In this blog, Dr Giovanni Aresi will discuss some reasons why adopting a cultural perspective is important for prevention scientists.
The 2018 conference was the first time I came in contact with the European Society for Prevention Research (EUSPR). As I have done (so far) little in terms of preventive intervention development, implementation and evaluation, I was actually unsure whether or not my work on alcohol drinking cultures (i.e., schema of beliefs, practices, and values maintained by a cultural group or society regarding alcohol use) would fit into the scope of the EUSPR. I was therefore very surprised when I learnt that I was awarded the 2018 early career award for outstanding promise based on poster presentation. On second thought, in a socio-ecological perspective, culture is an important level of influence to health outcomes, and therefore needs to be taken into consideration during all stages of intervention. This makes culture an important object of interest for EUSPR members.
In Lisbon I presented preliminary results of a cross-cultural research study I conducted during my Fulbright visiting at Washington State University, U.S.A. (poster available here). In continuation of previous work on the Italian cultural context1 2, this study used a mixed methods design to compare the drinking cultures of youth in the U.S.A. and in Italy, two paradigmatic examples of intoxication (‘dry’) and non-intoxication (‘wet’) oriented drinking cultures3. Results indicate that, while drinking cultures in the U.S.A. and Italy display overlapping features (e.g., alcohol used for recreational purposes over weekend days), crucial differences in societal schema of beliefs, informal social norms, practices, and values attached to alcoholic beverages still exist (e.g., alcohol as an intoxicant or also making part of the diet).
If, despite the great pressure towards homogenisation exerted by globalisation processes, drinking cultures still exist and have a considerable effect on people’s alcohol use and alcohol-related problems, what are the implications for practice?
There is a growing body of research on alcohol misuse interventions for adolescents and young people, though most interventions have been designed and implemented in the U.S.A., and the degree of applicability and required adaptation in other contexts and (drinking) cultures is unclear.
When it comes to transfer best practices developed elsewhere, with good reason, prevention science focuses a lot of attention on intervention fidelity. It comes without saying that, to be effective, interventions need to reflect best practices theory (mechanisms of change) and procedures of implementation. However, even in the case of established interventions such as the Life Skills Training Programme, when cultural boundaries are crossed, a thorough adaptation is needed4. School systems, policy frameworks and, crucially, cultures differ across regions and countries. When the core of the intervention needs to be preserved, implementation procedures and activities may be redesigned to better fit into the new implementation setting.
All good, but how to do that?
Even though there is little guidance on this issue, James White’s plenary speech at the 2018 EUSPR conference offered some insight on how a Transdisciplinary Action Research (TdAR) approach5 can be adopted for intervention development and adaptation. The TdAR is a methodological framework for intervention co-production consisting in action-research cycles in which researchers collaborate with lay and professional practitioners across different disciplines, organizations and institutions to co-produce applicable knowledge in the settings of implementation. In other words, policy makers and practitioners participate as co-researchers in co-producing and adapting interventions from the early stage. In his talk, James presented a three-stage framework (evidence review and stakeholder consultation, intervention co-production; and intervention prototyping) used in the development ASSIST+FRANK study, a school-based drug prevention intervention. In all stages the research team collaborated with delivery team, teachers, school students, health professionals to adapt existing, and co-produce new, intervention activities. An article describing this co-production process was recently published on BMC Public Health6.
What can we learn from the TdAR and experiences like the ASSIST+FRANK study?
Because key stakeholders bring their ‘insider’ point of view and know how things work in their respective real-life settings, harnessing their expertise maximises the potential acceptability and feasibility of interventions, and ultimately their adoption. In the case of intervention development and adaptation across drinking cultures, it means that interventions are more credible and better fit the specificities of the local drinking culture (e.g., drinking practices and use-values).
For all these reasons, prevention scientists should value the knowledge of those involved in real-life settings where intervention are implemented. There is a lot to learn from practitioners, policy makers, and even beneficiaries. Action-research frameworks can offer theoretical and methodological guidance to exploit this local knowledge, properly adapt intervention to the specificities of local contexts and cultures, and ultimately achieve the greatest intervention impact.
About the author:
Dr Giovanni Aresi is postdoctoral researcher in Community Health Psychology at Catholic University of Milan, Italy. His research focuses on the ways in which psychological, social and cultural influences shape young people’s health behaviours. He has leaded Lifestyle in Mobility, the first international research study on Erasmus students’ alcohol use and other health-related behaviours. As a Fulbright visiting research scholar at Washington State University he conducted a cross cultural study to compare the Italy-U.S.A drinking cultures. In 2019, he has received the Horizon 2020 Marie Skłodowska-Curie Actions (MSCA) Seal of Excellence for a proposal to develop an alcohol intervention targeting study abroad students. He leads the Early Career Researchers group of the Kettil Bruun Society, one of the most influential scientific society in the field of research on alcohol. His specialties are in mixed methods research, cross cultural research and participatory action research. You can contact him at giovanni.aresi[at]unicatt.it
- Aresi, Giovanni, Michael J. Cleveland, Elena Marta, and Sara Alfieri. 2018. ‘Patterns of Alcohol Use in Italian Emerging Adults: A Latent Class Analysis Study’, Alcohol and Alcoholism, 53: 294–301.
- Aresi, Giovanni, and Eric R. Pedersen. 2016. ‘‘That right level of intoxication’: A Grounded Theory study on young adults’ drinking in nightlife settings’, Journal of Youth Studies, 19: 204-20.
- Room, Robin. 2007. ‘Understanding cultural differences in young people’s drinking.’ in M. Järvinen and R. Room (eds.), Youth Drinking Cultures: European Perspectives (Ashgate: Aldershot, Hampshire).
- Velasco, Veronica, Kenneth W. Griffin, Mariella Antichi, and Corrado Celata. 2015. ‘A large-scale initiative to disseminate an evidence-based drug abuse prevention program in Italy: Lessons learned for practitioners and researchers’, Evaluation and Program Planning, 52: 27-38.
- Stokols, Daniel. 2006. ‘Toward a science of transdisciplinary action research’, American Journal of Community Psychology, 38: 63-77.
- Hawkins, J., K. Madden, A. Fletcher, L. Midgley, A. Grant, G. Cox, L. Moore, R. Campbell, S. Murphy, C. Bonell, and J. White. 2017. ‘Development of a framework for the co-production and prototyping of public health interventions’, BMC Public Health, 17: 689.