Asynchronous Focus Groups Research Articles

Listen up! perspectives of people of color who use augmentative and alternative communication in the United States

Every individual has a fundamental right to communicate and access equal opportunities to fully participate in society. However, this right may not be fully manifested for individuals with communication access needs especially those from underrepresented groups. This project had two aims, to determine 1) the specific experiences, challenges, and aspirations related to the cultural identities of people of color (POC) who use augmentative and alternative communication (AAC) and 2) how AAC service providers and manufacturers can support POC AAC users in a culturally and linguistically responsive manner. We conducted an online, asynchronous focus group with seven participants over eight weeks. The participants’ responses were coded qualitatively. Seven major themes were identified: AAC is a Culture, AAC System Features, Self-Identity as a Person of Color who uses AAC, Experience with Service Providers, Improvements to the Field of AAC, Racial Inequities in AAC Support, and Future Research. Suggestions are provided regarding how service providers and manufacturers can serve as better allies to support POC who use AAC.

Engaging in emotional and cultural work: Migrant mothers’ experiences of school-based sexuality education

Objective: By looking at the school-based sexuality education experiences of migrant mothers in Tiohtià:ke-Montréal (Canada), this article aims to shed light on the diverse and often invisible ways in which parents become involved in their child’s sexuality education. Method: Qualitative virtual asynchronous focus groups. Results: The findings shed light on the different ways in which migrant mothers become engaged in their children’s sexuality education. The results showed that participants engaged with cultural perspectives by discussing sexuality education topics with their child, thereby mitigating the power imbalance between themselves and the school by building on the parent–child relationship. Mothers also made their voices heard by actively becoming involved in change. Conclusion: Aligned with the principles of culturally responsive education and school–family partnership, the analysis and discussion raise awareness about the limitations of existing school-based sexuality education curricula, particularly when it comes to recognising and empowering parents as primary educators. Moving forward, the research urges educational institutions and actors to learn from the challenges faced by migrant parents and the strategies they employ. This learning can then be used to inform the development of school-based sexuality education curricula and policies so as to ensure that they are more responsive to the needs of migrant students and families.

"It Has Improved My Practice to Be Able to Offer Alternative Treatments": A Longitudinal Qualitative Study of Oregon Medicaid Back Pain Providers.

Introduction: This study aimed to understand health care providers' experiences implementing the Oregon Back Pain Policy (OBPP) over time. The Medicaid OBPP expanded coverage of evidence-based nonpharmacological therapy (NPT) for back pain and restricted access to opioid therapy and interventional approaches. Methods: The study included six online, asynchronous focus groups with providers in February 2020 (Time 1) and August 2022 (Time 2). Analysis was conducted with a longitudinal, recurrent cross-sectional approach. Analysis occurred in three stages: (1) An immersion/crystallization approach was used to analyze Time 1 focus group data, (2) reflexive thematic analysis was used to analyze Time 2 data, and (3) longitudinal analysis was used to integrate the findings across time points. Results: At Time 1, 48 clinicians and 44 NPT providers participated in the study. Time 2 included 63 clinicians and 59 NPT providers. The longitudinal analysis of the focus group data resulted in four themes: (1) general awareness of the policy, (2) providers support the policy and perceive a benefit to their patients, (3) barriers to NPT accessibility, and (4) barriers to referring patients to NPT. Conclusion: The goal of the OBPP was to improve back pain care for Oregon Medicaid members by increasing access to evidence-based NPT and decreasing reliance on opioid medications. This study revealed that, although clinicians and NPT providers supported the policy, they faced persistent implementation challenges related to referrals, prior authorizations, coverage limitations, low reimbursement rates, and a reduced workforce for NPT providers. In some cases, implementation barriers were removed during the COVID-19 pandemic, but other challenges were more prominent during the pandemic.

Community-generated solutions to cancer inequity: recommendations from transgender, non-binary and intersex people on improving cancer screening and care

ObjectiveTransgender, non-binary and intersex people are less likely to receive appropriate cancer screening for their bodies and have a higher incidence of certain cancers than cisgender people. We aimed to...

Experiences of nurses returning to work after the second/third childbirth and organizational support in Southeastern China: A qualitative exploration

Background: Since China encounters challenges of the aging population, especially a decrease in the working-age population, the Chinese government officially ended the one-child policy and has implemented the second/third child policies. This study aimed to explore nurses’ experiences, the supports they received from hospitals, and the supports they expected when returning to work after the second/third childbirth.Methods: Asynchronous focus groups and one-on-one in-person interviews were held with nurses from three hospitals in Wenzhou city who had returned to work within three months following their second/third childbirth. Data collection and analysis were conducted using Maslow’s Hierarchy of Needs as a guiding framework.Results: Twenty-three nurses were included in this study. Themes emerged around five needs, including physiological, safety, love and belonging, esteem, and self-actualization. Regarding these needs, nurses expressed receiving some support, including support from managers and colleagues and flexible scheduling assignments. However, there was also a lack of other supports, including dedicated time and space for breastfeeding, parental leave, nearby and affordable childcare, unit assignment and working schedules considering individual circumstances, mental health support, and opportunities for professional development.Conclusions: Our findings highlight the necessity to dedicate resources to support the diverse needs of returning nurse mothers such that they can balance family life and work. While longer-duration studies with larger sample sizes in other regions of China are needed, our findings also suggest future studies on exploring third childbirth experiences, evaluating supportive interventions, and creating a specific theoretical model on the comprehensive needs of nurses returning to work after childbirth.

Experiences of progestin-only pill users in the United States and attitudes toward over-the-counter access.

Removing the prescription requirement and making oral contraceptive pills available over the counter (OTC) could increase contraceptive access in the United States. Despite current efforts to make a progestin-only pill (POP) available OTC, there are no qualitative data exploring the experiences of POP users and their perspectives on making POPs available OTC. We conducted six online, asynchronous focus group discussions with 36 POP users between July and November 2020. We stratified focus group discussion placement based on three reasons for POP use: breastfeeding, having a contraindication to estrogen (for a reason other than breastfeeding), and for any other reason. We thematically analyzed these data using inductive and deductive coding. The majority of participants described their overall POP experience as positive, mostly because they experienced minor or no side effects and thought the pill was effective. Participants overwhelmingly supported OTC availability of POPs and expressed interest in purchasing an OTC POP. Over one-third of participants had very limited knowledge or held inaccurate assumptions about POPs before they started using this method and many stressed the need to disseminate accurate information and resources about POPs to the public. Most focus group discussion participants were satisfied with POPs and supported OTC access. While misconceptions and concerns about POPs should be addressed, an OTC POP has the potential to be a safe, effective, and convenient contraceptive option in the United States.

Implementing Blended Care to Discontinue Benzodiazepine Receptor Agonist Use for Insomnia: Process Evaluation of a Pragmatic Cluster Randomized Controlled Trial.

Long-term use of benzodiazepine receptor agonists (BZRAs) remains common despite European guidelines advising that these drugs be used in the lowest possible dose and for the shortest possible duration. Half of all BZRAs are prescribed in family practice. This creates a window of opportunity for discontinuation in primary care. Therefore, the effectiveness of blended care for the discontinuation of long-term BZRA use in adult primary care patients with chronic insomnia disorder was tested in a multicenter, pragmatic, and cluster randomized controlled superiority trial in Belgium. In the literature, information on implementing blended care in a primary care setting is scarce. The study aimed to contribute to a framework for the successful implementation of blended care in a primary care setting by increasing our understanding of this complex intervention through an evaluation of e-tool use and views and ideas of participants in a BZRA discontinuation trial. Based on a theoretical framework, this study evaluated the processes of recruitment, delivery, and response using 4 components: a survey on recruitment (n=76), semistructured in-depth interviews with patients (n=18), web-based asynchronous focus groups with general practitioners (GPs; n=19), and usage data of the web-based tool. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. For recruitment, the most common barriers were refusal by the patient and the lack of digital literacy, while facilitators were starting the conversation and the curiosity of patients. The delivery of the intervention to the patients was diverse, ranging from GPs who never informed the patient about their access to the e-tool to GPs consulting the e-tool in between consultations to have discussion points when the patient visited. Concerning response, patients' and GPs' narratives also showed much variety. For some GPs, daily practice changed because they received more positive reactions than expected and felt empowered to talk more often about BZRA discontinuation. Conversely, some GPs reported no changes in practice or among patients. In general, patients found follow-up by an expert to be the most important component in blended care, whereas GPs deemed the intrinsic motivation of patients to be the key element of success. An important barrier to implementation by the GP was time. Overall, the participants who had used the e-tool were positive about its structure and content. Nevertheless, many patients desired a more tailored application with feedback from an expert and personal tapering schedules. Strict pragmatic implementation of blended care seems to only reach GPs with an interest in digitalization. Although not superior to usual care, blended care could be a complementary tool that allows tailoring the discontinuation process to the personal style of the GP and the needs of the patient. ClinicalTrials.gov NCT03937180; https://clinicaltrials.gov/ct2/show/NCT03937180.

Parental Perspectives on Life-Altering News in Emergency Settings: A Qualitative Evaluation.

Delivering life-altering news is a difficult task that is frequently the responsibility of emergency physicians. However, the existing frameworks for guiding such interactions fail to address the physician-parent-patient dynamic of pediatric emergency encounters. To date, no study has investigated the parental perspective, limiting the ability to provide evidence-based recommendations. This study describes how parents experience receiving life-altering news about their child in emergency settings. This qualitative study used virtual asynchronous focus groups. Through purposeful sampling of virtual support and advocacy groups, we recruited parents of children diagnosed with either malignancy or type 1 diabetes in an emergency department. Participants were then assigned to private Facebook groups established solely for this study. Questions were posted to these groups over the course of 5 days. At their convenience, participants could post responses, replies, or new questions. Three members of the research team performed thematic analysis and used team consensus to ensure validity. Four focus groups were conducted with a total of 28 participants. Parents described their experiences receiving life-altering news as a process with 4 primary emergent themes: lens through which they view the experience, the ED encounter, the immediate response, and the long-term impact. Each parent entered into the ED encounter with a unique collection of personal experiences, circumstances, and knowledge. These factors shaped the lens through which they perceived the events of the ED encounter. Ultimately, this determined participants' response to the life-altering news, leading to many long-term impacts on the various dynamics within each parent's life. The words used to disclose life-altering news are only a small piece of the experience for parents. Personal lenses changed how encounters were perceived, resulting in variable and long-lasting implications. We recommend the following framework for providers: understand the lens, control encounters, manage responses, and respect long-term impacts.

Trends in Educational Research for Sustainable Development in Postgraduate Education Programs at a University in Peru

The Sustainable Development Goals are part of the formative management in multiple universities that are committed to a better and more sustainable future for all; contributing to this from the postgraduate management in education involves rethinking educational research from lines that ensure that the research work has a real impact on the 2030 agenda. In this regard, the objective of this study was to identify and characterize specific lines of educational research for sustainable development in a private university in Lima, specifically in Postgraduate Education (Doctorate, Master’s and Second Specialty). The methodology deployed a qualitative approach, synchronizing the methods of systematization of experiences and grounded theory. A total of 186 students and 16 teachers participated, and the collection of information used three techniques: (1)—documentary review (5398 titles and other normative documents), (2)—asynchronous focus group (16 experienced teachers), and (3)—interview (202 participants). The results show four specific lines of research: (1)—Quality educational management, (2)—Teaching–learning–assessment, (3)—Educational innovation and ICT, and (4)—Training, research, and psychosocial factors in education. It concludes with a characterization of these lines based on an epistemic foundation that integrates current trends in educational research for sustainable development.

Absence, multiplicity and the boundaries of research? Reflections on online asynchronous focus groups

During the COVID 19 pandemic, Online Asynchronous Focus Groups (OAFG) through WhatsApp were conducted to explore women’s experiences in the context of Congenital Syphilis prevention in Colombia. This paper discusses issues raised by the OAFGs (not least in relation to face-to-face focus groups). After a review of the literature on online and offline focus groups, there is a consideration of some key features of our OAFGs. In particular, we note how silence, presence, attention, continuity and multiplicity manifested in our OAFGs. We suggest that rather than regarding OAFGs as inferior to the ‘gold standard’ of face-to-face focus groups, our OAFGs raise important questions about our assumptions about focus group methodology. For instance, what counts as participant engagement, what comprises ‘useful’ social data, and what constitute the boundaries of a focus group all emerge as critical issues. We go on to reflect on some of the implications of these issues for the fruitfulness of OAFG methods.

Factors that influence the acceptance of future shared automated vehicles – A focus group study with United Kingdom drivers

The development of Shared Automated Vehicles (SAVs) is well underway to provide mobility as a service (MaaS) and bring benefits such as reduced traffic congestion, reduced reliance on privately owned vehicles and increased independence to non-drivers. To realise the benefits of SAVs, adoption by private vehicle users is crucial. Previous research has shown this subset of users as the least likely to adopt SAVs, and it is not well understood what factors are important to achieve such adoption. The purpose of this study is to obtain an in-depth understanding of attitudes, perceptions and preferences that influence the acceptance of future SAVs for drivers. This paper presents the results from an online asynchronous focus group study with 21 British drivers as participants. From the analysis, Service Quality, Trust and Price Value emerged as the three most prominent factors to understand user acceptance of SAVs. These three main factors may be of prime importance for convincing naïve private car owners to accept high-speed SAVs. Productive use of travel time has been frequently mentioned in previous research as a benefit of vehicle automation but was scarcely mentioned by participants in this study. Shared Space Quality in introduced as an indicator for Service Quality, together with Security and Trusting Co-passengers as two indicators of Trust. Based on the findings, this paper concludes with a conceptual SAV technology acceptance model is introduced, with the results added as extended model predictors to the Unified Theory of Acceptance and Use of Technology (UTAUT2).

Design of an mHealth application for winter mobility for mobility device users

Background There is limited evidence on the strategies, resources, and tools shown to improve winter mobility and community participation. Objective This paper describes a multifaceted approach taken to develop an mHealth application that provides information, resources, and strategies to facilitate winter mobility for mobility device users, service providers, community organisations, and researchers. Methods The study was conducted in three phases: (1) A scoping review of peer-reviewed and grey literature was completed to identify literature that reported on tools, strategies, resources, and recommendations used to promote winter mobility; (2) Online asynchronous focus groups were conducted to identify the type of content that mobility device users wanted to include in the web-based application; and (3) A prototype mHealth application was developed based on the findings from the previous phases. Using a rapid prototyping process that included stakeholder review through an online survey, four cycles of application design and development were undertaken. Results The scoping review identified 23 peer-reviewed studies and limited grey literature on winter mobility strategies, resources and recommendations. Twenty-four participants from across Canada engaged in one of five focus groups. Focus group analysis led to the development of the content categories for the mHealth application. The initial prototype application developed was reviewed by; 27 mobility device users, 16 health care providers, and seven consumer organisation representatives identified areas of strength and further refinement in regard to application design. Conclusions The approach used in this study provided a method to develop an application based on the ideas, needs, and interests of a variety of stakeholders. Once fully developed, the application has the potential to fill the gaps related to the lack of a unified collection of winter mobility strategies and resources, and open the dialogue on methods to improve winter participation among mobility device users. IMPLICATIONS FOR REHABILITATION Despite winter conditions being a common challenge among mobility device users, there is an absence of an organised approach towards helping individuals manage their winter mobility needs. As the development and usage of mHealth applications continues to increase, it is valuable to use methods of designing applications based on the ideas, needs, and interests of a variety of stakeholders. Development of a framework for collating information on winter mobility strategies and resources is the first step towards launching an mHealth application.

HPV Vaccination Champions: Evaluating a Technology-Mediated Intervention for Parents.

Human papillomavirus (HPV) vaccination prevents 6 HPV-related cancers in men and women. Yet, rates of HPV vaccination among adolescents in the United States lag behind other developed nations, revealing a significant public health issue. This feasibility study tested a collaborative online learning environment to cultivate HPV vaccination champions. A 3-month training program recruited parents to serve as proponents and social media influencers to identify solutions to overcome barriers to HPV vaccination. A mixed methods study design included a pretest survey, three online asynchronous focus groups, a posttest survey, as well as a longitudinal follow-up survey at 6 months. Participants included 22 parents who self-identified as female (95.4%) and white (90.9%). Overall, there was a statistically significant difference in knowledge of HPV and HPV vaccination between pretest and posttest (p = 0.0042). This technology-mediated intervention increased parents' confidence and motivated them to speak more freely about HPV vaccination in-person and online with others in their social networks. Participants identified prevalent misinformation about HPV vaccination and learned how to effectively craft messages to address concerns related to safety and side effects, gender, understanding of risk, and sexual activity. Objective measures and qualitative open-ended assessment showed high intervention engagement and treatment satisfaction. All participants (100%) indicated that they enjoyed participating in the intervention. The effectiveness of this feasibility study suggests that social media is an appropriate platform to empower parents to counter vaccine hesitancy and misinformation through HPV vaccination information that is simple and shareable in-person and online.

The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group.

BackgroundLoneliness is a growing area of concern, attracting attention as a public health concern due to its association with a variety of psychological and physical health problems. However, interventions targeting loneliness are less common than interventions for other mental health problems, such as depression and anxiety, and existing interventions focus primarily on building social skills and increasing opportunities for social interaction despite research suggesting these techniques are not the most effective. Furthermore, although there is an increasing need for scalable and convenient interventions, digital interventions for loneliness are even less common.ObjectiveUsing a qualitative approach, we explore how adults (18-64 years of age) who express wanting to be more connected to others experience loneliness and react to a digital mental health intervention targeting loneliness.MethodsA total of 11 participants were recruited from a pilot randomized controlled trial exploring the impact of a digital mental health intervention, Happify Health, on loneliness among adults aged 18-64 years who indicated wanting to feel more connected to others when signing up for the platform. Participants were invited to participate in a 3-day asynchronous focus group about their experiences with loneliness, with Happify Health, and with social distancing during the COVID-19 pandemic. All 11 participants completed the focus group in May 2020.ResultsParticipants’ responses were coded using thematic analysis, which led to identifying five themes, each with separate subthemes, that could be applied across the 3-day focus group: loneliness, relationships, social distancing, skill acquisition, and coping. Overall, we observed variability across participants in terms of the source of their loneliness, their perceptions of their social connections, and their motivation to reduce feelings of loneliness; however, participants commonly referred to negative self-perceptions as a cause or consequence of loneliness. Participants also varied in the extent to which they felt social distancing increased or decreased feelings of loneliness. In regard to the intervention, participants showed evidence of adopting skills they used to address their loneliness, particularly mindfulness and gratitude, and then using these skills to shift toward more active coping strategies following the intervention, including during the COVID-19 pandemic.ConclusionsThe heterogeneity in participants’ experiences with loneliness described during this focus group emphasizes the subjective and complex nature of loneliness. This highlights the importance of developing loneliness interventions that use a variety of strategies, including both direct and indirect strategies for reducing loneliness. However, based on our data, a key component to loneliness interventions is incorporating strategies for addressing underlying negative self-perceptions that stem from, but also contribute to, loneliness. This data also provides preliminary evidence that digital platforms may be an effective tool for disseminating loneliness interventions while providing the added benefit of offering a productive distraction when feeling lonely.

Assessing Research Compliance for Federally Funded Projects: The Good, the Bad, and the Publicly Accessible

In 2016, Utah State University launched a program to ensure their campus’ federal grant recipients were in compliance with funder mandates to share any data or publications produced as a result of the award. This article discusses how a cross-institutional team of librarians and administrators evaluated the success of this program using online asynchronous focus groups (OAFG) in conjunction with a traditional survey. The challenges and successes of using OAFGs to assess library services are also examined. An OAFG gave participants greater convenience, flexibility, participation, and time to craft answers, eliminating some of the hurdles to traditional focus group participation.

Transgender Youth Experiences and Perspectives Related to HIV Preventive Services.

In the United States, transgender youth are at especially high risk for HIV infection. Literature regarding HIV prevention strategies for this vulnerable, often-hidden population is scant. Before effective, population-based HIV prevention strategies may be adequately developed, it is necessary to first enhance the contextual understanding of transgender youth HIV risk and experiences with HIV preventive services. Two 3-day, online, asynchronous focus groups were conducted with transgender youth from across the United States to better understand participant HIV risk and experiences with HIV preventive services. Participants were recruited by using online advertisements posted via youth organizations. Qualitative data were analyzed by using content analysis. A total of 30 transgender youth participated. The average age was 18.6 years, and youth reported a wide range of gender identities (eg, 27% were transgender male, 17% were transgender female, and 27% used ≥1 term) and sexual orientations. Four themes emerged: (1) barriers to self-efficacy in sexual decision-making; (2) safety concerns, fear, and other challenges in forming romantic and/or sexual relationships; (3) need for support and education; and (4) desire for affirmative and culturally competent experiences and interactions (eg, home, school, and health care). Youth discussed experiences and perspectives related to their gender identities, sexual health education, and HIV preventive services. Findings should inform intervention development to improve support and/or services, including the following: (1) increasing provider knowledge and skills to provide gender-affirming care, (2) addressing barriers to services (eg, accessibility and affordability as well as stigma and discrimination), and (3) expanding sexual health education to be inclusive of all gender identities, sexual orientations, and definitions of sex and sexual activity.

LGBTQ bullying: a qualitative investigation of student and school health professional perspectives

Researchers and practitioners have recently called for greater involvement of school health professionals (SHPs; e.g., school psychologists, nurses, guidance counselors) in interventions to identify and address bullying of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) students. To inform future interventions, this study explored the perspectives of LGBTQ students and SHPs on LGBTQ bullying and SHPs’ responses to LGBTQ bullying. Five online, asynchronous focus groups were held in 2018 with 28 LGBTQ students and 19 SHPs recruited from Massachusetts, US. Methods were guided by Rapid Qualitative Inquiry. Results revealed a disconnect in perceptions of LGBTQ bullying among LGBTQ students versus SHPs, with LGBTQ students reporting a range of often significant verbal, social, and physical bullying experiences and SHPs reporting minimal awareness of LGBTQ bullying at their schools. Transgender students reported bullying related to their gender identity, including verbal, physical, and sexual harassment, deadnaming (referred to by their birth name), and misgendering (called an incorrect pronoun). LGBTQ students of color reported bullying based on their race/ethnicity and pronounced social isolation. LGBTQ students reported mixed experiences with reporting bullying to SHPs. Intervention efforts are needed to enhance communication between LGBTQ students and SHPs, and to strengthen SHPs’ skills to respond to LGBTQ bullying.

Profoundly Gifted Students’ Perceptions of Virtual Classrooms

The intent of this case study is to understand profoundly gifted students’ perceptions of virtual programs. The participants for this study were five profoundly gifted students who were enrolled in a fully virtual writing course hosted by a school that serves the profoundly gifted population. The researcher gathered data via asynchronous focus groups on an online discussion board, observations of synchronous sessions in their virtual classroom, and individual interviews with the participants. The participants reported a preference for frequent interactions with classmates and the instructor, but expressed concern about the lack of social opportunities. While technical difficulties did occur, these were mostly due to operator error or disuse of available tools. Finally, in terms of curriculum and pedagogy, the participants saw little difference between brick-and-mortar and virtual classrooms, suggesting that for profoundly gifted students, the quality of the content and instruction outweighs the realities of the learning environment. This information can be used either to improve online gifted education, or create new programs, thus diversifying opportunities.

Understanding Faculty Engagement in Assessment through Feedback and Dialogues: A Mixed Methods Approach

<p><span>The literature indicates faculty members' beliefs and attitudes toward assessment are crucial to the successful implementation of assessment. However, few empirical studies have examined the culture of assessment among faculty members. The intent of this single-level mixed methods case study is to identify the factors and examine how these factors influence faculty members' perceptions, attitudes, and their engagement in assessment activities by studying the case of a public teaching intensive university in the Southwest region of the U.S. An online survey and asynchronous focus group interviews are used. The implications for institutional policy making and professional development are discussed, based on the findings.</span></p>

Why Girls Choose Not to Use Barriers to Prevent Sexually Transmitted Infection During Female-to-Female Sex

PurposeUsing data from a national qualitative study of lesbian, bisexual, and other sexual minority adolescent girls in the U.S., this study examined their awareness of the risk of sexually transmitted infection (STI) and opportunities for barrier use. MethodsOnline asynchronous focus groups were conducted with lesbian and bisexual (LB) girls ages 14–18 years. Girls were assigned to online groups based on their self-identified sexual identity and whether they were sexually experienced or not. Two moderators posed questions and facilitated online discussions. Interpretive description analysis conducted by multiple members of the research team was used to categorize the results. ResultsKey factors in girls' decisions not to use barriers with female partners concerned pleasure, sex of sexual partner, lack of knowledge of sexual risk or of barrier use for female-to-female sexual activities, and use of STI testing as a prevention tool. ConclusionsAddressing knowledge and access gaps is an important first step for improving sexual health. Prevention priorities should focus on helping LB girls understand their risk of STI transmission in both opposite and same-sex relationships. Tailoring messaging to move beyond heteronormative scripts is critical to engaging LB girls and equipping them with the skills and knowledge to have safer sex regardless of the sex of their partner.