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: 16526
Organization: University of Toronto
Licensed Year(s): 2019 2018 2017 2016 2015
Issued: Sep 07, 2018
Project Team: Candice Lys (Principal Investigator, FOXY ), Dionne Gesink (Co-applicant, University of Toronto), Charlotte Loppie (Co-applicant, University of Victoria)

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;
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 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 (Fostering Open eXpression among Youth) 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 from t0 to t1 and t2. All participants will complete the same survey irrespective of their self-identified gender.

The researchers will conduct descriptive analyses of socio-demographic variables, including means and standard deviations (SD) and proportions to provide an overview of participant characteristics. The research team will sum items for each scale to calculate total/subscale scores for each measure and calculate means (SD). The team will test outcome measures for pre-intervention differences by socio-demographic characteristics using Pearson product-moment correlation for continuous variables, Student t-tests for dichotomous variables, and analysis of variance for variables of 3 or more categories. Mixed-effects regression will be used to model each continuous outcome measure as a function of 2 time dummy variables, one for post-intervention interview time point and one for 12 month follow-up. This method accounts for the correlated structure of 3 repeated measures (pre-intervention, post-intervention, 12 month follow-up and uses maximum likelihood estimation for inference that allows inclusion of cases with missing data. While accounting for within- and between-subject variability, regression based models also allow the flexibility to adjust for socio-demographic covariates. The model coefficients for the model dummy variables represent the change in outcome scores from pre-intervention to post-intervention and from pre-intervention to 12-month follow-up.

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.
Sampling, recruitment and measures. Participants will be assigned an ID number. The team will randomly sample 30 FOXY Arts-Based HIV Prevention Program participants and invite them to take part in in-depth individual (IDI) interviews at 2 points in time (t1, t2) 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.

Participant interviews will be digitally recorded and transcribed verbatim. The 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; this summary will be member checked with participants at t2. We 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.

This project hopes to improve peer leadership and youth sexual health. Youth will learn about resilience, strengths and sexual health.

The fieldwork for this study will be conducted from October 5, 2018 to December 31, 2018.