“Queremos Aprender”: Latino Immigrants’ Call to Integrate Cultural Adaptation with Best Practice Knowledge in a Parenting Intervention

Abstract

Despite the unique and challenging circumstances confronting Latino immigrant families, debate still exists as to the need to culturally adapt evidence-based interventions for dissemination with this population. Following the grounded theory approach, the current qualitative investigation utilized focus group interviews with 83 Latino immigrant parents to explore the relevance of culturally adapting an evidence-based parenting intervention to be disseminated within this population. Findings from this study indicate that Latino immigrant parents want to participate in a culturally adapted parenting intervention as long as it is culturally relevant, respectful, and responsive to their life experiences. Research results also suggest that the parenting skills participants seek to enhance are among those commonly targeted by evidence-based parenting interventions. This study contributes to the cultural adaptation/fidelity balance debate by highlighting the necessity of exploring ways to develop culturally adapted interventions characterized by high cultural relevance, as well as high fidelity to the core components that have established efficacy for evidence-based parenting interventions.

The dissemination of evidence-based parenting interventions constitutes a key strategy to increase the mental health and quality of life of ethnic minority populations (Castro et al., 2006). However, current scientific debate exists regarding the need to culturally adapt efficacious interventions before dissemination among ethnic minorities. Specifically, the cultural adaptation/fidelity balance debate “involves two competing aims: (a) to develop universal interventions and implement them with fidelity, and (b) to design interventions that are responsive to the cultural needs of a local community” (Castro, Barrera, & Martínez, 2004, p. 41).

Cultural adaptation scholars argue that evidence-based interventions developed with little or no inclusion of ethnic minorities should be culturally adapted before dissemination among diverse populations (Bernal & Sáez-Santiago, 2006; Kumpfer, Alvarado, Smith, & Bellamy, 2002). In contrast, fidelity scholars consider that the need for cultural adaptation has been overstated, particularly because it has not been sufficiently demonstrated in empirical research (Elliot & Mihalic, 2004). Researchers have also expressed that modifying existing interventions may reduce or eliminate the impact of the core components of original interventions (Chaffin et al., 2004; Gray, Jakes, Emshoff, & Blakely, 2003). An alternative for advancing the adaptation/fidelity debate is to conduct studies informed by research questions aimed at evaluating the extent to which both sides of the debate may be integrated. For example, “Is there a middle ground in the adaptation versus fidelity debate? Should contextual factors affect the decision to favor one side of the debate over another?” (Gray et al., 2003, p. 362).

PURPOSEOF THE STUDY

The purpose of this study was to explore with Latino¹ immigrant parents their perceptions about the relevance of culturally adapting an evidence-based parenting intervention before dissemination among Latino immigrant populations.² A secondary goal was to learn which components they considered should be included in the culturally adapted parenting intervention. This qualitative investigation focused on two main research questions: (a) How relevant do participants believe it would be to culturally adapt and disseminate a parenting intervention aimed at supporting their parenting efforts?, and (b) What components should be included in the adapted parenting intervention in order to increase parents’ motivation to participate, as well as their level of satisfaction with the adapted intervention?

THEORETICAL FRAMEWORK

Mental Health Disparities Experienced by Latino Immigrants in the United States

Although Latinos have become the largest ethnic minority population in the United States (U.S. Census Bureau, 2000), they continue to be seriously underrepresented in research and service delivery (Flores, Olson, & Tomany-Korman, 2005). Among Latinos, low-income immigrant families are very likely to be exposed to intense contextual challenges such as language barriers, intense work demands, limited access to social and health care services, and isolation (Ku & Matani, 2001). These challenges are likely to disrupt parenting practices among Latino immigrant families and can lead to child adjustment problems, including drug abuse and delinquency in late childhood and adolescence (Domenech Rodríguez, Rodríguez, & Davis, 2006).

Health disparities research indicates that Latino immigrant families underutilize evidence-based parenting interventions, particularly if they are not mandated to participate in such interventions (Flores et al., 2005). Latino immigrants who have experienced discrimination by service providers are less likely to request services due to fear of harsher discrimination (Blanchard & Lurie, 2004). Fear to access services is particularly detrimental among Latino immigrants who live in contexts characterized by antiimmigration climates, as they may perceive that they are identified as the source of diverse social problems (Berk & Schur, 2001). The aforementioned challenges can lead Latino immigrants to experience systematic marginalization from research and program design (Alderete, Vega, Kolody, & Aguilar-Gaxiola, 1999). Therefore, it is critical to address these barriers to service utilization, particularly because effective parenting practices prevent young children from engaging in serious antisocial and delinquent behaviors as they transition into adolescence (Patterson, 2002).

Cultural Adaptation/Fidelity Debate

The need for cultural adaptation

Cultural adaptation scholars assert that interventions for diverse ethnic groups should take into consideration the cultural values, traditions, and life experiences of minority populations (Bernal, Bonilla, & Bellido, 1995; Castro et al., 2004). Specifically, scholars argue there is a risk for a potential mismatch between existing interventions and the realities of ethnic minority populations, particularly if efficacious interventions were developed and tested with minimal inclusion of ethnic minorities (Bernal, 2006; Coatsworth, Santisteban, McBride, & Szapocznik, 2001). Cultural adaptation scholars also affirm that factors such as poverty, historical racism and structural segregation, language barriers, low rates of health insurance, social isolation, and distrust toward institutions can negatively affect rates of recruitment and retention of ethnic minorities in community-based interventions. Unless these issues are addressed, evidence-based interventions will remain irrelevant to ethnic minority populations (Castro et al., 2004; Kumpfer et al., 2002). Researchers also emphasize the importance of attending to the cultural values and traditions that target populations consider to be most relevant in their lives (Bernal, 2006; Castro et al., 2004). This approach is considered more appropriate than relying on theoretical and cultural preconceptions associated with specific ethnic minority populations (Griner & Smith, 2006).

Finally, scholars have highlighted the need to achieve cultural relevance as well as treatment efficacy. Specifically, Kumpfer and colleagues found that the culturally adapted version for Latino/a families of the intervention known as strengthening families program (SFP) led to an increased completion rate by the fifth year of implementation (65–90%) (Kumpfer et al., 2002). Researchers considered that high rates of retention and completion referred to the ways in which respect for family traditions informed the content and delivery of this family-skills intervention, aimed at reducing child and youth problem behaviors. However, researchers also reported that treatment outcomes were not as strong as previous SFP studies, possibly because low-risk children were recruited in the study. Under reporting at pretest due to confidentiality concerns was also identified. Thus, researchers concluded that culturally adapted interventions can substantially improve engagement and retention of ethnic families. However, there is also a great need to obtain better outcomes resulting from cultural adaptations that maintain fidelity (Kumpfer et al., 2002).

The need for fidelity

The call for cultural adaptation has been challenged by scholars who consider that such a need has not been sufficiently demonstrated in empirical research (Elliot & Mihalic, 2004). Researchers argue that dissemination of interventions with high fidelity has led to program effectiveness across gender, ethnicity, and socioeconomic status (Chaffin et al., 2004; Gray et al., 2003). Thus, changing the core components of original interventions could significantly reduce treatment efficacy (Kumpfer et al., 2002).

Researchers have also demonstrated that modifying evidence-based parenting interventions by adding components based on parent need may not necessarily increase efficacy. For example, Chaffin and collaborators (2004) did not find increased efficacy in a parenting intervention that included components that were added to address diverse issues presented by parents (e.g., parental depression, marital problems; Chaffin et al., 2004). Given these preliminary findings, scholars consider that additional studies are needed to further examine the relevance of adding parent need components to existing interventions (Chaffin et al., 2004).

Cultural adaptation research with Latino populations

Research with Latino parents has demonstrated the importance of adapting existing interventions for Latino populations by ensuring that program content is culturally relevant as well as linguistically appropriate (Domenech Rodríguez & Wieling, 2004). Studies have also confirmed that rigorous assessment procedures, commonly utilized in evidence-based interventions, can be implemented with Latino immigrants as long as they are conducted in a culturally sensitive manner (Domenech Rodríguez, Davis, Rodríguez, & Bates, 2006). In addition, exploratory research indicates that adding cultural components into existing interventions can be beneficial (Castro et al., 2006). For example, Martinez and Eddy (2005) adapted a parenting intervention aimed at preventing adolescent substance abuse and externalizing behaviors by adding culture-specific sessions. The intervention produced positive effects on parent and youth outcomes, as well as high rates of participant engagement and satisfaction with the intervention (Martinez & Eddy, 2005).

Interventions for Latino immigrants should also increase individuals’ motivation to participate by building alliances with them, developing trust, and effectively communicating the benefits of mental health interventions (Santisteban, Suarez-Morales, Robbins, & Szapocznik, 2006). Thus, researchers should develop engagement strategies capable of responding to the individual, familial, and contextual variables that are likely to influence participants’ decisions to remain engaged in community-based interventions (Kumpfer et al., 2002).

Finally, scholars have stressed the importance of ensuring that the adaptation of interventions for diverse Latino populations remains responsive to the realities faced by various Latino subgroups (Bernal, 2006; Castro et al., 2004). Therefore, interventions should result from a collaborative process in which the beneficiaries of proposed interventions can identify the values, traditions, and cultural experiences that are most relevant to their lives, rather than adapting existing interventions based on cultural generalizations or preconceptions associated with Latinos (Castro et al., 2006).

Cultural Adaptation and Community-Based Participatory Research (CBPR)

CBPR is characterized by active community involvement in the processes that shape the design and implementation of research (Fielden et al., 2007). According to CBPR principles, the identification of community health and mental health problems should result from a collaborative process between researchers and members of the community (O’Fallon & Dearry, 2002).

This qualitative study is part of a program of cultural adaptation research informed by the participatory approach proposed by Fraenkel (2006). According to this model, it is necessary to inform interventions based on feedback provided by the target population. It is also critical to engage community collaborators in the processes of design, implementation, and evaluation of proposed interventions (Fraenkel, 2006). The qualitative investigation reported here focuses on the initial stages of this model: establishing strong collaborative relationships with community partners and conducting in-depth interviews with the potential beneficiaries of the proposed intervention. The long-term goal of this program of research is to work collaboratively with community partners to develop culturally adapted parenting interventions for various Latino populations. An additional goal refers to establishing a sustainable strategy for implementing the adapted interventions within local Latino communities.

METHOD

Design

Recruitment

This investigation was conducted at two sites within the Midwestern United States. The first site, Ingham County, has a population of approximately 276,898 inhabitants, of which 6.1% are persons of Latino origin. The second site, Wayne County, has a population of approximately 1,971,853 inhabitants, of which 4.8% are persons of Latino origin (U.S. Census Bureau, 2006). These sites differ in that Wayne County has been identified by Latinos since the early 1900s as a key area for initial settlement. The city of Detroit, located within Wayne County, has several community-based organizations that offer a variety of services to immigrants free of charge or at a reduced cost (Maciak, Guzman, Santiago, Villalobos, & Israel, 1999). Detroit is also characterized by intense contextual stressors as the city ranks third in the nation on the percentage of people living below the poverty line (30%), and is one of the cities with the highest rates of violent crime in the United States (Bynum & McCluskey, 2007).

Throughout its implementation, this study presented many significant challenges to recruitment. Successful completion of this study was therefore only possible because of the commitment, leadership, and guidance provided by the community partners. In particular, the support of community partners was critical given the diverse ways in which the current antiimmigration climate in the United States has negatively impacted the lives of participants from both sites (Parra Cardona, Córdova, Holtrop, Villarruel, et al. 2008). Many participants were concerned about becoming involved in a focus group because they did not initially trust that their confidentiality would be protected. For example, some participants expressed fear that the audio recordings of the focus groups would be turned over to immigration authorities. Even individuals with documented immigration status were concerned their participation could implicate friends or family members whose status could be questioned. The interviewers handled this issue by validating such fears and extensively reviewing the standards of confidentiality and the rights of each participant (e.g., right to refuse to answer questions, right to withdraw from the study at any time without penalty). However, these efforts were given additional credibility through the trust participants had previously established with the community partners, which was crucial to recruitment efforts.

The community partners were also vital for their ability to review the recruitment protocol and point out limitations that would not be foreseen by interviewers living outside of the community. In particular, the original recruitment invitation for this study asked participants to meet at specific, preselected locations. Recruitment using this method was only minimally successful. The community partners understood that many members of the immigrant community were wary because raids by immigration authorities had increased at that time, resulting in the arrest and deportation of many individuals and families. Instead, the community partners suggested that participants be asked which sites they prefer to meet at. This change in procedure considerably increased recruitment rates as participants proposed sites that represented the greatest safety to them (e.g., churches, homes, specific community centers).

In partnership with the community collaborators, participants were recruited for this study from schools, churches, health clinics, and community centers. Three major recruiting strategies were utilized: (a) public announcements, (b) invitations to parents who were engaged in community services, and (c) word-of-mouth referrals. The most effective recruitment strategies were the word-of-mouth referrals among participants and the invitations directly delivered by community leaders. The participation of Extension coordinators and specialists proved particularly essential for the successful recruitment of participants in Detroit as this site is characterized by more intense contextual challenges.³

Sampling

To be selected for the study, participants had to (a) identify themselves as Latino or Hispanic, (b) be a first-generation immigrant, (c) identify Spanish as their preferred language, (d) have a child between the ages of 3 and 17 years old, and (e) express an interest to participate in the focus group interview. A broad selection criterion was utilized regarding children’s age because a main research goal was to recruit participants despite the challenging immigration climate. This wide range of child ages was allowable because the parenting intervention targeted for adaptation has been tailored to meet the needs of families with children of various age groups in prevention as well as clinical trials (Forgatch, DeGarmo, & Beldavs, 2005).

A total of 83 parents participated in this study. All participants provided consent to participate and completed the entire interview. Sixty-four participants were female and 19 participants were male. The majority of participants (n = 60) identified Mexico as their country of origin, followed by Cuba (n = 7), Colombia (n = 4), Costa Rica (n = 3), Guatemala (n = 3), Nicaragua (n = 2), Honduras (n = 2), and El Salvador (n = 2). The mean age of parents was 34.36 years (SD = 7.01) and no significant age difference was found based on interview site, t(81) = − 1.79, p> .05. The mean age of participants’ children was 5.98 years (SD = 6.95). Children ranged from 1 to 15 years of age. Specifically, 23% were between 1 and 2 years of age, 30% were between 3 and 5 years of age, 36% were between 6 and 11 years of age, and 11% were between 12 and 15 years of age. No significant differences on children’s age were found based on interview site, t(81) = −.195, p > .05.

Participants from both sites did differ regarding years living in the United States, level of education, and combined family income. Specifically, Wayne County participants reported living in the United States for a longer period of time (M = 7.77 years, SD = 4.19) than parents living in Ingham County (M = 2.4 years, SD = 2.6), t(81) = 5.34, p < .001. In addition, Wayne County participants reported lower levels of education and combined family income than their Ingham County counterparts. Table 1 presents a description of the participants’ demographic information, including statistical analyses.

Table 1.

Participant Demographics Information

	Ingham county (n = 36)	Wayne county (n = 47)
Average parent agea mean (standard deviation)	36.14 (8.11)	32.58 (6.22)
Average child ageb mean (standard deviation)	5.87 (3.62)	6.10 (7.78)
Highest educational degreec (percentages)
Elementary school	20%	73%
High school	54%	20%
College graduate (bachelor’s)	26%	7%
Combined annual family incomed (percentages)
<$10,000	23%	29%
$10,000–$20,000	24%	46%
$21,000–$30,000	30%	20%
$31,000–$40,000	23%	5%

^at (81) = − 1.79, p >.05.

^bt (81) = − .195, p >.05.

^cχ² (2, N = 83) = 18.18, p < .001.

^dCombined annual family income = sum of earnings for all family members within the household. χ² (3, N = 83) = 8.11, p < .05.

Data collection procedures

Data were collected through focus group interviews in order to obtain data generated by individuals as well as data produced through group interactions (Morgan & Krueger, 1993). Each focus group was audio recorded and then transcribed for purposes of data analyses. Data collection initiated after full approval from the Michigan State University Institutional Review Board was granted.

A total of 11 focus groups were conducted with a range of participation of 5–13 parents per group. A maximum number of 13 participants per group was established in order to better facilitate group discussions. Focus groups were conducted until all the parents who expressed interest in participating were invited. The quantity of focus groups conducted was therefore not predetermined. Each group interview lasted between 90 and 120 minutes. The implementation of focus groups across both sites lasted for 18 months.

Although it was planned in the original research protocol to implement male-only, female-only, and mixed-gender groups, the research design was modified in response to the contextual challenges associated with recruitment. In particular, participants were encouraged to come to whichever focus group was possible for them to attend. This resulted in a majority of mixed-gender groups. A total of 10 couples participated in these groups. Only one same-gender group resulted from this recruitment strategy, which happened to be a female-only group.

Each individual received a $20 gift card to one of two major retail stores in Michigan (i.e., Walmart or Meijer) for their participation in the focus group interview. Although participants were required by standard policy to complete a form documenting their receipt of this gift card, no information was requested which may have been sensitive to disclosure of participants’ immigration status (i.e., social security number). Parents were offered free child-care during the focus group and transportation support was available to and from the interview location. All focus groups started with a dinner, an overview of the study, and completion of a consent form and demographic questionnaire. These activities were followed by the focus group interview, which was led by bilingual researchers according to an interview guide. Interviews were always conducted with at least one researcher whose native language was Spanish.

Interview guide

The interview guide started with an introduction of the researchers and a general description of the study and the interview process.⁴ Participants were told that focus groups were being held in order to learn from Latino immigrant parents about their parenting experiences, as well as their interest in participating in future parenting groups especially designed for Latino immigrant parents. The interviewers explained that the research team sought to offer an existing parenting intervention to the Latino community that has proven beneficial to both parents and children. Therefore, the focus group interviews were a necessary first step toward clarifying how relevant Latino immigrant parents find the specific parenting skills covered in the original intervention, as well as exploring if the intervention is responsive to their life experiences and cultural context.

After completion of the introduction, group conversations were elicited by asking participants the following open-ended grand tour question, aimed at minimizing questioning bias and privileging participants’ feedback: “What themes do you consider should be included in a parenting intervention for Latinos/as? Please describe the importance of including such themes.” The grand tour question was followed by probes that referred to each of the five core components of the evidence-based intervention (e.g., Describe the importance of talking in parenting groups about ways to implement discipline with your children). The interview guide also included probes focused on cultural items aimed at exploring issues of engagement and satisfaction with the intervention (e.g., How can we motivate Latino parents to voluntarily participate in parenting groups offered in the community?, What cultural themes should be included in a parenting intervention for Latino immigrants?). Following the grounded theory approach, the interview guide was gradually modified to include probes for themes that participants identified as relevant that were not included in the original interview guide (Strauss & Corbin, 1998; e.g., some parents have expressed to us the need to talk about how experiences of discrimination negatively impact their parenting efforts. How relevant do you consider it is to talk about these issues in future parenting groups?).

Research team

Data were collected by the first five authors. The first author is a male Mexican native and first-generation immigrant. He has over 12 years of experience developing and evaluating community programs for Latinos. He served as principal investigator in this study and is currently an Assistant Professor in an accredited family therapy program in the United States. The second author is a Caucasian female doctoral student from the United States. She has been involved in community-based research with Latinos for the past 4 years. The third author is a male doctoral candidate and third-generation Latino whose parents were migrant workers. He is currently completing his clinical internship at a research and clinical center devoted to providing mental health services to Latinos. The fourth author is a female doctoral student who was born in Guatemala and has over six years of clinical experience with Latinos. The fifth author is a female African-American doctoral student who has actively engaged in clinical service with ethnic minorities. The remaining authors are community collaborators and senior researchers with differences in gender, ethnicity, and professional backgrounds.

The diversity of the research team provided great richness to this study. For example, the experiences of discrimination described by participants resonated strongly with some members of the research team who had lived similar experiences themselves. Other members of the research team not only highlighted the importance of analyzing data associated with such contextual challenges, but also emphasized the need to rigorously analyze contrasting data in an effort to contribute in an integrative way to the cultural adaptation debate. The three authors who are recognized leaders in the Latino community were essential for their support in implementing the study and for their ability to help ensure that study findings matched the experiences Latino parents report to them in various service settings.

Data analysis

Data were analyzed following the tenets of grounded theory (Strauss & Corbin, 1998), which includes a sequential coding scheme (i.e., open, axial, and selective coding) as well as the constant comparative method. Data analysis procedures initiated with open coding, which consists of breaking down data into discrete units of analysis and labeling different units as concepts (LaRossa, 2005). Concepts were labeled whenever possible by using the words expressed by participants (i.e., in vivo coding). Axial coding consisted of reaching a higher level of conceptualization of the data by creating categories (LaRossa, 2005), and analyzing such categories in terms of properties (i.e., characteristics of a category) and dimensions (i.e., location of a category along a continuum). For example, the category “Aprendiendo Juntos (Learning Together)” had variations in the type of learning experiences that participants expected to have in parenting interventions (e.g., learning from parent educators, learning from other parents), as well as the expected intensity of such learning experiences (e.g., motivation to become better parents, desire to encourage other parents to fight discriminatory practices in various social contexts). Axial coding led to the identification of 14 categories which were later reduced in the final phase of analyses. Thus, selective coding consisted of the integration of five categories which describe a theoretical schema, grounded in the experiences shared by participants (Strauss & Corbin, 1998).

Saturation was achieved after conducting approximately eight focus groups. Themes addressed in additional groups resembled those of previous groups although with variations in narrative. Data collection was not terminated when saturation was reached in order to strengthen trustworthiness of the data as information was collected from two sites. In addition, it was important to identify the engagement strategies that were most effective to successfully implement the study in a challenging environment. Data analyses were conducted using NVivo software version 2.0 (Bazeley & Richards, 2000).

Trustworthiness of the data

Trustworthiness in qualitative research refers to the standards that should be met in order to ensure quality and accuracy of research findings (Morrow, 2005). In order to monitor and minimize bias in data collection and data analytic procedures, a number of strategies were implemented. To ensure trustworthiness during data collection, every focus group was implemented by a minimum of two group facilitators to monitor the frequency with which specific topics were addressed by participants. Themes identified during selective coding were those that were addressed by a majority of participants in each focus group and were consistently mentioned across different focus groups.

To ensure trustworthiness during data analytic procedures, concepts resulting from open coding were compared between lead coders and similarities and differences were discussed. Categories and emerging themes identified in axial coding resulted from the common agreement between coders and were shared with other co-facilitators of the focus groups. At this point, a preliminary set of findings was shared with remaining members of the research team in order to evaluate the accuracy of the codes in relation to the comments and experiences shared by participants. The diverse composition of the research team increased the inclusion of multiple perspectives and helped to monitor biases based on preconceived notions (Spradley & McCurdy, 1988). An additional strategy to increase trustworthiness involved the lead authors keeping individual journals during the research process. These journals were used to monitor reactions that were associated with data collection and data analysis. Finally, an audit trail with relevant methodological decisions (e.g., modification of probes based on participants’ feedback) was kept by the lead investigator (Morrow, 2005).

RESULTS

Five categories emerged from the data that compose a theoretical schema describing the parents’ most relevant expectations related to their potential participation in a parenting intervention. Study findings also describe the parenting skills that participants would like to enhance, as well as the intervention characteristics they consider would increase its cultural relevance.

An unexpected finding of this study is that although participants resided in two different counties in the Midwest, qualitative results were similar across all focus groups. The only difference found between locations was the intensity with which parents described the contextual stressors that negatively impact their parenting efforts. Specifically, parents living in Wayne County reported examples of contextual challenges characterized by increased intensity such as a strong antiimmigration climate and high levels of community violence. Parents living in Ingham County reported similar contextual challenges, although these were comparatively less extreme.

“Queremos Aprender, Pero No Ofrezcan Clases De Blancos” (We Want to Learn, But Do Not Offer White Parenting Classes)

Participants expressed great interest in participating in interventions aimed at enhancing their parenting skills. For instance, one father said, “As a father, I worry about my kids, about how to be a father. … I would like to keep learning how to be a father for my kids. … I want to know what I need to improve so I can be a better father.” A mother described her perception about the need to promote parenting interventions in the Latino community:

We need this type of groups because there are things that you can learn about being a parent from other people, not only from our family. … Half of us are not perfect, we are imperfect. … And it’s beautiful that groups like this exist, so we can meet each other and we can express our experiences.

Parents highlighted the importance of parenting interventions being culturally relevant as well as delivered to participants in respectful ways. One mother, who had previous experience with parenting counseling in the community, affirmed:

We want to learn but don’t offer classes like White parenting classes … the advice that they give you is much separated from your life. … It’s like they see you like something weird, different, something that can’t be a parent. … ․ It’s like, “You’re different than me so I’m going to teach you.” … I don’t want to be judged in a parenting class.

By exploring with parents their reluctance to participate in parenting interventions, it became clear that rather than lack of interest to learn or enhance specific parenting skills, participants were reacting to the lack of collaboration they experienced in previous parenting counseling or parent education classes. A father elaborated on this issue:

We went with therapists, Anglos … when it went wrong is when they said, “you have to be this way, that way.” … We want to learn, but there is a way to share with others that can help … to say something like “I’ll share this with you, it’s not the complete solution, but it might work for you.”

Participants repeatedly emphasized how important it is to them that the parent educators be respectful and collaborative. As one mother expressed:

What helps is to be humble, they [parent educators] need to say “look, I’m not in your situation, but share with me your problems so I can understand.” … That’s when a person starts saying, “I’m doing something that is pushing my child away” … that is when a person with more experience can come in … that’s what helps. … To be humble.

Finally, participants explained that parenting interventions for Latinos must be developed with the understanding that parenting responsibilities in Latino families are frequently shared among several family members, including members of the extended family. One mother described this issue by saying, “American counselors or White counselors think that there’s no one else in the household … they think that you’re on your own raising your kid. … It’s not like that … there is always somebody else in my family who helps me.” Another mother further clarified the important role of the extended family, “In a Latino family, if the child has a temper tantrum maybe the uncle or the sister can come and tell him something … that is what is needed in a household, the family, not only the mother and children.”

“InculcándolesValores a Los Niños(as)” (InstillingValues in the Children)

Participants expressed the importance of offering parenting interventions to the Latino immigrant community based on an awareness of relevant Latino cultural values. Specifically, parents identified two major cultural values that they consider are particularly important in the Latino culture. First, parents identified the importance of la familia (the family) and the need to promote family cohesion. One mother said, “In Latin American countries, there is a lot of love for the family. … For these groups [parenting groups], first focus on the family and the importance of having a healthy family.” Another mother further described this issue:

Regarding the importance of family, we have to educate Latino parents on how to be parents in the society we have today. Our parents did not have the same problems that we have today. For instance, television, how many hours of television do kids see? My parents would only let me see television for an hour, hour and a half at most. … On Sundays we would all sit as a family and watch a TV show. After that, we had to do chores as a family … everybody had a responsibility to do and we would help each other. As a family we would do everything. … We need those types of ways for our families.

Respeto (respect) was also identified by participants as a cultural value they believe should be promoted in parenting interventions for Latinos. One mother described the importance of promoting respect among children, “Respect is very important in the Latino family. … I’m not going to generalize, but kids of Hispanics, from Hispanic communities, have a special respect for their parents. And from that, it generates respect to others when you are an adult.” Another participant highlighted the im- portance of communicating to children the existence of a hierarchy between children and parents, as well as the need for children to respect this hierarchy, “They [children] have to know who is who. … Kids need to learn to respect their parents.”

“Me Dice Mi Niña Que Va a Llamar al 911” (My Kid Tells Me She’s Calling 911)

Participants identified that being able to implement effective discipline with their children is a major parenting goal they have for themselves. However, participants also emphasized that interventions must expose parents to limit-setting skills based on an awareness of the contextual challenges that influence the implementation of these parenting practices. For example, participants reported that it is common among Latino immigrant parents to be afraid to use disciplinary strategies that are commonly accepted in their countries of origin (e.g., spanking), because these practices may lead to negative legal consequences in the United States. As a result, many parents reported feeling disempowered with regard to how to effectively discipline their children. One participant described this struggle, “If I spank my kid, she cries and tells me she is calling 911. … So, I have to stop because they can take me and put me in jail. … It’s difficult to discipline her when she misbehaves.” A mother also shared her perception regarding this issue:

Here [U.S.A], children feel more liberty in doing things because of the laws that protect them.… For instance, if you hit a child they can call the police … over there [Mexico], if you spank a child to shake him up, the police will understand. … Even though it’s not a preventive way to teach a child, at least in Mexico there is more flexibility.

In addition, parents described the dilemma of only being familiar with the limit-setting strategies they learned in their families of origin. Even when they no longer wanted to use these techniques with their children, parents were often unaware of alternative parenting strategies. As one mother expressed:

I still spank my children and I want to break with that chain, which was taught to me. … I try to manage situations differently but I don’t know how. … I have tried talking to my child but then she wants explanations. … I cannot do that … and I just say to her, “Do this because I’m your mother.” … I learned that from my father.

“Cómo Podemos Proteger a Nuestros Niños de las Drogas?” (How Can We Protect Our Kids from Drugs?)

Parents expressed fear and concern about the possibility that their children might engage in alcohol or drug abuse at an early age. Although parents acknowledged that a similar risk exists for the onset of alcohol abuse in Latin America, they considered drugs to be more accessible in the United States. One father described his concern, “One of my biggest fears for my children is the temptation of drugs … there is always someone who will offer it to you. … In the little time that I’ve been here [U.S.A.]. I have seen drugs as a culture. … A hidden culture.” A mother also expressed her fear and distress after becoming aware of how early children can be exposed to drugs:

My kid is in third grade and the teacher discovered that a classmate had marijuana … he was going to sell it to his classmates and he is only 9 years old … that’s why we need programs for parents.… I’m scared … I did not see that in Mexico … we need to learn how to protect our kids.

Parents articulated the need to acquire specific parenting skills, such as monitoring, which will help them prevent their children from engaging in substance use. One mother highlighted the importance of remaining aware of what her children do in the school setting:

We have to educate parents on how to be parents in this society. … For instance, it is not enough for people to tell me that my girls are doing okay at school. I need to go to the school and confirm this.

“Aprendiendo y Ayudándonos Juntos”(Learning and Helping Each Other)

Participants described the importance of facilitating learning experiences by promoting a sense of community with group participants. Specifically, rather than limiting group interventions to didactic sessions focused exclusively on teaching parenting skills, parents affirmed that interventions should also promote group cohesion and supportive relationships among participants. For example, many participants commented on how valuable the focus group interview was to them, as well as their desire to keep meeting as a group. One father reflected on this issue, “I would like to keep learning more for my children. … Let’s keep meeting as a group … and we [parents] can also help. … We can meet next time in my house so you do not have to pay for the food you bring.” A mother described her desire to engage in a collaborative learning experience with other Latina women⁵:

This is a Latino environment … these women have a lot of advice, they might not know it but I pick up on it. … And they’re not judging me because they’ve been through it and it’s a group counseling, rather than one person telling me what I should be doing.

When asked about what would make a parenting group attractive to Latino immigrant parents, a father responded:

To have a sense of community. … If there is a sense of community it is possible to achieve many goals, rather than one person fighting alone. … In this country [U.S.A.] it is like “It’s only me, that’s mine. … Don’t touch that because it is mine.… It is not like that in Costa Rica … over there people know each other and share with each other.… Here I feel alone.… And I need to defend myself from others.

An important benefit associated with promoting strong group cohesion in parenting groups refers to the fact that a sense of community can support immigrant parents as they adapt to various contextual challenges. Specifically, participants highlighted the great need to support parents who experience discrimination in various social settings. Thus, in addition to informing groups based on a collaborative approach, participants expressed that groups should constitute a resource for empowering parents who are experiencing intense contextual challenges. For example, a father described the importance of utilizing parenting interventions as a vehicle for empowering parents who are facing discriminatory practices. He affirmed, “Latino parents many times are afraid … afraid of being discriminated against … these groups [parenting interventions] should help them understand that they have rights … these groups should help them find community resources, so parents can be supported to fight for their rights.” A mother expanded on this issue, “These groups should help parents not to be afraid and help them to be respected.… We have been disrespected because we are Latinos, but we donot have to go through that. … These groups should help parents when they are feeling alone.”

DISCUSSION

Findings from this study underscore the strong desire of Latino parents to participate in parenting interventions and highlight the importance for interventions to be culturally relevant, respectful, and responsive to their life experiences. Thus, research results confirm previous findings related to parent training with Latino populations. In particular, it is important to inform interventions according to relevant Latino cultural values, there is a need to inform parent training based on collaborative approaches, and interventions should be designed to accommodate members of the extended family (Castro et al., 2006; Pantin et al., 2003).

This investigation also adds to the existing literature in important ways. For instance, the narratives shared by participants provide descriptions of the deleterious effects that experiences of discrimination can have on Latino immigrants’ motivation to voluntarily participate in community-based interventions. Findings highlight the need to define which specific cultural values are most relevant to each Latino target population, as well as the ways in which contextual issues can deter Latino immigrant parents from implementing specific parenting skills. In addition, participants conveyed the importance of promoting a sense of empowerment and community among parents taking part in the intervention and emphasized the important role this could play given the many contextual challenges they face. Results from this investigation also provide specific suggestions as to the cultural characteristics of adapted interventions that are likely to increase the motivation of Latino immigrant parents to participate.

Present findings contribute in a significant way to the cultural adaptation/fidelity debate. While participants agreed parenting interventions must be culturally relevant, they also reported clear similarities with regard to the parenting goals they wished to achieve. Specifically, the parenting skills participants sought to enhance are among those commonly targeted by evidence-based parenting interventions (Kaminski, Valle, Filene, & Boyle, 2008). Therefore, this study suggests that the two sides of the adaptation/fidelity balance debate may best be integrated by developing culturally adapted interventions that achieve high cultural relevance while maintaining fidelity to the core components that account for the efficacy of evidence-based interventions.

The Need for Culturally Relevant Interventions

Parents expressed the desire to participate in a parenting intervention that is responsive to the cultural practices and traditions that inform their lives, as well as to the contextual factors that impact their parenting efforts. For example, participants described the need for parent educators to remain attentive to the fact that child rearing in Latino immigrant families may be frequently shared with relatives and members of the extended family. This finding confirms the important role that members of the extended family play in the upbringing of children in Latino immigrant families (Toth & Xu, 1999). Thus, culturally adapted parenting interventions should ensure that content materials illustrate parenting situations in which relatives are involved, rather than relying exclusively on examples that only depict nuclear families. In addition, the delivery of interventions should be flexible enough to allow for the involvement of extended family members if participants express such a desire.

Parents also placed great emphasis on the need to inform the teaching of parenting skills according to specific Latino cultural values. Specifically, participants in this study primarily emphasized two key cultural values: the importance of promoting family cohesion and respect. Familismo is a Latino cultural value that emphasizes the importance of being rooted in the family and ensuring that one’s actions contribute to the welfare of all family members (Falicov, 1998). Respeto highlights the need to inform all relationships based on dutiful respect, particularly between parents and children (Falicov, 1998). This finding indicates that although several cultural values have been associated with Latinos in the literature, it is important not to assume that such values are equally relevant across various Latino subgroups. Thus, there is a need to identify which specific cultural values have the greatest influence on the parenting practices of each unique target population (Griner & Smith, 2006).

In addition, parents expressed a desire to participate in an intervention aimed at strengthening their social support networks to assist them in coping with the numerous contextual challenges they face as Latino immigrants. Thus, interventions that rely primarily on dyadic instruction between program leader and parent may be of limited appeal to this population. Instead, culturally relevant interventions for Latino immigrant parents should facilitate a group learning experience that promotes trust, social support, and empowerment. Previous research has confirmed the value of facilitating parental social support networks, as they assist parents in acquiring community resources which help them overcome contextual challenges (Pantin et al., 2003).

The critical role of engagement

Researchers and interventionists should remain cognizant of the deleterious effects that experiences of discrimination have on Latino immigrant parents’ motivation to engage in community-based parenting interventions (Pantin et al., 2003). Participants in this study emphasized that interventionists need to communicate to parents a genuine understanding of the contextual challenges that impact their lives, help them to address barriers to participation, and constantly promote a dialogue aimed at examining the cultural relevance of the parent training experience. They also highlighted the necessity of delivering parenting interventions in a collaborative manner. However, the need to establish a collaborative relationship with parents should not prevent educators from sharing their expertise. Instead, facilitators can communicate their knowledge in a way that demonstrates respect for participants’ cultural experiences, as well as an understanding of the challenges that negatively impact their lives (Santisteban et al., 2006).

The Need to Recognize the Value of Evidence-Based Interventions

Findings from this study indicate that the parenting skills Latino immigrant parents wish to strengthen are among the same skills that have been identified as target outcomes of the evidence-based parenting intervention to be adapted in this program of research. Specifically, parents want to improve their parenting skills to increase the quality of involvement with their children (i.e., positive involvement), as well as to refine their monitoring and limit-setting practices. These findings are highly relevant because research has demonstrated the long-term benefits of promoting these specific parenting practices (Forgatch et al., 2005).

Moving Toward Integration of Cultural Adaptation and Fidelity Frameworks

The results of this investigation suggest that Latino parents will be most receptive to exposure of the core components of an evidence-based parenting intervention if their cultural experiences and values are acknowledged and respected. For example, effective limit-setting has been identified in meta-analytic research on parent training as a parenting skill associated with positive child adjustment (Kaminski et al., 2008). Limit setting is also a core component of the intervention that will be adapted in this program of research (Forgatch & DeGarmo, 1999). Thus, new discipline strategies can be presented to Latino immigrant parents by acknowledging the value that parents attribute to their current discipline strategies, as well as describing how effective discipline can reinforce the values of respeto and familismo by strengthening parental hierarchy and family harmony. Likewise, learning noncorporal limit setting skills can eliminate parents’ fear of being reported to authorities for trying to discipline one’s children. In summary, findings from this study support an integrated framework combining high cultural relevance with fidelity to the core components that account for the efficacy of evidence-based parenting interventions.

RESEARCH LIMITATIONS

The authors acknowledge the limitations of this investigation. First, this study was not able to examine differences based on Latin American country of origin due to the small number of participants born in countries other than Mexico. Thus, present findings should be considered tentative when referring to the broader Latino population. In addition, data were collected from participants residing in the Midwestern United States. Therefore, present findings may not accurately describe the cultural and parenting expectations of Latino parents living in other regions of the country. It is also recognized that the ideal research design to evaluate the impact and relevance of cultural adaptation is one in which participants are exposed to two conditions: (a) a linguistically appropriate version of the original evidence-based intervention, and (b) an adapted version of the original intervention with inclusion of culture-specific sessions. Such a design can overcome the limitations associated with the qualitative methodology utilized in this study, particularly because exposure to both interventions can provide differential data associated with implementation feasibility, efficacy, and cultural relevance. In addition, the participants’ knowledge of the proposed intervention was limited to the descriptions of the intervention presented by the researchers. This limitation prevented participants from providing a type of feedback that can only be offered as a result of direct exposure to the intervention.

Finally, participants in this study were not selected based on rigorous clinical criteria (e.g., child oppositional behavior). Thus, feedback provided by participants with a more defined clinical criteria could differ from the data provided by participants of this study.

Despite these limitations, this investigation constitutes a useful contribution for family therapists and scholars interested in cultural adaptation research. It is noteworthy that this qualitative study consists of a large sample size, which considerably strengthens the trustworthiness of findings. The success of this study in recruiting such a large number of participants, especially given their fear and distrust toward institutions, also demonstrates that the participation of Latino immigrant parents in community-based interventions can be accomplished if research efforts are grounded in collaborative partnerships with trusted community leaders. Finally, the cultural adaptation of the proposed parenting intervention is justified as a prevention strategy based on the parents’ strong desire to enhance their parenting skills.

IMPLICATIONS FOR CLINICAL PRACTICE

A key clinical implication resulting from this study is that Latino immigrant parents expressed a desire to enhance parenting skills that are commonly targeted in evidence-based parenting interventions. This finding is relevant because results from meta-analytic research on parenting interventions have identified specific parenting skills as precursors of effective parenting and the reduction of externalizing behaviors in children (Kaminski et al., 2008). Thus, therapists should be familiar with parenting research that has identified such specific parenting skills.

Therapists must also know how to culturally engage Latino immigrant parents to foster an environment where they feel comfortable learning and improving their parenting skills. In order to engage parents in culturally relevant ways, it is critical to ensure that parent training is embedded within a framework of collaboration, cultural knowledge, and respect. This requires family therapists to examine their level of comfort associated with embracing a collaborative stance in clinical practice. Working from this position, therapists can promote a positive working relationship by exploring with Latino parents how culturally relevant specific parenting skills are to them, and carefully examining the ways in which contextual challenges have negatively impacted their ability to implement various parenting practices. For example, family therapists can discuss with clients the high value that Latino families tend to place on monitoring practices and offer to work collaboratively with them to help them enhance monitoring skills. In addition, family therapists can explore with parents strategies for overcoming contextual barriers that prevent them from implementing adequate monitoring practices (e.g., empowering parents in their interaction with school teachers).

Family therapists should also remain attentive to self-of-the-therapist issues by becoming aware of their biases and preconceptions associated with Latino families. For instance, some family therapists may consider the participation of extended family members in childrearing practices as an example of “enmeshment” or “weak boundaries.” Instead, this practice should be understood as an expression of resilience that has allowed Latino immigrant families to adapt to the many contextual stressors they face.

IMPLICATIONS FORRESEARCH

There is a great need to evaluate the effects of achieving high cultural relevance in culturally adapted interventions as well as high fidelity to the core components that have established efficacy for evidence-based interventions. Thus, the next phase of our program of research will consist of implementing a randomized controlled trial aimed at examining the differential effects of offering a translated and linguistically appropriate version of an evidence-based parenting intervention versus an adapted version of the intervention with culture-specific sessions.⁶ The utilization of a similar research design in additional studies can provide relevant data to extend the cultural adaptation/fidelity debate because this design allows for the measurement of effects associated with cultural adaptation, as well as fidelity to the core components of original interventions.

Future studies on cultural adaptation should also include multiple methods of data collection aimed at evaluating participants’ perceptions regarding the cultural relevance of adapted interventions (Martinez & Eddy, 2005). For example, mixed methods can be used to obtain quantitative indicators of satisfaction with the intervention, as well as qualitative descriptions of perceived cultural relevance. The integration of such methodologies could provide a deeper and more comprehensive understanding related to issues of cultural adaptation and intervention fidelity.

With regard to the family therapy field as a whole, there is a great need to promote cultural adaptation research. Despite the fact that family therapy training is informed by principles of systems theory, social justice, and cultural diversity, cultural adaptation studies conducted by family therapy researchers are almost nonexistent. This is a serious limitation of the field which should be addressed.

CONCLUSION

This study provides qualitative evidence indicating the need to integrate the contrasting arguments of the adaptation/fidelity balance debate. Specifically, it is necessary to continue exploring ways to develop culturally adapted interventions characterized by high cultural relevance as well as high fidelity to the core components of efficacious interventions. This integrative approach has the potential to bring about interventions that maintain maximum program effectiveness while also ensuring that they are responsive to the contextual and cultural realities of diverse populations, particularly those that have been historically excluded from the benefits of scientific research in the United States.