Prevention of Injuries Among Young Children: Tailoring a Home Supervision Intervention for Latinx Caregivers

3. APPROACH 3.1 Procedures. The SHS program will be extended to a Latinx population using procedures established by the Centers for Disease Control and Prevention and known as the Map of Adaptation Process. Although there is much diversity within Latinx cultures, the large majority of Latinx families living in Southwest Michigan are of Mexican heritage. Thus, our adaptations will reflect the culture and language of families from Mexico and Central America. The adaptation process emphasizes the need to maintain fidelity of the core elements of an evidence-based intervention like SHS while increasing its relevance (i.e., tailoring it) for a new population. This is achieved by following several steps, which will guide the present study. These steps include: (a) assess the target population's needs (established already by the literature); (b) select an intervention to address those needs (SHS program); (c) prepare the intervention for adaptation (steps 1-3 - see below); and (d) pilot and test the intervention (steps 4-5 below).

Thus, our study will involve an iterative process including five steps. In step 1 we will translate intervention materials (written materials and videos) and conduct focus groups with Latinx caregivers from the community and staff from three Latinx resource centers to identify modifications to be made to program materials. In step 2, the investigators will modify the intervention and video materials based on these focus group data. The investigators anticipate that this step will include making new program videos depicting local Spanish speaking families. The investigators will also make a new introductory video to feature a Spanish speaking narrator. In step 3, the investigators will conduct additional focus groups with Latinx caregivers and center staff using the modified intervention content and make additional changes to the materials if needed. In step 4, the investigators will pilot test the modified intervention with a small group of caregivers and make final modifications. In step 5, the investigators will conduct an RCT to test the modified intervention, including its impact on caregivers' supervision practices and children's injury frequency.

Local Latinx Resource Centers. The investigators will partner with three nearby agencies serving Latinx families: El Concilio (Kalamazoo), Voces (Battle Creek, 30 miles away from campus), and the Hispanic Center of West Michigan (Grand Rapids, 53 miles away). Each agency provides services for Latinx members of their respective communities, including professional translation and interpretation services, liaison services (between families and schools), support regarding immigration and legal issues, assistance accessing resources (e.g., Medicaid, food stamps), youth programs, English as a second language courses, adult education, workforce development and vocational training, and GED classes. Combined, the three Latinx community centers serve approximately 16,000 individuals per year. The Latinx population of each community is as follows: Kalamazoo (5.2%); Battle Creek (7.5%); and Grand Rapids (16.1%; US Census Bureau, 2019).

Head Start. The investigators will also recruit Latinx families from Kent County Head Start. The investigators have successfully collaborated with Kent County Head Start in past research. Head Start is a national program that provides free preschool for l0w-income families of children ages 3-5. The program focuses on kindergarten readiness and also typically provides additional supports for families, such as parental education and linkage to community resources. Kent County Head Start serves approximately 1500 children per year; 30% (450) of these children are Latinx.

Step One: In step 1, the investigators will identify modifications that need to be made to the SHS intervention by conducting 1.5 hour focus groups with both Latinx caregivers of young children (ages 2-5) as well as a focus group with staff from the three Latinx resource centers. Based on recommended sample sizes for focus group research, the investigators will present the SHS materials to Latinx caregivers in three in-person focus groups of 6-8 participants. The investigators will conduct one focus group in each of the Latinx centers from which the investigators will be recruiting (Kalamazoo, Battle Creek, and Grand Rapids). The investigators will conduct one additional focus group including 2-3 agency staff from each of the 3 Latinx serving centers. The investigators will use the SHS materials that have been modified to be appropriate for low-income families from Dr. Damashek's current R15. For these focus groups, the investigators will make preliminary changes to program materials (to make them suitable for the focus group) by translating written materials into Spanish, dubbing video materials to have Spanish voices, and translating subtitles on the videos into Spanish; Morrongiello and her graduate student will make video modifications. Professional translations will be conducted by certified translators at the Latinx resource center in Kalamazoo. Caregiver and staff focus groups will be facilitated by a bilingual RA, in combination with Dr. Damashek. Focus groups will be video recorded and transcribed by a bilingual RA. Transcriptions will be translated into English by a certified translator and will be coded by Drs. Damashek and Morrongiello and URA's to identify themes (i.e., aspects that were helpful about the materials and aspects that need to be changed).