Rationale, Design, and Methods for Nen Unkumbi/Edahiyedo (“We Are Here Now”): A Multi-Level Randomized Controlled Trial to Improve Sexual and Reproductive Health Outcomes in a Northern Plains American Indian Reservation Community

Rink, Elizabeth; Firemoon, Paula; Anastario, Michael; Johnson, Olivia; GrowingThunder, Ramey; Ricker, Adriann; Peterson, Malory; Baldwin, Julie A.

doi:10.3389/fpubh.2022.823228

Cited by 6 publications

(4 citation statements)

References 86 publications

(127 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Diné community places great trust in TKHs and future public health initiatives would be strengthened if TKHs were consulted during the process of creating health educational materials, and while training health messengers who will educate the community. Previous AI studies integrated cultural knowledge into their materials and emphasized the greater effectiveness when including cultural beliefs, stories, and ceremonial knowledge to help shift behavior change for health promotion [ 25 , 45 , 46 ]. This process could address language barriers when health education materials are presented in Diné bizaad (Diné language) or with use of culturally relevant terms that consider the traditional worldview.…”

Section: Discussionmentioning

confidence: 99%

Diné (Navajo) Traditional Knowledge Holders’ Perspective of COVID-19

Kahn

James

George

et al. 2023

IJERPH

View full text Add to dashboard Cite

From the start of the COVID-19 pandemic on the Navajo Nation, Diné (Navajo) traditional knowledge holders (TKHs), such as medicine men and women and traditional practitioners, contributed their services and healing practices. Although TKHs are not always fully acknowledged in the western health care system, they have an established role to protect and promote the health of Diné people. To date, their roles in mitigating the COVID-19 pandemic have not been fully explored. The purpose of this research was to understand the social and cultural contexts of the COVID-19 pandemic and vaccines based on the roles and perspectives of Diné TKHs. A multi-investigator consensus analysis was conducted by six American Indian researchers using interviews with TKHs collected between December 2021–January 2022. The Hózhó Resilience Model was used as a framework to analyze the data using four parent themes: COVID-19, harmony and relationships, spirituality, and respect for self and discipline. These parent themes were further organized into promoters and/or barriers for 12 sub-themes that emerged from the data, such as traditional knowledge, Diné identity, and vaccine. Overall, the analysis showed key factors that could be applied in pandemic planning and public health mitigation efforts based on the cultural perspective of TKHs.

show abstract

Section: Discussionmentioning

confidence: 99%

Diné (Navajo) Traditional Knowledge Holders’ Perspective of COVID-19

Kahn

James

George

et al. 2023

IJERPH

View full text Add to dashboard Cite

show abstract

“…NenUnkUmbi/EdaHiYedo was designed within the context of a 17 year tribal‐academic partnership and based on the Fort Peck Tribal Council's desire to implement a holistic sexual and reproductive health intervention for American Indian adolescents at Fort Peck that intervene at multiple levels within tribal adolescents human ecology. The details of the research leading up to NenUnkUmbi/EdaHiYedo 's design and implementation are published elsewhere (Rink et al, 2022). NenUnkUmbi/EdaHiYedo 's research team consists of three tribal members and two tribal elders that implement the study at the reservation through Fort Peck Community College and the Fort Peck Tribes Language and Culture Department.…”

Section: Methodsmentioning

confidence: 99%

Baseline results from NenŨnkUmbi/EdaHiYedo: A randomized clinical trial to improve sexual and reproductive health among American Indian adolescents

Rink

Anastario

Peterson

et al. 2023

Journal of Adolescence

Self Cite

View full text Add to dashboard Cite

We report on baseline findings from NenUnkUmbi/EdaHiYedo, a community based participatory research randomized controlled trial with American Indian adolescents to reduce sexual and reproductive health disparities. American Indian adolescents aged 13−19 years participated in a baseline survey that was administered in five schools. We used zero‐inflated negative binomial regression to evaluate how the count of protected sexual acts was associated with independent variables of interest. We stratified models by self‐reported gender of adolescents and tested for a two‐way interaction effect between gender and the independent variable of interest. Two hundred twenty‐three girls and 222 boys (n = 445) were sampled. The average number of lifetime partners was 1.0 (standard deviation = 1.7). Each additional lifetime partner was associated with a 50% increase in the number of protected sexual acts incident rate ratio (IRR = 1.5, 95% confidence interval [CI] 1.1−1.9) and more than a twofold increase in the likelihood of not having protected sexual acts (adjusted odd ratio [aOR] = 2.6, 95% CI 1.3−5.1). Each additional number of substances used in adolescentss' lifetime was associated with an increased likelihood of not having protected sexual acts (aOR = 1.2, 95% CI 1.0−1.5). In boys, each one standard deviation increase in depression severity was associated with a 50% reduction in the number of times a condom was used adjusted IRR (aIRR = 0.5, 95% CI 0.4−0.6, p < .001). Each 1‐unit increase in positive prospections of pregnancy was associated with a pronounced decrease likelihood of not having protected sexual acts (aOR = 0.01, 95% CI 0.0−0.1). Findings support the importance of tribally driven tailoring of sexual and reproducive health interventions and services for American Indian adolescents.

show abstract

“…A cluster-randomized stepped-wedge design (SWD) is being used to evaluate NE . The protocol for the original SWD trial is published elsewhere [ 1 ]. The unprecedented global COVID-19 pandemic and the mitigation strategies enacted in response to the pandemic, including school closures, social distancing measures, and stay-in-place orders, disrupted the planned implementation of the trial and likely had effects on the study’s primary outcomes [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Evidence of secular trends during the COVID-19 pandemic in a stepped wedge cluster randomized trial examining sexual and reproductive health outcomes among Indigenous youth

Anastario

Rink

Firemoon

et al. 2023

Trials

Self Cite

View full text Add to dashboard Cite

Background Nen ŨnkUmbi/EdaHiYedo (“We Are Here Now,” or NE) is an intervention to prevent STIs, HIV, HCV, and teen pregnancy among Assiniboine and Sioux youth of the Fort Peck Reservation in the state of Montana in the USA. A cluster-randomized stepped-wedge design (SWD) trial is used to evaluate NE, where clusters are schools. The purpose of this study is to evaluate whether there is evidence of a secular trend associated with the COVID-19 pandemic. Methods The original study design is a cluster-randomized stepped-wedge design (SWD), in which five schools that youth from Fort Peck attend are the clusters to be randomized into the intervention one at a time, with all schools eventually being randomized to the intervention across three steps. N/E is a 5-year study involving 456 15- to 18-year-old youth. For this study, we use a mixed quantitative and qualitative methods approach to understand how the COVID-19 pandemic may have been associated with the study’s primary outcome variables. Data were drawn from the first cluster exposed to the intervention and one control cluster that did not yet receive the intervention during the period in which COVID-19 mitigation efforts were being implemented. A pre-post COVID questionnaire was added to core measures administered, and semistructured qualitative interviews were conducted with youths regarding their perceptions of how the pandemic altered their sexual behaviors. Results One hundred eighteen youth responded to the questionnaire and 31 youth participated in semistructured qualitative interviews. Youth reporting having sex with less people due to COVID-19 reported more sex acts (incident rate ratio (IRR)=3.6, 95% CI 1.6–8.1) in comparison to those who did not report having sex with less people, and youth who reported having sex with the same amount of people due to COVID-19 reported less sex acts (IRR=0.31, 95% CI 0.14–0.7) in comparison to those who did not report having sex with the same amount of people. Youth reporting having sex less times due to COVID-19 experienced a greater number of sex acts in comparison to those who did not report having sex less times (IRR=2.7, 1.2–6.4). Results suggest that more sexually active individuals reported perceiving having sex with less people and less frequent engagement in sex during the pandemic. It is possible that the COVID-19 pandemic period was associated with a truncation in the distribution of sexual activity that would bias an estimate of the intervention’s effect. Conclusion Findings suggest evidence of a secular trend. This trend must be accounted for at trial end, and sensitivity analyses are recommended. Documenting and reporting on these findings encourages transparent reporting during the implementation of a SWD trial during a global pandemic, and informs endline analyses. Trial registration This trial is registered with the Clinical trials registry of the US National Library of Medicine at the National Institutes of Health (NIH). It was registered on October 1, 2018. The study presented in this manuscript is funded by NIH National Institute on Minority Health and Health Disparities (NIMHD), Award # R01MD012761-01, Elizabeth Rink (Principal Investigator). The study’s ClinicalTrials.gov number is NCT03694418.

show abstract

Rationale, Design, and Methods for Nen Unkumbi/Edahiyedo (“We Are Here Now”): A Multi-Level Randomized Controlled Trial to Improve Sexual and Reproductive Health Outcomes in a Northern Plains American Indian Reservation Community

Cited by 6 publications

References 86 publications

Diné (Navajo) Traditional Knowledge Holders’ Perspective of COVID-19

Diné (Navajo) Traditional Knowledge Holders’ Perspective of COVID-19

Baseline results from NenŨnkUmbi/EdaHiYedo: A randomized clinical trial to improve sexual and reproductive health among American Indian adolescents

Evidence of secular trends during the COVID-19 pandemic in a stepped wedge cluster randomized trial examining sexual and reproductive health outcomes among Indigenous youth

Contact Info

Product

Resources

About