A Culture Centered Narrative Approach for Health Promotion

描述(申请人提供)：拉美裔青少年的出生率、艾滋病毒感染和其他性传播感染(STI)的比率很高，无论是在全国范围内还是在霍利奥克。1拉美裔的青少年出生率是美国所有主要族裔/少数民族中最高的，为70.1‰，而总体青少年出生率为39.1‰。在所有种族/族裔中，拉美裔在所有成人和青少年艾滋病毒诊断中排名第二。3 2009年，美国15-19岁的拉丁裔衣原体感染率为21.9‰，与之相比，白人同龄人的比例为11.37/1000。4旨在促进拉美裔/a青年安全性行为的行为干预措施往往未能解决能够推动个人决策和行动的文化价值观。因此，它们往往是无效的。5显然有必要确定、传播和 实施以文化为基础的叙事干预。让青年参与者参与以艺术和叙事为基础的进程的干预措施，6-8，同时也承认他们的日常现实和性行为含义的多样性，包括积极的性行为观点，9和10，可能对促进性健康和福祉有效。通过突出拉美裔青年的声音，阐明他们自己对健康的意义，并在制定健康促进方案时考虑到这些观点，11以文化为中心的办法可以有效地促进积极的性健康结果。12，13虽然以文化为中心的内容与拉丁美洲青年的性健康促进联系在一起，但对以文化为中心的健康促进信息的总体有效性进行了评估，13、19、20叙述过程本身作为促进健康的机制的方式没有得到很好的检验。我们的多学科项目团队建议使用“年轻人驱动、研究人员协助”的叙事方法21来填补这一研究空白。拟议的项目采用叙事方法，使用数字讲故事(DST)来严格绘制参与者形成性、性健康和幸福的特定文化含义的机制。由此产生的特定于文化的数据将被用来为以文化为中心的性健康干预措施的未来发展提供信息。这一过程的影响将导致自尊心和个人性价值观清晰度的提高，性决策和沟通技能的提高，以及参与者对自己行为的感知选择的增加。该项目的具体目标是：(1)在三组波多黎各拉丁裔青少年中确定性健康的文化范例；(2)评估创作数字故事的过程对参与者的性态度/价值观、自决和使用保护行为的影响；以及(3)为讲习班参与者探索制作的数字故事的感知价值，以便在下一阶段的研究中选择共鸣的数字故事用于更大规模的推广工作。

DESCRIPTION (provided by applicant): Latina adolescents experience high rates of birth, HIV infection, and other sexually transmitted infections (STIs), both nationwide and in Holyoke.1 Latinas have the highest teen birth rate of any major ethnic/racial minority in the U.S. at 70.1/1000 births, in comparison to an overall teen birth rate of 39.1/1000.2 Among all racial/ethnic groups, Latinos rank second for all adult and adolescent HIV diagnoses.3 In 2009, U.S. Latinas ages 15-19 had rates of Chlamydia at 21.9/1000, in comparison to 11.37/1000 for their white peers.4 Behavioral interventions that seek to promote safer sex among Latino/a youth often fail to address the cultural values that can drive individual's decisions and actions. As a result, they are often ineffective.5 There is a clear imperative to identify, disseminate, and implement culturally specific narrative-based interventions. Interventions that engage youth participants in arts- and narrative-based processes, 6-8 while also acknowledging their everyday realities and the variability in meanings of sexuality, including a positive sexuality perspective, 9, and 10 may be effective for promoting sexual health and wellbeing. By foregrounding the voices of young Latinas to articulate their own meanings of health, and considering these perspectives in the development of health promotion programs,11 culture-centered approaches can effectively promote positive sexual health outcomes.12,13 While culturally centered content has been linked to sexual health promotion among young Latinas, with culture-centric health promotion messages evaluated for their overall effectiveness,13,19,20 the narrative process itself has not been well tested for the way that it works as a mechanism of health promotion. Our multidisciplinary project team proposes to use a "young person-driven, researcher-facilitated" narrative methodology21 to address this research gap. The proposed project takes a narrative approach, using digital storytelling (DST) to rigorously map the mechanisms by which participants form culturally specific meanings of sexuality, sexual health, and wellbeing. Resulting culturally specific data will be used to inform the future development of culturally centered sexual health interventions. The impact of the process will result in increased levels in self-esteem and clarity of personal sexual values, increases in sexual decision-making and communication skills, and an increase in perceived choices in one's actions among participants. The specific aims of this project are to (1) Identify cultural paradigms of sexual health among three groups of adolescent Puerto Rican Latinas; (2) Assess the effects of the process of creating digital stories on participants' sexual attitudes/values, self-determination, and use of protective behaviors; and (3) Explore the perceived value of produced digital stories for workshop participants, to inform the choice of resonant digital stories for use in a larger scale promotion effort in the next phase of research.