupport– Doyouhavehumanresources?– Doyouhavesupportforprogramresources?– Willthisprogramrequirefinancesforsustainability?

Makingityourown!

• TheADAPT-ITTprocesscreatesauniqueprogrambasedonyourpopulation/location/contextandneeds

• Usingapre-existingprogramservesonlyasabase,thisallowsyoutoincludetheinformation,naming,andbrandingthatismostappropriateforyourinstitution

Questions?

Thankyouforparticipating!

MichelleMunro-KramerAssistantProfessor

UniversityofMichiganSchoolofNursing

[email protected]