Significance. In the United States, disproportionately high rates of sexually transmitted infection (STI) and unplanned pregnancy among adolescents suggest the continuing need for evidence-based sexuality education. Efforts to address sexual health through traditional educational venues, principally schools, play an important role in targeting this recalcitrant problem; however, there remains a substantial gap between current sexual health understanding, current epidemiological outcomes, and targeted objectives. Other emerging venues appear to offer an opportunity to increase delivery of accurate and appropriate sexual health information and educational activities. Moving beyond traditional educational providers, community-based organizations (CBOs) have been identified as venues with significant potential to promote adolescent sexual health. Within CBOs, youth development professionals (YDP) are important sources of sexuality education for adolescents; however, recent research documents a need for systematic training and accessible resources for YDP and indicates that the YDP themselves desire ongoing education and support. CBO-based YDP are called upon to conduct reactive sexual health education-to respond to questions. They also frequently participate in proactive efforts-conducting workshops and outreach. Moreover, they, and their organizations, have little support in doing so. Innovation. To address the unique opportunity afforded by CBO-based YDP, we propose to extend emerging research, conducted by members of our team, by examining roles CBO-based YDP play in sexual health education, counseling, and support. Based on the results of those research efforts, we will develop and validate a CBO implementation toolkit: a wide ranging set of resources to enhance effective CBO implementation of proactive and reactive sexual health education and counseling. The toolkit will address issues from organizational readiness to YDP education to materials and resources for provision to CBO clients and client- parents. Although the effort will make use of innovative media and technologies-including multimedia, interactivity, social networking, and smart phone compatible delivery-the emphasis, and innovation, is the specific health problem and the holistic, educationally and behaviorally sound, integrated, approach to this problem, with technologies as tools to augment adoption and implementation to the extent that the technologies are accessible by CBO's, the YDPs, and their clients, and where supportive of targeted outcomes. Phase I will extend current YDP research by using community-based participatory research methods with a national sample of YDP from a broad range of organizations, design the overall CBO toolkit, develop a subset of these educational and support tools, and test those materials formatively within single-subject usability sessions and in a summative field trial. Phase II will develop the entire suite of materials and conduct a large- scale trial to validate them prior to widespread dissemination. Our proposed effort will: Specific Aim 1. Improve upon what is known about the role of YDP as sexual health educators by examining their information and skills needs, their understanding of evidence-based sexual health for adolescents, and the sexual health program/intervention needs of their organizations (CBOs). Specific Aim 2. Improve sexual health efforts of CBO-based YDP by developing resources to address: a. Reactive Education: Increase YDP efficacy for evidence-based responses to sexual health questions and increase YDP capacity to use behavioral change messages and interventions. b. Proactive Education: Increase frequency, accuracy, and effectiveness of outreach and educational efforts by YDP; increase YDP awareness of selves as sexual health models. c. Organizational Adoption: Enable CBOs, as organizations, to assess readiness, to assess effectiveness, and to develop a systematic approach to providing evidence-based sexual health programming. The proposed research effort will be an important contribution to the understanding of CBO-based YDP sexual health educational efforts and will also lead to the development and validation of innovative educational and performance support tools in an area where none currently exist.
Public Health Relevance Statement: Sexual health outcomes among adolescents remain problematic. Researchers, practitioners and public health officials have increasingly recognized the need to expand beyond traditional channels used to provide information and education related to sexual health in the United States. Community-based organizations (CBOs) have been identified as venues with significant potential to promote adolescent sexual health and support behavioral change and risk-reduction. Within CBOs, youth development professionals (YDP) are important sources of sexuality education for adolescents and have the potential to influence sexual decision- making and behavior. Often YDP have the ability to reach youth who may not be engaged through other efforts. Increasingly, YDP are called upon to provide sexual health information whether or not they have been prepared to do so; moreover, the often serve as sexual health role models, even when they do not overtly recognize this role. To do so accurately, efficiently, and effectively, both YDP, as individuals, and CBO, as organizations, need education and support resources for themselves and for the adolescents they serve. The proposed research effort will be an important contribution to the understanding of CBO-based YDP sexual health educational efforts and will lead to the development and validation of innovative educational and performance support tools in an area where none currently exist. The CBO tool kit will include web based courses for YDP and CBO administration; a range of support media (from paper to videos to games) for YDP to provide to clients; and organization small media, including posters, instructor led guides and media, and press releases for conducting outreach and workshops. There presently are no similar materials or products available, regardless of medium or quality. Given the large number of CBO and their documented need, the CBO Sexual Health Education Kits to be developed through Phase I and 2 of this effort should be commercially viable. CBO will be able roll out the materials, including staff courses and community workshops, in addition to the multimedia, video, and paper-based training and support components. Baldwin suggested that one of the single greatest barriers to YDP professional development is the lack of time to travel to sites for training, a barrier at leas partially surmountable by web- based courses. YDP engaged in the Fisher et al. research as well as others higher in the organizations have expressed interest in such efforts, especially one that would enable them to provide input into the final package to be adopted by the particular organization, as our proposed inclusion of CBPR methods will do. In the end, sexual health among adolescents continues to be an area in which there remains significant room for improvement. CBO-based YDP are well-placed to improve sexual health outcomes, frequently encounter sexual health related questions from their adolescent clientele, generally feel uncomfortable and unprepared to answer such questions and, in part perhaps as a result of this lack of preparation and comfort, less frequently conduct proactive educational activity regarding sexual health as compared to all other health and personal topics for which CBO conduct outreach. Moreover, when asked about sexual health programming, most YDP initially believe they rarely engage in any non-reactive educational efforts, yet when Baldwin further discussed a broader conceptualization of sexual health with the YDP, including the role they play as models of sexual relationships, the YDP realized that they in fact were always already acting as sexual beings, including modeling both positive and negative sexual health and relationship behaviors and stereotypes. Making this status overt is a first step toward more effectively addressing sexual health in this setting. The proposed effort will address this problem through judiciously selected technologies chosen to enhance a theoretically sound and evidence-based approach to organizational adoption, YDP education, and youth sexual health understanding and behavioral change. As such, the end result should not only provide a meaningful contribution to the related literatures but should also result in a product that is well-received by community based organizations and other groups with similar needs to engage in proactive and reactive sexual health counseling and education.
NIH Spending Category: Adolescent Sexual Activity; Behavioral and Social Science; Clinical Research; Health Services; Pediatric; Prevention
Project Terms: Address; Adolescent; Adopted; Adoption; Area; base; Behavior; Behavioral; Child; Client; Communities; community based participatory research; community organizations; Counseling; Decision Making; design; Development; Educational Activities; Educational aspects; Educational workshop; Effectiveness; Epidemiology; evidence base; Frequencies (time pattern); Health; health disparity; Health education; Health Educators; improved; Individual; innovation; instructor; interest; Internet; Intervention; intervention program; Lead; Literature; member; Methods; Modeling; Multimedia; Nonprofit Organizations; Online Systems; Organization and Administration; Outcome; outreach; Paper; Parents; Performance; Phase; Physicians; Play; Population; posters; Preparation; Press Releases; Professional Education; programs; Provider; public health medicine (field); Readiness; Recommendation; Research; Research Methodology; Research Personnel; Resources; response; Risk; Risk Reduction; Role; role model; Sampling; Schools; Self Perception; Services; Sexual Health; sexual relationship; Sexuality; Sexually Transmitted Diseases; Site; skills; social; Social Network; sound; Source; Stereotyped Behavior; Surgeon; Technology; Telephone; Testing; Time; tool; Training; Training Support; Travel; United States; Unplanned pregnancy; usability; Validation; Youth
