Addressing the needs for cultural adaptation of DARE-keepin' it REAL among Brazilian students: strategies to improve implementation.

Background: The widely implemented prevention program in Brazil, PROERD (a translated version of the DARE-kiR program), showed no evidence of effect in preventing drug use in a recent trial. The lack of cultural adaptation and instructors' deviations from the curriculum were identified as potential reasons for its ineffectiveness. This study aims to identify points of inadequacy of the PROERD program for the Brazilian culture, suggesting strategies for revising the curriculum to improve implementation.