Usability and Psychosocial Impact of Decision Support to Increase Sexual Health Education in American Indian and Alaska Native Communities

Despite sexual and reproductive health disparities, few evidence-based sexual health education programs exist for American Indian/Alaska Native (AI/AN) youth, with even fewer tools available to assist AI/AN communities in adopting, implementing, and maintaining such programs. iCHAMPSS (Choosing And Maintaining effective Programs for Sex education in Schools) is a theory- and web-based decision-support-system designed to address dissemination barriers and increase the reach and fidelity of evidence-based programs (EBPs), specifically sexual health education programs. To investigate the potential of iCHAMPSS in AI/AN communities, we pilot-tested iCHAMPSS with adult stakeholders (N = 36) from agencies across the country that serve AI/AN communities. Stakeholders were recruited to review selected iCHAMPSS tools over two weeks in spring 2016. Pre- and post-surveys were administered to assess usability constructs, short-term psychosocial outcomes, and perceived feasibility. Data were analyzed using descriptive and non-parametric statistics. iCHAMPSS was perceived as acceptable, easy to use, credible, appealing, more helpful than current resources, and impactful of EBP adoption, implementation, and maintenance. Conversely, using iCHAMPSS significantly increased participants’ perceived barriers to adopting an EBP (p = 0.01). Overall, AI/AN stakeholders responded positively to iCHAMPSS, indicating the potential for adaptation to support the dissemination and implementation of evidence-based sexual health education in AI/AN communities

Native IYG: Improving Psychosocial Protective Factors for HIV/STI and Teen Pregnancy Prevention among Youth in American Indian/Alaska Native Communities

Background: Few HIV/STI and pregnancy prevention programs for youth in American Indian and Alaska Native (AI/AN) communities have been rigorously evaluated despite sexual health disparities in this population. This study reports the evaluation of a culturally adapted Internet-based HIV/STI and pregnancy prevention program for AI/AN youth, Native It’s Your Game (Native IYG). Methods: A randomized study was conducted with 523 youth (12 to 14 years old), recruited from 25 tribal sites in Alaska, Arizona, and the Pacific Northwest. Participants were surveyed at baseline and upon completion of treatment or comparison interventions. Multivariable linear regression models were used to assess impact on short term psychosocial determinants of sexual initiation. Results: A sample of 402 intervention (n=290) and comparison (n=112) youth completed the post-intervention survey (76.9% retention) from 1 to 462 days post-baseline (mean = 114, SD = ±96.67). Participants were 55.5% female, mean age of 13.0 (± 0.97) years with 86.1% self-reporting as AI/AN. Reasons not to have sex, STI knowledge, condom knowledge, condom availability self-efficacy, and condom use self-efficacy were significantly impacted (all P ≤ .01). Limitations included variability in intervention exposure and time between data collection time points. Conclusions: Native IYG demonstrated efficacy to impact short-term psychosocial determinants of sexual behavior in a sample of predominantly AI/AN middle school youth

Assessing the Need and Receptivity for an Integrated Healthy Sexual and Dating Relationships Intervention for Community College Students

Background: In emerging adulthood, youth often become involved in more serious romantic relationships. However, many lack the skills to avoid an unplanned pregnancy or sexually transmitted infection (STI), and to ensure a healthy dating relationship. Community college students serve nearly half of all undergraduate students in the United States; yet, community colleges typically lack resources for sexual health promotion. Purpose: To assess the need and receptivity for a web-based integrated healthy sexual and dating relationships intervention among community college students. Methods: In summer 2016, we partnered with three community colleges in South Central Texas to conduct an online survey of students’ sexual behaviors and dating relationships, and usability testing of activities from an integrated, web-based healthy sexual and dating relationship intervention. Results: Online survey participants (n=271) were 70% female, 38% Hispanic, 24% White, 17% Black, and 16% Asian; 20% self-identified as sexual minority; mean age was 20.8 years (SD = 2.05). Participants reported high rates of sexual risk behavior including sex without a condom or an effective birth control method, low use of long-acting reversible contraception, frequent use of emergency contraception, and low use of dual protection to prevent pregnancy and sexually transmitted infections. Two-thirds reported experiencing any type of dating violence perpetration or victimization in the past year. Usability testing participants (n=14) were 86% female, 42% Hispanic, 50% Asian/Pacific Islander, 14% Black, and 7% White; 71% were sexually experienced; mean age was 20.7 years (SD = 1.64). The web-based activities were highly rated in terms of usability parameters, and positively impacted short-term psychosocial outcomes related to condom use, accessing contraceptive health services, and constructive interpersonal conflict resolution. Conclusion: Findings underscore the high need and receptivity for an integrated healthy sexual and dating relationship web-based intervention among community college students, an understudied subgroup of youth in emerging adulthood

Definition and evaluation of Good Practices in Public Health

Background Despite the increasing use of the good practices tool in health care organizations, there is no commonly accepted definition of good practice in public health in literature, especially for the difficulty of reconciling effectiveness and operational feasibility with the traditional hierarchy of scientific evidence; the lack of a formal definition and the difficulty in finding a suitable spot in the scientific literature often undermine the possibilities for classifying and spreading successful experiences that can be considered "good practices", hindering the harmonization of approaches towards different problems. Aim of the study \u2022 making a systematic review of the literature on good practice definitions and experiences in Public Health, identifying the most recurrent concepts and problems in scientific papers, thus developing a definition of good practice in Public Health; \u2022 developing a tool for classification and evaluation of good practices in Public Health; \u2022 developing a set of recommendations for planning, implementation and self-evaluation of Public Health good practices, to facilitate the design of good practice considering the factors that prevent or promote implementation and dissemination; \u2022 field-testing the tool picking up a set of available good practices, evaluating the tool versatility in good practices classification for different realities (local, regional and national) and its ability to be consulted with ease; Methods Good practice definition has been developed using a systematic review of the available literature and a separate search through institutional websites and portals for good practices collections and European projects/Joint Actions. Using data from systematic review, 14 frameworks with good practice evaluation criteria were identified. All criteria from different frameworks were grouped into previously identified thematic areas (dimension). Scoring system was developed weighting each dimension with the number of citations inside the original systematic review. Results A total of 9378 abstracts were screened, 339 records were assessed with full-text and a definitive number of 74 records were included in the final review; all good practice concepts where grouped into five main dimensions: Effectiveness, Sustainability, Replicability, Reach and Context. FIRST tool (acronym for Frame, Impact, Resources, Spread and Target) was developed from 14 selected frameworks included a total of 122 criteria, grouped into Plan phase, Do phase, Check phase and Act phase, according to the quality improvement circle. During FISRT tool field testing, 340 good practices were randomly selected from three web-based portals and assessed using FIRST tool: 129 national good practices, 62 regional, 61 local and 88 single hospital GPs. Conclusion The study produced a definition of good practice built on five domains based on the evidence available in literature, including frameworks from the most recent European Joint Action experiences. The FIRST tool was developed using frameworks available in literature, representing the first evaluation and self-evaluation tool for good practices. The FIRST tool was effective in providing a picture of different good practices settings, describing stronger dimensions and improvement opportunities, while setting stratification proved the tool flexible, although more suitable for widespread interventions than little, more local, experiences.Presupposti dello studio Nonostante le buone pratiche siano strumenti di sempre maggior utilizzo in determinati contesti, manca in letteratura una definizione di buona pratica per la Sanit\ue0 Pubblica, soprattutto per la difficolt\ue0 di conciliare l\u2019efficacia pratica (effectiveness) e la praticabilit\ue0 operativa nei diversi contesti con la tradizionale gerarchia delle evidenze scientifiche; la mancanza di una definizione condivisa e del conseguente inserimento a pieno titolo negli strumenti riconosciuti dalla comunit\ue0 scientifica e professionale, comporta la difficolt\ue0 nel classificare e diffondere esperienze di successo che possono essere considerate \u201cbuone pratiche\u201d potenzialmente esportabili in altri contesti, ostacolando perci\uf2 l\u2019armonizzazione degli approcci alle diverse problematiche e potenzialmente delle performance. Scopo dello studio Realizzare una revisione della letteratura sulle esperienze e definizioni di buona pratica in Sanit\ue0 Pubblica che identifichi i concetti maggiormente ricorrenti nei lavori scientifici, che consenta di sviluppare una definizione di buona pratica in Sanit\ue0 Pubblica; Sviluppare uno strumento per la classificazione e la valutazione delle buone pratiche in Sanit\ue0 Pubblica; Testare sul campo lo strumento raccogliendo una serie di buone pratiche, valutando la versatilit\ue0 dello strumento nella classificazione di buone pratiche realizzate a diversi livelli l\u2019affidabilit\ue0 per realt\ue0 differenti a livello (locale, regionale e nazionale), indispensabile per testare la reale efficacia pratica dello strumento nel rappresentare le diverse realt\ue0 ed esperienze e la sua capacit\ue0 di essere consultato; Metodi La definizione di buona pratica \ue8 stata sviluppata attraverso una revisione sistematica della letteratura e una ricerca separata attraverso portali istituzionali con collezioni di buone pratiche nonch\ue9 progetti europei / Joint Actions. Utilizzando i dati della revisione sistematica, sono stati identificati 14 framework con criteri di valutazione delle buone pratiche. Tutti i criteri di diversi quadri sono stati raggruppati in aree tematiche (dimensioni) precedentemente identificate. Il sistema di punteggio \ue8 stato sviluppato ponderando ogni dimensione con il numero di citazioni all'interno della revisione sistematica. Risultati Sono stati vagliati un totale di 9378 abstract, di questi 339 lavori sono stati valutati full-text e un numero definitivo di 74 manoscritti \ue8 stato incluso nella revisione finale; tutti le caratteristiche di buona pratica sono state raggruppate in cinque dimensioni principali: efficacia, sostenibilit\ue0, replicabilit\ue0, portata e contesto. Lo strumento FIRST (acronimo di Frame, Impact, Resources, Spread e Target) \ue8 stato sviluppato da 14 framework selezionati includendo un totale di 122 criteri, raggruppati in fasi plan, do, check, act.in base al ciclo di miglioramento della qualit\ue0. Durante il test sul campo dello strumento FISRT, 340 buone pratiche sono state selezionate casualmente da tre portali web e valutate utilizzando lo strumento FIRST: 129 buone pratiche nazionali, 62 GP regionali, 61 locali e 88 GP di singoli ospedali. Conclusioni Lo studio ha prodotto una definizione di buona pratica basata su cinque dimensioni costruite dalle evidenze disponibili in letteratura, comprese le pi\uf9 recenti esperienze di Joint Action europea. Lo strumento FIRST \ue8 stato sviluppato utilizzando i framework disponibili in letteratura, e rappresenta il primo strumento di valutazione e autovalutazione per le buone pratiche. Lo strumento FIRST si \ue8 dimostrato efficace nel fornire una fotografia delle buone pratiche disponibili nei diversi setting, descrivendo le dimensioni pi\uf9 solide e quelle con le mag