An intervention to promote healthy relationships among transgender and gender expansive youth

项目总结 变性人和性别膨胀(TGE)青年认为自己是与出生时的性别不同的性别。研究 倾向于根据性传播感染(STI)的高发病率、性危险行为、 暴力暴露和其他健康后果。很少有工作使用支持性的、基于弹性的框架 或者是以人为中心的方法。我们进行了初步的定性/合作设计研究，以了解性别 健康内容需求和格式/设计偏好。TGE青年推荐的内容领域，他们的 家庭、提供者和/或倡导者包括：a)青少年/提供者指出，青春期会产生焦虑症 TGE青少年和信息/工具将是有益的；b)与会者要求不加评判 关于性传播感染风险和预防的信息；c)青年/提供者要求提供关于避孕的内容 澄清肯定性别的医疗干预措施不能防止意外怀孕；d)参与者 建议消除性吸引力和性欲的多样性并使之正常化；e)培养青年 披露TGE身份是一项独特的挑战，并要求进行沟通技能培训以帮助他们 维护机构关于何时以及如何披露的信息；以及f)参与者描述了与合作伙伴导航的困难 同意，因为在性教育课程中，它经常被描述为异性关系的、二元的术语。青年时代 还描述了倾向于在书面材料中提供更多基于事实的避孕和性传播感染内容，互动 需要按性别和/或医疗过渡程度进行个性化的内容格式，以及多媒体 强调生活体验视角的方法，以获取有关欲望、性别认同的信息 披露和同意。参与者还提供了设计指南(例如，使用隐蔽的调色板 不会无意中公开透露用户的变性人身份)和特定功能(例如，列入黑名单 保护用户免受内容触发的功能；强大的搜索和过滤系统，轻松定位信息 具体到个人的需要)。基于这些主题，我们共同设计了一个纸质干预原型 太年轻了。在这项建议中，我们会聘请一个青年谘询委员会和社区顾问共同设计 与TGE青年(目标1a)和行为建立一个功能齐全的在线互动式性教育工具(OISET) 认知访谈，以完善选择的调查工具，并确保性别肯定干预效果衡量 在未来的R01(目标1b)。然后，我们将对40名青年进行一项不平衡的随机对照试验研究 (30项干预：10项对照)完善内容并确定OISET和数据收集的可行性 协议/程序(目标2)。主要结果将是干预的可用性/可行性/适当性/ 可接受性和研究可行性。我们将收集基线、干预后和3个月的知识数据； 一般/性自我效能感；伴侣沟通；危险性行为；社会支持； 恢复力。该项目具有创新性、严谨性，并响应了NICHD/NINR/SGMRO的优先事项。一定会有结果的 在第一个基于证据和优势的针对TGE青年性健康的在线干预中。

PROJECT SUMMARY Transgender and gender expansive (TGE) youth identify as a gender different from their sex at birth. Research tends to define this group based on high rates of sexually transmitted infections (STIs), sexual risk behaviors, violence exposures, and other health outcomes. Little work has used a supportive, resilience-based framework or a human-centered approach. We conducted preliminary qualitative/co-design studies to understand sexual health content needs and format/design preferences. Content areas recommended by TGE youth, their families, providers, and/or advocates include: a) Youth/ providers noted that puberty can produce dysphoria for TGE adolescents and that information/tools would be beneficial; b) Participants asked for non-judgmental information about STI risks and prevention; c) Youth/providers asked for content around contraception that clarifies that gender-affirming medical interventions do not prevent unintended pregnancies; d) Participants recommended destigmatizing and normalizing diversity in sexual attractions and desires; e) TGE youth raised disclosure of TGE identity as a unique challenge and asked for communication skills training to help them maintain agency over when and how to disclose; and f) Participants described difficulties navigating partner consent because it is often described in heteronormative, binary terms in sexual education classes. TGE youth also described favoring written materials for more fact-based content on contraception and STIs, interactive formats for content that requires personalization by gender and/or degree of medical transition, and multimedia approaches emphasizing lived experience perspectives for information around desire, gender identity disclosure, and consent. Participants also provided design guidance (e.g., use of a covert color palette that would not unwantedly disclose users’ transgender status in public) and specific features (e.g., blacklisting functions to protect the user from triggering content; robust search and filter system to easily locate information specific to an individual’s needs). Based on these themes, we co-designed a paper intervention prototype with TGE youth. In this proposal, we will engage a Youth Advisory Board and Community Consultants to co-design a fully functional online interactive sexual education tool (OISET) with TGE youth (Aim 1a) and conduct cognitive interviews to refine select survey tools and ensure gender-affirming intervention effect measurement in a future R01 (Aim 1b). We will then conduct an unbalanced, randomized controlled pilot study with 40 youth (30 intervention:10 control) to refine content and establish feasibility of the OISET and data collection protocols/procedures (Aim 2). Primary outcomes will be intervention usability/feasibility/appropriateness/ acceptability and study feasibility. We will collect baseline, post-intervention, and 3 month data on knowledge; general/sexuality-specific self-efficacy; partner communication; risky sexual behaviors; social support; and resilience. This project is innovative, rigorous, and responsive to NICHD/NINR/SGMRO priorities. It will result in the first evidence- and strengths-based online sexual health intervention for TGE youth.