It worked in the Caribbean – What about here?

While there is extensive data on the high rates of HIV, STIs and unintended pregnancies among Black populations in the U.S., this racial category problematically subsumes the ethnic diversity of immigrant Black populations. Today, one in ten Black people in the U.S. are immigrants, with Caribbean immigrants accounting for approximately 46% of the total Black immigrant population.

It can’t be assumed that the variety of effective behavioral interventions (EBIs) that exist to address sexual and reproductive health for Black populations will be effective with Afro-Caribbean youth. A complex variety of factors impact Caribbean immigrant’s sexual behaviors and HIV rates, including acculturation pressures (especially for adolescents), racial discrimination, intersectional identities, and common residence in urban HIV epicenters with high rates of STIs. Yet currently, there are no existing U.S. EBI programs developed specifically for these populations.

Now, with a new grant from the National Institute of Minority Health and Health Disparities, researchers from social science R&D firm dfusion, a (Scotts Valley, CA) as well as West Virginia University and the UMass Chan Medical School will be working to address this gap in culturally tailored sexual health education for Caribbean youth in the U.S. This work will build on insights from over a decade of prior study the researchers conducted with the support of government and community leaders in the Bahamas.^1-7

Helpful insights from earlier research in the Bahamas.  

In 1998, the Bahamian government selected the U.S. program Focus on Youth and Informed Parents and Children Together (FOY+ImPACT) from the Centers for Disease Control’s “Diffusion of Effective Behavioral Interventions” for cultural adaptation, implementation, and evaluation country wide. Focus on Youth in the Caribbean (FOYC) – based on the FOY program, Dr. Bonita Stanton developer – is a community-based, eight-session group intervention providing youth with the skills and knowledge needed to protect themselves from HIV, other STIs, and pregnancy. ImPACT is an additional single-session parent component.

In the Bahamian studies, FOYC+ImPACT was evaluated through a series of randomized controlled trials and shown to be effective in improving condom use rates, condom use skills, self-efficacy, intention to use a condom, and HIV/AIDS knowledge, with sustained effects over time.^1-7 Ms. Lynette Deveaux with the Bahamas’ Ministry of Health was instrumental in adapting and testing FOYC+ImPACT for Bahamian youth, and she will consult on the current project as our team adapts FOYC+ImPACT for a U.S. Caribbean audience.

Firpo-Triplett notes that while it was “a really challenging study, after years of positive results in the Bahamas, (the program has) been completely adopted by The Bahamian government for every child in public school,” something she described as “a journey and an accomplishment.” 

In subsequent years, researchers learned that desired youth outcomes were highly correlated with educators’ implementation fidelity, and that fidelity goals presented more challenges for community-based educators. Moreover, external challenges – from hurricanes to the COVID pandemic – showed that a flexible, new type of program delivery platform was warranted, one that supports the abilities of diverse educators (e.g., teachers, community leaders, and parents) to meet program fidelity goals.

          As Dr. Lesley Cottrell of West Virginia University observes, “the environment where we teach our students and children is changing and varies greatly across situations.”  She emphasizes that “while some teachers have many resources they could pull to implement the program, others do not but still value the message and want to share the program with their students.”  By developing a flexible evidence-based program like FOYC+ImPACT, “teachers can present that message and do it effectively, even with the most limited resources, significantly advancing our community work in this area.”

Addressing the gap: new research, delivery methods, and youth populations

For the newly awarded project, the research team led by co Principal Investigators Regina Firpo Triplett (CEO, dfusion) and Dr. Lesley Cottrell (Professor, West Virginia University) will take what was learned abroad and apply it to offering meaningful support to underserved and under evaluated Caribbean youth communities in the U.S. Specifically, the team will test the feasibility of developing FOYC+ImPACT U.S, a customizable digital platform for delivering an effective sexual health education intervention in diverse Caribbean community settings in the U.S.  During Phase 1, the research team will be working with a team of expert advisors and community leaders to:

1) Revise and implement the FOYC+ImPACT program in a new, broader context, making it customizable and scalable across Caribbean communities in the U.S.

2) Develop a cloud-based platform where educators can build their own customized curriculum for FOYC+ImPACT U.S., with all program components modularized and available in both digital (e-learning) and in-person formats.

3) Address cultural tailoring needs by creating a customizable version of the curriculum, allowing teachers to access core program components in a range of formats and to customize by age, imagery, and country/region-specific content and linguistic references.

At the end of Phase 1, a pilot test will be conducted to assess the impact of FOYC+ImPACT US on student knowledge and improvement in implementation fidelity. In Phase II, the research team will complete the remaining lessons, add new lessons/content to update the program, and demonstrate effectiveness through a randomized controlled trial. Adds Firpo-Triplett, “we’re thrilled to have this bicoastal and international team working on this important project.”

a  dfusion Inc. is a California-based health tech organization that designs technology to improve health outcomes. www.dfusioninc.com

Research Key Personnel:

• Regina Firpo-Triplett, MPH, CEO, dfusion, Co-PI
• Lesley Cottrell, PhD, Professor of the Department of Pediatrics, West Virginia University School of Medicine, Co-PI
• Bo Wang, PhD, Professor, UMass Chan Medical School, Research Partner
• Lynette Deveaux, MA, The Bahamian Ministry of Health

Project funding:

National Office on Minority Health and Health Disparities, Grant # R43HD112261

Citations:

1. Deveaux, L., Lunn, S., Bain, RM, Gomez, P., Kelly, T. Brathwaite, N., Russell-Rolle, G. Li, X., and Stanton, B. 2011. Focus on Youth in the Caribbean: Beyond the Numbers. J Int Assoc Physicians AIDS Care (CHIC), 2011:10(5):316-325.
2. Wang B, Deveaux L, Knowles V, et al. Fidelity of implementation of an evidence-based HIV prevention program among Bahamian sixth grade students. Prev Sci. 2015; 16(1):110-121.
3. Wang B, Stanton B, Deveaux L, et al. 2015. Factors influencing implementation dose and fidelity thereof and related student outcomes of an evidence-based national HIV prevention program. Implement Sci. 2015; 10:44.
4. Stanton B, Dinaj-Koci V, Wang B, Deveaux L, Lunn S, Li X, Rolle G, Brathwaite N, Marshall S, Gomez P. Adolescent HIV Risk Reduction in the Bahamas: Results from Two Randomized Controlled Intervention Trials Spanning Elementary School Through High School. AIDS Behav. 2016 Jun;20(6):1182-96
5. Chen X, Lunn S., Deveaux L., Cottrell L., and Stanton B. 2009. A cluster randomized controlled trial of an adolescent HIV prevention program among Bahamian youth: effect at 12 months post intervention. AIDS Behavior. 2009; 13(3):499-508.
6. Gong J., Stanton B., Lunn S, et al. 2009. Effects through 24 months of an HIV/AIDS prevention intervention program based on protection motivation theory among preadolescents in The Bahamas. Pediatrics. 2009;123(5): e917-e928. Epub 2009 Apr 20.
7. Chen X, Stanton B. Gome P., et al. 2010. Sustained effect of an HIV prevention program at 36 months post-intervention – A cluster randomized controlled trial among Bahamian youth. Int J STD AIDS 2010; 21(9):622-630.