Abstract
We piloted the preventive intervention e-Familias Unidas, delivered exclusively through the Internet to maximize reach and sustainability. This program is an adaptation of an evidence-based, family-centered intervention that aims to prevent Hispanic adolescent drug use and risky sexual behavior through improving family functioning. The purpose of this feasibility trial was to: (1) explore the use of Facebook and a trusted community champion in the online recruitment of Hispanic parents of adolescents, (2) test an online-only assessment and randomization protocol, (3) pilot intervention delivery via e-familiasunidas.com, and (4) assess pre-post changes in family functioning. We tracked participant recruitment and enrollment via Facebook analytics and REDCap. Intervention completion was tracked via our website. We conducted an ANCOVA to test for between group (e-Familias Unidas vs. control) differences post-intervention. Recruitment lasted for a total of 10 weeks and was divided into three phases, with each phase systematically assessing which strategies maximized recruitment and enrollment. Overall, 93 Hispanic parents enrolled in the study. Of those randomized to the intervention group (n = 46), 70% were engaged and watched an average of 5.4 out of the 12 online videos. We found that participants recruited through a community champion, versus Facebook advertisements, had higher rates of enrollment and intervention completion. There was a significant improvement in parent-adolescent communication for parents who received e-Familias Unidas compared to those in the control group (n = 47). This pilot trial demonstrated it is feasible to recruit, assess, and deliver e-Familias Unidas to Hispanic parents through an online-only platform. Our findings highlight the promise of an online platform to optimize the reach of preventive interventions for underserved populations, to more effectively target participants, and to disseminate sustainable evidence-based interventions. We discuss lessons learned and recommendations for future research.
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Notes
Facebook advertisements directed participants to the study. Facebook page promotion directed participants to our public Facebook page, which had information on how to enroll in the study, parenting tips, and other Familias Unidas-related materials.
Screenshots of advertisements and Facebook Page can be found in Appendix A.
References
Abbott, J. H. (2014). The distinction between randomized clinical trials (RCTs) and preliminary feasibility and pilot studies: What they are and are not. Journal of Orthopaedic & Sports Physical Therapy, 44(8), 555–558. https://doi.org/10.2519/jospt.2014.0110.
Abdus, S., Mistry, K. B., & Selden, T. M. (2015). Racial and ethnic disparities in services and the patient protection and affordable care act. American Journal of Public Health, 105(S5), S668–S675. https://doi.org/10.2105/AJPH.2015.302892.
Anderson-Lewis, C., Darville, G., Mercado, R. E., Howell, S., & Di Maggio, S. (2018). mHealth technology use and implications in historically underserved and minority populations in the United States: Systematic literature review. Journal of Medical Internet Research mHealth and uHealth, 6(6), e128. https://doi.org/10.2196/mhealth.8383.
Bailey, M. B., & Nawara, S. P. (2018). Addressing women and minorities on social media by the 2016 US presidential candidates. Social Science Computer Review. https://doi.org/10.1177/0894439318779342.
Barnes, H. L., & Olson, D. H. (1985). Parent-adolescent communication and the circumplex model. Child Development, 56(2), 438–447.
Bennett, G. G., & Glasgow, R. E. (2009). The delivery of public health interventions via the Internet: Actualizing their potential. Annual Review of Public Health, 30, 273–292. https://doi.org/10.1146/annurev.publhealth.031308.100235.
Biernacki, P., & Waldorf, D. (1981). Snowball sampling: Problems and techniques of chain referral sampling. Sociological Methods & Research, 10(2), 141–163. https://doi.org/10.1177/004912418101000205.
Brown, C. H., Bennett, M. E., Li, L., & Bellack, A. S. (2011). Predictors of initiation and engagement in substance abuse treatment among individuals with co-occurring serious mental illness and substance use disorders. Addictive Behaviors, 36(5), 439–447. https://doi.org/10.1016/j.addbeh.2010.12.001.
Brown, A., Lopez, G., & Lopez, M. H. (2016). Hispanics and mobile access to the internet Retrieved May 5, 2017, from http://www.pewhispanic.org/2016/07/20/3-hispanics-and-mobile-access-to-the-internet/.
Council, N. R. (2014). Strategies for scaling effective family-focused preventive interventions to promote children’s cognitive, affective, and behavioral health: Workshop summary. Washigton: National Academies Press.
Curran, K., Graham, S., & Temple, C. (2011). Advertising on Facebook. International Journal of E-business Development, 1(1), 26–33.
Estrada, Y., Lee, T. K., Huang, S., Tapia, M. I., Velázquez, M.-R., Martinez, M. J., et al. (2017). Parent-centered prevention of risky behaviors among Hispanic youths in Florida. American Journal of Public Health, 107(4), 607–613. https://doi.org/10.2105/AJPH.2017.303653.
Estrada, Y., Lee, T. K., Wagstaff, R., Rojas, L. M., Tapia, M. I., Velasquez, M. R., et al. (2019). eHealth Familias Unidas: Efficacy trial of an evidence-based intervention adapted for use on the internet with Hispanic families. Prevention Science, 20(1), 68–77. https://doi.org/10.1007/s11121-018-0905-6.
Estrada, Y., Molleda, L., Murray, A., Drumhiller, K., Tapia, M., Sardinas, K., et al. (2017). eHealth familias unidas: Pilot study of an internet adaptation of an evidence-based family intervention to reduce drug use and sexual risk behaviors among Hispanic adolescents International. Journal of Environmental Research and Public Health, 14(3), 264. https://doi.org/10.3390/ijerph14030264.
“Facts on Latinos in the U.S.” Pew Research Center, Washington, D.C. (2019). Retrieved October 7, 2020, from http://pewresearch.org/about/terms-and-conditions/
Gorman-Smith, D., Tolan, P. H., Zelli, A., & Huesmann, L. R. (1996). The relation of family functioning to violence among inner-city minority youths. Journal of Family Psychology, 10(2), 115. https://doi.org/10.1037/0893-3200.10.2.115.
Gruver, R. S., Bishop-Gilyard, C. T., Lieberman, A., Gerdes, M., Virudachalam, S., Suh, A. W., et al. (2016). A social media peer group intervention for mothers to prevent obesity and promote healthy growth from infancy: Development and pilot trial. Journal of Medical Internet Research Research Protocols. https://doi.org/10.2196/resprot.5276.
Haggerty, K. P., MacKenzie, E. P., Skinner, M. L., Harachi, T. W., & Catalano, R. F. (2006). Participation in “Parents Who Care”: Predicting program initiation and exposure in two different program formats. Journal of Primary Prevention, 27(1), 47–65. https://doi.org/10.1007/s10935-005-0019-3.
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap): A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010.
Ketelaar, P. E., Janssen, L., Vergeer, M., van Reijmersdal, E. A., Crutzen, R., & van‘t Riet , J. (2016). The success of viral ads: Social and attitudinal predictors of consumer pass-on behavior on social network sites. Journal of Business Research, 69(7), 2603–2613. https://doi.org/10.1016/j.jbusres.2015.10.151.
Kosinski, M., Matz, S. C., Gosling, S. D., Popov, V., & Stillwell, D. (2015). Facebook as a research tool for the social sciences: Opportunities, challenges, ethical considerations, and practical guidelines. American Psychologist, 70(6), 543. https://doi.org/10.1037/a0039210.
Martinez, C. R., McClure, H. H., Eddy, J. M., Ruth, B., & Hyers, M. J. (2012). Recruitment and retention of Latino immigrant families in prevention research. Prevention Science, 13(1), 15–26. https://doi.org/10.1007/s11121-011-0239-0.
McTigue, K. M., Conroy, M. B., Hess, R., Bryce, C. L., Fiorillo, A. B., Fischer, G. S., et al. (2009). Using the internet to translate an evidence-based lifestyle intervention into practice. Telemedicine and e-Health, 15(9), 851–858. https://doi.org/10.1089/tmj.2009.0036.
Miller, P. G., & Sønderlund, A. L. (2010). Using the internet to research hidden populations of illicit drug users: A review. Addiction, 105(9), 1557–1567. https://doi.org/10.1111/j.1360-0443.2010.02992.x|.
Molleda, L., Bahamon, M., George, S. M. S., Perrino, T., Estrada, Y., Herrera, D. C., & Prado, G. (2017). Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. Journal of Pediatric Health Care, 31(3), 350–361. https://doi.org/10.1016/j.pedhc.2016.11.001.
Molleda, L., Estrada, Y., Lee, T. K., Poma, S., Terán, A. M. Q., Tamayo, C. C., et al. (2017). Short-term effects on family communication and adolescent conduct problems: Familias Unidas in Ecuador. Prevention Science, 18(7), 783–792. https://doi.org/10.1007/s11121-016-0744-2.
Nieuwboer, C. C., Fukkink, R. G., & Hermanns, J. M. (2013). Online programs as tools to improve parenting: A meta-analytic review. Children and Youth Services Review, 35(11), 1823–1829. https://doi.org/10.1016/j.childyouth.2013.08.008.
Oesterle, S., Epstein, M., Haggerty, K. P., & Moreno, M. A. (2018). Using Facebook to recruit parents to participate in a family program to prevent teen drug use. Prevention Science. https://doi.org/10.1007/s11121-017-0844-7.
Pantin, H. (1996). Ecodevelopmental measures of support and conflict for Hispanic youth and families. Miami, FL: University of Miami School of Medicine.
Pantin, H., Prado, G., Lopez, B., Huang, S., Tapia, M. I., Schwartz, S. J., et al. (2009). A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems. Psychosomatic Medicine, 71(9), 987. https://doi.org/10.1097/PSY.0b013e3181bb2913.
Pedersen, E. R., & Kurz, J. (2016). Using Facebook for health-related research study recruitment and program delivery. Current Opinion in Psychology, 9, 38–43. https://doi.org/10.1016/j.copsyc.2015.09.011.
Perrino, T., Brincks, A., Howe, G., Brown, C. H., Prado, G., & Pantin, H. (2016). Reducing internalizing symptoms among high-risk, Hispanic adolescents: Mediators of a preventive family intervention. Prevention Science, 17(5), 595–605. https://doi.org/10.1007/s11121-016-0655-2.
Perrino, T., Coatsworth, J. D., Briones, E., Pantin, H., & Szapocznik, J. (2001). Initial engagement in parent-centered preventive interventions: A family systems perspective. Journal of Primary Prevention, 22(1), 21–44. https://doi.org/10.1023/A:1011036130341.
Perrino, T., Estrada, Y., Huang, S., St George, S., Pantin, H., Cano, M. Á., et al. (2018). Predictors of participation in an eHealth, family-based preventive intervention for Hispanic youth. Prevention Science, 19(5), 630–641. https://doi.org/10.1007/s11121-016-0711-y.
Prado, G., Cordova, D., Huang, S., Estrada, Y., Rosen, A., Bacio, G. A., et al. (2012). The efficacy of Familias Unidas on drug and alcohol outcomes for Hispanic delinquent youth: Main effects and interaction effects by parental stress and social support. Drug and Alcohol Dependence, 125, S18–S25. https://doi.org/10.1016/j.drugalcdep.2012.06.011.
Prado, G., & Pantin, H. (2011). Reducing substance use and HIV health disparities among Hispanic youth in the USA: The Familias Unidas program of research. Intervencion Psicosocial, 20(1), 63. https://doi.org/10.5093/in2011v20n1a6.
Prado, G., Pantin, H., Briones, E., Schwartz, S. J., Feaster, D., Huang, S., et al. (2007). A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents. Journal of Consulting and Clinical Psychology, 75(6), 914. https://doi.org/10.1037/0022-006X.75.6.914.
Prado, G., Pantin, H., Schwartz, S. J., Lupei, N. S., & Szapocznik, J. (2005). Predictors of engagement and retention into a parent-centered, ecodevelopmental HIV preventive intervention for Hispanic adolescents and their families. Journal of Pediatric Psychology, 31(9), 874–890. https://doi.org/10.1093/jpepsy/jsj046.
Ramo, D. E., Thrul, J., Chavez, K., Delucchi, K. L., & Prochaska, J. J. (2015). Feasibility and quit rates of the tobacco status project: A Facebook smoking cessation intervention for young adults. Journal of Medical Internet Research. https://doi.org/10.2196/jmir.5209.
Rodríguez, M. D., Rodriguez, J., & Davis, M. (2006). Recruitment of first-generation Latinos in a rural community: The essential nature of personal contact. Family Process, 45(1), 87–100. https://doi.org/10.1111/j.1545-5300.2006.00082.x|.
Rojas, L. M., Ochoa, L. G., Sanchez Ahumada, M., Quevedo Teran, A., Retamal, V., Condo Tamayo, C., & Prado, G. (2020). Parent attendance in a family-based preventive intervention delivered in Latin America and the United States. Health Promotion Practice. https://doi.org/10.1177/1524839919900765.
Sandler, I., Ingram, A., Wolchik, S., Tein, J. Y., & Winslow, E. (2015). Long-term effects of parenting-focused preventive interventions to promote resilience of children and adolescents. Child Development Perspectives, 9(3), 164–171. https://doi.org/10.1111/cdep.12126|.
Smith, A., & Anderson, M. (2018). Social Media Use in 2018. Retrieved from http://www.pewinternet.org/2018/03/01/social-media-use-in-2018/.
Spoth, R., & Redmond, C. (2000). Research on family engagement in preventive interventions: Toward improved use of scientific findings in primary prevention practice. Journal of Primary Prevention, 21(2), 267–284. https://doi.org/10.1023/A:1007039421026.
Trust for America's Health. (2019). Promoting health and cost control in states: How states can improve community health & well-being through policy change. Trust for America's Health. Washington, D.C. Retrieved May 7, 2017, from https://www.tfah.org/wp-content/uploads/2019/02/2019-PHACCS-Report_FINAL.pdf.
Vyas, A. N., Landry, M., Schnider, M., Rojas, A. M., & Wood, S. F. (2012). Public health interventions: Reaching Latino adolescents via short message service and social media. Journal of Medical Internet Research, 14(4), e99. https://doi.org/10.2196/jmir.2178.
Yancey, A. K., Ortega, A. N., & Kumanyika, S. K. (2006). Effective recruitment and retention of minority research participants. Annual Review of Public Health, 27, 1–28. https://doi.org/10.1146/annurev.publhealth.27.021405.102113.
Yonker, L. M., Zan, S., Scirica, C. V., Jethwani, K., & Kinane, T. B. (2015). “Friending” teens: Systematic review of social media in adolescent and young adult health care. Journal of Medical Internet Research. https://doi.org/10.2196/jmir.3692.
Acknowledgements
We would like to thank our community partner and the participants.
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This research was funded by a research award to Dr. Hilda Pantin from the Department of Public Health Sciences at the University of Miami Miller School of Medicine. The videos adapted for use in this study were funded by the Centers for Disease Control and Prevention grant # U01PS000671 (PI: Yannine Estrada).
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Rojas, L.M., Bahamon, M., Lebron, C. et al. A Feasibility Trial of an Online-Only, Family-Centered Preventive Intervention for Hispanics: e-Familias Unidas. J Primary Prevent 42, 97–124 (2021). https://doi.org/10.1007/s10935-020-00620-1
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DOI: https://doi.org/10.1007/s10935-020-00620-1