Bright Idea: Adapting Pregnancy Prevention Programs for Native Hawaiian Youth Yields Lessons for Others

Hawaii is known for its pristine beaches, active volcanoes, fabulous surfing, and—among reproductive health workers—its high teen pregnancy rates. Only nine states have higher teen pregnancy rates than Hawaii.

The state’s youth-serving organizations knew they had to do something to reverse the trend of teen pregnancy. They also knew anything they did had to be tailored to the Aloha State’s mix of cultures.

“Hawaii is truly a unique culture,” says Judith Clark, executive director of Hawaii Youth Services Network, the statewide coalition of youth-serving organizations. “Our population is always evolving, so we’re always adapting and willing to learn something new about each other. ”

Using federal teen pregnancy prevention grants, the network has targeted messages about health and pregnancy prevention toward Pacific Islander and Native Hawaiian youth, who represent two-thirds of pregnant teens  in Hawaii.

Here’s what Clark and her colleagues have learned so far about adapting evidence-based teen pregnancy prevention programs for a specific group of young people:

Try a program out before you make changes. Initially, Clark asked all of the facilitators and health educators to teach the evidence-based curricula exactly as written, even when aspects of the examples and activities, such as characters wearing heavy sweaters, didn’t seem to fit local life.

“We wanted to see what worked and what doesn’t work,” she says.

Then, when it was time to make changes, Clark got input from all the facilitators. “We brought them all together to identify where we needed to adapt,” she says, “and we made those adaptations together. ”

The group approach has ensured that all the facilitators use the adaptations consistently.

Understand the culture youth come from. Clark says a number of attributes of Pacific Islander and Native Hawaiian cultures have affected how the network delivers its teen pregnancy prevention messages.

As in many cultures, young people lacked a basic understanding of human anatomy and puberty because their parents tended not to talk to them about sex. So Clark and her colleagues added lessons about the human body.

They also worked hard to respect traditional male and female roles and to highlight strong role models for boys and girls.

Small changes can make a big difference. Most every change the facilitators recommended was what is known in evidence-based programming as a “green light adaptation”—a minor change in content that does not weaken the program or affect its outcome.

For example, Clark and her colleagues changed the names of characters from, say, Jim to Masauko, swapped images of snow-capped mountains for beaches, and infused Hawaiian slang into role plays.

Those minor tweaks have paid off with significant results, she says. “You can see the impact it’s had. Before the youth would have glazed eyes, and now they’re listening and laughing and responding. ”