The Development and Testing of a Multi-Level, Multi-Component Pilot Intervention To Reduce Sexual and Reproductive Health Disparities in a Tribal Community.

ABSTRACT This manuscript presents the results from a multi- level, multi-component pilot intervention designed to reduce sexual and reproductive health (SRH) among American Indian (AI) youth living on a reservation in the Northwestern United States. Our theoretical framework included community based participatory research (CBPR) and Ecological Systems Theory (EST). The pilot intervention was a school-based curriculum for youth and parents and a cultural mentoring program. Mixed methods were used including a pre/post test design and focus groups. Quantitative data was analyzed using McNemar’s chi-square and a random effects model. Qualitative data was analyzed with grounded theory and content analysis. Parents reported increased communication about SRH topics with their children. Youth reported increased condom use self-efficacy, increased condom use, and positive agreement with attitudes toward pregnancy. Our results also suggest increased communication about SRH topics in parent dyads and the need for increased communication with elders. Future research is needed to test the efficacy of multi-level, multi-component tribally driven SRH interventions for AI youth and their families that integrate contemporary SRH issues with traditional values and beliefs.