Michelle Jasczynski, Ed.M. Reality Check: Community Consultative Process to Develop a Targeted Youth Sexual Health Intervention Michelle Jasczynski, Ed.M. Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention PHAP 2014 Class Summer Training June 2nd, 2015 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

Framing the Problem: DC Adolescents and STDs The adolescent population of the District presently experiences rates of chlamydia and gonorrhea that are correspondingly double and triple the national adolescent average. Data and Graphic Source: Reportable STDs in Young People 15-24 Years of Age, 2013 courtesy of National Electronic Telecommunications System for Surveillance, Centers for Disease Control and Prevention. CDC/NCHS 2012 bridged population estimates, derived from US Census data, used for rate denominators.

Framing the Problem: DC Adolescents and STDs Graphic Source: Reportable STDs in Young People 15-24 Years of Age, 2013 courtesy of National Electronic Telecommunications System for Surveillance, Centers for Disease Control and Prevention. CDC/NCHS 2012 bridged population estimates, derived from US Census data, used for rate denominators.

Framing the Problem: DC Adolescents and STDs In response to the high rates of both chlamydia and gonorrhea, the DC Department of Health was tasked to develop a cost-effective, youth-acceptable intervention that would reduce barriers to sexual health information and care. In reviewing prior strategies and best practices for youth sexual health programs, it was determined that a text-message based program the best programmatic approach. For this program, the DOH collaborated with a technical partner, YTH to assist with programmatic design and manage the technical infrastructure.

Scope of Intervention Goals and Objectives of the Text Message Program: Health Goal: Reduction in Chlamydia and Gonorrhea incidence and prevalence in Washington DC residents ages 13-24. Behavioral Goal: Reduction in unsafe sexual behaviors among Washington DC adolescents after the design and implementation of an intervention based on risk and protective factors gathered from this focus group. Program Goal: Recommended intervention strategies, based on the findings of qualitative research, to increase knowledge and comprehension of sexual health risks and linkage to resources among Washington DC adolescents regarding STD prevention.

Methods - Design Qualitative design with information gathered through one pre-activity questionnaire and focus group. Formative research to gain in-depth information from participants so that the subsequent content for the text-message information reflects the realities of DC adolescent experiences and opinions. Planned as a semi-structured conversation so that participants respond to promote debate and discussion among participants on issues related to sexual health, relationships and intimacy, alcohol and drug use, and * Citations, references, and credits – Calibri, 11pt

Methods – Participants and Procedures One focus group: 13 participants (n=13) ages 14-18 living in the District of Columbia. Recruitment: Participants were requested and referred through DC community-based organizations Protocol: a set of pre-group questionnaires followed by a 2 hour discussion group led by DOH facilitators. Discussion was guided by an agenda. Questions were asked open-endedly, with the opportunity for participants and facilitators to respond, probe, and follow-up. All activities were recorded using a tape recorder.

Methods – Data Collection Procedures Focus group occurred on February 5, 2015 Research staff: two facilitators and one assistant Location: DOH Conference Room Data Collection Tools: Questionnaires, audio recorder and facilitator notes Confidentiality: Confidential data storage and record keeping Informed Consent: Verbally given by facilitator at the start of the focus group

Methods – Data Analysis 2 focus group facilitators for audio recording . Simplified, emic coding schema. Facilitators focused on the themes and interests of the groups than bring an etic approach to the data. The pre-group survey questionnaires were likewise coded with a simplified ranking system to again determine the topics adolescents found most engaging and/or important. After listening and noting overarching themes in the the audio recording of the session, the facilitators compared findings to create categories for text-message content development.

Results & Implications for Practice The coding process yielded six categories for content development: Symptoms/Not Getting Tested Discussing Sexual Health Sex and Drugs LGBTQ Condoms Confidentiality/Privacy/Insurance The emic coding of the data align with established best practices for youth interventions. A community consultative process as a method may be replicated to develop further youth-focused programmatic strategies.

Limitations Small sample size (n=13) of focus group Gender imbalance in sample size (11 female to 2 male) As focus group was designed specifically for District of Columbia adolescents, the results may lack external validity. + Sample size = 13 students aged 14-18; missed older age bracket between 18-24 + (11 female to 2 male) Image courtesy of Dave Gandy, Wikimedia Commons

Acknowledgements District of Columbia Department of Health – HAHSTA Robert Bangert, MSW Bhupendra Sheoran, MD Jaime Labrija, MA Veronica Urquilla, MSW Yasir Shah, MPH

Contact Information: Michelle Jasczynski ypf7@cdc.gov michelle.jasczynski@dc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support