A Parenting Intervention for HIV+ Moms: The IMAGE program

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DESCRIPTION (provided by applicant): The incidence of HIV is high among women of childbearing age in the U.S., and mothers living with HIV (MLH) report their greatest source of stress is combining the maternal role with the psychological and medical demands of coping with a chronic, life-threatening condition. The purpose of this R01 pilot study is to develop and then test the feasibility of implementing a parenting intervention for HIV-infected mothers with well children age 6 - 14 years old. The intervention is designed to improve parenting skills and maternal self-care skills in order to improve child and maternal outcomes. The basis for development of this intervention is work from two previous R01s (MH # 5R01MH057207, currently Yr. 12) designed to longitudinally assess HIV-positive mothers and their children. MLH (n = 60) and their children (total N = 120) will be recruited, randomized to a theory- based, skills training intervention or a control condition, and assessed at baseline and 3, 6, and 12-month follow-ups. The intervention ("Improving Mothers' parenting Abilities, Growth, & Effectiveness"-the IMAGE program) will consist of 5 sessions, and will be based on the Information - Motivation - Behavioral Skills (IMB) model of health behavior change, with specific skills selected based on our 10-year observational study of MLH and their children, which is on-going at UCLA. A random subset of 40% of the intervention mothers (n = 12) will be asked to participate in an in-depth qualitative interview after their last follow-up, to obtain detailed process information on their experiences in the intervention. The main aims of this randomized pilot trial are to: 1. develop the intervention and then evaluate the feasibility and acceptability of implementing the 5-week, theory based, individual behavior intervention to enhance positive parenting skills of MLH; and 2. conduct preliminary evaluation of the data for effect sizes and investigate trends in the data for: a. parenting practices outcomes (utilizing the parent practices scale), and secondary outcomes of parenting efficacy; b. parenting behaviors targeted (parent-child communication, parental monitoring, family routines, and appropriate parentification), and the self-care skills targeted (social support, disclosure, dealing with perceived stigma); c. maternal outcomes for mental health indicators and physical health indicators; d. child outcomes of mental health indicators, behavioral problems, and self-concept and coping; and e. family outcomes (family functioning, parent-child relationship). We are now in the third decade of the HIV epidemic, and few interventions, other than for prevention or medication adherence, are available for women living with HIV; this study will be the first step in the evaluation an intervention that will assist HIV-positive mothers in dealing with the stress of parenting while coping with HIV. The pilot data will lead to a future application for a full-scale trial of the intervention to test efficacy. PUBLIC HEALTH RELEVANCE: The purpose of this R01 is to conduct a pilot test of a parenting intervention for HIV-infected mothers with children age 6 - 14 years of age. We are now in the third decade of the HIV epidemic, and few interventions, other than for prevention or medication adherence, are available for women living with HIV; this study will pilot an intervention that will assist HIV-positive mothers in dealing with the stress of parenting while coping with HIV. The study will allow us to study mothers and children after the MLH obtain skills in the intervention to determine whether skill use increases over time and with practice, and provide information necessary for subsequent conduct of a full scale trial of the intervention.