1. 1. NATIVE Its Your Game: Toward Tech- based Sexual Health Education for American Indian and Alaska Native Youth Amanda M Gaston Northwest Portland Area Indian Health Board Native Its Your Game Project Manager agaston@npaihb.org 503-416-3288 April 26-28, 2015 San Francisco, CA #YTHLive Annual Conference on Youth + Tech + Health
2. 2. US Census Bureau. American Indian and Alaska Native Heritage Month, Nov 2012. www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb12-ff22.html
3. 3. Study Goal To adapt and evaluate the effectiveness of an Internet-based HIV/STI & pregnancy prevention program for middle school- aged youth (12-14 years old) in three geographically dispersed AI/AN communities in Alaska, Arizona & Pacific Northwest.
4. 4. Distal Determinants Problem-solving Personal Control Social support Decision-making Cultural beliefs Native identity Proximal Determinants Knowledge Beliefs Perceived Norms Perceived Risk Self-efficacy Refusal Condom use Proximal Determinants Healthy Friendships Healthy Dating Relationships Sexual Intentions Sexual Behavior Outcomes Delay sexual debut Use condoms & contraception Decrease # of sexual partners Get tested for HIV/STI and pregnancy , if at risk
5. 5. Social Environment Peer Influence Parental Influence Media Influence Dating Violence Access to Services Access to Resources Access to Alcohol & Drugs Mental Health
6. 6. Resnicow et al. (1999) Strategies proposed by Kreuter et al. (2003) Examples Surface culture Peripheral Clothing, music, colors, images, fonts, pictures of group members, places Evidential Epidemiological data Linguistic Language(s), terms, literacy level Deep culture Constituent- involving Indigenous staff, lay health workers, involving community in planning & decision-making Sociocultural Cultural values & beliefs; social, historical, environmental and psychological forces that influence target health behavior Resnicow et al. (1999). Cultural sensitivity in public health: Defined and demystified. Ethnicity & Disease, 9:10-21. Kreuter et al. (2003). Achieving cultural appropriateness in health promotion programs: Targeted and tailored approaches. Health Education & Behavior 30:133-146.
7. 7. Intro Video
8. 8. Adaptation: Youth agreement Usability Parameters Item Response Range (%) Pre-adapta Post-adaptb Likability a lot or a little 51-98 68-94 Credibility information was correct 69-97 77-100 information was trust-worthy 67-94 77-100 Motivational appeal would recommend to classmate 49-82 37-100 AI/AN appropriate would make changes 12-39 NA meets needs of AI/AN youth NA 54-86 a Number of youth who rated each lesson ranged from 33 69; b Number of youth who rated each lesson ranged from 6 27; c Pace and understandability was impacted by unreliable access to internet-based program via internet in one testing location.
9. 9. Adaptation: Adult stakeholder agreement IYG-Tech adapted activities % Introduction video featuring Native montage 100 Elder wisdom advising on life decisions (Datu) 91 Elder voice video introductions (Rene and Kirby) 79 -100 Expert videos HIV; condom and dental dam demo (Native health educator) 42 - 82 Private wall (Cyber Caf journal activity) 83-100
10. 10. Evaluation RCT to test NATIVE-IYG efficacy. Sites in AK, AZ, and Pacific Northwest (n=25) American Indian/Alaska Native youth (12-14 y.o.) (n=529) Follow-up immediately after NATIVE-IYG and at 12 months. Results pending Next Steps Spread the Word - Letters to participants and parents - Community newsletters - Presentations - Publications