An Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth (Project Youth AFFIRM): Protocol for an Implementation Study

Shelley L Craig, Lauren B McInroy, Andrew David Eaton, Gio Iacono, Vivian Wy Leung, Ashley Austin, Cheryl Dobinson, Shelley L Craig, Lauren B McInroy, Andrew David Eaton, Gio Iacono, Vivian Wy Leung, Ashley Austin, Cheryl Dobinson

Abstract

Background: Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral 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 SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential.

Objective: The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY.

Methods: SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 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. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol.

Results: Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of 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.

International registered report identifier (irrid): DERR1-10.2196/13462.

Keywords: cognitive behavioral therapy; coping behavior; implementation science; pragmatic clinical trial; sexual and gender minorities; youth.

Conflict of interest statement

Conflicts of Interest: None declared.

©Shelley L Craig, Lauren B McInroy, Andrew David Eaton, Gio Iacono, Vivian WY Leung, Ashley Austin, Cheryl Dobinson. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 06.06.2019.

References

    1. Scourfield J, Roen K, McDermott L. Lesbian, gay, bisexual and transgender young people's experiences of distress: resilience, ambivalence and self-destructive behaviour. Health Soc Care Community. 2008 May;16(3):329–36. doi: 10.1111/j.1365-2524.2008.00769.x.
    1. Benibgui M. Mental Health Challenges and Resilience in Lesbian, Gay, And Bisexual Young Adults : Biological and Psychological Internalization of Minority Stress and Victimization. Montreal, QC, Canada: Concordia University Library; 2010.
    1. Horn SS, Kosciw JG, Russell ST. Special issue introduction: new research on lesbian, gay, bisexual, and transgender youth: studying lives in context. J Youth Adolesc. 2009 Aug;38(7):863–6. doi: 10.1007/s10964-009-9420-1.
    1. Williams T, Connolly J, Pepler D, Craig W. Peer victimization, social support, and psychosocial adjustment of sexual minority adolescents. J Youth Adolescence. 2005 Oct;34(5):471–82. doi: 10.1007/s10964-005-7264-x.
    1. Hoffman ND, Freeman K, Swann S. Healthcare preferences of lesbian, gay, bisexual, transgender and questioning youth. J Adolesc Health. 2009 Sep;45(3):222–9. doi: 10.1016/j.jadohealth.2009.01.009.
    1. Craig SL. Precarious partnerships: designing a community needs assessment to develop a system of care for gay, lesbian, bisexual, transgender and questioning (GLBTQ) youth. J Community Pract. 2011 Jul;19(3):274–91. doi: 10.1080/10705422.2011.595301.
    1. Cross T, Friesen B, Jivanjee P, Gowen K, Bandurraga A, Matthew C, Maher N. Defining youth success using culturally appropriate community-based participatory research methods. Best Pract Ment Health. 2011;7(1):94–114.
    1. D'augelli AR, Grossman AH, Starks MT. Families of gay, lesbian, and bisexual youth: what do parents and siblings know and how do they react? J GLBT Fam Stud. 2008 Apr 17;4(1):95–115. doi: 10.1080/15504280802084506.
    1. Ueno K. Sexual orientation and psychological distress in adolescence: examining interpersonal stressors and social support processes. Soc Psychol Q. 2005 Sep;68(3):258–77. doi: 10.1177/019027250506800305.
    1. Martin-Storey A, Crosnoe R. Sexual minority status, peer harassment, and adolescent depression. J Adolesc. 2012 Aug;35(4):1001–11. doi: 10.1016/j.adolescence.2012.02.006.
    1. Mustanski B, Andrews R, Herrick A, Stall R, Schnarrs PW. A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. Am J Public Health. 2014 Feb;104(2):287–94. doi: 10.2105/AJPH.2013.301744.
    1. Public HAOC . 2014. [2019-05-17]. HIV/AIDS in Canada: Surveillance report to December 31st, 2013 .
    1. Dysart-Gale D. Social justice and social determinants of health: lesbian, gay, bisexual, transgendered, intersexed, and queer youth in Canada. J Child Adolesc Psychiatr Nurs. 2010;23(1):23–28. doi: 10.1111/j.1744-6171.2009.00213.x.
    1. Davis TS, Saltzburg S, Locke CR. Supporting the emotional and psychological well being of sexual minority youth: youth ideas for action. Child Youth Serv Rev. 2009 Sep;31(9):1030–41. doi: 10.1016/j.childyouth.2009.05.003.
    1. Saewyc EM, Skay CL, Hynds P, Pettingell S, Bearinger LH, Resnick MD, Reis E. Suicidal ideation and attempts in North American school-based surveys: are bisexual youth at increasing risk? J LGBT Health Res. 2008 Oct 11;3(2):25–36. doi: 10.1300/J463v03n02_04.
    1. Meyer IH, Dietrich J, Schwartz S. Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations. Am J Public Health. 2008 Jun;98(6):1004–6. doi: 10.2105/AJPH.2006.096826.
    1. Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics. 2009 Jan;123(1):346–52. doi: 10.1542/peds.2007-3524.
    1. Doty ND, Willoughby BL, Lindahl KM, Malik NM. Sexuality related social support among lesbian, gay, and bisexual youth. J Youth Adolesc. 2010 Oct;39(10):1134–47. doi: 10.1007/s10964-010-9566-x.
    1. Birkett M, Espelage DL, Koenig B. LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes. J Youth Adolesc. 2009 Aug;38(7):989–1000. doi: 10.1007/s10964-008-9389-1.
    1. Craig SL, Austin A. The AFFIRM open pilot feasibility study: A brief affirmative cognitive behavioral coping skills group intervention for sexual and gender minority youth. Child Youth Serv Rev. 2016 May;64:136–44. doi: 10.1016/j.childyouth.2016.02.022.
    1. Berlan ED, Corliss HL, Field AE, Goodman E, Austin SB. Sexual orientation and bullying among adolescents in the growing up today study. J Adolesc Health. 2010 Apr;46(4):366–71. doi: 10.1016/j.jadohealth.2009.10.015.
    1. DiPlacido J. Stigma and Sexual Orientation: Understanding Prejudice Against Lesbians, Gay Men and Bisexuals. Thousand Oaks, CA: Sage Publications; 1998. Minority stress among lesbians, gay men,bisexuals: a consequence of heterosexism, homophobia,stigmatization; pp. 138–59.
    1. Detrie PM, Lease SH. The relation of social support, connectedness, and collective self-esteem to the psychological well-being of lesbian, gay, and bisexual youth. J Homosex. 2007;53(4):173–99. doi: 10.1080/00918360802103449.
    1. Statistics Canada. Ottawa: Statistics Canada; 2018. [2019-05-17]. A portrait of Canadian youth .
    1. . 2014. [2019-05-17]. Population-specific status report: HIV/AIDS and other sexually transmitted and blood borne infections among youth in Canada .
    1. Goodenow C, Szalacha LA, Robin LE, Westheimer K. Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. Am J Public Health. 2008 Jun;98(6):1051–8. doi: 10.2105/AJPH.2005.080531.
    1. Travers R, Paoletti D. Responding to the support needs of HIV positive lesbian, gay and bisexual youth. Can J Hum Sex. 1999;8(4):271–84.
    1. Saewyc E, Skay C, Richens K, Reis E, Poon C, Murphy A. Sexual orientation, sexual abuse, and HIV-risk behaviors among adolescents in the pacific northwest. Am J Public Health. 2006 Jun;96(6):1104–10. doi: 10.2105/AJPH.2005.065870.
    1. Thoma BC, Huebner DM, Rullo JE. Unseen risks: HIV-related risk behaviors among ethnically diverse sexual minority adolescent females. AIDS Educ Prev. 2013 Dec;25(6):535–41. doi: 10.1521/aeap.2013.25.6.535.
    1. Saewyc E. Adolescent pregnancy among lesbian, gay, and bisexual teens. In: Cherry AL, Dillon ME, editors. International Handbook of Adolescent Pregnancy. New York, NY: Springer; 2014. pp. 159–69.
    1. Saewyc E. Research on adolescent sexual orientation: development, health disparities, stigma, and resilience. J Res Adolesc. 2011;21(1):256–72. doi: 10.1111/j.1532-7795.2010.00727.x.
    1. Gangamma R, Slesnick N, Toviessi P, Serovich J. Comparison of HIV risks among gay, lesbian, bisexual and heterosexual homeless youth. J Youth Adolesc. 2008;37(4):456–64. doi: 10.1007/s10964-007-9171-9.
    1. Canadian Mental Health Association. 2013. [2019-05-17]. Fast facts about mental illness .
    1. Diane B. Sexual Orientation And Victimization. Ottawa, ON, Canada: Statistics Canada, Canadian Centre For Justice Statistics; 2004.
    1. Hatzenbuehler ML, McLaughlin KA, Xuan Z. Social networks and risk for depressive symptoms in a national sample of sexual minority youth. Soc Sci Med. 2012 Oct;75(7):1184–91. doi: 10.1016/j.socscimed.2012.05.030.
    1. Taylor C, Peter T. Egale Canada. 2011. [2019-05-17]. Every class in every school: the first national climate survey on homophobia, biphobia, and transphobia in Canadian schools 2011 .
    1. Craig SL, McInroy L. The relationship of cumulative stressors, chronic illness and abuse to the self-reported suicide risk of black and hispanic sexual minority youth. J. Community Psychol. 2013 Jul 22;41(7):783–98. doi: 10.1002/jcop.21570.
    1. Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, Pollack L, Binson D, Osmond D, Catania JA. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003 Jun;93(6):939–42. doi: 10.2105/AJPH.93.6.939.
    1. Craig SL, McInroy L. You can form a part of yourself online: the influence of new media on identity development and coming out for LGBTQ youth. J Gay Lesbian Ment Health. 2014 Jan 30;18(1):95–109. doi: 10.1080/19359705.2013.777007.
    1. Resnick MD, Catalano RF, Sawyer SM, Viner R, Patton GC. Seizing the opportunities of adolescent health. Lancet. 2012 Apr 28;379(9826):1564–7. doi: 10.1016/S0140-6736(12)60472-3.
    1. Marshal MP, Dermody SS, Cheong J, Burton CM, Friedman MS, Aranda F, Hughes TL. Trajectories of depressive symptoms and suicidality among heterosexual and sexual minority youth. J Youth Adolesc. 2013 Jun 20;42(8):1243–56. doi: 10.1007/s10964-013-9970-0.
    1. Ferlatte O, Hottes TS, Trussler T, Marchand R. Evidence of a syndemic among young Canadian gay and bisexual men: uncovering the associations between anti-gay experiences, psychosocial issues, and HIV risk. AIDS Behav. 2014 Jul;18(7):1256–63. doi: 10.1007/s10461-013-0639-1.
    1. Singer M. Introduction to Syndemics: A Critical Systems Approach to Public and Community Health. Hoboken, NJ: Wiley, John & Sons, Incorporated; 2009.
    1. Stall R, Friedman M, Catania J. Interacting epidemics and gay men's health: a theory of syndemic production among urban gay men. In: Wolitski R, Stall R, Valdiserri R, editors. Unequal Opportunity: Health Disparities Affecting Gay and Bisexual Men in the United States. New York, NY: Oxford University Press; 2007.
    1. Mustanski B, Garofalo R, Herrick A, Donenberg G. Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention. Ann Behav Med. 2007 Dec;34(1):37–45. doi: 10.1007/BF02879919.
    1. Parsons JT, Grov C, Golub SA. Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: further evidence of a syndemic. Am J Public Health. 2012 Jan;102(1):156–62. doi: 10.2105/AJPH.2011.300284.
    1. Meyer I. Minority stress and mental health in gay men. J Health Soc Behav. 1995 Mar;36(1):38–56.
    1. Kelleher C. Minority stress and health: Implications for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) young people. Couns Psychol Q. 2009 Dec;22(4):373–9. doi: 10.1080/09515070903334995.
    1. D'Augelli AR, Hershberger SL, Pilkington NW. Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths. Suicide Life Threat Behav. 2001;31(3):250–64. doi: 10.1521/suli.31.3.250.24246.
    1. Frost DM, Meyer IH. Internalized homophobia and relationship quality among lesbians, gay men, and bisexuals. J Couns Psychol. 2009;56(1):97–109. doi: 10.1037/a0012844.
    1. Almeida J, Johnson RM, Corliss HL, Molnar BE, Azrael D. Emotional distress among LGBT youth: the influence of perceived discrimination based on sexual orientation. J Youth Adolesc. 2009 Aug;38(7):1001–14. doi: 10.1007/s10964-009-9397-9.
    1. Bidell M. School counselors and social justice advocacy for lesbian, gay, bisexual, transgender, and questioning students. J School Counsel. 2011;9(10)
    1. Compton SN, March JS, Brent D, Albano AM, Weersing R, Curry J. Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review. J Am Acad Child Adolesc Psychiatry. 2004 Aug;43(8):930–59. doi: 10.1097/.
    1. Beck A. Cognitive Therapy And The Emotional Disorders. New York, NY: Plume; 1979.
    1. Beck AT. Cognitive therapy: past, present, and future. J Consult Clin Psychol. 1993;61(2):194–8. doi: 10.1037/0022-006X.61.2.194.
    1. Beck A, Alford B. Depression: Causes And Treatment, Second Edition. Pittsburgh, PA: University Of Pennsylvania Press; 2009.
    1. Fenn K, Byrne M. The key principles of cognitive behavioural therapy. InnovAiT. 2013 Sep 6;6(9):579–85. doi: 10.1177/1755738012471029.
    1. Martell C, Safren S, Prince S. Cognitive-Behavioral Therapies with Lesbian, Gay, and Bisexual Clients. New York, NY: Guilford Press; 2012.
    1. Ross LE, Doctor F, Dimito A, Kuehl D, Armstrong MS. Can talking about oppression reduce depression? Modified CBT group treatment for LGBT people with depression. J Gay Lesbian Soc Serv. 2008 Oct 11;19(1):1–15. doi: 10.1300/J041v19n01_01.
    1. Hart TA, Tulloch TG, O’Cleirigh C. Integrated cognitive behavioral therapy for social anxiety and HIV prevention for gay and bisexual men. Cogn Behav Pract. 2014 May;21(2):149–60. doi: 10.1016/j.cbpra.2013.07.001.
    1. Austin A, Craig SL. Empirically supported interventions for sexual and gender minority youth: a stakeholder driven model. J Evid Based Soc Work. 2015 Apr 29;12(6):567–78. doi: 10.1080/15433714.2014.884958.
    1. Shoptaw S, Reback CJ, Peck JA, Yang X, Rotheram-Fuller E, Larkins S, Veniegas RC, Freese TE, Hucks-Ortiz C. Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug Alcohol Depend. 2005 May;78(2):125–34. doi: 10.1016/j.drugalcdep.2004.10.004.
    1. Craig SL, Austin A, Alessi E. Gay affirmative cognitive behavioral therapy for sexual minority youth: a clinical adaptation. Clin Soc Work J. 2012 Dec 22;41(3):258–66. doi: 10.1007/s10615-012-0427-9.
    1. Champion JD, Collins JL. Comparison of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection: Results of a randomized controlled trial. Int J Nurs Stud. 2012 Feb;49(2):138–50. doi: 10.1016/j.ijnurstu.2011.08.010.
    1. Senyonyi RM, Underwood LA, Suarez E, Musisi S, Grande TL. Cognitive behavioral therapy group intervention for HIV transmission risk behavior in perinatally infected adolescents. Health. 2012;04(12):1334–45. doi: 10.4236/health.2012.412195.
    1. Hops H, Ozechowski TJ, Waldron HB, Davis B, Turner CW, Brody JL, Barrera M. Adolescent health-risk sexual behaviors: effects of a drug abuse intervention. AIDS Behav. 2011 Aug 11;15(8):1664–76. doi: 10.1007/s10461-011-0019-7.
    1. Pachankis JE, Hatzenbuehler ML, Rendina HJ, Safren SA, Parsons JT. LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach. J Consult Clin Psychol. 2015 Oct;83(5):875–89. doi: 10.1037/ccp0000037.
    1. McCart MR, Sheidow AJ, Letourneau EJ. Risk reduction therapy for adolescents: targeting substance use and HIV/STI-risk behaviors. Cogn Behav Pract. 2014 May;21(2):161–75. doi: 10.1016/j.cbpra.2013.10.001.
    1. Lucassen MF, Merry SN, Hatcher S, Frampton CM. Rainbow SPARX: a novel approach to addressing depression in sexual minority youth. Cogn Behav Pract. 2015 May;22(2):203–16. doi: 10.1016/j.cbpra.2013.12.008.
    1. Brown JL, Sales JM, Swartzendruber AL, Eriksen MD, DiClemente RJ, Rose ES. Added benefits: reduced depressive symptom levels among African-American female adolescents participating in an HIV prevention intervention. J Behav Med. 2013 Dec 24;37(5):912–20. doi: 10.1007/s10865-013-9551-4.
    1. Safren SA, O'Cleirigh C, Tan JY, Raminani SR, Reilly LC, Otto MW, Mayer KH. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol. 2009 Jan;28(1):1–10. doi: 10.1037/a0012715.
    1. Safren S, O'Cleirigh C, Bullis J, Otto M, Stein M, Pollack M. Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial. J Consult Clin Psychol. 2012 Jun;80(3):404–15. doi: 10.1037/a0028208.
    1. Bullis JR, Fortune MR, Farchione TJ, Barlow DH. A preliminary investigation of the long-term outcome of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Comprehensive Psychiatry. 2014;55(8):1920–1927.
    1. Moradi B, Mohr JJ, Worthington RL, Fassinger RE. Counseling psychology research on sexual (orientation) minority issues: conceptual and methodological challenges and opportunities. J Couns Psychol. 2009;56(1):5–22. doi: 10.1037/a0014572.
    1. Bonet L, Wells BE, Parsons JT. A positive look at a difficult time: a strength based examination of coming out for lesbian and bisexual women. J LGBT Health Res. 2008 Oct 11;3(1):7–14. doi: 10.1300/J463v03n01_02.
    1. Morrison DM, Casey EA, Beadnell BA, Hoppe MJ, Gillmore MR, Wilsdon A, Higa D, Carlisle S, Wells EA. Effects of friendship closeness in an adolescent group HIV prevention intervention. Prev Sci. 2007 Dec;8(4):274–84. doi: 10.1007/s11121-007-0075-4.
    1. Compas BE, Connor-Smith JK, Saltzman H, Thomsen AH, Wadsworth ME. Coping with stress during childhood and adolescence: problems, progress, and potential in theory and research. Psychol Bull. 2001;127(1):87–127. doi: 10.1037/0033-2909.127.1.87.
    1. Mustanski B, Newcomb ME, Garofalo R. Mental health of lesbian, gay, and bisexual youth: a developmental resiliency perspective. J Gay Lesbian Soc Serv. 2011 Jan 1;23(2):204–25. doi: 10.1080/10538720.2011.561474.
    1. Craig SL. Affirmative supportive safe and empowering talk (ASSET): leveraging the strengths and resiliencies of sexual minority youth in school-based groups. J LGBT Issues Couns. 2013 Oct;7(4):372–86. doi: 10.1080/15538605.2013.839342.
    1. Seiffge-Krenke I, Klessinger N. Long-term effects of avoidant coping on adolescents' depressive symptoms. J Youth Adolesc. 2000 Dec;29(6):617–30. doi: 10.1023/A:1026440304695.
    1. Craig SL, McInroy L, Austin A, Smith M, Engle B. Promoting self-efficacy and self-esteem for multiethnic sexual minority youth: an evidence-informed intervention. J Soc Serv Res. 2012 Oct;38(5):688–98. doi: 10.1080/01488376.2012.718194.
    1. Kulkin HS. Factors enhancing coping and mental health in lesbian youth: a review of the literature. J Homosex. 2006 Jul 16;50(4):97–111. doi: 10.1300/J082v50n04_05.
    1. Matta R, Doiron C, Leveridge MJ. The dramatic increase in social media in urology. J Urol. 2014 Aug;192(2):494–8. doi: 10.1016/j.juro.2014.02.043.
    1. Dentato MP, Craig SL, Smith MS. The vital role of social workers in community partnerships: the alliance for gay, lesbian, bisexual, transgender youth. Child Adolesc Soc Work J. 2010 Jun 25;27(5):323–34. doi: 10.1007/s10560-010-0210-0.
    1. Cashman SB, Adeky S, Allen AJ, Corburn J, Israel BA, Montaño J, Rafelito A, Rhodes SD, Swanston S, Wallerstein N, Eng E. The power and the promise: working with communities to analyze data, interpret findings, and get to outcomes. Am J Public Health. 2008 Aug;98(8):1407–17. doi: 10.2105/AJPH.2007.113571.
    1. Eaton AD, Tsang AK, Craig SL, Ginocchio GF. Peer researchers in post-professional healthcare: a glimpse at motivations and partial objectivity as opportunities for action researchers. Action Res J. 2018 Nov 19;:147675031881191. doi: 10.1177/1476750318811913.
    1. Craig SL, Dentato MP, Iacovino GE. Patching holes and integrating community: a strengths-based continuum of care for lesbian, gay, bisexual, transgender and questioning youth. J Gay Lesbian Soc Serv. 2015 Feb 20;27(1):100–15. doi: 10.1080/10538720.2015.988317.
    1. Graham R. The Health Of Lesbian, Gay, Bisexual, And Transgender People: Building A Foundation For Better Understanding. Washington, DC: National Academies Press; 2011.
    1. Crisp C, McCave EL. Gay affirmative practice: a model for social work practice with gay, lesbian, and bisexual youth. Child Adolesc Soc Work J. 2007 Sep 1;24(4):403–21. doi: 10.1007/s10560-007-0091-z.
    1. Handley MA, Schillinger D, Shiboski S. Quasi-experimental designs in practice-based research settings: design and implementation considerations. J Am Board Fam Med. 2011;24(5):589–96. doi: 10.3122/jabfm.2011.05.110067.
    1. Tunis SR, Stryer DB, Clancy CM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. J Am Med Assoc. 2003 Sep 24;290(12):1624–32. doi: 10.1001/jama.290.12.1624.
    1. Eaton AD, Chan Carusone S, Craig SL, Telegdi E, McCullagh JW, McClure D, Wilson W, Zuniga L, Berney K, Ginocchio GF, Wells GA, Montess M, Busch A, Boyce N, Strike C, Stewart A. The ART of conversation: feasibility and acceptability of a pilot peer intervention to help transition complex HIV-positive people from hospital to community. BMJ Open. 2019 Mar 30;9(3):e026674. doi: 10.1136/bmjopen-2018-026674.
    1. Li F, Frangakis CE. Designs in partially controlled studies: messages from a review. Stat Methods Med Res. 2016 Jul 2;14(4):417–31. doi: 10.1191/0962280205sm405oa.
    1. Brown CA, Lilford RJ. The stepped wedge trial design: a systematic review. BMC Med Res Methodol. 2006 Nov 08;6(1):54. doi: 10.1186/1471-2288-6-54.
    1. Bonell CP, Hargreaves J, Cousens S, Ross D, Hayes R, Petticrew M, Kirkwood BR. Alternatives to randomisation in the evaluation of public health interventions: design challenges and solutions. J Epidemiol Community Health. 2009 Feb 12;65(7):582–7. doi: 10.1136/jech.2008.082602.
    1. Patsopoulos NA. A pragmatic view on pragmatic trials. Dialogues Clin Neurosci. 2011;13(2):217–24.
    1. Zuidgeest MG, Welsing PM, van Thiel GJ, Ciaglia A, Alfonso-Cristancho R, Eckert L, Eijkemans MJ, Egger M. Series: pragmatic trials and real world evidence: Paper 5. Usual care and real life comparators. J Clin Epidemiol. 2017 Oct;90:92–98. doi: 10.1016/j.jclinepi.2017.07.001.
    1. Hussey MA, Hughes JP. Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials. 2007 Feb;28(2):182–91. doi: 10.1016/j.cct.2006.05.007.
    1. Eaton AD, Cattaneo JS, Watchorn JM, Bilbao-Joseph C, Bowler S, Hazelton M, Myslik J, Ross A, Chambers L. From serodiscordant to magnetic: the feasibility and acceptability of a pilot psychoeducational group intervention designed to improve relationship quality. Soc Work Groups. 2017 Sep 22;41(4):323–35. doi: 10.1080/01609513.2017.1369922.
    1. Green LW. Making research relevant: if it is an evidence-based practice, where's the practice-based evidence? Fam Pract. 2008 Sep 15;25(Supplement 1):i20–4. doi: 10.1093/fampra/cmn055.
    1. Bavinton BR, Gray J, Prestage G. Assessing the effectiveness of HIV prevention peer education workshops for gay men in community settings. Aust N Z J Public Health. 2013 Aug;37(4):305–10. doi: 10.1111/1753-6405.12076.
    1. Majer JM, Glantsman O, Palmer JS, Jason LA. Predictors of abstinence self-efficacy: examining the role of HIV-risk sexual behavior. J Soc Serv Res. 2014 Aug 12;41(1):39–48. doi: 10.1080/01488376.2014.935559.
    1. Beck AT, Steer RA, Brown GK. Beck Depression Inventory: Second Edition Manual. London, UK: Pearson; 1996. pp. 490–8.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. Washington, DC: American Psychiatric Association; 2013.
    1. Rowley AA, Roesch SC, Jurica BJ, Vaughn AA. Developing and validating a stress appraisal measure for minority adolescents. J Adolesc. 2005 Aug;28(4):547–57. doi: 10.1016/j.adolescence.2004.10.010.
    1. Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92–100. doi: 10.1207/s15327558ijbm0401_6.
    1. Greenglass E, Schwarzer R, Jakubiec D. The proactive coping inventory (PCI): A multidimensional research instrument. 20th International Conference of the Stress and Anxiety Research Society (STAR); July 12-14, 1999; Cracow, Poland. 1999.
    1. Snyder CR, Harris C, Anderson JR, Holleran SA, Irving LM, Sigmon ST, Yoshinobu L, Gibb J, Langelle C, Harney P. The will and the ways: development and validation of an individual-differences measure of hope. J Pers Soc Psychol. 1991 Apr;60(4):570–85. doi: 10.1037/0022-3514.60.4.570.
    1. Nungesser L. Homosexual Acts, Actors and Identities. Westport, CT: Greenwood Press; 1983.
    1. Tuckman BW. The scaling of mood. Educ Psychol Meas. 2016 Sep 7;48(2):419–27. doi: 10.1177/0013164488482014.
    1. Williams DR, Yan Y, Jackson JS, Anderson NB. Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol. 1997 Jul;2(3):335–51. doi: 10.1177/135910539700200305.
    1. Woodford MR, Chonody JM, Kulick A, Brennan DJ, Renn K. The LGBQ microaggressions on campus scale: a scale development and validation study. J Homosex. 2015 Jul;62(12):1660–87. doi: 10.1080/00918369.2015.1078205.
    1. Faul F, Erdfelder E, Lang A, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175–91. doi: 10.3758/BF03193146.
    1. King G, Honaker J, Joseph A, Scheve K. Analyzing incomplete political science data: an alternative algorithm for multiple imputation. Am Polit Sci Rev. 2001;95(1):49–69.
    1. Stansfield B, Hawkins K, Adams S, Bhatt H. A mixed linear modelling characterisation of gender and speed related changes in spatiotemporal and kinematic characteristics of gait across a wide speed range in healthy adults. Med Eng Phys. 2018 Oct;60:94–102. doi: 10.1016/j.medengphy.2018.07.015.
    1. Weirich S, Hecht M, Böhme K. Modeling item position effects using generalized linear mixed models. Appl Psychol Meas. 2014 May 30;38(7):535–48. doi: 10.1177/0146621614534955.
    1. Boudiaf N, Laboissière R, Cousin ?, Fournet N, Krainik A, Baciu M. Behavioral evidence for a differential modulation of semantic processing and lexical production by aging: a full linear mixed-effects modeling approach. Neuropsychol Dev Cogn. 2016 Nov 24;25(1):1–22. doi: 10.1080/13825585.2016.1257100.
    1. Bengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus Open. 2016;2:8–14. doi: 10.1016/j.npls.2016.01.001.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever