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O'Connell M, Gluskin B, Parker S, Burke PJ, Pluhar E, Guss CE, Shrier LA. Adapting a Counseling-Plus-mHealth Intervention for the Virtual Environment to Reduce Sexual and Reproductive Health Risk Among Young Women with Depression. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:196-208. [PMID: 36881344 PMCID: PMC9989584 DOI: 10.1007/s11121-023-01506-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/08/2023]
Abstract
MARSSI (Momentary Affect Regulation - Safer Sex Intervention) is a counseling-plus-mobile health (mhealth) intervention to reduce sexual and reproductive health (SRH) risks for women with depression and high-risk sexual behavior. Due to the COVID-19 pandemic limiting in-person care, we sought to develop the counseling and mhealth app onboarding for virtual implementation. A team with SRH, adolescent medicine, motivational interviewing, cognitive behavioral therapy, and technology expertise adapted the counseling through an iterative consensus process. We identified essential aspects of the counseling, specified the content so the counseling could be delivered in person or virtually with fidelity, and considered best practices for telehealth for the focus population. Virtual counseling retained key elements from in-person counseling while including enhancements with engaging visual and audio-video aids. Instructions and programming were developed to support virtual counseling delivery and onboarding for the mhealth app component of MARSSI. After testing the virtual format in mock sessions, we implemented a small-scale feasibility study in an adolescent medicine clinic with women with depressive symptoms and high-risk sexual behavior age 18-24 years (N = 9). Participants experienced minimal technical difficulties and expressed satisfaction with the virtual format, and all were able to complete app onboarding successfully. Expanding delivery options for SRH interventions to include virtual can improve access, particularly for populations with psychological and environmental barriers to care.
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Affiliation(s)
- Maddie O'Connell
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Brittany Gluskin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Parker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Bouvé College of Health Sciences, School of Nursing, Northeastern University, Boston, MA, USA
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Emily Pluhar
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
| | - Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Markham CM, Rushing SC, Manthei J, Singer M, Jessen C, Gorman G, Peskin MF, Hernandez BF, Sacca L, Evans GS, Luna-Meza C, Merritt Z, Shegog R. The Healthy Native Youth Implementation Toolbox: Using Implementation Mapping to adapt an online decision support system to promote culturally-relevant sexual health education for American Indian and Alaska Native youth. Front Public Health 2022; 10:889924. [PMID: 36388328 PMCID: PMC9659648 DOI: 10.3389/fpubh.2022.889924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/03/2022] [Indexed: 01/21/2023] Open
Abstract
Background American Indian and Alaska Native (AI/AN) youth experience serious disparities in sexual and reproductive health, including the highest teen birth rate among racial/ethnic groups, and disproportionate rates of sexually transmitted infections (STI), including HIV. A growing number of evidence-based programs (EBPs) that integrate the strengths and cultural teachings of Native communities exist. Yet, multiple factors, including lack of trained personnel, limited resources, and geographic isolation, may hinder their adoption and implementation. Innovative implementation strategies that facilitate the adoption and implementation of sexual health EBPs in Native communities may help reduce these disparities. Methods We applied Implementation Mapping, a systematic planning framework that utilizes theory, empirical evidence, and community input, to adapt a theory-based, online decision support system, iCHAMPSS (CHoosing And Maintaining Effective Programs for Sex Education in Schools), to support underlying dissemination and implementation processes unique to Native communities. We used an iterative design process, incorporating input from Native practitioners and academicians, to ensure that the adapted decision support system reflects cultural identification, community values, and experiences. Results Grounded in diffusion of innovations, organizational stage theory, and social cognitive theory, the Healthy Native Youth Implementation Toolbox supports Native practitioners through five phases (Gather, Choose, Prepare, Implement, and Grow) to adopt, implement, and maintain a culturally-relevant, age-appropriate sexual health EBP. The Toolbox provides tools, ready-to-use templates, and guidance to plan, implement, and grow a culturally-relevant adolescent health program with their Tribe or community. Hosted within the Healthy Native Youth website (www.healthynativeyouth.org), the Toolbox comprises: (1) a curriculum portal with access to 15 culturally-relevant, age-appropriate evidence-based health promotion programs for AI/AN youth; (2) a "resource library" comprising 20+ support tools, templates, and links to external resources, and (3) "stories from the field" comprising testimonials from experienced Native educators, who have implemented sexual health programs. Conclusion There is a continued need to design, test, and evaluate D&I strategies that are relevant to Native communities. The Healthy Native Youth Implementation Toolbox contributes to the dissemination and implementation of evidence-based, culturally-relevant sexual health education programs in diverse Native communities. Implementation Mapping provided a systematic approach to guide the adaptation process and integrate community voice with the ultimate goal of enhancing sexual health equity among AI/AN youth.
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Affiliation(s)
- Christine M. Markham
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | | | - Jane Manthei
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Cornelia Jessen
- Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Gwenda Gorman
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ, United States
| | - Melissa F. Peskin
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Belinda F. Hernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, San Antonio, TX, United States
| | - Lea Sacca
- College of Medicine, Florida International University, Miami, FL, United States
| | - Gabrielle S. Evans
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Claudia Luna-Meza
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Zoe Merritt
- Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
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Sacca L, Markham C, Hernandez B, Shegog R, Peskin M, Craig Rushing S, Warren H, Tsosie M. The Impact of COVID-19 on the Delivery of Educational Programs in Native American Communities: Qualitative Study. JMIR Form Res 2022; 6:e32325. [PMID: 35348464 PMCID: PMC9004623 DOI: 10.2196/32325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/02/2022] [Accepted: 03/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background Despite the availability of culturally responsive sexual health educational programs for American Indian and Alaska Native (AI/AN) youth, barriers to their uptake and utilization persist in tribal communities. These challenges were exacerbated by the COVID-19 pandemic, which required flexible program delivery using both in-person and virtual classrooms. Objective This exploratory study provides a preliminary understanding of the extent to which pre-existing challenges impact the delivery of culturally responsive sexual health education programs in Native communities and to what extent they were exacerbated by the COVID-19 pandemic. It also highlights the challenges faced by adolescent health advocates when adapting culturally responsive health curricula to online platforms. Finally, this study discloses major socioeconomic, health, and mental challenges experienced by AI/AN youth during the pandemic. Methods An exploratory, descriptive, qualitative design approach was adopted to carry out 5 individual and 1 collective in-depth key informant interviews. A total of 8 Native and non-Native sexual health educators served as key informants and shared their personal experiences with the delivery of sexual health education programs for youth during the COVID-19 pandemic. The interviews were conducted virtually from October to November 2020 using Zoom to reach participants dispersed across different regions of the United States. We followed the consolidated criteria for reporting qualitative research (COREQ) as a reference for the study methodology. We also used the Braun and Clarke framework (2006) to conduct a thematic analysis. Results Experts’ opinions were structured according to 5 main themes: (1) competing community priorities during COVID-19; (2) moving to web-based programming: skills, training, support; (3) recruiting youth; and (4) challenges for implementation in a household environment; and (5) recommendations to overcome implementation challenges. These themes are complementary, connected, and should be considered holistically for the development, dissemination, and implementation of online sexual health programs for AI/AN youth, specifically during the COVID-19 pandemic. The results raised the following points for discussion: (1) Building partnerships with schools and community organizations facilitates program adaptation and implementation, (2) there is a need to adopt a holistic approach when addressing youth sexual health in AI/AN communities, (3) a systematic and culturally responsive adaptation approach ensures effective virtual program delivery, and (4) community and youth engagement is essential for the success of virtual sexual health programs. Conclusions Findings can provide recommendations on actions to be taken by sexual health educators and guidelines to follow to ensure cultural sensitivity, effective adaptation, and successful implementation when setting out to advocate for online sexual health programs for AI/AN youth.
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Affiliation(s)
- Lea Sacca
- Center for Health Promotion and Disease Prevention, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Christine Markham
- Center for Health Promotion and Disease Prevention, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Belinda Hernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Ross Shegog
- Center for Health Promotion and Disease Prevention, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Melissa Peskin
- Center for Health Promotion and Disease Prevention, University of Texas Health Science Center Houston, Houston, TX, United States
| | | | - Hannah Warren
- Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Monique Tsosie
- Inter Tribal Council of Arizona, Phoenix, AZ, United States
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Craig Rushing S, Kelley A, Bull S, Stephens D, Wrobel J, Silvasstar J, Peterson R, Begay C, Ghost Dog T, McCray C, Love Brown D, Thomas M, Caughlan C, Singer M, Smith P, Sumbundu K. Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial. JMIR Ment Health 2021; 8:e26158. [PMID: 34524092 PMCID: PMC8482172 DOI: 10.2196/26158] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Culturally relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. OBJECTIVE We aim to conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. METHODS From October to December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044 participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health, help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested using linear mixed-effect models and linear regressions. RESULTS A total of 833 AI/AN teenagers and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and help-seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.03), positive coping (P<.001), self-efficacy (P=.02), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant in those exhibiting risky behaviors at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average; however, no difference was found in risky drug and alcohol use (P<.001). The number of participants who used SMS text messages to help themselves increased from 69.1% (427/618) at 3 months to 76% (381/501; P<.001) at 8 months. Similarly, the number of participants who used SMS text messages to help friends or family members increased from 22.4% (138/616) at 3 months to 54.6% (272/498) at 8 months. CONCLUSIONS This is the first national randomized controlled trial of a mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career messages. This study provides new insights for supporting the next generation of AI/AN changemakers. TRIAL REGISTRATION ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481.
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Affiliation(s)
| | - Allyson Kelley
- Allyson Kelley & Associates PLLC, Sisters, OR, United States
| | - Sheana Bull
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado, aurora, CO, United States
| | - David Stephens
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Julia Wrobel
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado, aurora, CO, United States
| | - Joshva Silvasstar
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado, aurora, CO, United States
| | - Roger Peterson
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Corey Begay
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Thomas Ghost Dog
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Celena McCray
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Danica Love Brown
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Morgan Thomas
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Colbie Caughlan
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Paige Smith
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Kanku Sumbundu
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado, aurora, CO, United States
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Sacca L, Craig Rushing S, Markham C, Shegog R, Peskin M, Hernandez B, Gaston A, Singer M, Trevino N, Correa CC, Jessen C, Williamson J, Thomas J. Assessment of the Reach, Usability, and Perceived Impact of " Talking Is Power": A Parental Sexual Health Text-Messaging Service and Web-Based Resource to Empower Sensitive Conversations with American Indian and Alaska Native Teens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9126. [PMID: 34501715 PMCID: PMC8431363 DOI: 10.3390/ijerph18179126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early sexual debut among American Indian and Alaska Native (AI/AN) adolescents has been associated with an increased risk of teenage pregnancies and sexually transmitted infections, along with an increased risk of having multiple lifetime sexual partners, and engaging in greater frequency of sex, substance abuse, and lack of condom use. A major protective factor against early sexual debut among AI/AN youth is the familial system. Interventions aiming to improve parent-child communication and parental warmth toward adolescent sexual health topics were reported to contribute to positive youth sexual health outcomes, specifically among minority youth. Healthy Native Youth thus developed the Talking is Power text-messaging service to guide parents and caring adults on how to initiate sensitive topics with youth and how to support them in making informed decisions regarding sex and healthy relationships. METHODS Descriptive statistics were used to demonstrate website analytics and reach per views and time spent on each page, and for displaying participants' responses to the questions on the usability of the Talking is Power text-messaging series. To assess the perceived impact of the series, the differences in mean percentage scores of the question assessing parental comfort in engaging in sexual health topics with youth between pre- and post-intervention were calculated using two-sample t-tests of equal variances. Descriptive content analysis was adopted to highlight emerging themes from open-ended items. RESULTS When looking at reach, 862 entrances were recorded during the specified time period (5.8% of total entrances to HNY website), while the bounce rate was set at 73.1% (22.6% greater than the industry average), and the exit rate was 54.3% (15.2% greater than the industry average). Series usability was highly ranked on the 5-Likert scale in terms of signing up for a similar series on a different topic, quality of images, texts, and links, relating to prompts, and change in sparking sensitive conversations with youth. High likelihood of recommending the series to a friend or colleague was also reported by participants (0-10). No significant difference in parental comfort levels was reported (p = 0.78 > 0.05). Main themes provided suggestions for improving the series mode of delivery, while others included positive feedback about the material, with the possibility of expanding the series to other adolescent health topics. CONCLUSION Lessons learned during the design, dissemination, and evaluation of the resource's usability, reach, and perceived impact may be of interest to other Indigenous communities who are in the process of adapting and/or implementing similar approaches.
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Affiliation(s)
- Lea Sacca
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Stephanie Craig Rushing
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Christine Markham
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Melissa Peskin
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Belinda Hernandez
- School of Public Health, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
| | - Amanda Gaston
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Nicole Trevino
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Chrystial C. Correa
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Cornelia Jessen
- Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA; (C.J.); (J.W.)
| | - Jennifer Williamson
- Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA; (C.J.); (J.W.)
| | - Jerri Thomas
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ 85004, USA;
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Stephens D, Peterson R, Singer M, Johnson J, Rushing SC, Kelley A. Recruiting and Engaging American Indian and Alaska Native Teens and Young Adults in a SMS Help-Seeking Intervention: Lessons Learned from the BRAVE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9437. [PMID: 33339260 PMCID: PMC7765783 DOI: 10.3390/ijerph17249437] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 12/26/2022]
Abstract
This paper shares lessons learned recruiting and engaging participants in the BRAVE study, a randomized controlled trial carried out by the Northwest Portland Area Indian Health Board and the mHealth Impact Lab. The team recruited 2330 American Indian/Alaska Native (AI/AN) teens and young adults nationwide (15-24 years old) via social media channels and text message and enrolled 1030 to participate in the 9 month study. Teens and young adults who enrolled in this study received either: 8 weeks of BRAVE text messages designed to improve mental health, help-seeking skills, and promote cultural pride and resilience; or 8 weeks of Science Technology Engineering and Math (STEM) text messages, designed to elevate and re-affirm Native voices in science, technology, engineering, math and medicine; and then received the other set of messages. Results indicate that social media channels like Facebook and Instagram can be used to recruit AI/AN teens and young adults. Retention in this study was high, with 87% of participants completing both the BRAVE and STEM intervention arms. Lessons learned from this process may help teen and young adult-serving organizations, prevention programs, policy makers, researchers, and educators as they support the next generation of AI/AN change makers.
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Affiliation(s)
- David Stephens
- Northwest Portland Area Indian Health Board, 2121 SW Broadway #300, Portland, OR 97201, USA; (D.S.); (R.P.); (M.S.); (J.J.)
| | - Roger Peterson
- Northwest Portland Area Indian Health Board, 2121 SW Broadway #300, Portland, OR 97201, USA; (D.S.); (R.P.); (M.S.); (J.J.)
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, 2121 SW Broadway #300, Portland, OR 97201, USA; (D.S.); (R.P.); (M.S.); (J.J.)
| | - Jacqueline Johnson
- Northwest Portland Area Indian Health Board, 2121 SW Broadway #300, Portland, OR 97201, USA; (D.S.); (R.P.); (M.S.); (J.J.)
| | - Stephanie Craig Rushing
- Northwest Portland Area Indian Health Board, 2121 SW Broadway #300, Portland, OR 97201, USA; (D.S.); (R.P.); (M.S.); (J.J.)
| | - Allyson Kelley
- Allyson Kelley & Associates, Principal, 69705 Lake Drive, Sisters, OR 97759, USA;
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Anastario M, FireMoon P, Ricker A, Holder S, Rink E. Self-reported Exposure to Sexual and Reproductive Health Information among American Indian Youth: Implications for Technology Based Intervention. JOURNAL OF HEALTH COMMUNICATION 2020; 25:412-420. [PMID: 32584646 PMCID: PMC8018870 DOI: 10.1080/10810730.2020.1777599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While technology-based interventions show promise in certain populations of American youth, the technology may intrinsically widen intergenerational communication chasms associated with youth's increased access to Smartphone technologies. The authors examined self-reported exposure to sexual and reproductive health information and evaluated its relationship with sexual risk behaviors with American Indian youth. Approximately 296 students, ages of 15-18 years old, were surveyed to examine self-reported exposure and attitudes to information received about sexual intercourse, reproduction, and social media use in relation to sexual risk behaviors. Results indicate that information received regarding sexual intercourse and birth control from intra-familial network members was associated with more engagement in sex, and that increased social media use to talk or learn about sex was associated with not using a condom at the last sexual encounter. We advise that researchers and programmers considering technology-based interventions with AI communities carefully consider the gravity of investing preventive resources into technology-based interventions that may further deepen communication gaps that youth experience within their community networks.
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Affiliation(s)
| | | | | | - Shannon Holder
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA, Montana State University, Bozeman, MT, USA
| | - Elizabeth Rink
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
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Kenyon DB, McMahon TR, Simonson A, Green-Maximo C, Schwab A, Huff M, Sieving RE. My Journey: Development and Practice-Based Evidence of a Culturally Attuned Teen Pregnancy Prevention Program for Native Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E470. [PMID: 30736271 PMCID: PMC6388191 DOI: 10.3390/ijerph16030470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 11/16/2022]
Abstract
A clear need exists for teen pregnancy prevention programs that are responsive to the specific needs and cultural contexts of Native American communities. Recent data indicates that the birth rate for Native teens is nearly two and a half times the rate for White teens (32.9 versus 13.2). To address this disparity, we conducted formative research with Northern Plains Native American community members, resulting in My Journey, a culturally attuned curriculum for 6⁻8th graders. My Journey is grounded in traditional values and teachings to promote self-efficacy in sexual health decision-making and engagement in prosocial behaviors. We conducted a pilot study with 6⁻8th grade students (n = 45), aged 11⁻14 years (22 females, 23 males). Pilot study findings confirm program feasibility and acceptability. The process evaluation revealed that teachers liked the curriculum, particularly its adaptability of cultural components and ease of student engagement. The outcome evaluation demonstrated that My Journey provided an avenue for NA youth to increase their sex refusal self-efficacy. Application of the culture cube framework revealed My Journey has made a meaningful practice-based evidence contribution as a community-defined, culturally integrated curriculum that is effective. Future directions include broader implementation of My Journey, including adaption for additional populations.
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Affiliation(s)
- DenYelle Baete Kenyon
- Behavioral Sciences, Sanford Research, Sioux Falls, SD 57104, USA.
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA.
| | - Tracey R McMahon
- Behavioral Sciences, Sanford Research, Sioux Falls, SD 57104, USA.
| | - Anna Simonson
- Behavioral Sciences, Sanford Research, Sioux Falls, SD 57104, USA.
| | | | - Ashley Schwab
- Marketing, Sanford Health, Sioux Falls, SD 57104, USA.
| | - Melissa Huff
- Sisseton-Wahpeton Oyate Tribal Health Administration, Agency Village, SD 57262, USA.
| | - Renee E Sieving
- School of Nursing & Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA.
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Craig Rushing S, Stephens D, Shegog R, Torres J, Gorman G, Jessen C, Gaston A, Williamson J, Tingey L, Lee C, Apostolou A, Kaufman C, Markham CM. Healthy Native Youth: Improving Access to Effective, Culturally-Relevant Sexual Health Curricula. Front Public Health 2018; 6:225. [PMID: 30175091 PMCID: PMC6107849 DOI: 10.3389/fpubh.2018.00225] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 11/13/2022] Open
Abstract
Tribal health educators across the United States have found it challenging to locate engaging, culturally-relevant sexual health curricula for American Indian and Alaska Native (AI/AN) youth. Healthy Native Youth is a new online resource that provides a "one-stop-shop" for tribal health advocates to access age-appropriate curricula. The site was designed by a team of advisers representing a diverse group of tribal communities, using a collaborative planning process. The website content and navigation was then refined through usability testing with the target audience. The portal allows users to filter and compare curricula on multiple dimensions, including: age, delivery setting, duration, cost, and evidence of effectiveness, to determine best-fit. It includes all materials needed for implementation free-of-charge, including: facilitator training tools, lesson plans, materials to support participant marketing and recruitment, information about each program's cultural relevance, evaluation methods and findings, and references to publications and reports. The website currently includes mCircle of Life, Native It's Your Game, Native STAND, Native VOICES, and Safe in the Village, among others. Since its launch in August 2016, the site has had over 31,000 page views in all 50 States. The Healthy Native Youth portal provides educators in rural communities a promising new tool to support the dissemination and implementation of evidence-based health curricula in geographically-disbursed AI/AN communities. Lessons learned during the design and dissemination of the Healthy Native Youth website may be of value to other Indigenous populations interested in our approach and our findings.
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Affiliation(s)
| | - David Stephens
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Torres
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Gwenda Gorman
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ, United States
| | - Cornelia Jessen
- Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Amanda Gaston
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Jennifer Williamson
- Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Lauren Tingey
- Johns Hopkins Center for American Indian Health, Baltimore, MD, United States
| | - Crystal Lee
- UCLA David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, Global Center for Children and Families, Los Angeles, CA, United States
| | - Andria Apostolou
- Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, MD, United States
| | - Carol Kaufman
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, United States
| | - Christine Margaret Markham
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Black KJ, Morse B, Tuitt N, Big Crow C, Shangreau C, Kaufman CE. Beyond Content: Cultural Perspectives on Using the Internet to Deliver a Sexual Health Intervention to American Indian Youth. J Prim Prev 2018; 39:59-70. [PMID: 29344773 DOI: 10.1007/s10935-017-0497-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
American Indian and Alaska Native (AIAN) youth are characterized by high rates of pregnancy and risky sexual behavior. Reaching these youth with culturally appropriate interventions is difficult due to geographic dispersion and cultural isolation. Online interventions can provide opportunities for reaching and engaging AIAN youth. However, electronic interventions are also impersonal and this can be culturally incongruous for AIANs and other populations for whom traditional ceremonies, practices and patterns of interpersonal communication are central. This paper describes the application of community based participatory research methods to: (1) identify concerns about the exclusive use of an online sexual health program; (2) address community concerns by developing supplemental class lessons, and (3) evaluate the feasibility and acceptability of the new hybrid intervention. Data derives from qualitative and quantitative sources. During the formative phase of the project, qualitative data from partner interactions was analyzed with participatory inquiry to inform intervention development. To evaluate the intervention, qualitative data (e.g., interviews, surveys) were used to understand and explain quantitative measures such as implementation fidelity and attendance. Implementers were enthusiastic about the hybrid intervention. The lessons were easy to teach and provided opportunities for meaningful discussions, adaptations, and community involvement. The use of online videos was an effective method for providing training. Working with community partners, we resolved cultural concerns arising from the exclusive use of the Internet by creating a hybrid intervention. The additional burden for staff to deliver the class lessons was considered minimal in comparison to the educational and programmatic benefits of the hybrid intervention. ClinicalTrials.gov identifier NCT01698073.
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Affiliation(s)
- Kirsten J Black
- Centers for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA.
| | - Bradley Morse
- Butler Institute for Families, University of Denver, Denver, CO, USA
| | - Nicole Tuitt
- Centers for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - CeCe Big Crow
- Navigator Program, Great Plains Tribal Chairman's Health Board, Rapid City, SD, USA
| | - Carly Shangreau
- Centers for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
- Northern Plains Regional Field Office, Pine Ridge, SD, USA
| | - Carol E Kaufman
- Centers for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
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Markham CM, Craig Rushing S, Jessen C, Gorman G, Torres J, Lambert WE, Prokhorov AV, Miller L, Allums-Featherston K, Addy RC, Peskin MF, Shegog R. Internet-Based Delivery of Evidence-Based Health Promotion Programs Among American Indian and Alaska Native Youth: A Case Study. JMIR Res Protoc 2016; 5:e225. [PMID: 27872037 PMCID: PMC5138449 DOI: 10.2196/resprot.6017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 10/15/2016] [Accepted: 10/28/2016] [Indexed: 11/29/2022] Open
Abstract
Background American Indian and Alaska Native (AI/AN) youth face multiple health challenges compared to other racial/ethnic groups, which could potentially be ameliorated by the dissemination of evidence-based adolescent health promotion programs. Previous studies have indicated that limited trained personnel, cultural barriers, and geographic isolation may hinder the reach and implementation of evidence-based health promotion programs among AI/AN youth. Although Internet access is variable in AI/AN communities across the United States, it is swiftly and steadily improving, and it may provide a viable strategy to disseminate evidence-based health promotion programs to this underserved population. Objective We explored the potential of using the Internet to disseminate evidence-based health promotion programs on multiple health topics to AI/AN youth living in diverse communities across 3 geographically dispersed regions of the United States. Specifically, we assessed the Internet’s potential to increase the reach and implementation of evidence-based health promotion programs for AI/AN youth, and to engage AI/AN youth. Methods This randomized controlled trial was conducted in 25 participating sites in Alaska, Arizona, and the Pacific Northwest. Predominantly AI/AN youth, aged 12-14 years, accessed 6 evidence-based health promotion programs delivered via the Internet, which focused on sexual health, hearing loss, alcohol use, tobacco use, drug use, and nutrition and physical activity. Adult site coordinators completed computer-based education inventory surveys, connectivity and bandwidth testing to assess parameters related to program reach (computer access, connectivity, and bandwidth), and implementation logs to assess barriers to implementation (program errors and delivery issues). We assessed youths’ perceptions of program engagement via ratings on ease of use, understandability, credibility, likeability, perceived impact, and motivational appeal, using previously established measures. Results Sites had sufficient computer access and Internet connectivity to implement the 6 programs with adequate fidelity; however, variable bandwidth (ranging from 0.24 to 93.5 megabits per second; mean 25.6) and technical issues led some sites to access programs via back-up modalities (eg, uploading the programs from a Universal Serial Bus drive). The number of youth providing engagement ratings varied by program (n=40-191; 48-60% female, 85-90% self-identified AI/AN). Across programs, youth rated the programs as easy to use (68-91%), trustworthy (61-89%), likeable (59-87%), and impactful (63-91%). Most youth understood the words in the programs (60-83%), although some needed hints to complete the programs (16-49%). Overall, 37-66% of the participants would recommend the programs to a classmate, and 62-87% found the programs enjoyable when compared to other school lessons. Conclusions Findings demonstrate the potential of the Internet to enhance the reach and implementation of evidence-based health promotion programs, and to engage AI/AN youth. Provision of back-up modalities is recommended to address possible connectivity or technical issues. The dissemination of Internet-based health promotion programs may be a promising strategy to address health disparities for this underserved population. Trial Registration Clinicaltrials.gov NCT01303575; https://clinicaltrials.gov/ct2/show/NCT01303575 (Archived by WebCite at http://www.webcitation.org/6m7DO4g7c)
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Affiliation(s)
- Christine M Markham
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Cornelia Jessen
- Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Gwenda Gorman
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ, United States
| | - Jennifer Torres
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | | | | | | | - Robert C Addy
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Melissa F Peskin
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ross Shegog
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Feldman Farb A, Margolis AL. The Teen Pregnancy Prevention Program (2010-2015): Synthesis of Impact Findings. Am J Public Health 2016; 106:S9-S15. [PMID: 27689501 DOI: 10.2105/ajph.2016.303367] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Amy Feldman Farb
- Amy Feldman Farb and Amy L. Margolis are with the US Department of Health and Human Services, Office of the Assistant Secretary for Health, Office of Adolescent Health, Rockville, MD
| | - Amy L Margolis
- Amy Feldman Farb and Amy L. Margolis are with the US Department of Health and Human Services, Office of the Assistant Secretary for Health, Office of Adolescent Health, Rockville, MD
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