A Parenting Intervention for HIV+ Moms: The IMAGE program

描述（由申请人提供）：美国育龄妇女中艾滋病毒的发病率很高，感染艾滋病毒的母亲（MLH）报告说，她们最大的压力来源是将母亲的角色与应对慢性、危及生命的疾病的心理和医疗需求结合起来。这项R01试点研究的目的是开发并测试对感染艾滋病毒的母亲实施父母干预的可行性，这些母亲的6 - 14岁的孩子都很健康。干预措施的目的是提高养育技能和产妇自我护理技能，以改善儿童和产妇的结局。开发这一干预措施的基础是先前两项r01 （MH # 5R01MH057207，目前为12年）的工作，旨在对艾滋病毒阳性母亲及其子女进行纵向评估。将招募MLH （n = 60）及其子女（总n = 120），随机分配到基于理论、技能培训干预或对照条件，并在基线和3、6和12个月随访时进行评估。干预（“提高母亲的养育能力、成长和有效性”- IMAGE计划）将包括5个阶段，并将基于信息-动机-行为技能（IMB）健康行为改变模型，并根据我们在加州大学洛杉矶分校进行的对MLH及其子女的10年观察研究选择具体技能。在最后一次随访后，将随机抽取40%的干预母亲（n = 12）参加一次深入的定性访谈，以获得有关其干预经历的详细过程信息。这个随机试验的主要目的是：1。制定干预措施，并评估实施5周、以理论为基础的个体行为干预以提高MLH积极育儿技能的可行性和可接受性；和2。对效应量数据进行初步评估，并调查以下数据的趋势：a.养育实践结果（利用父母实践量表）和养育效能的次要结果；B.有针对性的养育行为（亲子沟通、父母监督、家庭惯例和适当的养育），有针对性的自我照顾技能（社会支持、披露、处理感知到的耻辱）；C.孕产妇心理健康指标和身体健康指标的结果；D.儿童心理健康指标、行为问题、自我概念和应对的结果；e.家庭结果（家庭功能，亲子关系）。我们现在处于艾滋病毒流行的第三个十年，除了预防或坚持服药之外，感染艾滋病毒的妇女几乎没有什么干预措施；这项研究将是评估干预的第一步，该干预将帮助艾滋病毒阳性的母亲在应对艾滋病毒的同时处理养育子女的压力。试点数据将导致未来对该干预措施进行全面试验，以测试其有效性。

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.