Adapting Evidence-Based Sexual Health Interventions to Make Them Culturally Relevant for Native American Youth

Two Native American young people talking on a school campus.

Native VOICES: Adapting a Video-based Sexual Health Intervention for American Indian Teens and Young Adults Using the ADAPT-ITT Model” (abstract). Stephanie Craig Rushing and Wendee Gardner. American Indian and Alaska Native Mental Health Research, Vol. 23, No. 1 (2016).

What it’s about: Researchers Rushing and Gardner sought to create an intervention that prevents sexually transmitted infections, including HIV, among Native American youth, ages 15 to 24. To do so, they used the 8-phase model, ADAPT-ITT, to tailor two video- and evidence-based interventions that the Centers for Disease Control and Prevention have highlighted as “high impact” approaches for HIV prevention: “Video Opportunities for Innovative Condom Education and Safer Sex (VOICES)” and “Safe in the City.”

The sample included youth identifying as heterosexual, and as lesbian, gay, bisexual, transgender, or two-spirit (LGBT-TS), and  living in urban or reservation communities in the Pacific Northwest.  During the first two years of the study the authors held focus groups and conducted individual interviews with 62 youth. The authors also interviewed parents, teachers, community elders, health practitioners, and health advocates. The third year was spent revising the VOICES video script, a process which involved 14 Native American youth who read or acted in multiple drafts of the script. The fourth and final year involved collecting feedback from adult community stakeholders.

Why read it: Native American youth are at higher risk for adverse sexual health outcomes compared to their non-Native American peers, such as experiencing higher than average rates of sexually transmitted infections, the authors write. While the Centers for Disease Control and Prevention recognize many evidence-based interventions (EBIs)   for preventing HIV among young people, prior to this study, none of the EBIs were designed for or rigorously evaluated with AI/AN youth, Rushing and Gardner add. This study’s description of using the ADAPT-ITT model to tailor evidence-based interventions for Native American youth may serve as a guide for other youth-serving agencies.

Biggest takeaways from the research: Following the ADAPT-ITT model led to a well-received, culturally-sensitive video that raises awareness about sexual health issues for Native American youth, Rushing and Gardner write. Some  key points about the development of the adaptation are as follows.

  • Youth and adult stakeholders can help shape an adaptation. Data from focus groups and interviews helped the authors design new scenes that Native American youth could more easily identify with, such as using backdrops that reflect their day-to-day lives, and feature figures whom youth identified as important community members such as an “auntie” and an elder. The authors also added a character who identified as LGBT-TS and was presented in a positive light as a well-respected community member.
  • Young people need videos tailored for their age group. One of the original videos, VOICES, targeted an adult audience, so the authors made sure the Native VOICES video accurately targeted young people.  By incorporating the tone and characteristics of young people’s communication such as slang and witty replies, the authors made the intervention more youth-friendly.

At the time of the study’s publication, the authors had completed part of the final phase of the ADAPT-ITT model: testing. The authors conducted a randomized controlled trial with 800 Native American youth, ages 15 to 24, who lived in nine Tribal communities across the United States. The trial is  ongoing, and the authors hope the trial’s results will demonstrate that Native VOICES is an effective intervention for the prevention of HIV and other sexually-transmitted infections among Native youth.

Additional references: Look for more articles on American Indian and Alaska Native (Native American) youth, sexual health interventions, and video-based interventions in our digital library.

Read research about how providers communicate about sexually transmitted infections with Native American youth, and learn how historical trauma affects how Inuit parents talk to teens about sexual health.

Publications discussed here do not necessarily reflect the views of the National Clearinghouse on Families and Youth, the Family and Youth Services Bureau, or the Administration for Children and Families.

9-5 pm Eastern