{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:41:23Z","timestamp":1784205683023,"version":"3.55.0"},"reference-count":33,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UC Irvine Institute of Clinical Translational Science","award":["UL1 TR001414"],"award-info":[{"award-number":["UL1 TR001414"]}]},{"DOI":"10.13039\/100001445","name":"Alex\u2019s Lemonade Stand Foundation","doi-asserted-by":"publisher","award":["ALS-5577146"],"award-info":[{"award-number":["ALS-5577146"]}],"id":[{"id":"10.13039\/100001445","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Parents of children with cancer experience significant psychological distress that is associated with poorer health outcomes. A recent review of caregiver interventions illustrated none targeting Latino parents of children with cancer and a significant need for culturally congruent intervention approaches. Aims: Following our first paper in this issue describing the development of a community co-developed intervention to address psychosocial outcomes in Spanish-speaking Latino families impacted by childhood cancer, this second paper describes the formative evaluation and exploratory analysis of preliminary efficacy in a single-arm pre\u2013post trial. Methods: A total of 32 Spanish-speaking Latino parents\/caregivers of children with cancer received the 12-session intervention targeting health literacy, culturally congruent care, and caregiver well-being. Quantitative measures of health literacy and emotional well-being were collected at baseline, post-intervention, and 3 months post-intervention and mixed methods formative evaluation data were collected immediately post-intervention. Results: Mixed methods formative evaluation showed that the intervention was useful, helpful, and relevant. Exploratory preliminary efficacy data using a non-parametric Friedman test showed that health literacy doubled from pre- (33%) to post-intervention (67%) and was sustained at 3 months (X2(2) = 12.52, p = 0.002; Cohen\u2019s d = 0.65). Repeated measures ANOVA showed that emotional distress decreased significantly from baseline to immediately post-intervention with sustained treatment effects at 3 months post-intervention (F(2,62) = 4.37, p = 0.046; Cohen\u2019s d = 0.42). Satisfaction scores were well above treatment acceptability (M = 39.13, SD = 2.80). Conclusions: Implementation of a community co-developed intervention with the goal of achieving cultural congruency was feasible, likeable, and relevant for Spanish-speaking Latino parents and caregivers of children undergoing treatment for cancer. Moreover, the exploratory analysis showed the intervention was associated with improvements in health literacy and emotional well-being and high levels of treatment satisfaction.<\/jats:p>","DOI":"10.3390\/children13030392","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T09:23:03Z","timestamp":1773307383000},"page":"392","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Culturally Congruent Psychosocial Intervention for Latino Caregivers of Children with Cancer: Formative Evaluation and Preliminary Efficacy"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8896-3650","authenticated-orcid":false,"given":"Michelle A.","family":"Fortier","sequence":"first","affiliation":[{"name":"UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Orange, CA 92868, USA"},{"name":"Sue & Bill Gross School of Nursing, University of California-Irvine, Irvine, CA 92697, USA"},{"name":"Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lessley","family":"Torres","sequence":"additional","affiliation":[{"name":"UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Orange, CA 92868, USA"},{"name":"Sue & Bill Gross School of Nursing, University of California-Irvine, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5650-971X","authenticated-orcid":false,"given":"Belinda","family":"Campos","sequence":"additional","affiliation":[{"name":"UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Orange, CA 92868, USA"},{"name":"Department of Chicano\/Latino Studies, University of California-Irvine, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haydee","family":"Cortes","sequence":"additional","affiliation":[{"name":"UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Orange, CA 92868, USA"},{"name":"Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4629-0993","authenticated-orcid":false,"given":"Sonia","family":"Morales","sequence":"additional","affiliation":[{"name":"Department of Oncology, Rady Children\u2019s Health, San Diego, CA 92123, USA"},{"name":"Department of Pediatrics, School of Medicine, University of California-Irvine, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Oncology, Rady Children\u2019s Health, San Diego, CA 92123, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilibeth","family":"Torno","sequence":"additional","affiliation":[{"name":"Department of Oncology, Rady Children\u2019s Health, San Diego, CA 92123, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeev N.","family":"Kain","sequence":"additional","affiliation":[{"name":"UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Orange, CA 92868, USA"},{"name":"Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8094","DOI":"10.1245\/s10434-023-14200-0","article-title":"Social Determinants of Cancer Disparities","volume":"30","author":"Syrnioti","year":"2023","journal-title":"Ann. Surg. Oncol."},{"key":"ref_2","unstructured":"Stepler, R., and Brown, A. (2016). Statistical Portrait of Hispanics in the United States, Pew Research Center."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1002\/onco.13729","article-title":"Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors","volume":"26","author":"Kronenfeld","year":"2021","journal-title":"Oncologist"},{"key":"ref_4","unstructured":"(2024, August 02). Cancer Treatment|Survivor Facts & Figures. Available online: https:\/\/www.cancer.org\/research\/cancer-facts-statistics\/survivor-facts-figures.html."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1038\/s41416-020-01038-6","article-title":"Cancer health disparities in racial\/ethnic minorities in the United States","volume":"124","author":"Zavala","year":"2021","journal-title":"Br. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1891\/rtnp.20.2.109","article-title":"Accommodating the stranger en casa: How Mexican American elders and caregivers decide to use formal care","volume":"20","author":"Crist","year":"2006","journal-title":"Res. Theory Nurs. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bisht, J., Rawat, P., Sehar, U., and Reddy, P.H. (2023). Caregivers with Cancer Patients: Focus on Hispanics. Cancers, 15.","DOI":"10.3390\/cancers15030626"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3995","DOI":"10.1002\/cncr.30960","article-title":"Disparities in prognosis communication among parents of children with cancer: The impact of race and ethnicity","volume":"123","author":"Ilowite","year":"2017","journal-title":"Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1093\/jpepsy\/jst049","article-title":"Parenting stress among caregivers of children with chronic illness: A systematic review","volume":"38","author":"Cousino","year":"2013","journal-title":"J. Pediatr. Psychol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1093\/jpepsy\/26.3.155","article-title":"Childhood illness-related parenting stress: The pediatric inventory for parents","volume":"26","author":"Streisand","year":"2001","journal-title":"J. Pediatr. Psychol."},{"key":"ref_11","first-page":"807","article-title":"Developing a literature base to understand the caregiving experience of parents of children with cancer: A systematic review of factors related to parental health and well-being","volume":"15","author":"Klassen","year":"2007","journal-title":"Support. Care Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1080\/02739615.2013.816602","article-title":"Risk for Psychosocial Problems in Pediatric Cancer: Impact of Socioeconomics","volume":"42","author":"Karlson","year":"2013","journal-title":"Child. Health Care"},{"key":"ref_13","first-page":"e13515","article-title":"Effectiveness of technology-based psychosocial interventions for child, adolescents and young adults undergoing cancer treatment: A meta-analysis of randomised controlled trials","volume":"31","author":"Ozturk","year":"2022","journal-title":"Eur. J. Cancer Care"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Caminiti, C., Annunziata, M.A., Di Giulio, P., Isa, L., Mosconi, P., Nanni, M.G., Piredda, M., Verusio, C., Diodati, F., and Maglietta, G. (2023). Psychosocial Impact of Virtual Cancer Care through Technology: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cancers, 15.","DOI":"10.3390\/cancers15072090"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Erdmann, F., Feychting, M., Mogensen, H., Schmiegelow, K., and Zeeb, H. (2023). Social Inequalities Along the Childhood Cancer Continuum: An Overview of Evidence and a Conceptual Framework to Identify Underlying Mechanisms and Pathways. Front. Public Health, 7.","DOI":"10.3389\/fpubh.2019.00084"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1080\/15524256.2010.529023","article-title":"A Three-dimensional Model of Cultural Congruence: Framework for Intervention","volume":"6","author":"Schim","year":"2010","journal-title":"J. Soc. Work End-Life Palliat. Care"},{"key":"ref_17","unstructured":"(2023, March 19). Healthcare Literacy: Multiple Perspectives Grounded in the Experience of Mexican American Caregivers\u2014ProQuest. Available online: https:\/\/www.proquest.com\/openview\/d2517abdc3268640a9bab8adf3ffc7a5\/1?cbl=33118&pq-origsite=gscholar&parentSessionId=63RQF5zOEKxVto1T4OGKoeg9mowwN6GU1RC3aVZN%2FWk%3D."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1370\/afm.405","article-title":"Quick Assessment of Literacy in Primary Care: The Newest Vital Sign","volume":"3","author":"Weiss","year":"2005","journal-title":"Ann. Fam. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1080\/10410236.2014.990079","article-title":"Utilization of the Newest Vital Sign (NVS) in Practice in the United States","volume":"31","author":"Shealy","year":"2016","journal-title":"Health Commun."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1177\/1073191111411667","article-title":"Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS\u00ae): Depression, anxiety, and anger","volume":"18","author":"Pilkonis","year":"2011","journal-title":"Assessment"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/HCM.0000000000000117","article-title":"The Influence of Hospital Market Competition on Patient Mortality and Total Performance Score","volume":"35","author":"Haley","year":"2016","journal-title":"Health Care Manag."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1037\/amp0000122","article-title":"Incorporating the cultural diversity of family and close relationships into the study of health","volume":"72","author":"Campos","year":"2017","journal-title":"Am. Psychol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/BF00960495","article-title":"Development of a modified treatment evaluation inventory","volume":"11","author":"Kelley","year":"1989","journal-title":"J. Psychopathol. Behav. Assess."},{"key":"ref_24","unstructured":"Strauss, A., and Corbin, J. (1998). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory, Sage. [2nd ed.]."},{"key":"ref_25","unstructured":"Charmaz, K. (2015, November 16). Constructing Grounded Theory: A Practical Guide Through Qualitative Research. SagePublications Ltd Lond. Available online: https:\/\/scholar.google.com\/scholar?q=charmaz+2006&btnG=&hl=en&as_sdt=0%2C5#0."},{"key":"ref_26","first-page":"359","article-title":"A Framework for Using Qualitative Comparative Analysis for the Review of the Literature","volume":"22","author":"Onwuegbuzie","year":"2017","journal-title":"Qual. Rep."},{"key":"ref_27","first-page":"41","article-title":"Meaningful Member-Checking: A Structured Approach to Member-Checking","volume":"7","author":"McKim","year":"2023","journal-title":"Am. J. Qual. Res."},{"key":"ref_28","unstructured":"(2025, May 08). Orange County, CA|Data USA. Available online: https:\/\/datausa.io\/profile\/geo\/orange-county-ca."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1200\/JCO.23.01290","article-title":"Systematic Review of Interventions Addressing Racial and Ethnic Disparities in Cancer Care and Health Outcomes","volume":"42","author":"Grant","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1037\/fsh0000856","article-title":"Pediatric psychosocial preventative health model: Achieving equitable psychosocial care for children and families","volume":"42","author":"Kazak","year":"2024","journal-title":"Fam. Syst. Health"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Glasgow, R.E., Battaglia, C., McCreight, M., Ayele, R., Maw, A.M., Fort, M.P., Holtrop, J.S., Gomes, R.N., and Rabin, B.A. (2022). Use of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to guide iterative adaptations: Applications, lessons learned, and future directions. Front. Health Serv., 2.","DOI":"10.3389\/frhs.2022.959565"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","article-title":"Evaluating the public health impact of health promotion interventions: The RE-AIM framework","volume":"89","author":"Glasgow","year":"1999","journal-title":"Am. J. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Glasgow, R.E., Harden, S.M., Gaglio, B., Rabin, B., Smith, M.L., Porter, G.C., Ory, M.G., and Estabrooks, P.A. (2019). RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice with a 20-Year Review. Front. Public Health, 7.","DOI":"10.3389\/fpubh.2019.00064"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/392\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T10:28:10Z","timestamp":1773311290000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/392"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["children13030392"],"URL":"https:\/\/doi.org\/10.3390\/children13030392","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]}}}