Coping Skills, Hiv, Mental Health Issue, Stigma, Social
Conditions
Keywords
Sexual and gender minority youth, Cognitive behavioral therapy
Brief summary
AFFIRM is an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviours and psychosocial distress among SGMY. AFFIRM is delivered by two facilitators (primarily social workers and peers) through a combination of education and rehearsal (i.e., simulation of real-life experiences) in a manner that affirms participants' sexual and gender minority identities and experiences. AFFIRM is being tested in a five-year trial using a stepped wedge waitlist crossover design, where all participants receive the intervention in clusters.
Detailed description
Session 1 focus Introduction to cognitive behavioral therapy (CBT), exploring lesbian, gay, bisexual, transgender, and queer (LGBTQ)+ identities, and understanding minority stress. Session 1 activities Introductions Discussing the theory and purpose of CBT approaches Exploring stress and minority stress Understanding the causes of stress in our lives Session 2 focus Understanding the impact of anti-LGBTQ attitudes and behaviors on stress. Session 2 activities Check in and review Examining homophobia, heterosexism, and transphobia at the individual, institutional, and cultural level Identifying how these experiences impact thoughts, feelings, and behaviors Fostering strategies for both coping with and combating anti-LGBTQ discrimination at all levels Session 3 focus Understanding how thoughts impact feelings. Session 3 activities Check in and review Distinguishing between thoughts and feelings Exploring how thoughts influence feelings and behaviors Identifying counterproductive thinking patterns Recognizing negative self-talk and feelings of hopelessness Learning thought stopping Session 4 focus Using thoughts to change feelings. Session 4 activities Check in and review Increasing positive thinking and feelings of hope Changing negative thoughts to positive thoughts Challenging negative thinking and internalized homophobia/negative feelings through the ABCD (activating event, belief, consequence, and debate) method Session 5 focus Exploring how activities impact feelings. Session 5 activities Check in and review Examining the impact of various activities on feelings Identifying supportive and identity-affirming activities The impact of LGBTQ-affirming activities on feelings Session 6 focus Planning to overcome counterproductive thoughts and negative feelings. Session 6 activities Check in and review Distinguishing between clear and unclear goals Identifying short, mid-, and long-term goals Creating a sexual health plan Fostering hope for the future Session 7 focus Understanding the impact of minority stress and anti-LGBTQ attitudes or behaviors on social relationships. Session 7 activities Check in and review Anti-LGBTQ discrimination can lead to feelings of discomfort around others Responding to discrimination or harassment in social situations Learning to be assertive Session 8 focus Putting it all together: developing safe, supportive, and identity-affirming social networks. Session 8 activities Check in and review Maintaining a healthy social network: attending to thoughts, expectations, feelings, and behaviors within relationships Identifying a plan for building a supportive network
Interventions
BEHAVIORALAFFIRM
AFFIRM is an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviours and psychosocial distress among SGMY. AFFIRM is delivered by two facilitators (primarily social workers and peers) through a combination of education and rehearsal (i.e., simulation of real-life experiences) in a manner that affirms participants' sexual and gender minority identities and experiences.
Sponsors
University of Toronto
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Masking description
Participants are not blinded as they know which arm they are allocated too. Care providers and outcome assessors are blinded as the investigator runs the allocation sequence and outcomes are administered via survey weblink
Intervention model description
Participants are allocated in a 2:1 fashion to arm 1: AFFIRM intervention; or arm 2: waitlisted control.
Eligibility
Sex/Gender
ALL
Age
14 Years to 29 Years
Healthy volunteers
No
Inclusion criteria
* Aged 14 to 29 years at time of screening * Identifies as a sexual and/or gender minority * Reads, writes, and speaks fluent English * Is interested in participating in the 8-session AFFIRM intervention
Exclusion criteria
* Assessed to be in crisis (i.e., high risk of suicidality) * Warrenting a more intensive intervention
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility - participant attendance at group sessions | week 56 | Proportions of participants that enroll, commence, and complete the intervention. |
| Acceptability - participant satisfaction with group sessions | week 56 | Participants will complete a satisfaction questionnaire. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intervention fidelity - how closely facilitators adhere to intervention model | Study period sessions 1-8 (weeks 1-8) | Independent coders will complete a checklist questionnaire of AFFIRM intervention items, based on the manual, to determine how closely intervention facilitators adhered to the model |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in DSM 5a Self-Rated Level 1 Cross-Cutting Symptom Measure - Child | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | Twenty items. Scores range from 0 to 80. Lower scores mean better outcomes. |
| Change in Current Mood Scale | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | Six items. Scores range from 0 to 60. Lower scores mean better outcomes. |
| Change in Beck Depression Inventory-II | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | Twenty items. Scores range from 0 to 80. Lower scores mean better outcomes. |
| Change in Brief COPE Scale | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | 28 items. Scores range from 28 to 112. Higher scores mean better outcomes. |
| Change in Proactive Coping Inventory for Adolescents-A - Reflective Coping Subscale | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | 11 items. Scores range from 0 to 33. Higher scores mean better outcomes. |
| Change in Sexual Health Capacity Scale | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | Four items. Scores range from 4 to 16. Higher scores mean better outcomes. |
| Change in Adult Hope Scale | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | 12 items. Scores range from 12 to 96. Higher scores mean better outcomes. |
| Change in Internalized Homophobia Scale | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | 10 items. Score range from 10 to 100. Lower scores mean better outcomes. |
| Change in Everyday Discrimination Scale | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | 7 items. Scores range from 7 to 42. Higher scores mean better outcomes. |
| Change in LGBTQ Microaggressions Scale | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | 15 items. Scores from 0 to 75. Lower scores mean better outcomes. |
| Change in Stress Appraisal Measure for Adolescents | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | 13 items. Scores range from 13 to 65. Higher scores mean better outcomes. |
| Abstinence Self-Efficacy Scale | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | Five items. Scores range from 5 to 20. Higher scores mean better outcomes. |
| Protection Self-Efficacy Scale | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) | Eight items. Scores range from 8 to 32. Higher scores mean better outcomes |
Countries
Canada
Outcome results
None listed