Translating Effective Behavioural Interventions - Replicating a proven interventon to meet the sexual and reproductive

Lead Research Organisation: University College London
Department Name: Unlisted

Abstract

The sexual health of young women from black and minority ethnic communities has deteriorated. In particular, women from black-Caribbean backgrounds have been disproportionately affected. One way to address this problem is by providing behavioural interventions to enable women to acquire new skills that help reduce their future risk of STI, HIV and unwanted pregnancies. However, developing and evaluating entirely new interventions can be time consuming and potentially expensive, and this problem is urgent. An alternative would be to translate an intervention we already know works with other minority women, into a format that specifically addresses UK black-Caribbean women. However we know very little about what is required to translate such interventions to new groups successfully. That is the aim of our research: To translate a proven intervention into a format culturally specific to young UK black-Caribbean women, and to pilot it assessing its feasibility and acceptability.

There are 3 stages involved in this research. The first involves reviewing in detail the parent intervention, that is, the one we are trying to reproduce, and how it was developed and implemented. The second stage involves undertaking new research with black-Caribbean women, and other consumers, community and service stakeholders to identify areas of specific need, and to determine what can be done to improve young black-Caribbean women?s sexual health options. In the third stage, we use the information obtained in stage 2, and with assistance from community stakeholders and young black-Caribbean women themselves, begin adapting the content of the intervention to specifically address black-Caribbean women?s needs. We then pilot the ?new? intervention with groups of women to see what they think, making more minor adaptations along the way, based on what we see happening and what the women feedback to us. At the end of our research we will have developed an intervention package that is culturally specific to the expressed and actual needs of young black-Caribbean women.

To be successful our research relies heavily on the involvement of black-Caribbean women and others in the community. To ensure that there are different ways people from the community can contribute, we are devising our research in partnership with a respected local organisation and a specialist in patient advocacy. They will help us make sure the community knows about our work and feels able to have as much involvement as possible.

Technical Summary

Effective behavioural interventions to address the deteriorating sexual health of young women from black and minority ethnic communities are needed urgently. There are few clinically effective interventions, based on rigorous randomised controlled trials (RCT) and none, specifically targeting women, that are routinely provided in UK sexual health or contraceptive services. Our aim is to translate a proven intervention into a format that is culturally specific to young UK black-Caribbean women, and pilot it to assess its acceptability, feasibility and potential in UK sexual health settings.

The parent intervention for this translation study, known as Project SAFE, was originally developed for in formats for African-American and for Hispanic women in Texas, USA. Its efficacy has been demonstrated in two rigorous randomised controlled trials (RCT). Project SAFE is a good candidate for this type of translation research because its development followed carefully defined stages that closely resemble the processes recommended by the MRC. This included selecting a validated model of behaviour change, extensive formative research and piloting of successive iterations. Its objectives and content of Project SAFE were largely the same for both groups of women and concentrated on reducing STI risks. However unique ?cultural cues? that played to the women?s individual realities, that supported personal risk recognition and that could be used to motivate behaviour change, were integrated into the intervention content and delivery, thus making it cultural specific and adding to its relevance. Our study will test the hypothesis that pragmatic accelerated development of a culturally specific behavioural intervention for young black-Caribbean women can be achieved by combining: a) faithful replication of the structure, delivery and implementation procedures of Project SAFE; with b) precise adaptations to the intervention content and delivery scripts based on formative research with young black-Caribbean women.

The proposed methods for this study involve a comprehensive review of the formative, development and implementation aspects of Project Safe; qualitative research employing innovative participatory methodologies, with consumer, community and service stakeholders, as well as detailed, in-depth work with young black-Caribbean women themselves. Making the actual adaptations to the parent intervention for the UK context will involve the entire study team as well consumer and community representatives. The final research stage involves a pilot study of the translated intervention with young black-Caribbean women to assess its acceptability, feasibility and potential for wider use in UK sexual health services.
 
Description NIHR Fellowship
Amount £266,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 11/2008 
End 10/2011
 
Title Young Brent Project Report executive summary 
Description The Young Brent Project executive summary includes guidelines on the elements that facilitatoed the intervention translation. 
Type Of Material Improvements to research infrastructure 
Year Produced 2010 
Provided To Others? Yes  
Impact Once the final report has been approved, the executive summary will be provided to the organisations that expressed interest in the Young Brent Project and in intervention translation. 
 
Title The Young Brent Project Intervention manual 
Description The Young Brent Project manual includes instructions and the flip chart information and hand outs to be used during the 4 3-hour sessions that make up the behavioural intervention. The intervention was piloted during the MRC funded project and needs to be evaluated next, on a wider scale through step wise roll out or an RCT. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Early clinical assessment
Year Development Stage Completed 2007
Development Status On hold
Impact Positive feedback from participants of the three pilot runs of the intervention. Participants reported improved communication skills within relationships and greater confidence in their sexual health knowledge Positive feedback from sexual health practitioners at the GUM clinic involved in the study. Interest in the intervention from local sexual health educators who work with young people locally. 
 
Description Adaptation workshop- Presentation of the exploratory qualitative findings 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Primary Audience Participants in your research and patient groups
Results and Impact The YBP research team organised an adaptation workshop to consult with participants about the changes that needed to be made to the original intervention being translated. Among several activities, this involved presenting the parent intervention and the findings from the qualitative work on the context of sexual risk taking.

Interest from participants in the intervention and dissemination of information about the study. Modifications were made to the pilot intervention based on the outcome of the consultation exercised conducted during the workshop.
Year(s) Of Engagement Activity 2007
 
Description Exploring the context of sexual risk taking among black and minority youth in NW London: A qualitative study to inform an intervention to reduce STI re-infection in female GUM attendees 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Primary Audience Health professionals
Results and Impact BASHH - ASTDA 3rd Joint Conference. Poster presented at a joint US/ UK meeting aimed at sexual health professionals.

This poster became the basis of the published paper.
Year(s) Of Engagement Activity 2008
 
Description NationalAfrican HIV Conference 2008-Presentation 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Primary Audience Public/other audiences
Results and Impact Presentation on the findings about the context of sexual risk taking among black and minority youth in NW London. These findings fed into the intervention translation. There were 60+ participants at the conference. They included sexual health care providers, community organisations and policy makers.

Increased awareness of the project. There was interest from delegates about the intervention translation process.
Year(s) Of Engagement Activity 2008
 
Description Naz Project Lonodon Conference: Taboos & Mixed Messages- Panel discussion 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Primary Audience Public/other audiences
Results and Impact National Naz Project London Conference -Findings from the study about the context in which sexual risk taking occurs were discussed by the researcher as an invited member of the panel discussion on Improving BME young people's sexual health. 60+ delegates attended and included a mixture of people including social care services, youth and sexual health workers, clinicians, policy planners, health care staff and health promotion specialists.

Interest from delegates
Year(s) Of Engagement Activity 2007
 
Description NoCLoR 2008: Innovations into practice-Presentation on the intervention translation process 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Primary Audience Policymakers/politicians
Results and Impact An oral presentation on translating an effective clinic-based behavioural intervention from the United States to the United Kingdom to reduce STI re-infection rates among young ethnic minority women to the conference participants. There were 40+ participants. The conference focused on the challenge of translating innovation into patient care in a timely and safe manner. Participants included policy makers, sexual health commissioners, sexual health practitioners, senior managers and academics.

Dissemination of the Young Brent Project. Interest about the intervention from the Camden sexual health commissioner.
Year(s) Of Engagement Activity 2008
 
Description Patrick Clements Clinic staff meeting-Presentation of feedback from the intervention pilots 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Primary Audience Health professionals
Results and Impact The results from the 3 pilot interventions, the follow up interviews with participants and the reunion meeting with pilot participants were presented at a staff meeting. This was at the GUM clinic from which the participants were recruited and the clinic staff helped in the recruitment of participants and provided feedback about the pilot sessions.

Discussions about the feasibility of a GUM clinic running the behavioural intervention. We felt it was important to report back to the staff who had helped us in recruiting participants for the pilot and had provided space for the pilot sessions to run.
Year(s) Of Engagement Activity 2008
 
Description Patrick Clements Clinic staff meeting-Presentation of qualitative study findings 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Primary Audience Health professionals
Results and Impact The findings on the context of sexual risk taking among the young people in NW London were presented to the GUM clinic staff during a staff meeting. This was the clinic from which participants were going to be recruited for the pilot study. About 15 staff members attended meeting.

Increased interest in the pilot intervention and voluntary participation by some staff members in assessing the pilot sessions.
Year(s) Of Engagement Activity 2007
 
Description Public Health Improvement Research Network: Health Challenge Wales- Presentation 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Primary Audience Policymakers/politicians
Results and Impact Presentation given on the qualitative findings from the Young Brent Project at the Evidence for Policy Seminar Series-12 Young people's sexual health: future strategies and interventions. There were 20+ participants. The aim of the network is "to increase the quantity and quality of public health improvement research by bringing together public health researchers, policy makers and practitioners in Wales."

Dissemination of study findings. Greater awareness of the importance of differentiating types of concurrency in providing advice to young people.
Year(s) Of Engagement Activity 2009
 
Description South West London HIV & GUM Clinical Services Network (SWAGNET)-Presentation 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Primary Audience Health professionals
Results and Impact Presentation given on sexual behaviour in young people which included a summary of research published 2006-2007 and the Young Brent Project. There were 30+ participants. The aim of the network is to "develop collaboration and co-ordination between the organisations and professional groups who deliver clinical services for HIV & GUM within South West London, to ensure that services are patient-focused, high quality, effective and equitable."

Interest from GUM clinic staff in the intervention
Year(s) Of Engagement Activity 2008