August 2018 // Volume 56 // Number 4 // Tools of the Trade // v56-4tt1
RELAX to Relajarse: A Framework for Culturally Adapting Educational Programming in Extension
Family life and Extension family and consumer science educators are encouraged to adapt existing curricula to effectively use with ethnically diverse audiences. Scholars have described different methods for culturally adapting programming; however, few have documented the process by which Extension educators may tackle this endeavor. The purpose of this article is to provide a framework and step-by-step example for how one Extension program was translated and culturally adapted for U.S. Latino participants. Lessons learned and recommendations are provided.
In an increasingly diverse world, the need for culturally appropriate educational programming for diverse audiences is of utmost concern for Extension family and consumer science (FCS) educators (Duncan & Goddard, 2017; Francis, Noterman, & Litchfield, 2014; Hurtado, Olsen, Alvarez de Davila, & Campoverde, 2018). For the past two decades, there has been an increase in scholarship focused on developing tailored approaches to serving ethnically diverse audiences via culturally adapted programs (e.g., Skogrand, Barrios-Bell, & Higginbotham, 2009). This has led to evidence suggesting that culturally adapted interventions can positively affect recruitment and retention efforts as well as overall program effectiveness (Barrera, Castro, Strycker, & Toobert, 2013; Hawthorne, Robles, Cannings-John, & Edwards, 2010; Hurtado et al., 2018).
Most FCS programs used today were originally developed in relation to Caucasian middle-class participants (Duncan & Goddard, 2017; Meraz, Petersen, Marczak, Brown, & Rajasekar, 2013). Consequently, many FCS programs do not appropriately reflect the unique needs and challenges of diverse populations (Aubrecht & Eames-Sheavly, 2012; Wiley & Ebata, 2004). Often programs fail to account for varied cultural beliefs and practices that influence the therapeutic or educational processes and may compromise participants' experiences (Pan, Huey, & Hernandez, 2011). The process of culturally adapting existing programs proves difficult for many scholars, as they must balance retaining programmatic efficacy with applying culturally appropriate content and delivery (Aubrecht & Eames-Sheavly, 2012; Castro, Barrera, & Steiker, 2010).
Until recently, literature on the adaptation processes of intervention programs was limited, and few published accounts of FCS programs exist (Robinson, Anding, & Hinojosa, 2003; Watson, 2001). Today, several models exist to guide program development (Castro et al., 2010), with the majority including some combination of "top-down" and "bottom-up" approaches to cultural adaptation. This means that program developers should consider the use of theory and study efficacy (top-down approach) as well as input from the targeted audience (bottom-up approach) when culturally adapting programming (Barrera et al., 2013). Other scholars have suggested that the adaptation process lies along a continuum (Okamoto, Kulis, Marsiglia, Steiker, & Dustman, 2014). One end includes surface-level changes that focus on presentation (e.g., pictures), and the other focuses on deep-content changes that reflect cultural values and beliefs. Although scholars have yet to solidify best practices in culturally adapting FCS programming (St. George et al., 2017), most agree that a combination of these varying modalities is effective.
In an effort to provide an example of these suggested adaptation modalities for the FCS field, and Extension educators specifically, we describe herein a framework by which one program, titled RELAX: Alternatives to Anger (RELAX), was culturally adapted and translated for U.S. Latino audiences into Relajarse.
RELAX: Alternatives to Anger—Program Background
RELAX is a research-based anger and stress management program developed by Michigan State University Extension (Michigan State University Extension, 2012). In RELAX, participants learn various strategies for appropriately expressing emotions, navigating stress, resolving interpersonal conflict, and building skills to form and maintain healthful relationships. Published evaluation data for RELAX indicate positive effects through measured increases in the social and emotional well-being of participants (Pish, Clark-Jones, Eschbach, & Tiret, 2016; Reck, Tiret, Meuser, Perry, & Quintin, 2017). Due to the increase in Michigan's Latino population, and indicated positive impacts of RELAX among Caucasian and Latino populations, Michigan State University Extension educators determined the need to translate and culturally adapt RELAX for Latino adult audiences.
Step-by-Step Process for Adapting RELAX
Table 1 provides the step-by-step framework by which RELAX was culturally adapted into Relajarse. Descriptions of activities associated with each step are provided. These steps and activities provide a general framework for Extension educators to follow when culturally adapting and translating FCS programs.
|Step||Example of activities used in revising RELAX|
|Step 1: Planning and preparatory work||a. Researched fastest growing Latino populations in state by county. Determined focus group locations.
b. Determined budget based on costs for researchers' time, focus group incentives, travel, equipment, and translation and design.
c. Hired two bilingual-bicultural facilitators to conduct focus groups.
d. Formed advisory group (Extension staff, university faculty, research experts, and Latino community members) to provide process input.
|Step 2: Project design||a. Drafted logic model. Developed consent forms, recruitment strategies, and qualitative questions. Translated all documents to Spanish.
b. Developed focus group methods (five groups in four counties). Set target N as 30–50 people.
c. Gained university internal review board approval.
|Step 3: Focus groups||a. Recruited focus group participants.
b. Conducted community-based, instructor-translated Spanish RELAX courses.
c. Facilitated and recorded five focus groups (N = 36). Sites were located in two large cities, one small city, and one rural area.
|Step 4: Qualitative analysis||a. Translated and transcribed recorded focus group transcripts from Spanish to English.
b. Trained four team members in qualitative software (NVivo 10) and analysis methodology (Bogdan & Biklen, 2006).
c. Completed thematic analysis. Determined surface-level program changes, such as colors and pictures, and deep-level cultural adaptations, such as recognizing familism and machismo values. Special attention was given to how Latinos expressed and dealt with anger at a cultural level. Four researchers reviewed, coded, and synthesized data.
|Step 5: Revision of English version||a. Revised English content on the basis of qualitative results.
b. Sent program to two RELAX authors and two external family and consumer science specialists for efficacy review.
c. Revised program on the basis of reviewer feedback.
|Step 6: Translation and design||a. Hired translation/design company. Worked to ensure appropriate translation for target audience. Addressed surface-level changes.
b. Sent program to Extension staff for final review.
c. Made revisions on the basis of feedback.
|Step 7: Production and distribution||a. Made electronic version of program available for purchase via flash drive at university bookstore.
b. Distributed electronic version of program to focus group instructors.
|Step 8: Implementation and evaluation||a. Collaborated with Extension units across the United States for future program offerings and evaluation study.
b. Developed and implemented program evaluation protocol.
Lessons Learned and Recommendations
We learned a number of lessons during the process of adapting RELAX into Relajarse. One lesson was to hire bilingual-bicultural instructors. In all but one of the focus group sessions, bilingual-bicultural instructors taught the courses and conducted the focus group interviews. In one instance, an English-speaking instructor taught the course with an interpreter. This approach resulted in limited focus group feedback because participants' responses focused more on their frustrations with the interpretation process than on the cultural applicability of the program's content. Therefore, using bilingual-bicultural instructors and evaluators is highly recommended.
A second lesson was to acquire researchers with experience in qualitative analysis and cultural program adaptation to provide guidance in using existing theory, program effectiveness research, and participant feedback when adapting program content. Such researchers can guide the development of qualitative methodology and protocols for acquiring both surface-level and deep-level data, information not adequately addressed in straight English-to-Spanish translation efforts. Furthermore, having frequent and open communication with the translation/graphic design team is critical as small wording or design changes may lead to different cultural meanings. For RELAX, hiring an organization that provided both translation and graphic design services was useful.
It is important to note that the translation process can be difficult. For RELAX, frequent discussions between our team, the translating organization, and the advisory group members were required. Even adapting the program title involved significant discussion around the meaning of the word relajarse to different Latino populations. Other factors such as the program's purpose, expected instructors, targeted audience, and exact Spanish dialect were also considered. Had the program been developed in a different state, targeting another subcultural Latino audience, the final title and program content may have differed. Multistate evaluations of Relajarse will determine whether programmatic efficacy remains.
Finally, the success of the project was heavily dependent on the guidance and input of colleagues, other researchers, and cultural guides. Recognizing the importance of including a bottom-up approach involving feedback from the targeted population was essential. This led to more significant content change that included deep-level adaptations that quick-fix English-to-Spanish translations cannot address. The project's success further depended on our ability to engulf ourselves in the rich, diverse culture and subtle nuances of the Latino audience. We feel that because we did so, the Relajarse program is more reflective of and meaningful to the targeted audience.
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