Digital Prototyping of a Family-Based Intervention to Prevent Substance Misuse and Promote Mental Health among Adolescents on and near the Cherokee Nation Reservation

Rural and American Indian adolescents experience disproportionate burdens of suicide, drug overdose, and substance misuse, underpinned by historical and structural inequities. At the same time, Tribal Nations like Cherokee Nation have demonstrated substantial leadership and investment in prevention initiatives for youth and families. Connect Kits for Family Action (CKFA) is a culturally informed, family-based prevention program that was developed and tested as part of a multilevel cluster randomized trial conducted on and near the Cherokee Nation Reservation. CKFA demonstrated preventive effects on adolescent substance use, including significant reductions in alcohol, cannabis, and prescription opioid misuse; effects on anxiety and depressive symptoms also trended favorably. However, CKFA is delivered using printed materials, which constrains scalability, flexibility, and opportunities for broader dissemination.

The goal of this pilot project is to develop and conduct preliminary usability testing of a digital prototype of one CKFA module as a foundational step toward future large-scale digital implementation. Using user-centered design and mixed methods, the study will preserve CKFA’s core components while adapting the program for digital delivery. Participants will include emerging adults who previously received CKFA during the original trial, high school-aged youth, and caregivers, recruited in partnership with Cherokee Nation Behavioral Health. In Aim 1, we will identify user needs, preferences, and contextual factors relevant to digitizing CKFA through interviews and surveys with emerging adults and caregivers. In Aim 2, we will co-design a prototype module with youth advisors, Cherokee Nation collaborators, and digital designers. In Aim 3, we will assess the prototype’s usability, acceptability, and cultural relevance through individual usability testing sessions with youth and caregivers. This formative research will produce a digital prevention prototype designed to enhance accessibility and scalability of family-based prevention for rural and Tribal communities. Findings will guide preparation for a hybrid effectiveness-implementation trial to support wider dissemination of CKFA.