A Culture Centered Narrative Approach for Health Promotion

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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.