Background:
In 2005, CDC launched a National HPV Awareness/Education effort for the public (Caucasian, African American, Latino adults). It is now being expanded to include special populations.

Objective:
To adapt and test culturally appropriate HPV materials for sexually active American Indian and Alaska Native (AI/AN) audiences in rural and urban settings.

Method:
In 2006, CDC's Division of STD Prevention used a snowball technique to solicit feedback from AI/AN organizations on the appropriateness of its HPV materials. Materials were revised based on feedback received from ~12 individuals/organizations; four organizations agreed to partner with CDC for materials testing. A total of 109 men and women participated in same-sex focus groups from February-April 2007 in Portland and Warm Springs Indian Reservation, OR; Minneapolis, MN; Albuquerque NM; Anchorage, AK; and Rapid City, SD.

Result:
Materials were adapted to be simpler and more action oriented, positive, family focused, and specific to AI/AN audiences. Focus groups revealed that most participants were aware of HPV, with at least superficial knowledge. Most felt the materials were useful/appropriate, and understood the key take-home messages. Confusion arose regarding HPV testing, transmission, and the differential health consequences/prevention options for men and women. Men wanted more male-specific information. Some thought materials should be separate for men and women since sexual health is not generally discussed between the sexes. Participants wanted more Native imagery/art, vibrant colors, and “everyday people” who looked like them, yet they did not want to feel singled out.

Conclusion:
HPV education materials should be developed separately for men and women, and be specific to Native audiences in content and design.

Implications:
Given the sensitive nature of HPV and the complexity of government-tribal relations, local AI/AN partnerships are critical to enable effective development and dissemination of HPV education in Native communities. Findings should guide future HPV education efforts.