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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.
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
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| AFFIRM | Experimental | AFFIRM is an 8-session psychoeducational weekly group intervention |
|
| Waitlisted control | No Intervention | Waitlisted control |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| AFFIRM | Behavioral | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Feasibility - participant attendance at group sessions | Proportions of participants that enroll, commence, and complete the intervention. | week 56 |
| Acceptability - participant satisfaction with group sessions | Participants will complete a satisfaction questionnaire. | week 56 |
| Measure | Description | Time Frame |
|---|---|---|
| Intervention fidelity - how closely facilitators adhere to intervention model | 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 | Study period sessions 1-8 (weeks 1-8) |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Sexual Health Capacity Scale | Four items. Scores range from 4 to 16. Higher scores mean better outcomes. | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Abstinence Self-Efficacy Scale |
Inclusion Criteria:
Exclusion Criteria:
Participants must self-identify as a sexual minority and/or as a gender minority
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| Name | Affiliation | Role |
|---|---|---|
| Shelley L Craig, PhD | Professor | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| COMPASS Health | Hamilton | Ontario | L8L4N5 | Canada | ||
| Hamilton Family Health Team |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31172957 | Background | Craig SL, McInroy LB, Eaton AD, Iacono G, Leung VW, Austin A, Dobinson C. 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. JMIR Res Protoc. 2019 Jun 6;8(6):e13462. doi: 10.2196/13462. | |
| 40922004 | Derived |
| Label | URL |
|---|---|
| Project Website | View source |
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No individual participant data will be available to other researchers.
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Participants are allocated in a 2:1 fashion to arm 1: AFFIRM intervention; or arm 2: waitlisted control.
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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
|
Five items. Scores range from 5 to 20. Higher scores mean better outcomes. |
| Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Protection Self-Efficacy Scale | Eight items. Scores range from 8 to 32. Higher scores mean better outcomes | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Change in DSM 5a Self-Rated Level 1 Cross-Cutting Symptom Measure - Child | Twenty items. Scores range from 0 to 80. Lower scores mean better outcomes. | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Change in Current Mood Scale | Six items. Scores range from 0 to 60. Lower scores mean better outcomes. | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Change in Beck Depression Inventory-II | Twenty items. Scores range from 0 to 80. Lower scores mean better outcomes. | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Change in Brief COPE Scale | 28 items. Scores range from 28 to 112. Higher scores mean better outcomes. | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Change in Proactive Coping Inventory for Adolescents-A - Reflective Coping Subscale | 11 items. Scores range from 0 to 33. Higher scores mean better outcomes. | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Change in Stress Appraisal Measure for Adolescents | 13 items. Scores range from 13 to 65. Higher scores mean better outcomes. | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Change in Adult Hope Scale | 12 items. Scores range from 12 to 96. Higher scores mean better outcomes. | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Change in Internalized Homophobia Scale | 10 items. Score range from 10 to 100. Lower scores mean better outcomes. | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Change in Everyday Discrimination Scale | 7 items. Scores range from 7 to 42. Higher scores mean better outcomes. | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Change in LGBTQ Microaggressions Scale | 15 items. Scores from 0 to 75. Lower scores mean better outcomes. | Baseline visit (week -1), postintervention visit (week 8), 6-month follow-up (week 32), 1-year follow-up (week 56) |
| Hamilton |
| Ontario |
| L8R2K8 |
| Canada |
| Reach Out Centre for Kids - Positive Space Network | Oakville | Ontario | L6H3K4 | Canada |
| The 519 Church Street Community Centre | Toronto | Ontario | M4Y2C9 | Canada |
| Sherbourne Health Centre | Toronto | Ontario | M5A2S5 | Canada |
| Asian Community AIDS Services (ACAS) | Toronto | Ontario | M5T2E3 | Canada |
| Centre for Addiction and Mental Health (CAMH) | Toronto | Ontario | M6J1H4 | Canada |
| Craig SL, Leung VWY, Hui JA, Iacono G, Pascoe RV, Dillon F, Austin A, Pang N, Dobinson C, Brooks AS. LGBTQ + Affirmative CBT: a hierarchical linear model of longitudinal outcomes and mechanisms of change. BMC Psychol. 2025 Sep 8;13(1):1006. doi: 10.1186/s40359-025-03314-7. |
| ID | Term |
|---|---|
| D000163 | Acquired Immunodeficiency Syndrome |
| D057545 | Social Stigma |
| D003075 | Coitus |
| ID | Term |
|---|---|
| D015658 | HIV Infections |
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D007239 | Infections |
| D015229 | Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D016180 | Lentivirus Infections |
| D012192 | Retroviridae Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D012897 | Slow Virus Diseases |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D007153 | Immunologic Deficiency Syndromes |
| D007154 | Immune System Diseases |
| D012919 | Social Behavior |
| D001519 | Behavior |
| D012725 | Sexual Behavior |
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