Moving to another phase in the development of an app that will help Native American adolescents navigate topics such as intimate relationships and reproductive health, a group of teenage girls from the Fort Peck Reservation in Montana and the White Mountain Apache Tribe in Arizona came to Johns Hopkins recently for a four-day workshop to share ideas and create content.
Over the course of the workshop, the girls wrote and recorded scripts for videos about menstruation, pregnancy and birth control; came up with questions for a chat bot; created journaling prompts; and developed quizzes on reproductive health and relationships.
“[The girls] have done a couple activities as a large group to help them conceptualize what the app could look like–creating concept maps of the app,” said Kevalin Aulandez, a student at the Johns Hopkins Bloomberg School of Public Health who is working on the project. “They also did a strengths, weaknesses, and threats analysis for dissemination of the app in their communities.”
Dr. Allison Barlow, director of the Johns Hopkins Center for American Indian Health (CAIH), is co-leading the Safe Passage project with Dr. Teresa Brockie from the School of Nursing, who is from the White Clay Nation in Montana; Francene Larzelere and Novalene Goklish from the White Mountain Apache Tribe; Dr. Tak Igusa from the Whiting School of Engineering; and Anne Kenney, the project coordinator from CAIH. The project is funded by the Johns Hopkins Alliance for a Healthier World.
The team drew ideas for content from a similar app called Crush, which is geared toward African American and Latinx communities. Originally, they planned to purchase the rights to the app and adapt it to Native American communities, but ultimately decided to create a whole new app from the ground up.
“We liked the pace of Crush; it felt very youthful, and we showed it to the girls when we visited with them in their communities,” Barlow said. “But we also thought it really wouldn’t feel like it was their own, and of course we really wanted to include cultural components.”
Barlow also hopes that other tribes will eventually develop their own versions of the app.
“From a health equity perspective, we wanted to make sure the tribes would own these apps and continue to develop them,” she said. “I think by the time we get to the end of this project, we’ll know what aspects of the app have to be specified for each tribe.”
Based on the girls’ feedback during the workshop, the team identified topics to add to the app that they wouldn’t have otherwise considered, such as mental health and the college application process. Igusa explained that the process is designed to be iterative, so that new ideas can be added to the app as they come up.
He also noted that because the team was incorporating feedback from two different tribes, they could determine which features should be built into the basic architecture of the app and which should be personalized for each tribe.
“We started thinking about the differences between the two tribes and what are the common features,” he said. “There are a lot of common features, and we put those into the architecture of the app. But then there are differences in the tribes, and we can make sure the two versions of the app are tailored toward these differences without having to redesign the app.”
During one of the sessions, the girls broke out into small groups to develop quizzes. They first looked through an example quiz from the Crush app, then brainstormed how to adapt the questions for Safe Passage. Each group was assigned a quiz on a different topic, such as healthy relationships or birth control. The girls discussed their own experiences and filled out a worksheet to help them come up with questions.
Although Isabella Rudolfo, 16, found it difficult to come up with suitable quiz questions, she was glad to have the opportunity to be part of the workshop, and thinks Safe Passage will be a useful tool for her community.
“I think it’s cool that they’re doing this for Native Americans,” she said. “I’d totally use it. I’ll probably make my friends use it, too.”
Barlow, Aulandez and Igusa said they were impressed with the girls’ enthusiasm for the app and with the amount of work that they accomplished over the course of the week.
“We had some worries—like would this work, could we really pull this off—and it’s been amazing,” Barlow said. “I think it’s exceeded all our expectations.”
Igusa agreed that the group ended up generating far more content than he expected.
“For the first half hour, they were trying to figure out what they were going to be doing here and what is it they want from us,” he said. “But after the first half hour they basically figured it out, and they’ve been extremely productive. It’s really amazing what they were able to do.”
Barlow was also surprised by how willing the girls were to talk about difficult, personal topics like reproductive health.
“Over the last few days we’ve seen them talk more and more, and when they get in their small groups they’re really very comfortable sharing. Wednesday morning especially we were talking about a lot of hard topics, and they were sharing a lot and I was just so impressed,” she said.
The next step for developing Safe Passage, Aulandez said, is compiling all the drawings, recordings, and other materials generated from the workshop, then coordinating with the engineering team to incorporate it all into the app. The team may also hire professionals to work on other aspects of the app, such as illustrations.
Igusa stressed the importance of continuing to work on and add new features to the app to ensure that it remains relevant.
“If you develop the app a certain level and then just stop working on it, it becomes stale. It’s just part of the youth culture – they want to see something new,” he said. “That’s part of the architecture of the app – it’s easy to add new features.”
The tribal leaders who chaperoned the trip are also incredibly proud of everything the girls have accomplished. Edna Wetsit, a chaperone from Fort Peck, said that adolescent girls currently don’t receive any kind of education on reproductive health and healthy relationships on the reservation.
“I hope the app is going to be a success,” she said. “The girls are going to be so proud when they see that app out there and they can say ‘I did that, I helped with that.’”
Article by AHW Global Health Scholar Alyssa Wooden. Alyssa is majoring in Public Health Studies and minoring in Environmental Studies. Since 2017 she has served as the editor for the Johns Hopkins News-Letter and has worked with a local organization to prepare policy briefs for environmental impacts on child health.