Adaptation of a multimedia sexual health education 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 sexual education for this population. Purpose: To adapt a promising computer-based middle school sexual health education program for urban minority youth, ‘It’s Your Game Tech’ (IYG-Tech) for use with AI/AN youth in Alaska, the Pacific Northwest, and Arizona. Methods: Pre- and post-adaptation usability tests were conducted with AI/AN youth (pre: n=80; post: n= 45) and adults (pre: n=18; post: n=25). Parameters for informing adaptation were quantitatively (survey) and qualitatively assessed (survey and group process). Results: IYG-Tech comprises 13 computer-based lessons. Pre-adaptation testing indicated that AI/AN youth and adults viewed IYG-Tech favorably. However, recommendations were made to enhance its relevance for AI/AN youth. Deep cultural changes included adjusting the context of risky situations to reflect circumstances relevant to AI/AN youth, improving skills to avoid drugs/alcohol, and to avoid/address unhealthy relationships. Surface changes included featuring AI/AN youth, adding traditional music, and culturally relevant settings. The adapted program, NATIVE-IYG (N-IYG), was rated as easy to use (79-100%), paced just right (58-100%), correct and trustworthy (77-100%), understandable (74-100%), likable (68-94%) and impactful in making healthier choices (73-100%). Adults indicated N-IYG would be appealing and relevant for AI/AN youth, and that most tribal communities would support implementation. Conclusions: Native IYG’s effectiveness to delay sexual debut is being evaluated in a randomized controlled trial in 25 AI/AN communities.