The Healthy Native Youth Implementation Toolbox:
Reaching American Indian and Alaska Native communities with online adolescent health promotion decision support. (Preprint)
Authors: Sidhu Amrita , Shegog Ross , Craig-Rushing Stephanie , Trevino Nicole , Singer Michelle , Jessen Cornelia , Gorman Gwenda , Simpson Sean , Peskin Melissa , Hernandez Belinda , Markham Christine 
Published: November 2024

BACKGROUND

American Indian and Alaska Native (AI/AN) youth experience numerous health inequities, including those in sexual, reproductive, and mental health. Implementation of culturally relevant, age-appropriate evidence-based programs may mitigate these inequities. However, numerous barriers limit the adoption and implementation of evidence-based adolescent health promotion programs in AI/AN communities.

OBJECTIVE

This study examines user reach and engagement from 2022 through 2024 of online decision support (the Healthy Native Youth (HNY) website and the embedded HNY Implementation Toolbox), designed to increase implementation of evidence-based adolescent health promotion programming in AI/AN communities.

METHODS

Promotional strategies were designed for optimal geographic reach to tribal organizations, opinion leaders, federal decision-makers and funders. Promotional channels included grassroots, community, and professional networks. We used Google Analytics to examine uptake of the HNY website and HNY Implementation Toolbox from January 2022 to January 2024. The Toolbox provides culturally relevant tools and templates to help users navigate through five phases of program adoption and implementation: Gather, Choose, Prepare, Implement, and Grow. User reach was estimated by demographic characteristics and geographic location; user engagement was estimated by visit frequency and duration, bounce rates, and frequency of page and tool access.

RESULTS

Over the study period, page views of the HNY website and HNY Toolbox increased 10-fold and 27-fold, respectively. Over the 2-year evaluation period since the Toolbox ‘go live’ date, approximately one in eight users of the HNY website visited the Toolbox. The majority of HNY website users were located in Washington (n=1,515), California (n=1,290), and Oregon (n=1,019) and were aged between 18-24 (21.7%) and 25-34 (23.29%) years. Toolbox users were primarily located in California (n=1,238), Washington (n=1,142), and Oregon (n=986), mostly aged between 35-44 years (35%). Both website and toolbox users were primarily female and accessed via desktop computers. The most frequently accessed phase pages within the Implementation Toolbox were Gather, Choose, Implement, and Prepare, as supported by bounce rates and average time on page. The most viewed phase was the “Gather” phase, with 3,278 views. The most frequently downloaded tools within the Toolbox were Gather: Community Needs and Resource Assessment, with 136 downloads. The phases and tools accessed may have differed based on the user’s goal or stage of implementation.

CONCLUSIONS

Findings indicate positive initial reach and engagement of the HNY website and HNY Implementation Toolbox among AI/AN educators that has consistently increased over the 2 years. The provision of online decision support that guides AI/AN users through the adoption, implementation, and maintenance of culturally relevant, age-appropriate, evidence-based adolescent health promotion programs in their communities may help increase the implementation of effective adolescent health promotion programs to ultimately increase health equity among AI/AN youth.

CLINICALTRIAL

N/A