Enhancing Psychological Capital to Foster Health Outcomes in Homeless Young Women

说明(申请人提供)：无家可归的年轻女性，18-23岁，是无家可归者中最脆弱的群体。他们经历了许多可怕的健康后果，如性传播感染、乙肝和丙型肝炎以及意外怀孕，特别是与药物使用和随之而来的性行为有关；然而，他们也有内在的力量，如希望、自我效能和韧性，这些都代表了他们的一些心理资本。到目前为止，很少有理论驱动的干预措施在寻求卫生和社会服务的人群中开发和测试。这项可行性随机对照试验的具体目的是：1)检验街头短期干预的可行性，以提高无家可归年轻女性(18-23岁)的心理资本(希望、韧性、自我效能和乐观)，并促进认知、情感(社会连通性、未来期望、生活质量)和行为健康相关结果(目标实现、安全性行为和负责任的物质使用行为)；2)确定这一短暂干预的初步效果和成本。我们将招募总共0名年轻女性，并随机将40人分配到干预组，40人分配到注意对照组。每组将参加四次小组讨论和技能培养活动。干预组将在设定目标和确定减少危险物质使用和性行为的策略的背景下，专注于发展他们的心理资本(希望、韧性、自我效能和乐观)。一个注意力控制小组将收到有关街道安全和保持健康的一般信息。在四个疗程之后，两组的参与者都将获得一个月的预付费手机。干预组的受试者每周都会通过手机收到小组协调人发来的鼓励信息，而控制组的受试者每周都会收到消息，提醒他们这项研究的最终数据收集日期。定量数据将在基线时收集，在干预或对照组的四次会议之后立即收集，并在4周后收集。在最后的数据收集阶段之后，将对干预组中的人进行离职访谈。定量数据将使用描述性和推断性统计检验进行分析，包括重复测量方差分析(ANOVA)和均值之间差异的t检验。访谈数据将被录音、逐字转录，并使用内容分析程序进行分析。干预保真度将通过对干预小组会议的随机选择的音频记录进行审查来确定。研究结果将用于修改干预手册和研究方案，以便使用随机对照试验设计进行更大规模的多点干预试验。 公共卫生相关性：18至23岁的无家可归年轻妇女极易受到不良健康后果的影响，特别是与药物使用和性行为有关的不良健康后果；因此，我们需要制定和测试干预措施，帮助她们过上富有成效和令人满意的生活。如果不采取这种干预措施，它们对公众健康构成极大威胁，因为药物滥用、艾滋病毒/艾滋病、多发性传播感染、乙型和丙型肝炎以及创伤后应激障碍等代价高昂的健康问题。这项研究的结果将有助于进一步开发和测试理论驱动的干预措施，这些干预措施是有效的，可以在多个公共卫生服务环境中以较低的成本提供。

DESCRIPTION (provided by applicant): Homeless young women, 18-23 years of age, are the most vulnerable of homeless groups. They experience many dire health outcomes such as sexually transmitted infections, Hepatitis B and C, and unplanned pregnancies, related particularly to substance use and concomitant sexual behaviors; however, they also have inherent strengths such as hope, self-efficacy, and resilience that represent some of their psychological capital. To date very few theory-driven interventions have been developed and tested in this population in settings where they seek health and social services. The specific aims of this feasibility randomized controlled trial are to 1) Examine the feasibility of a brief, street-based intervention to enhance psychological capital (hope, resilience, self-efficacy, and optimism) and foster cognitive, affective (social connectedness, future expectations, quality of life), and behavioral health-related outcomes (goal attainment, safe sex behaviors, and responsible substance use behaviors) in homeless young women (ages 18-23); and 2) Determine the preliminary efficacy and cost of this brief intervention. We will recruit a total of 0 young women and randomly assign 40 to the intervention group and 40 to an attention control group. Each group will attend four sessions of group discussions and skill-building activities. The intervention group will focus on developing their psychological capital (hope, resilience, self-efficacy, and optimism) in the context of setting goals and identifying strategies to curtail their risky substance use and sexual behavior. An attention control group will receive general information about street safety and staying healthy. Following the four sessions, participants in both groups will receive a one-month pre-paid cell phone. Those in the intervention group will receive encouraging messages from their group facilitators weekly via the cell phones while those in the control group will receive weekly messages reminding them of the date of the final data collection for the study. Quantitative data will be collected at baseline, immediately following the four sessions of intervention or control groups, and 4 weeks later. Exit interviews will be done with those in the intervention group following the final data collection period. Quantitative data will be analyzed using descriptive and inferential statistical tests including repeated measures analysis of variance (ANOVA) and t-tests for differences between means. Interview data will be audio-recorded, transcribed verbatim, and analyzed using content analysis procedures. Intervention fidelity will be ascertained by reviews of a random selection of audio recordings of the intervention group sessions. Findings will be used to revise the intervention manual and research protocol for a larger multi-site test of the intervention using a randomized controlled trial design. PUBLIC HEALTH RELEVANCE: Homeless young women, ages 18-23 years, are extremely vulnerable to poor health outcomes related particularly to substance use and sexual behaviors; thus, we need to develop and test interventions that help them live lives that are productive and satisfying. Without such interventions, they represent a great threat to the public health for costly health problems such as substance abuse, HIV/AIDS, multiple sexually transmitted infections (STIs), hepatitis B and C, and post-traumatic stress disorder (PTSD). Findings from this study will contribute to the further development and testing of theory-driven interventions that are effective and that can be delivered at little cost in multiple public health service settigs.