Visual and Performance Art for HIV Prevention with Indigenous Youth in the Northwest Territories

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

Tags: social sciences, sexually transmitted infection, youth, sexual health, art

Principal Investigator: Logie, Carmen (12)
Licence Number: 16445
Organization: University of Toronto
Licensed Year(s): 2019 2018 2017 2016 2015
Issued: Dec 19, 2018

Objective(s): To explore two arts-based HIV prevention programs that currently work with Northern Indigenous youth in promoting sexual health.

Project Description: The objectives of this research are to:
1. explore experiences and conceptualizations of social and structural contexts of human immunodeficiency virus (HIV) vulnerability (e.g. stigma), and protective factors (e.g. empowerment), among Northern Indigenous youth;
2. build capacity and leadership in HIV prevention and research among Northern Indigenous youth;
3. evaluate the effect of arts-based HIV prevention programs on Northern Indigenous youth’s HIV and sexually transmitted infection (STI) knowledge, cultural connectedness, self-esteem, empowerment and safer sex self efficacy; and,
4. promote North-North Indigenous partnership building, knowledge exchange/cross-learning, and capacity building among and between Indigenous community-based HIV prevention programs.

These objectives will be met through a two-phase research project:
Phase 1, Arts-based Intervention and Evaluation: will involve a survey and longitudinal qualitative interviews with Northern Indigenous youth participating in arts-based HIV prevention programs; FOXY (Fostering Open eXpression among Youth) and Nunavut Sexual Health Drama Program.
Phase 2, Youth Peer Leadership and Training: longitudinal qualitative interviews with Youth Peer Leaders regarding their participation in training and subsequently in co-facilitating arts-based HIV prevention programs.

Phase 1 of the study will evaluate FOXY and SMASH (Strengths, Masculinities and Sexual Health) in the Northwest Territories (NWT). Participants will be placed into the programs based on their self-identified gender (e.g. men and women workshop groups). The programs will be led by same gendered facilitators in order to ensure participants are comfortable discussing sexual health and facilitators can better relate to participants’ sexual health experiences.

Quantitative Evaluation of FOXY and SMASH in the NWT—Survey:
Hypotheses: Participants engaging in the arts-based HIV preventions programs, FOXY and SMASH, will report higher primary (HIV knowledge) and secondary (self-esteem, empowerment, safer sex self-efficacy, cultural connectedness) outcome scores. All participants will complete the same survey irrespective of their self-identified gender.

Longitudinal qualitative research (LQR) is often embedded in mixed-methods research and focuses on experiences, processes and critical moments associated with change over time. LQR is valuable in assessing complex interventions to explore change mechanisms, feasibility, and acceptability, thus also operating as a process evaluation. The research team will specifically implement LQR to understand processes by which the FOXY Arts-Based HIV Prevention Program contributed to changes in participants’ perception of HIV, sexual health, empowerment and/or cultural connectedness.

Participants will be assigned an ID number. The team will randomly sample 30 FOXY Arts-Based HIV Prevention Program participants (across Yellowknife, Hay River, Inuvik and Fort Smith) and invite them to take part in in-depth individual (IDI) interviews at 2 points in time that correspond with the timing of intervention measures. The research team will use semi-structured, open-ended interview guides. For the subsequent interview, participants will be provided a summary of the prior interview and will be asked to reflect on the summary and explore changes since the last interview.

Data Analysis. Participant interviews will be digitally recorded and transcribed verbatim. The research team will use narrative thematic analysis to identify, analyze, and report themes in data. First, line-by-line review of the transcripts will be performed, and first-level codes—descriptors of important categories—noted in the margins. All codes will then be entered into NVivo tagged to associated sections of text. Text corresponding to each of the first-level codes will be reviewed by 3 independent investigators; subcodes will be established using a constant comparative method to divide first-level codes into smaller categories. The research team will conduct preliminary analyses of each interview and summarize themes. The research team aim to understand situational elements (e.g. culture, discourses, people, social arenas, knowledge, material things) involved in shaping sexual health, promoting HIV prevention and wellbeing, and fostering leadership among Northern Indigenous youth in the NWT, including risk and protective factors, to address questions from situational analyses including: “Who and what matters in this situation? What elements ‘make a difference’ in this situation?” Data source triangulation (comparing data between groups of youth [e.g. rural/urban]) and researcher triangulation (2-3 investigators independently coding the same transcripts) will enhance reliability of the findings. Member checking will be conducted among 2 participants, the research coordinator and the Principal knowledge user Lys in the NWT to acquire feedback and assess interpretations.

Data collected from intervention participants will include qualitative interviews and survey responses. The research team will triangulate data sources and methods by comparing the quantitative results on the intervention impact with qualitative narratives describing in-depth experiences with the intervention; researcher triangulation will be implemented by having multiple investigators code transcripts. Triangulation will enhance the reliability and integration of findings. To integrate qualitative and quantitative results the team will implement: 1) a triangulation protocol, where a convergence coding matrix will be developed to assess convergence, complementarity and discrepancies between findings from each method; and 2) a mixed-methods matrix, to explore novel and unexpected findings from different data sources (IDI, survey) on a single case, and patterns across all cases. This corresponds with integrative mapping in situational analyses that aims to explore analytic findings across different data sources and types to better understand the phenomenon (e.g., how—and if—arts-based interventions reduce HIV risk and increase protective factors among Northern Indigenous youth).

The research team are working with the Communications and Knowledge Translation Advisor of the NWT SPOR (Strategy for Patient-Oriented Research) Support Unit to create fact sheets and policy briefs.

The fieldwork for this study will be conducted from January 1, 2019, to December 31, 2019.