Post on 21-Jan-2018
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
• 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.
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.
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
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10
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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
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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.
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
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