Understanding syndemics and HIV/STI vulnerability among Northern Indigenous youth in Northwest Territories

Regions: Inuvialuit Settlement Region, Gwich'in Settlement Area, Sahtu Settlement Area, Dehcho Region, North Slave Region, South Slave Region

Tags: health, social sciences, sexually transmitted infection, aboriginal youth

Principal Investigator: Logie, Carmen (12)
Licence Number: 16024
Organization: University of Toronto
Licensed Year(s): 2019 2018 2017 2016
Issued: Jan 19, 2017

Objective(s): To evaluate the impact of a peer leadership training workshop called FOXY (Fostering Open eXpression among Youth) on young Indigenous men and women’s human immunodeficiency virus vulnerability, empowerment and cultural connectedness.

Project Description: The purpose of this study is to evaluate the impact of a peer leadership training workshop called FOXY (Fostering Open eXpression among Youth) on young Indigenous men and women’s HIV vulnerability, empowerment and cultural connectedness. FOXY is an arts-based Indigenous agency created with young women in the Northwest Territories (NWT) to foster communication and expression regarding sexuality. While the peer leadership training retreat for FOXY girls, a peer based sexual health education program originally for young Indigenous women has successfully occurred over the past 4 years, the workshop has yet to be evaluated. There has also not been a FOXY for boys youth leadership retreat. We aim to conduct a thorough evaluation of the retreats and its impact on young Indigenous men and women. We also want to integrate a digital storytelling component into the FOXY for workshops for girls.

The objectives of this research are to:
1. Explore the experiences and conceptualizations of social contexts and norms of teen dating and teen dating violence, gender norms, and resilience, with Indigenous and Northern youth in the NWT;
2. Examine resilience and cultural connectedness as protective factors that reduce the likelihood of experiencing substance use, mental health issues and human immunodeficiency virus/sexually transmitted infection (HIV/STI) vulnerabilities;
3. Promote intergenerational dialogue and knowledge mobilization on resilience and healthy relationships among and between youth, parents and Elders in the NWT.

Through this study the research team will address these objectives by collecting feedback via surveys from 2 groups of young Indigenous women and 1 group of young Indigenous men who complete the FOXY peer leadership training retreat (Project A). Based on recommendations from the study collaborators, young Indigenous women from the peer leader retreats will be requested to participate in the creation of digital stories (Project B) to be used as learning tools and prompt self-empowerment.

In the first part of this study, Project A, young Indigenous men and women will be trained as peer leaders to help facilitate existing FOXY workshops for young women and future FOXY related workshops for young men in the Northwest Territories. FOXY explores sexual health, HIV/STI and healthy relationships among young women in the NWT while using the arts to facilitate education and foster more open expression and healthy communication regarding sexual health and sexuality. Peer leader training takes place during a retreat and the core components involve: (1) training youth as peer leaders for HIV prevention in their communities; (2) a peer leadership training retreat grounded in Indigenous knowledge and methods of teaching and learning; (3) visual (body-mapping) and performance (theatre) arts; (4) a focus on youth empowerment. Young men and women who participate in the peer leader training will complete survey prior to the training, post-training, and 6 months after training to evaluate the impact that FOXY peer leadership training has on young Indigenous men and women’s HIV vulnerability, self-empowerment and cultural connectedness.

The second component of this study, Project B, involves inviting young Indigenous women who have participated in the peer leadership training to participate in a Digital Storytelling Intervention. The Digital Storytelling Intervention will be developed and focuses on cultural connectedness for young Indigenous women. Digital Storytelling consists of a short 3-5 minute narrative, often narrated in the first person, which involves oral voice, imagery and digital text. This method gives people the opportunity to share stories, engage in self-expression, and to describe their experiences. Digital stories detail in-depth lived experiences that can serve as role models for participants to learn coping strategies. The stories will also tap into the role of cultural connectedness in Indigenous women’s physical and sexual health by including women’s perspectives on their identity, cultural traditions and spirituality. Stories will be created by Indigenous and Northern young women participants in FOXY’s peer leadership retreat. Participants can choose to keep their digital story private, or if they would like to share their digital story with FOXY and future FOXY workshops and retreats. The creation of digital stories will also involve dialogue between youth and Elders. Youth will be invited to sit with Elders who will share their personal stories and lessons learned with a focus on healthy relationships, culture and identity, and wellbeing. Prior to the creation of the digital stories, youth reflect on what they have learned from Elders.

Project A: Assessing FOXY Peer Leadership Training:
Project A will assess the FOXY peer leadership training and its impact on young Indigenous men and women’s HIV vulnerability, self-empowerment and cultural connectedness. The research team will hold 3 youth peer leader training retreats with Northern Indigenous youth aged 13-15 years in the Northwest Territories. Two retreats will be with young women (n=50, 25 per retreat) and the other retreat with young men (n=25). In total, 75 youth will participate in the training and the survey evaluating the training. The participants in these retreats will be purposively sampled from 18 communities in the NWT (Yellowknife, Hay River, Inuvik, Fort Smith, N’Dilo, Norman Wells, Fort Providence, Behchoko, Tuktoyaktuk, Wha Ti, Fort Resolution, Aklavik, K’atlodeeche First Nation, Ulukhaktok, Fort Liard, Fort Simpson, Lutselk’e, Fort McPherson).

Participants in the peer leadership training will be asked to complete surveys prior to the training, after the training and 6 month following the training. Participants will complete a survey on ipads immediately prior and post retreat and at 6 month follow up. The survey will measure the impact that the peer leadership training has on the following: HIV knowledge (using the Brief HIV Knowledge Questionnaire), resilience (using The Child and Youth Resilience Measure-28), self-esteem (using the Rosenberg Self-Esteem Scale), empowerment (using the Empowerment Measure), safer-sex self-efficacy (using the Safer Sex Self-Efficacy Scale) , and cultural connectedness (using the Awareness of Connectedness Scale developed to assess culture-specific factors with Alaska Native Youth).

The retreats will be held at Blachford Lake Lodge, NWT. Blachford Lake Lodge is located out on the land with fly-in access only, allowing for the inclusion of Indigenous cultural components such as smudge ceremonies, drum circles held outside, and hikes where participants can learn traditional knowledge about the land. Art facilitators from FOXY and Elders will co-lead workshops in traditional Aboriginal beading, drumming, traditional smudging ceremonies during each drum circle, photography, storytelling, and drama techniques. A Chipewyan Elder who has worked with FOXY will facilitate traditional arts workshops at the retreat that allow participants to engage with Indigenous culture. Art Facilitator and Dene educator and mentor who was born and raised in the NWT will facilitate small music and cultural workshops, leads group cultural activities such as drumming and smudges, and works one-on-one and in small groups with youth at the retreat.

Project B: Digital Storytelling Intervention:
Participants at FOXY girls workshops will have the option at the 5-day retreat to participate in a digital storytelling workshop based on ideas from Intergenerational Dialogue Exchange and Action (IDEA). This is optional, voluntary, and workshop participants do not have to attend the digital storytelling workshop. Following Stewart et al.’s steps in video making, and FOXY’s experience creating digital stories, the research team will facilitate small group work during the 2 retreats. The young women participants will be invited to produce digital stories on the interconnections between culture (can include Northern culture, Indigenous culture), resilience, healthy relationships, mental health, and sexual health. The digital stories will be created by participants using ipads at the retreat site.

There will be an expert in digital storytelling who formerly worked at CBC North, at the FOXY girls retreat to guide the girls in creating a digital story. This will involve deciding on what the story should be, creating a storyboard, selecting images (e.g. photos they take, magazine clips, drawings), filming/recording the story on the ipad, and learning how to edit using imovie. The participants can choose to keep their digital story private for themselves, or if they want to share it with FOXY participants at school workshops and future retreats.

This project includes participation of youth 13 to 15 years of age. Parental/guardian consent will be sought from participants. Consent to participate in research will follow the same process and protocols already in practice through FOXY who requires parental/guardian reverse consent and assent for youth in order for youth participate in programs and workshops. An assent form will be used for youth. A letter is sent to parents/guardians seven days prior to training and parents are informed that their children can “opt-out” of participation by returning a signed form or by calling the school. In addition, at FOXY, the research team are working with peer research assistants and research staff who have extensive experience working with adolescents and are well versed in anonymity, confidentiality, and explaining consent processes and protocols clearly and in non-academic language.

Community forums: Four forums in NWT (Yellowknife, Hay River, Inuvik, Fort Smith) to critically discuss study findings. The research team will screen the digital stories produced during the retreats. Following the screenings, the team will facilitate a discussion with a focus on brainstorming culturally, gender and age appropriate strategies to increase self-empowerment, resiliency and ways to address HIV/STI vulnerabilities.

Project report: A project report for arts-based prevention strategies for Northern Indigenous youth will be developed in various formats (e.g. USB key, report) about mental and sexual health, teen dating violence and HIV/STI prevention strategies. The digital stories will also be stored on USB keys for use in community and school-based activities.

Stakeholder Roundtables: The research team will conduct roundtables at the study sites to disseminate the study findings, as well as share the project report and digital stories with community members, service providers and researchers.

Website: A website will be developed to store and share the project report and digital stories.

The fieldwork for this study will be conducted from January 19, 2017 to December 31, 2017.