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 classroom 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 The aims of this study were to create a multicultural adaptation of the Mighty Girls program using a mobile app that is less costly to disseminate and is acceptable to parents of 7th grade girls. Methods This study used a three-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (nonprobability) sampling of low-income, multicultural, urban metropolitan groups (7th grade girls and their parents) within central Florida. Phase 1 involved two videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (N=14) and the other serving as a single-group pretest-posttest pilot study (N=23). Phase 2 involved development of a narrative cell phone app prototype, which was subjected to usability testing (N=25). App usability and engagement were assessed qualitatively (observation, focus group, open-ended questions) 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 were supported by a System Usability Scale score of 76 (exceeding 68 per the 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, termed Mighty Teens, that uses a narrative-generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. This study also provides evidence of the preliminary effectiveness of Mighty Teens classroom sessions. The sampling method and sample size were appropriate for adaptation, but research involving a more representative US 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 and increasing the number of narratives produced, which should in turn increase the program’s behavior change potency.

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Introduction: Hispanic adolescents are at high risk of engaging in sexual risk-taking behaviors. Parent–child communication protects against such behaviors. Among Hispanic families, it is critical to explore how cultural characteristics influence mothers–daughter communication about sex. The purpose of this qualitative study was to understand how cultural values influence mothers’ communication about sex with their early adolescent Hispanic daughters. Methodology: Twenty-one Hispanic mothers of seventh-grade daughters participated in this focus group study. Directed content analysis was used to analyze the data. Results: Four Hispanic cultural values ( familismo, machismo, marianismo, and respeto) and how each value influences mother–daughter communication about sex were identified. While mothers want to protect their daughters, there are multiple cultural norms that made it challenging for them to have critical conversations. Discussion: The study informs researchers and clinicians how to facilitate parent–child conversations about sex and to equip parents to teach their children how to avoid engaging in sexual risk-taking behaviors.

BACKGROUND Taking evidence-based interventions to scale is a primary challenge for prevention science. Adapting an intervention to be multi-cultural is a useful pathway for scaling up interventions, particularly those that are school based. So too is finding simpler but powerful technological components to reduce overall cost without jeopardizing effectiveness. Mighty Girls is a sexual pressure resistance program developmentally and culturally tailored for 7th grade Latinas. The program combines classroom sessions with an interactive videogame that reinforces program concepts. However, both the exclusive focus on Latinas and game cost (currently relies on digital puppetry by trained inter-actors) limit dissemination. OBJECTIVE Create a multi-cultural program that uses a narrative phone app to reinforce program concepts and build resistance skills. Specific, adaptation goals included: (1) modify classroom lessons; (2) conduct a pilot study to evaluate feasibility and preliminary efficacy of classroom lessons; (3) develop a narrative app to reinforce curriculum content and build resistance skills; (4) conduct usability test of the app; and (5) assess parents’ views of lesson content and activities, and the app as well as their supervision of child's cell phone use. METHODS Consultation with 4 adult key informants, and a series of research activities involving 7th grade girls attending either a “development school” (n=14) or “pilot study school” (n=23), and parents (n=6) addressed adaptation goals. Activities included: focus groups, pilot study (one group pre-test post-test design), and usability testing. Pilot study self-report measures assessed resistance self-efficacy and intentions, and sexual intentions (including intention to delay intercourse). Usability testing self-report measures included the System Usability Scale (SUS), adapted for use with an app and for teens, an open-ended question soliciting suggestions for improving usability, and a 5-item Like scale for assessing engagement. RESULTS Qualitative analyses of interviews, focus groups, and responses to open-ended questions supported multicultural content, and identified simple changes to improve engagement and learning. These changes were supported by quantitative findings from the pilot study school. Preliminary program effectiveness was supported by a significant pre-post difference in intention to delay sexual intercourse (P=.04). A SUS score of 76 (exceeding 68, industry standard) and a “liking” score of 3.2 on a 4-point scale (SD=.60) supported usability and appeal. CONCLUSIONS Our multi-step adaptation process resulted in a multicultural program that is now paired with an app with good usability and engagement properties. Pilot study findings provided preliminary support for program effectiveness. Modifications identified for the app will be addressed in building out of the app as we move toward commercialization and are expected to increase intervention potency. The resulting program is suitable for universal uptake due to its focus on sexual pressure resistance rather than abstinence or comprehensive sex education.