Acceptability, feasibility and fidelity of the culturally adapted version of Unplugged (“Yo Se Lo Que Quiero”), a substance use preventive program among adolescents in Chile: a pilot randomized controlled study

Abstract

Introduction. The consumption of alcohol, tobacco, and marijuana is a public health problem that impacts the cognitive, social, and emotional development of adolescents. Prevention strategies such as the "Unplugged" program are effective in delaying the progression of daily smoking and episodes of drunkenness among adolescents. "Yo Se Lo Que Quiero" (YSLQQ) corresponds to the adaptation of this program to the Chilean context. This study assesses the acceptability and feasibility of implementing this program to the local reality. Material and methods. This was a cluster-randomized controlled pilot study conducted on six public schools. All consented students attending 6th, 7^th, and 8th grades (n = 1,180) participated in the study. The schools were randomly assigned to one of two conditions in a 1:1 ratio: 1) the "YSLQQ" intervention group (n = 526), and 2) the Control group (n = 654). The program consisted of a 12-hour class-based curriculum based on a comprehensive social-influence approach delivered by a trained facilitator. The acceptability and feasibility were assessed in the intervention group at the end of the intervention using questionnaires answered by students and facilitators. The quality and fidelity of the program were evaluated during the implementation using self-ported surveys answered by the facilitators and the assessment of video-recorded sessions rated by external observers. Finally, a pre-test and a post-test survey assessing past and current substance use and risk and protective factors were conducted before and immediately after the program's implementation. Results. A high proportion of students (49.6%) liked the sessions. 79.2% reported that the YSLQQ helped them learn about the dangers of drugs, while 65.8% reported having more skills to avoid drug use in the future. Regarding students' satisfaction with YSLQQ, 62.9% reported being happy or very happy with the program. Facilitators reported implementing the intervention according to the manual in 73.9% of sessions. Regarding drug use, students who participated in the intervention groups reported a significant reduction in drunkenness in the last year and last 30-day prevalence and also a significant reduction in a lifetime and 30-day prevalence of cannabis use when compared with those students in the control group. Conclusions. Our results suggest that YSLQQ has adequate acceptability and feasibility to be implemented in the Chilean context, and there were promising results in reducing drunkenness and cannabis use. Future research should confirm these results in a larger RCT study. Trial registration: NCT04566627