Date of Award


Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Debbie Humphries

Second Advisor

Lucian (Luke) Davis


Introduction: In December 2018 the Navajo County Public Health Services District established a countywide working group to address rising rates of sexually transmitted infections (STIs). Methods: The activities, outputs, and outcomes of the workgroup were retrospectively analyzed using a multimethod approach based upon an implementation science framework. Syphilis, chlamydia, and gonorrhea cases reported between 2013 and 2020 (N = 2044) were analyzed as pre-post periods by sex and syphilis-specific indicators. Correlates were identified using bivariate and multivariable logistic regression. Interviews conducted with prior workgroup members (N = 4) examined perceptions toward workgroup operation via thematic analysis. Results: Men more consistently experienced greater odds of infection in the post-implementation period, especially concerning syphilis-specific infection (OR = 1.91) and STIs among men aged 30-44 years old (OR = 2.63, 2.84, and 4.06). Qualitative findings relay an unanimously favorable view on workgroup operation. Areas of improvement include stronger community inclusion and county-tribal coordination. Discussion: This study gathered new information on the prior program’s operation and on potential study designs and analytical tools for future studies. Conclusion: As the pandemic eases, there is an opportunity for improved STI programming by incorporating lessons taken from past programs. The Navajo County STI Workgroup helped to improve collaboration among the public health workforce and began to strengthen awareness among the medical and at-risk community. These areas warrant further study for directing program evaluation and implementation efforts towards STI burden.


This thesis is restricted to Yale network users only.