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Abstract
Persistent health disparities are an indication that efforts to achieve parity are falling short. It may be that programs are not matching the ecological niche of effected communities. Conceptualization of what makes a program culturally competent in reaching the intended niche is improving; however, methods for evaluating such programs are limited. The current project is a sequential multimethod evaluation of the Strong African American Families (SAAF) program, a family-based preventative intervention designed to reduce sexual risk behavior in rural African American adolescents. It is hoped that it will serve as a model for evaluating cultural competence in programs for underserved populations. Study 1 is a process evaluation using conversation analysis. There is much room for adaptation between program design and implementation. Methods of understanding implementation are traditionally limited to rudimentary fidelity assessments. Through video-recorded interactions during the program (N = 91), the current study uses conversation analysis to illuminate the artfulness of implementation in the SAAF program and shows how program facilitators and participants cocreate meaning within the curriculum. Study 2 is an outcome evaluation using Structural Equation Modeling (SEM). The purpose of the current study was to identify the mechanisms through SAAF reduced sexual risk behavior among rural African American adolescents across a 29-month period. African American families (N = 284) with 11-year-old children in rural Georgia participated in the 7-week Strong African American Families (SAAF) project. Random assignment to intervention or control conditions occurred at the county level. The program was evaluated via pretest, posttest, and long-term follow-up interview data collected in the families homes. SEM was used to detect the pathways by which increases in universal and racially specific intervention-targeted parenting practices led to reduced sexual risk at the long-term follow-up. Most study hypotheses were supported. Participation in the SAAF program was associated with positive parenting behaviors at the posttest. Parenting was associated indirectly with sexual risk behavior through adolescent self-pride, peer orientation, and sexual intent. Culturally competent programs, developed through empirical and theoretical research within the targeted communities, can have a long-term effect on adolescent sexual risk behavior by fostering adaptive universal and racially specific parenting.