Using Youth-Participatory Research to Address Health Disparities in Sexually Transmitted Infections Among Homeless Youth

2.50
Hdl Handle:
http://hdl.handle.net/10755/622064
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Using Youth-Participatory Research to Address Health Disparities in Sexually Transmitted Infections Among Homeless Youth
Other Titles:
Adolescent Sexual Health
Author(s):
Dang, Michelle
Lead Author STTI Affiliation:
Zeta Eta-at-Large
Author Details:
Michelle Dang, PhD, RN, APHN-BC, Professional Experience: I have a PhD in human development and my dissertation was on the support networks of homeless youth. I have conducted research with this population since 2007. Author Summary: Dr. Michelle Dang is an associate professor in the School of Nursing at California State University, Sacramento where she teaches nursing research, community health nursing, and human sexuality. She has been a nurse for 30 years and worked in diverse settings. Her research focus is on the health of and social supports for marginalized youth.
Abstract:

Purpose:

Sexually transmitted infections (STIs), including HIV, among homeless youth are a significant public health issue with STI rates among homeless youth being more than twice that of nonhomeless youth. Despite known risk factors, effective interventions for STI prevention and treatment for this population remain elusive. Evidence-based STI interventions targeted at adolescents typically encompass community or school-based, behavioral approaches; such approaches are a poor fit with a highly mobile population and do not address underlying social conditions that contribute to unsafe sexual behaviors such as survival needs, social norms, and access to health education.

This project is an exploratory study using a youth-participatory approach to determine the most effective methods in STI research with homeless youth as well as identifying key social and structural characteristics that will inform programs that target this population in developing culturally-specific interventions that will increase protective sexual behavior and improve access to care. Four current and former homeless youth (2 males, 2 females, ages 19-21) were recruited as co-researchers and cultural informants and co-designed the study’s methodologies and instruments.

Methods:

The PI and youth researchers, hereafter team, determined that focus groups with homeless youth would be the appropriate first step design to gather data about the overall health care access for STI-related issues and the general perceptions of youth about STIs. After completing IRB training, the youth researchers collaborated with the PI to develop focus group questions and recruited other homeless youth to participate in the focus groups through word of mouth and in-person invitations. The PI trained the youth researchers in how to facilitate focus groups, and the team conducted mock focus groups prior to actual data collection. A total of three focus groups were completed, and one youth researcher facilitated each focus group along with the PI, who was present at all the focus groups.

Results:

The team analyzed the data together using thematic analysis. Data from the focus groups revealed four main themes: 1) mistrust of the healthcare system; 2) stigma and shame related to STIs; 3) concerns about confidentiality; and 4) lack of knowledge about insurance coverage. These findings support the need for more in-depth qualitative interviews with homeless youth to illuminate processes related to these concerns (2nd phase). As a youth-participatory project, the research team also identified systems issues that posed challenges to a full academic-youth partnership.

To gain more in-depth information about the issues identified in the focus groups, the team collaborated in developing interview questions and identified brief standardized questionnaires about STI knowledge and stigma to include in the study. Twenty homeless youth were recruited for one-on-one interviews conducted by the PI. Data analysis indicated that participants had good knowledge about STIs with the vast majority being able to identify all of the correct answers on a brief quiz about STIs. Sample questions included, “A person can have a sexually transmitted disease or STD and not know it,” “STDs that aren’t cured early can cause sterility in women.” Participants also reported that access to STI testing and treatment was not a barrier to them getting tested, and that they advocated for testing for themselves and their partners. Two main themes arose regarding concerns about getting tested: 1) fear of the unknown and how their friends will perceive them; and 2) fear of getting STDs that non-curable such as herpes and HIV. In terms of the decision making process as to whether they would use condoms during sex, several themes emerged: 1) condoms reduce pleasure associated with sex; 2) condoms are not necessary if you know someone well; and 3) not using condoms when they are “in the moment”.

Conclusion:

Findings from both the focus groups and semi-structured interviews indicate that homeless youth have adequate understanding about STIs and access to testing and treatment as well as free condoms. Interventions to prevent STIs often focus on education alone. The narratives provided by the youth in this study support a need to provide developmentally appropriate interventions. The youth in this study have a clear understanding about how STIs are spread and prevented; and access to testing and treatment does not pose a barrier as would be expected for this population. They also reported feeling comfortable talking with health care providers about getting tested for STIs. Findings suggest that interventions should not focus only on education and access to care. An emphasis should be placed on normalizing routine STI testing and reducing stigma and fear. Nurses and other health care providers are trusted by youth and can serve as an important catalyst in changing young people’s perceptions about getting tested for STIs.

Keywords:
STI; Homeless Youth; Youth Participatory Research
Repository Posting Date:
24-Jul-2017
Date of Publication:
24-Jul-2017
Other Identifiers:
INRC17B16
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleUsing Youth-Participatory Research to Address Health Disparities in Sexually Transmitted Infections Among Homeless Youthen_US
dc.title.alternativeAdolescent Sexual Healthen
dc.contributor.authorDang, Michelleen
dc.contributor.departmentZeta Eta-at-Largeen
dc.author.detailsMichelle Dang, PhD, RN, APHN-BC, Professional Experience: I have a PhD in human development and my dissertation was on the support networks of homeless youth. I have conducted research with this population since 2007. Author Summary: Dr. Michelle Dang is an associate professor in the School of Nursing at California State University, Sacramento where she teaches nursing research, community health nursing, and human sexuality. She has been a nurse for 30 years and worked in diverse settings. Her research focus is on the health of and social supports for marginalized youth.en
dc.identifier.urihttp://hdl.handle.net/10755/622064-
dc.description.abstract<p><strong>Purpose:</strong></p> <p>Sexually transmitted infections (STIs), including HIV, among homeless youth are a significant public health issue with STI rates among homeless youth being more than twice that of nonhomeless youth. Despite known risk factors, effective interventions for STI prevention and treatment for this population remain elusive. Evidence-based STI interventions targeted at adolescents typically encompass community or school-based, behavioral approaches; such approaches are a poor fit with a highly mobile population and do not address underlying social conditions that contribute to unsafe sexual behaviors such as survival needs, social norms, and access to health education.</p> <p>This project is an exploratory study using a youth-participatory approach to determine the most effective methods in STI research with homeless youth as well as identifying key social and structural characteristics that will inform programs that target this population in developing culturally-specific interventions that will increase protective sexual behavior and improve access to care. Four current and former homeless youth (2 males, 2 females, ages 19-21) were recruited as co-researchers and cultural informants and co-designed the study’s methodologies and instruments.</p> <p><strong>Methods:</strong></p> <p>The PI and youth researchers, hereafter team, determined that focus groups with homeless youth would be the appropriate first step design to gather data about the overall health care access for STI-related issues and the general perceptions of youth about STIs. After completing IRB training, the youth researchers collaborated with the PI to develop focus group questions and recruited other homeless youth to participate in the focus groups through word of mouth and in-person invitations. The PI trained the youth researchers in how to facilitate focus groups, and the team conducted mock focus groups prior to actual data collection. A total of three focus groups were completed, and one youth researcher facilitated each focus group along with the PI, who was present at all the focus groups.</p> <p><strong>Results:</strong></p> <p>The team analyzed the data together using thematic analysis. Data from the focus groups revealed four main themes: 1) mistrust of the healthcare system; 2) stigma and shame related to STIs; 3) concerns about confidentiality; and 4) lack of knowledge about insurance coverage. These findings support the need for more in-depth qualitative interviews with homeless youth to illuminate processes related to these concerns (2<sup>nd</sup> phase). As a youth-participatory project, the research team also identified systems issues that posed challenges to a full academic-youth partnership.<strong></strong></p> <p>To gain more in-depth information about the issues identified in the focus groups, the team collaborated in developing interview questions and identified brief standardized questionnaires about STI knowledge and stigma to include in the study. Twenty homeless youth were recruited for one-on-one interviews conducted by the PI. Data analysis indicated that participants had good knowledge about STIs with the vast majority being able to identify all of the correct answers on a brief quiz about STIs. Sample questions included, “<em>A person can have a sexually transmitted disease or STD and not know it,” “STDs that aren’t cured early can cause sterility in women.” </em>Participants also reported that access to STI testing and treatment was not a barrier to them getting tested, and that they advocated for testing for themselves and their partners. Two main themes arose regarding concerns about getting tested: 1) fear of the unknown and how their friends will perceive them; and 2) fear of getting STDs that non-curable such as herpes and HIV. In terms of the decision making process as to whether they would use condoms during sex, several themes emerged: 1) condoms reduce pleasure associated with sex; 2) condoms are not necessary if you know someone well; and 3) not using condoms when they are “in the moment”.</p> <p><strong>Conclusion:</strong></p> <p>Findings from both the focus groups and semi-structured interviews indicate that homeless youth have adequate understanding about STIs and access to testing and treatment as well as free condoms. Interventions to prevent STIs often focus on education alone. The narratives provided by the youth in this study support a need to provide developmentally appropriate interventions. The youth in this study have a clear understanding about how STIs are spread and prevented; and access to testing and treatment does not pose a barrier as would be expected for this population. They also reported feeling comfortable talking with health care providers about getting tested for STIs. Findings suggest that interventions should not focus only on education and access to care. An emphasis should be placed on normalizing routine STI testing and reducing stigma and fear. Nurses and other health care providers are trusted by youth and can serve as an important catalyst in changing young people’s perceptions about getting tested for STIs.</p>en
dc.subjectSTIen
dc.subjectHomeless Youthen
dc.subjectYouth Participatory Researchen
dc.date.available2017-07-24T16:05:18Z-
dc.date.issued2017-07-24-
dc.date.accessioned2017-07-24T16:05:18Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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