Protecting our future generation: study protocol for a randomized controlled trial evaluating a sexual health self-care intervention with Native American youth and young adults

Abstract

BackgroundDisparities in sexually transmitted infections (STI) are an urgent problem among Native American youth and young adults which are not fully explained by different sexual or related behaviors. These sexual health disparities are more likely attributed to social environments and structural determinants such as a shortage of sexual healthcare providers, lower socioeconomic status, and access barriers to STI screening and treatment, including geographic isolation and confidentiality concerns. Innovative, non-clinic based alternatives to promote STI screening and treatment are essential for alleviating these disparities. Self-care, or the care taken by individuals towards their own health and well-being may be such a strategy. This study will assess the efficacy of a self-care intervention, called Protecting Our Future Generation, for increasing uptake of STI screening and impacting sexual risk and protective behaviors among Native American youth and young adults living in a reservation-based community in the Southwestern United States.MethodsThe proposed study is a randomized controlled trial to test the efficacy of a self-care intervention compared to a control condition. Participants will be Native Americans ages 14–26 years old who have had vaginal or anal sex at least once in their lifetime. Participants will be randomized to the intervention which includes: 1) a sexual health self-assessment with embedded clinical prediction tool predicting STI positivity, and 2) personalized messaging with key steps to lower risk for STIs, or the control condition which includes: 1) a self-assessment about water, soda and sugar sweetened beverage consumption, and 2) personalized messaging to meet recommended daily intake. All participants will be offered a self-administered STI test. Participants will complete assessments at baseline, 3- and 6-months follow-up. The primary outcome measure is completion of STI screening.DiscussionProtecting Our Future Generation is among the first self-care interventions uniquely focused on sexual health among a Native American population, who endure significant sexual health disparities and are under-represented in research. If efficacious, the intervention will be a model of sexual health self-care for Native American youth and young adults adaptable for use in healthcare and community-based settings.Trial registrationClinical Trials: http://clinicaltrials.gov; NCT03895320; Registered 03/28/2019.

Assessing the Effectiveness of the Respecting the Circle of Life Project on Condom and Contraception Self-efficacy Among American Indian Youth

“…Tribal communities are close knit, often with close familial ties which may make it difficult for youth to ask for contraception or condoms due to confidentiality concerns (Fisher & Ball, 2003 ; Pampati et al, 2019 ). Thus, RCL reported higher self-efficacy pertaining to obtaining condoms and contraception at IHS than control youth is promising as it may indicate RCL helps youth to overcome previously reported concerns about seeking reproductive and sexual health care at IHS including the perceived lack of privacy within IHS (Tingey et al, 2019 ; Strom Chambers, 2021 ).…”

“There Is a Lot of Practice in Not Thinking about That”: Structural, Interpersonal, and Individual-Level Barriers to HIV/STI Prevention among Reservation Based American Indians

“…A lack of transportation to distant health care facilities has been previously identified as a prominent barrier to accessing healthcare in other AI/AN communities [20,21]. In small, close-knit, and remote communities, such as those that are involved in the current study, concerns regarding a lack of privacy while accessing health services is a legitimate concern [20,[22][23][24]. Recognizing other community members in a healthcare facility serving the AI/AN community is a plausible experience, which raises concerns as to whether an individual might be able to maintain anonymity while obtaining HIV/STI-related health services.…”