Adaptation of a computer-based HIV, STD, teen pregnancy prevention program for American Indian and Alaska Native Youth

Background: Persistent disparities in adolescent birth and sexually transmitted infection (STI) rates between American Indian/Alaska Native (AI/AN) youth and other US teens indicate a need for effective HIV/STI/pregnancy prevention for this population. Purpose: To adapt “It's Your Game…Keep It Real” (IYG), an evidence-based HIV/STI/pregnancy prevention curriculum for urban minority youth, for middle school-aged AI/AN youth via usability testing in 3 large geographically dispersed AI/AN communities in Alaska, the Pacific Northwest, and Arizona. Methods: Usability testing was conducted with AI/AN youth (n=53) and adult stakeholders (n=16) within a larger CDC- and ACF-funded randomized control trial. Parameters for informing surface and deep cultural adaptation were quantitatively (survey) and qualitatively assessed (survey and group process) and included satisfaction, ease of use, credibility, understandability, and motivational appeal. Results: IYG lessons were rated easy to use (55%-98%), timed just right (63%-100%), correct and trustworthy (72%-100%), and understandable (76%-94%). The majority of students liked the lessons (56%-92%) and indicated they would help them make better choices (81%-100%). Three to forty-five percent of youth respondents recommended making culturally related changes to IYG. AI/AN adults, who reacted favorably towards the program, also made recommendations. Surface structural changes included showing Native youth profiles, more traditional music, and culturally relevant settings. Deep cultural recommendations included altering risky situations, skills to avoid drugs and alcohol, and skills to avoid/address unhealthy relationships. Conclusions: A systematic community-based approach to surface and deep cultural adaptation has the potential to make a preexisting evidence-based sexual health program such as IYG more salient for AI/AN youth.