JMIR Publications

ABSTRACT

Background:

Sexual and Gender Minority Youth (SGMY) (ages 14 – 29) face increased risks to their well-being compared to their cisgender, heterosexual peers—including rejection by family¬¬, exclusion from society, depression, substance use, elevated suicidality and harassment. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive Behavioural Therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help improve mood and increase coping by teaching youth how to identify, challenge and change maladaptive thoughts, beliefs and behaviours. Based on promising pilot study results, AFFIRM is a CBT-informed group intervention that is being tested in a pragmatic trial to assess its implementation potential.

Objective:

This project is intended to scale-up implementation and delivery of AFFIRM, an eight-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. This project aims to decrease sexual risk-taking, poor mental health and internalized homophobia, and increase levels of sexual self-efficacy and proactive coping among SGMY.

Methods:

SGMY are recruited via flyering at community agencies and organizations, as well as online advertising. Potential participants are assessed for suitability for the group intervention via online screening, and are allocated in a 2:1 fashion to the AFFIRM intervention or a waitlisted control in a stepped wedge waitlist crossover design. The intervention groups are hosted by Collaborating Community Agency Sites (CCASs) (e.g., community health centres and family health teams) across Ontario, Canada. Participants are assessed at pre-wait (if applicable), pre-intervention, post-intervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. All data collection occurs online, either independently or at CCASs via tablet. Participants in crisis are assessed using an established distress protocol.

Results:

Data collection is ongoing, with a target sample of 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t-tests, and repeated measures linear mixed modeling (LMM) using SPSS to test for differences pre and post intervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions, univariate, and multivariate normality of all variables will be assessed.

Conclusions:

AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY, but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact.