A community-based mixed methods approach to developing behavioural health interventions among indigenous adolescent populations

Native American and indigenous populations experience the greatest behavioural health disparities in the world. A constellation of factors impacting Native American Tribes contributes to high rates and co-morbidity of mental health disorders, substance use and sexually transmitted infection (STI), and considerable barriers to prevention and treatment. In Native communities, adolescents are the subgroup most affected by these behavioural health disparities. Suicide is sometimes an outcome of complex mental health problems and Native adolescents have the highest suicide rate in the U.S. Native Americans are diagnosed with STIs at four times the rate of Whites, have twice the rate of teen pregnancies, and are the only U.S. racial group in which HIV rates are increasing. Furthermore, substance use is a significant risk factor for suicide and HIV/STI transmission, and Native adolescents have the highest substance use and related morbidity and mortality in the U.S. This thesis presents a series of formative, pilot and efficacy studies that have demonstrated significant reductions in behavioural health risk for suicide, substance use, STIs, and HIV/AIDS among Native adolescents. A model of community-based research is presented in three distinct stages: 1) characterization of behavioural health disparities as described by community members, 2) exploration of community-specific risk, protective, and contextual factors, and 3) development, adaptation, and evaluation of interventions that reflect this unique profile. Rooted in a participatory process developed with a Native American Tribe, this research approach has relevance for other indigenous populations facing similar challenges and may serve as a platform for uptake and dissemination.