NWT RESEARCH DATABASE

Regions: Inuvialuit Settlement Region, Gwich'in Settlement Area, Sahtu Settlement Area, Dehcho Region, North Slave Region, South Slave Region

Tags: social sciences, sexually transmitted infection, youth, sexual health, art

Objective(s): To build capacity and leadership in human immunodeficiency viruses (HIV) prevention and research among Northern and Indigenous youth in the NWT and evaluate the effect of arts-based HIV prevention programs on Northern and Indigenous youth’s HIV and sexually transmitted infections (STI) knowledge, cultural connectedness, self-esteem, empowerment and safer sex self efficacy.

Project Description: This licence has been issued for the scientific research application No.5458. The objectives of this research are to:1) Build capacity and leadership in human immunodeficiency viruses (HIV) prevention and research among Northern and Indigenous youth in the NWT; 2) Evaluate the effect of arts-based HIV prevention programs on Northern and Indigenous youth’s HIV and sexually transmitted infections (STI) knowledge, cultural connectedness, self-esteem, empowerment and safer sex self efficacy. Fostering Open Expression among Youth (FOXY) and Strength, Masculinities, and Sexual Health (SMASH) School-Based Workshops: Quantitative Evaluation of FOXY in the NWT—Survey: Hypotheses: Participants engaging in the arts-based HIV preventions programs FOXY will report higher primary (HIV knowledge) and secondary (self-esteem, empowerment, safer sex self-efficacy, and cultural connectedness) outcome scores from t0 to t1 and t2. All participants will complete the same survey irrespective of their self-identified gender. Measures: This is a multi-centre non-randomised pragmatic cohort pilot study using a pre-test/post-test design with a multi-year 12-month follow-ups for FOXY/SMASH. Participants in FOXY (n=500) and its counterpart SMASH for young men (n=300) will complete a structured interview directly before participating in the intervention at baseline (t0), directly following the completion of the intervention (t1) and at 12 month follow up (t2). The research team will pilot test the survey with peer research assistants and integrate feedback to enhance validity, cultural relevance and clarity. The primary outcome, HIV knowledge, will be measured using the Brief HIV Knowledge Questionnaire. Secondary outcomes include: 1) resilience, using The Child and Youth Resilience Measure-28, 2) self-esteem, assessed using the Rosenberg Self-Esteem Scale; 3) empowerment using the Empowerment Measure that assesses power within (e.g. confidence), power to (e.g. relationship dynamics) and power with (e.g. social membership), 4) safer-sex self efficacy using the Safer Sex Self-Efficacy Scale and 5) cultural connectedness using the Awareness of Connectedness Scale developed to assess culture-specific factors with Alaska Native Youth. Data Analysis: The research team will conduct descriptive analyses of socio-demographic variables, including means and standard deviations (SD) and proportions to provide an overview of participant characteristics. The team will sum items for each scale to calculate total/subscale scores for each measure and calculate means (SD). The team will test outcome measures for pre-intervention differences by socio-demographic characteristics using Pearson product-moment correlation for continuous variables, Student t-tests for dichotomous variables, and analysis of variance for variables of 3 or more categories. The team will use mixed-effects regression to model each continuous outcome measure as a function of 2 time dummy variables, one for post-intervention interview time point and one for 12 month follow-up. This method accounts for the correlated structure of 3 repeated measures (pre-intervention, post-intervention, 12 month follow-up and uses maximum likelihood estimation for inference that allows inclusion of cases with missing data. While accounting for within- and between-subject variability, regression based models also allow the flexibility to adjust for socio-demographic covariates. The model coefficients for the model dummy variables represent the change in outcome scores from pre-intervention to post-intervention and from pre-intervention to 12-month follow-up. Summer Peer Leader Retreats: The research team will conduct three to five 7-day retreats in the summer, each with 25 young Indigenous women aged 13-17 (FOXY) and one with 25 young Indigenous men aged 13-17 (SMASH) (n=50). The team will conduct 2 focus groups at each retreat (n=4; ~12 participants/focus group). Participants will be from across the NWT. Participants will also be invited to complete a pre-survey on the first day of the retreat and a post-test on the last day of the retreat. The purpose of the focus groups is to understand the sexual and reproductive health (SRH) needs of participants as well as their ideas for developing solutions and strengthening FOXY/SMASH land-based retreats. The purpose of the surveys is to assess changes in SRH knowledge and understanding as well as protective factors. Reproductive health: For (hetero) sexually active the team will ask what birth control methods they/their partner are using and to self-report any unplanned pregnancies since the last survey. Protective factors: Empowerment will be assessed with the Empowerment Measure that assesses power within (confidence), power to (relationship dynamics) and power with (social membership). Cultural connectedness will be assessed using the Awareness of Connectedness Scale developed to explore cultural protective factors. Individual, relational and contextual resilience will be assessed with the Child and Youth Resilience Measure (CYRM-28). Stress factors: Teen dating violence will be assessed using the attitudes toward dating violence scale that assesses psychological, physical and sexually abuse behaviours. Depression symptoms will be assessed using the two-item Patient Health Questionnaire-2 (PHQ-2). The CRAFFT Substance Use Screening Test will be used to assess drug and alcohol use. Focus groups will be digitally recorded and transcribed verbatim. Qualitative data will be analyzed using content analysis to examine underlying patterns and themes. As a theory driven approach, content analysis will facilitate exploration of the underlying meaning, patterns, and themes of discourses informed by the Context-Mechanism-Outcome lens. Triangulation through member checking (research team, FOXY/SMASH staff) and inviting multiple analysts to provide unique perspectives of the data will enhance reliability of findings. The team will look for differences between narratives informed by gender-based analyses to explore how intersectional identities (e.g. gender, age, rural residence) may influence SRH, sexual decision making processes, and FOXY/SMASH participation experiences. To analyze surveys the team will conduct descriptive analyses to examine the distribution of socio-demographic variables, including means and standard deviations for continuous variables and proportions for binary variables. Second, the team will conduct unadjusted and adjusted linear regressions to estimate the regression coefficients of continuous SRH variables; unadjusted and adjusted logistic regressions will examine odds ratios of dichotomous SRH outcomes. Explanatory variables will include empowerment, cultural connectedness, resilience, teen dating violence, depression and drug/alcohol use, controlling for age, gender, and sexual orientation. Phase 3 of this study will involve Knowledge Translation and Exchange (KTE). During Phase 3, the team will aim to share knowledge about experiences of promoting HIV prevention and capacity building with Indigenous Northern youth using arts-based strategies. The research team will work in collaboration with partners in NWT (Institute for Circumpolar Health Research , Aurora College, Government of NWT, Aurora Research Institute) to implement participatory KTE. The team will produce infographics, a project report, and national/international conference presentations and peer-reviewed journal article submissions. The team regularly collaborate with Hotii ts’eeda NWT Strategy for Patient-Oriented Research (SPOR) Support Unit to produce communication materials. The fieldwork for this study will be conducted from January 23, 2023 to December 31, 2023.