¡Cuídate!

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
Languages Available
English, Spanish
Monitoring and Evaluation Tools
Monitoring and evaluation tools available
No
Monitoring and evaluation tool usage required
No
Program Core Components

The data presented on this page reflects responses from the program’s developer or distributor to a program component checklist that asked them to report on the individual components within their TPP program. The same program component checklist was sent to the developer or distributor of every active TPP program with evidence of effectiveness. The program component table provides data on seven types of program components including content, delivery mechanism, dosage, staffing, format, environment, and intended population characteristics; whether the component was present or optional in the program; whether the component is considered to be core to the program; and the lesson number or activity where the component can be found in the program. For more details, refer to the FAQ.

Program component data is not available.

Program Objectives
The program has three primary goals. They are to:
  1. 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).
  2. Highlight cultural values that support safer sex, and reframe cultural values that are perceived as barriers to safer sex.
  3. 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:
  1. Introduction and Overview
  2. Building Knowledge about HIV, STDs and Pregnancy
  3. Understanding Vulnerability to Pregnancy, STDs and HIV Infection
  4. Attitudes and Beliefs About Pregnancy, STDs, HIV and Safer Sex
  5. Building Condom Use Skills
  6. 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.
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.

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/

 

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.
Adaptation Guidelines or Kit
Yes
Reviewed Studies
Citation High-Quality Randomized Trial Moderate-Quality Randomized Trial Moderate-Quality Quasi-Experiment Low Study Rating Did Not Meet Eligibility Criteria

Villarruel, A. M., Jemmott, J. B., Jemmott, L. S. (2006). A randomized controlled trial testing an HIV prevention intervention for Latino youth. Archives of Pediatrics Adolescent Medicine, 160(8), 772-777.

 		✓

Mueller, T. E., Castaneda, C. A., Sainer, S., Martinez, D., Herbst, J. H., Wilkes, A. L., Villarruel, A. M. (2009). The implementation of a culturally based HIV sexual risk reduction program for Latino youth in a Denver area high school. AIDS Education and Prevention, 21, Supplement B, 164-170.

 		✓

Larson, K. L., Ballard, S. M., Nuncio, B. J., Swanson, M. (2014). Testing the Feasibility of ¡Cuídate! With Mexican and Central American Youth in a Rural Region of a Southern State. Research in Nursing Health, 1-14. DOI: 10.1002/nur.21621

 		✓

Serowoky, M. L., George, N., Yarandi, H. (2015). Using the program logic model to evaluate ¡Cuídate!: A sexual health program for latino adolescents in a school-based health center. Worldviews on Evidence-Based Nursing, 12(5), 297-305.

 		✓

Abt Associates. ¡Cuídate!: Interim Impact Report, Teen Pregnancy Prevention Replication Study, Report prepared for the Office of Adolescent Health and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, September 2015c.

Kelsey, M., Layzer, C., Layzer, J., Price, C., Juras, R., Blocklin, M., Mendez, J. (2016a). Replicating ¡Cuídate!: 6-month impact findings of a randomized controlled trial. American Journal of Public Health, 106, S70-S77. doi:10.2105/AJPH.2016.303371

Kelsey, M., Layzer, J., Price, C., and Juras, R. "¡Cuídate!: Final Impact Report." Draft Teen Pregnancy Prevention Replication Study, Abt Associates: Cambridge, MA, November 2016b.

 		✓

Espada, J. P., Escribano, S., Morales, A., Orgil's, M. (2017). Two-Year Follow-Up of a Sexual Health Promotion Program for Spanish Adolescents. Evaluation the Health Professions, 40(4), 483–504. https://doi.org/10.1177/0163278716652217

 		✓
Study Characteristics
Citation Setting Majority Age Group Majority Racial/Ethnic Group Gender Sample Size

Villarruel, A. M., Jemmott, J. B., Jemmott, L. S. (2006). A randomized controlled trial testing an HIV prevention intervention for Latino youth. Archives of Pediatrics Adolescent Medicine, 160(8), 772-777.

 		After school 14 to 17 Hispanic or Latinx of any race Youth of any gender

684

Mueller, T. E., Castaneda, C. A., Sainer, S., Martinez, D., Herbst, J. H., Wilkes, A. L., Villarruel, A. M. (2009). The implementation of a culturally based HIV sexual risk reduction program for Latino youth in a Denver area high school. AIDS Education and Prevention, 21, Supplement B, 164-170.

 		n.a. n.a. n.a. n.a. n.a.

Larson, K. L., Ballard, S. M., Nuncio, B. J., Swanson, M. (2014). Testing the Feasibility of ¡Cuídate! With Mexican and Central American Youth in a Rural Region of a Southern State. Research in Nursing Health, 1-14. DOI: 10.1002/nur.21621

 		n.a. n.a. n.a. n.a. n.a.

Serowoky, M. L., George, N., Yarandi, H. (2015). Using the program logic model to evaluate ¡Cuídate!: A sexual health program for latino adolescents in a school-based health center. Worldviews on Evidence-Based Nursing, 12(5), 297-305.

 		n.a. n.a. n.a. n.a. n.a.

Abt Associates. ¡Cuídate!: Interim Impact Report, Teen Pregnancy Prevention Replication Study, Report prepared for the Office of Adolescent Health and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, September 2015c.

Kelsey, M., Layzer, C., Layzer, J., Price, C., Juras, R., Blocklin, M., Mendez, J. (2016a). Replicating ¡Cuídate!: 6-month impact findings of a randomized controlled trial. American Journal of Public Health, 106, S70-S77. doi:10.2105/AJPH.2016.303371

Kelsey, M., Layzer, J., Price, C., and Juras, R. "¡Cuídate!: Final Impact Report." Draft Teen Pregnancy Prevention Replication Study, Abt Associates: Cambridge, MA, November 2016b.

 		After school 14 to 17 Hispanic or Latinx of any race Youth of any gender

2022

Espada, J. P., Escribano, S., Morales, A., Orgil's, M. (2017). Two-Year Follow-Up of a Sexual Health Promotion Program for Spanish Adolescents. Evaluation the Health Professions, 40(4), 483–504. https://doi.org/10.1177/0163278716652217

 		n.a. n.a. n.a. n.a. n.a.
Study Findings

Evidence by Outcome Domain and Study

Citation Sexual Activity Number of Sexual Partners Contraceptive Use STIs or HIV Pregnancy

Villarruel, A. M., Jemmott, J. B., Jemmott, L. S. (2006). A randomized controlled trial testing an HIV prevention intervention for Latino youth. Archives of Pediatrics Adolescent Medicine, 160(8), 772-777.

 		Potentially favorable evidence Potentially favorable evidence Favorable evidence n.a. n.a.

Mueller, T. E., Castaneda, C. A., Sainer, S., Martinez, D., Herbst, J. H., Wilkes, A. L., Villarruel, A. M. (2009). The implementation of a culturally based HIV sexual risk reduction program for Latino youth in a Denver area high school. AIDS Education and Prevention, 21, Supplement B, 164-170.

 		n.a. n.a. n.a. n.a. n.a.

Larson, K. L., Ballard, S. M., Nuncio, B. J., Swanson, M. (2014). Testing the Feasibility of ¡Cuídate! With Mexican and Central American Youth in a Rural Region of a Southern State. Research in Nursing Health, 1-14. DOI: 10.1002/nur.21621

 		n.a. n.a. n.a. n.a. n.a.

Serowoky, M. L., George, N., Yarandi, H. (2015). Using the program logic model to evaluate ¡Cuídate!: A sexual health program for latino adolescents in a school-based health center. Worldviews on Evidence-Based Nursing, 12(5), 297-305.

 		n.a. n.a. n.a. n.a. n.a.

Abt Associates. ¡Cuídate!: Interim Impact Report, Teen Pregnancy Prevention Replication Study, Report prepared for the Office of Adolescent Health and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, September 2015c.

Kelsey, M., Layzer, C., Layzer, J., Price, C., Juras, R., Blocklin, M., Mendez, J. (2016a). Replicating ¡Cuídate!: 6-month impact findings of a randomized controlled trial. American Journal of Public Health, 106, S70-S77. doi:10.2105/AJPH.2016.303371

Kelsey, M., Layzer, J., Price, C., and Juras, R. "¡Cuídate!: Final Impact Report." Draft Teen Pregnancy Prevention Replication Study, Abt Associates: Cambridge, MA, November 2016b.

 		Potentially unfavorable evidence n.a. Indeterminate evidence Indeterminate evidence Indeterminate evidence

Espada, J. P., Escribano, S., Morales, A., Orgil's, M. (2017). Two-Year Follow-Up of a Sexual Health Promotion Program for Spanish Adolescents. Evaluation the Health Professions, 40(4), 483–504. https://doi.org/10.1177/0163278716652217

 		n.a. n.a. n.a. n.a. n.a.
KEY
Evidence Indication
Favorable findings
Two or more favorable impacts and no unfavorable impacts, regardless of null findings
Potentially favorable findings
At least one favorable impact and no unfavorable impacts, regardless of null findings
Indeterminate findings
Uniformly null findings
Conflicting findings
At least one favorable and at least one unfavorable impact, regardless of null findings
Potentially unfavorable findings
At least one unfavorable impact and no favorable impacts, regardless of null findings
Unfavorable findings
Two or more unfavorable impacts and no favorable impacts, regardless of null findings
Note: n.a. indicates the study did not examine any outcome measures within that particular outcome domain, or the study examined outcome measures within that domain but the findings did not meet the review evidence standards.
Detailed Findings
Citation Details

Villarruel, A. M., Jemmott, J. B., Jemmott, L. S. (2006). A randomized controlled trial testing an HIV prevention intervention for Latino youth. Archives of Pediatrics Adolescent Medicine, 160(8), 772-777.

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.

Mueller, T. E., Castaneda, C. A., Sainer, S., Martinez, D., Herbst, J. H., Wilkes, A. L., Villarruel, A. M. (2009). The implementation of a culturally based HIV sexual risk reduction program for Latino youth in a Denver area high school. AIDS Education and Prevention, 21, Supplement B, 164-170.

This study did not meet the review's screening criteria

Larson, K. L., Ballard, S. M., Nuncio, B. J., Swanson, M. (2014). Testing the Feasibility of ¡Cuídate! With Mexican and Central American Youth in a Rural Region of a Southern State. Research in Nursing Health, 1-14. DOI: 10.1002/nur.21621

This study did not meet the review's eligibility criteria

Serowoky, M. L., George, N., Yarandi, H. (2015). Using the program logic model to evaluate ¡Cuídate!: A sexual health program for latino adolescents in a school-based health center. Worldviews on Evidence-Based Nursing, 12(5), 297-305.

This study did not meet the review's eligibility criteria

Abt Associates. ¡Cuídate!: Interim Impact Report, Teen Pregnancy Prevention Replication Study, Report prepared for the Office of Adolescent Health and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, September 2015c.

Kelsey, M., Layzer, C., Layzer, J., Price, C., Juras, R., Blocklin, M., Mendez, J. (2016a). Replicating ¡Cuídate!: 6-month impact findings of a randomized controlled trial. American Journal of Public Health, 106, S70-S77. doi:10.2105/AJPH.2016.303371

Kelsey, M., Layzer, J., Price, C., and Juras, R. "¡Cuídate!: Final Impact Report." Draft Teen Pregnancy Prevention Replication Study, Abt Associates: Cambridge, MA, November 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.

Espada, J. P., Escribano, S., Morales, A., Orgil's, M. (2017). Two-Year Follow-Up of a Sexual Health Promotion Program for Spanish Adolescents. Evaluation the Health Professions, 40(4), 483–504. https://doi.org/10.1177/0163278716652217

This study did not meet the review's screening criteria

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample. A blank cell indicates the study did not examine any outcome measures within the particular outcome domain or the findings for the outcome measures within that domain did not meet the review evidence standards.

Information on evidence of effectiveness is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.