NATIVE-It’s Your Game: Adapting a Technology-Based Sexual Health Curriculum for American Indian and Alaska Native youth

Abstract

Sexually transmitted infection (STI) and birth rates among American Indian/Alaska Native (AI/AN) youth indicate a need for effective middle school HIV/STI and pregnancy prevention curricula to delay, or mitigate, the consequences of early sexual activity. While effective curricula exist, there is a dearth of curricula with content salient to AI/AN youth. Further, there is a lack of sexual health curricula that take advantage of the motivational appeal, reach, and fidelity of communication technology for this population, who are sophisticated technology users. We describe the adaptation process used to develop Native It’s Your Game, a stand-alone 13-lesson Internet-based sexual health life-skills curriculum adapted from an existing promising sexual health curriculum, It’s Your Game-Tech (IYG-Tech). The adaptation included three phases: (1) pre-adaptation needs assessment and IYG-Tech usability testing; (2) adaptation, including design document development, prototype programming, and alpha testing; and (3) post-adaption usability testing. Laboratory- and school-based tests with AI/AN middle school youth demonstrated high ratings on usability parameters. Youth rated the Native IYG lessons favorably in meeting the needs of AI/AN youth (54–86 % agreement across lessons) and in comparison to other learning channels (57–100 %) and rated the lessons as helpful in making better health choices (73–100 %). Tribal stakeholders rated Native IYG favorably, and suggested it was culturally appropriate for AI/AN youth and suitable for implementation in tribal settings. Further efficacy testing is indicated for Native IYG, as a potential strategy to deliver HIV/STI and pregnancy prevention to traditionally underserved AI/AN middle school youth.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. American Indian Law Center, Inc. (1999). Model tribal research code, with materials for tribal research and checklist for Indian health boards. Albuquerque, NM.

  2. Amnesty International. (2007). Maze of injustice: The failure to protect Indigenous women from sexual violence in the USA. London: Amnesty International Publications.

    Google Scholar 

  3. Aufrecht, S. E. (1999). Missing: Native American governance in American public administration literature. The American Review of Public Administration, 29(4), 370–390.

    Article  Google Scholar 

  4. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs: Prentice-Hall.

    Google Scholar 

  5. Bartholomew, L. K., Parcel, G. S., Kok, G., & Gottlieb, N. (2011). Planning health promotion programs: An intervention mapping approach (3rd ed.). San Francisco: Jossey-Bass.

    Google Scholar 

  6. Beauvais, F. (1998). American Indians and alcohol. Alcohol Health & Research World, 22(4), 253–259.

    CAS  Google Scholar 

  7. Bernal, G., Bonilla, J., & Bellido, C. (1995). Ecological validity and cultural sensitivity for outcome research: Issues for the cultural adaptation and development of psychosocial treatments with Hispanics. Journal of Abnormal Child Psychology, 23, 67–82. doi:10.1007/BF01447045.

    CAS  Article  PubMed  Google Scholar 

  8. Bernal, G., & Domenech Rodriguez, M. M. (Eds.). (2012). Cultural adaptations. Washington, DC: American Psychological Association.

    Google Scholar 

  9. Bernal, G., & Saez-Santiago, E. (2006). Culturally centered psychosocial interventions. Journal of Community Psychology, 34, 121–132. doi:10.1002/jcop.20096.

    Article  Google Scholar 

  10. Buston, K., Wight, D., Hart, G., & Scott, S. (2002). Implementation of a teacher-delivered sex education programme: Obstacles and facilitating factors. Health Education Research, 17(1), 59–72.

    Article  PubMed  Google Scholar 

  11. Card, J. J., Solomon, J., & Cunningham, D. (2011). How to adapt effective programs for use in new contexts. Health Promotion Practice, 12(1), 25–35.

    Article  PubMed  Google Scholar 

  12. CDC. (2013). Youth risk behavior surveillance system (YRBSS 2013). Youth online: High school YRBS. Retrieved July 15 2014, from http://nccd.cdc.gov/youthonline/App/Default.aspx?SID=HS

  13. CDC, Division of STD Prevention. (2010). Sexually transmitted disease surveillance 2009 (Tables 11B, 21B, 34B). Atlanta: U.S. Department of health and Human Services. http://www.cdc.gov/std/stats09/surv2009-complete.pdf

  14. Chewning, B., Douglas, J., Kokotailo, P. K., LaCourt, J., Clair, D. S., & Wilson, D. (2001). Protective factors associated with American Indian adolescents’ safer sexual patterns. Maternal and Child Health Journal, 5(4), 273–280.

    CAS  Article  PubMed  Google Scholar 

  15. Chino, M., & Debruyn, L. (2006). Building true capacity: Indigenous models for indigenous communities. American Journal of Public Health, 96(4), 596–599.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Coyle, K. K., Kirby, D. B., Main, B. V., Gomez, C. A., & Gregorich, S. E. (2004). Draw the line/respect the line: A randomized trial of a middle school intervention to reduce sexual risk behaviors. American Journal of Public Health, 94(5), 843–851.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Craig Rushing, S., & Stephens, D. (2011). Use of media technologies by Native American teens and young adults in the Pacific Northwest: Exploring their utility for designing culturally appropriate technology-based health interventions. Journal of Primary Prevention, 32(3), 135–145. doi:10.1007/s10935-011-0242-z.

    Article  Google Scholar 

  18. Craig Rushing, S., & Stephens, D. (2012). Tribal recommendations for designing culturally appropriate technology-based sexual health interventions targeting native youth in the pacific northwest. American Indian and Alaska Native Mental Health Research, 19(1), 76–101.

    Article  PubMed  Google Scholar 

  19. Dailard, C. (2006). Legislating against arousal: The growing divide between federal policy and teenage sexual behavior. Guttmacher Policy Review, 9(3), 12–16.

    Google Scholar 

  20. Dalla, R. L., & Gamble, W. C. (1997). Exploring factors related to parenting competence among Navajo teenage mothers: Dual techniques of inquiry. Family Relations, 46(2), 113–121.

    Article  Google Scholar 

  21. Dilorio, C., Resnicow, K., McCarty, F., De, A. K., Dudley, W. N., Wang, D. T., et al. (2006). Keepin’ it REAL! Results of a mother-adolescent HIV prevention program. Nursing Research, 55(1), 43–51.

    Article  Google Scholar 

  22. Domenech-Rodriguez, M., & Wieling, E. (2004). Developing culturally appropriate, evidence-based treatments for interventions with ethnic minority populations. In M. Rastogi & E. Wieling (Eds.), Voices of color: First-person accounts of ethnic minority therapists (pp. 313–333). Thousand Oaks: Sage.

    Google Scholar 

  23. Edwards, S. (1992). Among Native American teenagers, sex without contraceptives is common. Family Planning Perspectives, 24(4), 189–191.

    Article  Google Scholar 

  24. Fox, S., & Jones, S. (2009). The social life of health information. Washington, DC: Pew Internet & American Life Project. http://www.pewinternet.org/Reports/2009/8-The-Social-Life-of-Health-Information.aspx?r=1.

  25. Gray, J. S., & Rose, W. J. (2012). Cultural adaptation for therapy with American Indians and Alaska Natives. Multicultural Counseling and Development, 40, 82–92.

    Article  Google Scholar 

  26. Hellerstedt, W. L. (2004). Native teen voices: Feelings about sex, pregnancy, and parenting. University of Minnesota. http://www.ntv.umn.edu/

  27. Hellerstedt, W. L., Peterson-Hickey, M., Rhodes, K. L., & Garwick, A. (2006). Environmental, social, and personal correlates of having ever had sexual intercourse among American Indian youths. American Journal of Public Health, 96(12), 2228–2234.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173–202.

    CAS  Article  PubMed  Google Scholar 

  29. Jemmott, J. B., I. I. I., Jemmott, L. S., & Fong, G. T. (1998). Abstinence and safer sex HIV risk-reduction interventions for African-American adolescents. Journal of the American Medical Association, 279(19), 1529–1536.

    Article  PubMed  Google Scholar 

  30. Kaestle, C. E., Halpern, C. T., Miller, W. C., & Ford, C. A. (2005). Young age at first sexual intercourse and sexually transmitted infections in adolescents and young adults. American Journal of Epidemiology, 161(8), 774–780.

    Article  PubMed  Google Scholar 

  31. Kaufman, C. E., Beals, J., Mitchell, C. M., Lemaster, P., & Fickenscher, A. (2004). Stress, trauma, and risky sexual behaviour among American Indians in young adulthood. Culture, Health & Sexuality, 6(4), 301–318.

    Article  Google Scholar 

  32. Kaufman, C. E., Desserich, J., Big Crow, C. K., Holy, R. B., Keane, E., & Mitchell, C. M. (2007). Culture, context, and sexual risk among Northern Plains American Indian Youth. Social Science & Medicine, 64(10), 2152–2164.

    Article  Google Scholar 

  33. Kaufman, C. E., Mitchell, C. M., Beals, J., Desserich, J., Keane, E., Sam, A., et al. (2010). Circle of Life: Rationale, design, and baseline results of a HIV prevention intervention among young American Indian adolescents of the Northern Plains. Prevention Science, 11(1), 101–112.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kaufman, C. E., Rumbaugh Whitesell, N., Keane, E., Desserich, J., Giago, C., Sam, A., et al. (2014). Effectiveness of circle of life, an HIV-preventive intervention for American Indian middle school youths: A group randomized trial in a Northern Plains tribe. American Journal of Public Health, 104(6), e106–e112.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Komro, K. A., Perry, C. L., Williams, C. L., Stigler, M. H., Farbakhsh, K., & Veblen-Mortenson, S. (2001). How did project Northland reduce alcohol use among young adolescents? Analysis of mediating variables. Health Education Research, 16(1), 59–70. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11252284

  36. Kreuter, M., Lukwago, S. N., Bucholtz, D. C., Clark, E. M., & Sanders-Thompson, V. S. (2003). Achieving cultural appropriateness in health promotion programs: Targeted and tailored approaches. Health Education and Behavior, 30, 133–146.

    Article  PubMed  Google Scholar 

  37. Kumpfer, K. L., Alvarado, R., Smith, P., & Bellamy, N. (2002). Cultural sensitivity and adaptation in family-based prevention interventions. Prevention Science, 3(3), 241–246.

    Article  PubMed  Google Scholar 

  38. Landry, D. J., Singh, S., & Darroch, J. E. (2000). Sexuality education in fifth and sixth grades in U.S. public schools, 1999. Family Planning Perspectives, 32(5), 212–219.

    CAS  Article  PubMed  Google Scholar 

  39. Leong, F. T. L., & Lee, S. H. (2006). A cultural accommodation model of psychotherapy: Illustrated with the case of Asian Americans. Psychotherapy: Theory, Research, Practice, Training, 43, 410–423. doi:10.1037/0033-3204.43.4.410.

    Article  Google Scholar 

  40. Leston, J. D., Jessen, C. M., & Simons, B. C. (2012). Alaska Native and rural youth views of sexual health: A focus group project on Sexually Transmitted Diseases, HIV/AIDS, and unplanned pregnancy. American Indian/Alaska Native Mental Health Research, 19(1), 1–14.

    Article  Google Scholar 

  41. Manlove, J., Franzetta, K., McKinney, K., Papillo, A. R., & Terry-Humen, E. (2004). No time to waste: Programs to reduce teen pregnancy among middle school-aged youth. Washington, DC: National Campaign to Prevent Teen Pregnancy.

    Google Scholar 

  42. Markham, C. M., Tortolero, S. R., Peskin, M. F., Shegog, R., Thiel, M., Baumler, E. R., et al. (2012). Sexual risk avoidance and sexual risk reduction interventions for middle school youth: A randomized controlled trial. Journal of Adolescent Health, 50, 279–288.

    Article  PubMed  Google Scholar 

  43. Minkler, M., & Wallerstein, N. (2003). Community-based participatory research for health. San Francisco: Jossey-Bass.

    Google Scholar 

  44. Minnesota University, Minneaplois Division of General Pediatrics and Adolescent Health. (1992). The state of native American youth health. Atlanta: University of Minnesota Adolescent Health Program.

    Google Scholar 

  45. Mitchell, C. M., Kaufman, C. E., Beals, J., Choice, P., & Team, H. W. P. (2005). Resistive efficacy and multiple sexual partners among American Indian young adults: A parallel-process latent growth curve model. Applied Developmental Science, 9(3), 160–171.

    Article  Google Scholar 

  46. Mitchell, C. M., Rumbaugh Whitesell, N., Spicer, P., Beals, J., & Kaufman, C. E. (2007). Cumulative risk for early sexual initiation among American Indian youth: A discrete-time survival analysis. Journal of Research on Adolescence, 17(2), 387–412.

    Article  Google Scholar 

  47. Morris, T. L., & Meinrath, S. D. (2009). New media, technology and internet use in Indian Country: Quantitative and qualitative analyses. Flagstaff: Native Public Media.

    Google Scholar 

  48. National Campaign to Prevent Teen and Unplanned Pregnancy. (2007). Fact sheet: Teen sexual activity, pregnancy, and childbearing among Native Americans. Washington, DC.

  49. Nielsen, J. (1993). Usability engineering. San Diego: Morgan Kaufmann.

    Google Scholar 

  50. Nixon, S. J., Phillips, M., & Tivis, R. (2000). Characteristics of American-Indian clients seeking inpatient treatment for substance abuse. Journal of Studies on Alcohol, 61(4), 541–547.

    CAS  Article  PubMed  Google Scholar 

  51. O’Donnell, L., O’Donnell, C. R., & Stueve, A. (2001). Early sexual initiation and subsequent sex-related risks among urban minority youth: The Reach for Health study. Family Planning Perspectives, 33(6), 268–275.

    Article  PubMed  Google Scholar 

  52. O’Donnell, L., Stueve, A., San, D. A., Duran, R., Haber, D., Atnafou, R., et al. (1999). The effectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students. American Journal of Public Health, 89(2), 176–181.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Palacios, J., & Kennedy, H. P. (2010). Reflections of Native American teen mothers. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 39(4), 425–434.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Paulussen, T., Kok, G., & Schaalma, H. (1994). Antecedents to adoption of classroom-based AIDS education in secondary schools. Health Education Research, 9, 485–496.

    Article  Google Scholar 

  55. Perry, C. L. (1999). Creating health behavior change: How to develop community-wide programs for youth. Thousand Oaks: Sage Publications.

    Google Scholar 

  56. Peskin, M. F., Shegog, R., Markham, C. M., Thiel, M., Baumler, E. R., Addy, R. C., et al. (2015). Efficacy of It’s Your Game-Tech: A computer-based sexual health education program for middle school youth. Journal of Adolescent Health,. doi:10.1016/j.jadohealth.2015.01.001.

    PubMed Central  Google Scholar 

  57. Resnicow, K., Baranowski, T., Ahluwalia, J. S., & Braithwaite, R. L. (1999). Cultural sensitivity in public health: Defined and demystified. Ethnicity and Disease, 9(1), 10–21.

    CAS  PubMed  Google Scholar 

  58. Rideout, V. J., Foehr, U. G., & Roberts, D. F. (2010). Generation M2: Media in the lives of 8- to 18-year-olds. Menlo Park: Henry J. Kaiser Family Foundation.

    Google Scholar 

  59. Rolleri, L. A., Wilson, M. M., Paluzzi, P. A., & Sedivy, V. J. (2008). Building capacity of state adolescent pregnancy prevention coalitions to implement science-based approaches. American Journal of Community Psychology, 41, 225–234.

    Article  PubMed  Google Scholar 

  60. Rolo, M. A. (1999). Indian country’s hidden healthcare crisis. Civil Rights Journal, 4(1), 44–48.

    Google Scholar 

  61. Santisteban, D. A., Muir-Malcom, J. A., Mitrani, J. B., & Szapocznik, J. (2001). Integrating the study of ethnic culture and family psychology intervention science. In H. A. Liddle, D. A. Santisteban, R. F. Levant, & J. H. Bray (Eds.), Family psychology: Science-based interventions (pp. 331–351). Washington, DC: American Psychological Association.

    Google Scholar 

  62. Shegog, R., Peskin, M. F., Markham, C., Thiel, M., Gabay, E. K., Addy, R. C., et al. (2014). ‘It’s Your Game-Tech’: Toward sexual health in the digital age. Creative Education, 5(15), 1428–1447. doi:10.4236/ce.2014.515161.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Smith, M. U., Rushing, S. C., & The Native STAND Curriculum Development Group. (2011). Native STAND (students together against negative decisions): Evaluating a school-based sexual risk reduction intervention in Indian boarding schools. The Health Education Monograph Series, 28(2), 67–74.

    Google Scholar 

  64. Story, M., Lytle, L. A., Birnbaum, A. S., & Perry, C. L. (2002). Peer-led, school-based nutrition education for young adolescents: Feasibility and process evaluation of the TEENS study. Journal of School Health, 72(3), 121–127.

    Article  PubMed  Google Scholar 

  65. Tortolero, S. R., Markham, C. M., Peskin, M. F., Shegog, R., Addy, R. C., Escobar-Chaves, S. L., et al. (2010). It’s your game: Keep it real: Delaying sexual behavior with an effective middle school program. Journal of Adolescent Health, 46(2), 169–179.

    Article  PubMed  Google Scholar 

  66. Trimble, J. E., Scharron-del-Rio, M. R., & Hill, J. S. (2012). Ethical considerations in the application of cultural adaptation models with ethnocultural populations. In G. Bernal & M. M. Domenech Rodriguez (Eds.), Cultural adaptations. Washington, DC: American Psychological Association.

    Google Scholar 

  67. Turner, W. (2000). Cultural consideration is family-based primary prevention programs in drug abuse. Journal of Primary Prevention, 21(2), 285–303.

    Article  Google Scholar 

  68. Vernon, I. S., & Bubar, R. (2001). Child sexual abuse and HIV/AIDS in Indian country. Wicazo Sa Review, 16(1), 47–63.

    Article  Google Scholar 

  69. Viswanathan, M., Ammerman, A., Eng, E., Gartlehner, G., Lohr, K. N., Griffith, D., et al. (2004). Community-based participatory research: Assessing the evidence. Evidence report/technology assessment no. 99. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ Publication No. 04-E022-2.

  70. Yellow Horse, S., & Yellow Horse Brave Heart, M. Native American Children. (2002). DSHS, Washington State Department of Social and Health Services. PDF available from http://www.nrc4tribes.org/files/Native%20Best%20Practice.pdf

Download references

Acknowledgments

This work was made possible through funding from CDC cooperative agreement (Award# 5U48DP001949) and DHHS Agency for Children and Families Grant (Award# HHS-2011-ACF-ACYF-AT-0157) and through the collaboration of tribes in Alaska, Arizona, and the Pacific Northwest, with Public Health Advisors Lori de Ravello, MPH and Scott Tulloch of the Indian Health Service, consultants Carol Kaufman, PhD. and William Lambert, PhD., and Zsolt L. Levai who facilitated manuscript development.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ross Shegog.

Ethics declarations

Conflict of Interest

The authors have no conflicts of interest to disclose.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Shegog, R., Craig Rushing, S., Gorman, G. et al. NATIVE-It’s Your Game: Adapting a Technology-Based Sexual Health Curriculum for American Indian and Alaska Native youth. J Primary Prevent 38, 27–48 (2017). https://doi.org/10.1007/s10935-016-0440-9

Download citation

Keywords

  • Teen pregnancy prevention
  • Cultural adaptation
  • Communication technology
  • Computer-based learning
  • Behavior
  • Adolescents
  • Web-based health education
  • Computer-based health education
  • Health communications
  • School-based health