¡Cuídate!

Featured Grant OpportunitySchool Emergency Response to Violence (Project SERV) (Funding Opportunity) 

Featured Grant OpportunityShare with Youth: NOAA Student Opportunities Database

Developers

Antonia M. Villarruel, Ph.D., R.N., F.A.A.N., Loretta Sweet Jemmott III, Ph.D., R.N., F.A.A.N., and John B. Jemmott III, Ph.D

Program Summary

“¡Cuídate! (Take Care of Yourself)” is a culturally tailored program designed specifically for Latino youth. The program is an adaptation of the Be Proud! Be Responsible! program. ¡Cuídate! emphasizes Latino cultural beliefs to frame abstinence and condom use, as culturally accepted and effective ways to prevent unwanted pregnancy and sexually transmitted diseases, including HIV/AIDS. The focus of ¡Cuídate! is to increase each participant’s skill level and self-efficacy in communicating and negotiating with sexual partners about abstinence and condom use. The program also helps teens develop the technical skills they need for correct condom use. ¡Cuídate! provides important information about the causes, diagnosis, transmission, and prevention of HIV and STDs, as well as the risk of HIV infection for Latino youth.

Intended Population

¡Cuídate! is designed for Latino youth, ranging from 13 to 18 years old, and has been evaluated with Latino teens who were 14 to 17 years old.

Program Setting

The program is designed for and has been evaluated in school and community-based settings.

Contact and Availability Information

Nancy Gonzalez-Caro, MPH
Evidence-Based Product Specialist
ETR
100 Enterprise Way, Suite G300
Scotts Valley, CA 95066
Phone: 1-800-321-4407
Website: http://www.etr.org/ebi/programs/cuidate/

Cody Sigel, MPH, CHES
Health Education Training Coordinator
ETR
1333 Broadway, Suite P110
Oakland, CA 94612
Phone: 510-858-0995
Website: http://www.etr.org/ebi/programs/cuidate/

Sample of curriculum available for review prior to purchase

Yes

Adaptation guidelines or kit available

Yes

Languages available

English and Spanish

Program Core Components

Program Objectives

The program has three primary goals. They are to:

Influence attitudes, behavioral and normative beliefs, and self-efficacy regarding HIV risk-reduction behaviors, specifically abstinence and condom use, by incorporating the theme of ¡Cuídate! (i.e. taking care of oneself, one’s partner, family, and community).
Highlight cultural values that support safer sex, and reframe cultural values that are perceived as barriers to safer sex.
Emphasize how cultural values influence attitudes and beliefs in ways that affect HIV risk-associated sexual behavior.

Program Content

The program focuses on incorporating the theme of ¡Cuídate! (taking care of oneself and one's partner, family and community) throughout the program. It does so by using culturally and linguistically appropriate materials and activities (including modeling and role-plays), to show and emphasize core Latino cultural values, specifically familialism and gender-roles, and how those are consistent with safer-sex behavior. The intervention incorporates activities that increase knowledge and influence positive attitudes, beliefs and self-efficacy regarding HIV sexual risk-reduction behaviors.

The program's six sessions are:

Introduction and Overview
Building Knowledge about HIV, STDs and Pregnancy
Understanding Vulnerability to Pregnancy, STDs and HIV Infection
Attitudes and Beliefs About Pregnancy, STDs, HIV and Safer Sex
Building Condom Use Skills
Building Negotiation and Refusal Skills

iCuidate! also includes the development of an Advisory Board made up of community members, which can provide unique insight to the target population.

Program Methods

Participants model and practice the effective use of condoms, and build skills in problem solving, negotiation of safer-sex and refusal of unsafe sex. Sessions are facilitator-led, and designed to be highly participatory, and rely on interactive small groups, role-plays and scenarios to demonstrate and emphasize specific points. Participants are encouraged to practice the skills learned. The program uses music and videos relevant to the target population or community.

Program Structure and Timeline

The program consists of six 60-minute modules delivered over 2 days or more. Participants are organized in small mixed gender groups of 6 to 10 youth.

Staffing

The program requires at least one formally trained staff member to help organize and facilitate the program's implementation. Facilitators should have a comprehensive understanding of Latino culture (with particular emphasis on sexual relationship dynamics), the developing sexual needs of youth, and the relevance of HIV/AIDS, STD, and pregnancy for Latino youth.

Support staff and an Advisory Board are also needed to assist facilitators and program managers.

Support staff can include members of the community, current staff members of the implementing agency, or peer advisors/mentors.
The Advisory board should be comprised of community members with insights into the needs of targeted youth.

Program Materials and Resources

The iCuidate! 2nd edition implementation kit consists of:

Facilitator Curriculum
Curriculum DVD and CD set
- ¡Cuidate! Take Care of Yourself
- Demasiado Joven
- Sofia & Miguel: Condom Negotiation
- Music CD
Activity Set
A printable activity set (on CD)

The distributor also provides access to a table of contents and a sample lesson on their website: http://www.etr.org/ebi/programs/cuidate/

Additional Needs for Implementation

Location selection should be based on several factors, such as adequate, safe, secure space, access to material that cannot be transported (e.g., electrical outlets for TV/DVD player), and a central location that is easily accessible.

Fidelity

Guidance for implementing iCuidate! with fidelity can be found on ETR’s Program Success Center website: http://www.etr.org/ebi/programs/cuidate/

Staff Training

Formal training is highly recommended for educators who plan to teach iCuidate! to prepare them to effectively implement and replicate the curriculum with fidelity for the intended participants.

Training on ¡Cuídate! is available through ETR's Professional Learning Services. Training options include a 2-day Training of Educators with follow-up support. Visit http://www.etr.org/ebi/training-ta/types-of-services/training-of-educators/ for more information or submit a Training & TA Request Form.

Technical Assistance and Ongoing Support

ETR provides in-person and web- or phone-based technical assistance before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation. Contact ETR’s Professional Learning Services through the Program Support Help Desk or visit http://www.etr.org/ebi/training-ta/.

Allowable Adaptations

The developer notes the following allowable adaptations to the program, but consultation with the model developer in the adaptation process is necessary to ensure fidelity:

Program Structure:

In the original research study, the program was conducted in two sessions (3 modules per session) within a 1-week period. It would be feasible to deliver more sessions (e.g., 3 sessions with 2 modules per session, over a 3-week period or 6 sessions with 1 module per session, over a 6-week period). It is recommended that there be a minimum of two sessions to allow sufficient time for participants to process the information presented.

Program Participants:

In the original research study, groups included boys and girls. Both girls and boys responded favorably to the group mix, saying they were interested in what the other sex thought. Single gender groups might also be effective. Group size should be large enough to provide interaction among participants, and to allow all youth to practice skills. Larger groups may be feasible if more than one facilitator is available.
Age range of participants is 13 to 18 years. In the original research study, a diverse age range did not create difficulties. You may decide to include a similar age range or restrict groups to a specific age range.

Program Facilitators:

Facilitators able to work with youth and demonstrate correct condom use techniques: Professionals and community workers can effectively deliver the ¡Cuídate! program. They should be comfortable with youth and in discussing sexual issues.

Program Activities:

Use of role-plays and scenarios to demonstrate and emphasize specific points included in the program and to allow participants to practice skills learned: Specifics of role-plays can be changed to address the age, sexual experience, language, race/ethnicity and sexual orientation of the group.
Use of music and videos relevant to your population or community: Several places in the program allow flexibility in choosing music or videos to reinforce important messages or themes in the program.

Program Language:

Sessions may be conducted in either English or Spanish. It is recommended that the program be conducted in only one language because switching languages when youth are NOT bilingual can interrupt the group dynamic.

Reviewed Studies

Citation	High-Quality Randomized Trial	Did Not Meet Eligibility Criteria
		✓
Abt Associates 2015c Kelsey et al. 2016a Kelsey et al. 2016b	✓
Larson et al. 2014		✓
Mueller et al. 2009		✓
Serowoky et al. 2015		✓
Villarruel et al. 2006	✓

Study Characteristics

Citation	Setting	Majority Age Group	Majority Racial/Ethnic Group	Gender	Sample Size
	n.a.	n.a.	n.a.	n.a.	n.a.
Abt Associates 2015c Kelsey et al. 2016a Kelsey et al. 2016b	After school	14 to 17	Hispanic or Latinx of any race	Youth of any gender	2022
Larson et al. 2014	n.a.	n.a.	n.a.	n.a.	n.a.
Mueller et al. 2009	n.a.	n.a.	n.a.	n.a.	n.a.
Serowoky et al. 2015	n.a.	n.a.	n.a.	n.a.	n.a.
Villarruel et al. 2006	After school	14 to 17	Hispanic or Latinx of any race	Youth of any gender	684

Study Findings

Evidence by Outcome Domain and Study

Citation	Sexual Activity	Number of Sexual Partners	Contraceptive Use	STIs or HIV	Pregnancy
	n.a.	n.a.	n.a.	n.a.	n.a.
Abt Associates 2015c Kelsey et al. 2016a Kelsey et al. 2016b		n.a.
Larson et al. 2014	n.a.	n.a.	n.a.	n.a.	n.a.
Mueller et al. 2009	n.a.	n.a.	n.a.	n.a.	n.a.
Serowoky et al. 2015	n.a.	n.a.	n.a.	n.a.	n.a.
Villarruel et al. 2006				n.a.	n.a.

Detailed Findings

Citation	Details

Abt Associates 2015c Kelsey et al. 2016a Kelsey et al. 2016b	A subsequent study by a separate group of researchers evaluated the program when implemented on a broader scale and with a more broadly-defined target population. The study used a randomized controlled trial involving adolescents recruited from schools and community-based organizations across three states (Arizona, California, and Massachusetts). Study participants were randomly assigned to either a treatment group that was offered the program during school or as part of an afterschool program, or to a control group that received their regular school curriculum and (in some sites) a healthy lifestyle curriculum or other after-school activities. Surveys were administered before random assignment (baseline), and six and 18 months after study enrollment. For the full study sample, six months after study enrollment, the study found no statistically significant program impacts on the likelihood of respondents reporting ever being sexually active, being sexually active in the last 90 days, or having sex without a condom or other form of birth control in the last 90 days. Among the subgroup of study participants who were sexually experienced at baseline, the study found evidence of an adverse effect six months after study enrollment: adolescents in the intervention group were significantly more likely to report having had sexual intercourse in the previous 90 days. This difference was not observed in the subgroup of study participants who had never been sexually active at baseline. For the follow-up that occurred 18 months after study enrollment, the study found no evidence of statistically significant programs impacts on the likelihood of being sexually active in the last 90 days or having sex without a condom or other form of birth control in the last 90 days, for the full sample. Among the subgroup of adolescents who were not sexually experienced at baseline, the study found no evidence of statistically significant program impacts on sexual initiation. At the 18-month follow-up, the study also found no evidence of statistically significant program impacts on the likelihood of becoming pregnant or getting someone pregnant since baseline, or being diagnosed with a STI in the last 12 months. The study findings are not directly comparable with those reported in the initial study of the program (Villaruel et al. 2006) because they estimate program impacts at a single time point, whereas the initial study reported impacts averaged across multiple follow-up periods. The study also examined program impacts on attitudes, motivation, skills, and intentions related to sexual activity, as well as subgroup impacts by race. Findings for these outcomes and subgroups were not considered for the review because they fell outside the scope of the review.
Larson et al. 2014
Mueller et al. 2009
Serowoky et al. 2015
Villarruel et al. 2006	The program's evidence of effectiveness was first established in a randomized controlled trial involving Latino adolescents recruited from three neighborhood high schools and community-based organizations in Philadelphia. About half the study participants were randomly selected for a treatment group that was offered the eight-hour intervention over two consecutive Saturdays. The other participants were assigned to a control group that received a general health promotion curriculum on diet, exercise, and substance use. Surveys were administered immediately before the program (baseline), immediately after the program, and three, six and 12 months after the program ended. The study found that, averaged across all follow-up periods, adolescents in the intervention group were significantly less likely to report having had sexual intercourse and having had multiple sexual partners in the past three months, and reported significantly fewer days of unprotected sex. Adolescents in the intervention group were also more likely to report consistent condom use. The study found no statistically significant program impacts on condom use at last sex or the proportion of days of condom-protected sex.

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