NATIVE IT’S YOUR GAME:
ADAPTATION OF
AN EFFECTIVE HIV, STI, AND PREGNANCY
PREVENTION PROGRAM FOR AMERICAN
INDIAN & ALASKA NATIVE YOUTH
Cornelia “Connie” Jessen, MA
HIV/STD Prevention Program
Alaska Native Tribal Health Consortium
Funded by the Centers for Disease Control & Prevention (CDC) and
by the Administration for Children & Families (ACF)
It’s Your Game…Keep It Real
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Theory-based, multimedia
program for 7th & 8th grade
2 randomized controlled trials
Effective outcomes by follow-up at
9th grade
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An Effective HIV/STI and
Pregnancy prevention
Program For
M i d d l e S c h o o l Yo u t h
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Delayed initiation of sexual
intercourse
Reduced frequency of sex
Increased condom use
Positive impact on psychosocial
variables
National Recognition and Awards
IYG Tech: Lessons & Topics
1
Introduce IYG program
2
Healthy & Unhealthy Friendships
3
Identify Personal Rules & Risky Situations
4
Effective/Ineffective Refusal Skills (ALASKA)
5
Anatomy, Physiology & Reproduction
6
Healthy/Unhealthy Dating Relationships
7
Consequences of Sex; Reasons to Wait
8
Communication & Negotiation Skills; Internet Communication & Safety
9
Realities of Teen Parents (ALASKA)
10
Consequences of STI/HIV & Importance of Testing
11
Contraception Knowledge & Skills
12
“Select, Detect, Protect” Review; Condom Negotiations
13
Review of IYG; Personalize Reasons for Not Having Sex
Study Activities
PHASE 1
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Year 1
Gain Community Support
 Review Existing
Resources for AI/AN
youth
 Pre-Adaptation Usability
Testing
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Year 2
Adaptation
 Post-Adaptation Testing
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PHASE 2
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Years 3 & 4
 Efficacy Trial
 Dissemination of Results
Phase One - Year 1
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Gaining community support
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Review existing resources for AI/AN youth
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Meet with tribal leaders, community stakeholders
Obtain tribal and IRB approval
Identify culturally-appropriate content, learning strategies
Usability testing of non-adapted IYG program
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Adult stakeholders
80 youth across all 3 regions (~ 1/3rd from each region)
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60% female
Assessed for ease of use, credibility, motivational appeal,
understandability and cultural relevance.
Ideas for improvement
Pre-Adaptation Usability Findings
Category
Gradient
Range of Responses across
Lessons (%)*
Satisfaction
‘a lot’ or ‘a little’
56-92
Ease of use
‘very easy’ or ‘kind of easy’
55-98
‘pace of lessons just right’
63-100
‘information was correct’
76-100
‘information was trust-worthy’
72-97
‘would recommend to classmate’
48-83
“help them make better choices’
81-100
‘words are understandable’
76-94
‘did not need adult help’
69-96
‘would make changes’
3-45
Credibility
Motivational appeal
Understandability
Cultural Relevance
* Number of youth who rated each lesson ranged from 33 – 69
Youth – Recommended Topics/Features
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Native culture, stories, values
or history
Drug & alcohol use
Native identity & pride
Bullying
Traditional healing methods
Religion/spiritual beliefs
Stress
Suicide
Depression
Dating violence
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Native music or
audio
Video games
A place to write
personal thoughts
Photos or videos of
youth like them
Native graphics,
symbols & designs
Numbers or statistics
Feedback from Alaska Native Parents
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“I wish they had this [IYG] when I was a teenager. I was a teenage
mother at age 15.”
“It would be important that you guys keep talking about sex to the
teens, because a lot of teens are getting pregnant. And that it [teen
pregnancy] needs to be stopped.”
“Good for the parents and children to understand about safe sex and
also too much teen pregnancies here in the villages.”
“Very important [topic] because some parents don’t know how to talk to
their children about these things, sex, boyfriends. Now that I’ve seen the
video it will be much easier to get into the conversation about sex and
abuse. Thank you for this information.”
“Sexual awareness should be taught to the teens. Teens need to be
aware that it is cool to wait [to have sex].”
“A good idea would be to let the teens watch a movie of a teenage
mother. How some struggle of being a single mother, also teenage,
single mother. It would give them a second thought about sex, to see the
struggles of teenage parents.”
Phase One - Year 2
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Prioritize lessons to adapt/change
Video production with AI/AN youth & elders
Usability testing of adapted IYG program
45 youth from all 3 regions, 56% female
 Replication of pre-adaptation usability testing with adult
stakeholders and youth
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Program Adaptation Strategies
Tribal Elders & Native Health Expert
“Ap’ii and Datu”: Promoting Healthy
Decision Making – Lesson 9
NATIVE YOUTH
Fact Sheets
Post-Adaptation Youth Usability Findings
Category
Gradient
Range of Responses across
Lessons (%)
Satisfaction
‘a lot’ or ‘a little’
68-94
Ease of use
‘very easy’ or ‘kind of easy’
79-100
‘pace of lessons just right’
58-100
‘information was correct’
77-100
‘information was trust-worthy’
77-100
‘would recommend to classmate’
37-100
“help them make better choices’
73-100
‘words are understandable’
74-100
‘did not need adult help’
44-89
‘meets the needs of AI/AN youth’
54-86
Credibility
Motivational appeal
Understandability
Cultural Relevance
Alaska Stakeholder Feedback
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“I think the program does great to fill a need in our communities
and in a way that is interactive and easy to administer”
“It’s neat and will draw teens into this program”
“Very interesting. Comfortable way to learn about sex, STDs,
and ones’ body”
“It’s great! It’s good to see Alaskans being a part of helping out
in prevention “
“I think it will be very beneficial and I like that it plays to the
teens. It’s more interactive and exciting than boring standard
health ed”
“I think that this program is WONDERFUL and I love it! I believe
that this will make a big impact in my town”
“Currently there isn’t much curricula or programs addressing this,
particularly for natives. The program provides a holistic
approach and incorporates indigenous perspectives, values, and
issues”
Summary
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Despite great need for culturally sensitive programs,
few behavioral interventions for AI/AN youth
Using a systematic approach to cultural adaptation
can make an existing evidence-based sexual health
program like IYG more meaningful and relevant for
AI/AN youth
Primary Research Partners
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Alaska
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Arizona
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Gwenda Gorman
Travis Lane
Pacific Northwest
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Connie Jessen
Taija Revels
Jeni Williamson
Stephanie Craig Rushing
Amanda Gaston
UTPRC
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Ross Shegog
Christine Markham
Jennifer Torres
Thank you! Questions
Contact:
Connie Jessen
[email protected]
729-3955