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，艾滋病毒携带者(MLH)的母亲报告说，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在一起。这项R01试点研究的目的是开发并测试对6-14岁孩子健康的艾滋病毒感染母亲实施育儿干预的可行性。这项干预旨在提高育儿技能和产妇自我护理技能，以改善儿童和产妇的结局。此干预措施的开发基础是前两个R01(MH#5R01MH057207，目前为年)的工作。12)旨在对艾滋病毒阳性母亲及其子女进行纵向评估。MLH(n=60)和他们的孩子(总计N=120)将被招募，随机进入以理论为基础的技能培训干预或对照条件，并在基线和3、6和12个月的随访中进行评估。干预(“改善母亲的育儿能力、成长和有效性”--IMAGE计划)将包括5个疗程，将基于健康行为改变的信息-动机-行为技能(IMB)模型，具体技能的选择是基于我们对MLH及其子女的10年观察研究，该研究正在加州大学洛杉矶分校进行。40%的干预母亲(n=12)将被要求在最后一次随访后参加深入的定性访谈，以获得有关其干预经验的详细过程信息。这项随机试点试验的主要目的是：1.开发干预措施，然后评估实施为期5周的基于理论的个人行为干预的可行性和可接受性，以提高MLH的积极育儿技能；2.对数据进行效果大小的初步评估，并调查数据中的趋势：a.育儿实践结果(利用父母行为量表)，以及育儿效能的次要结果；b.有针对性的育儿行为(亲子沟通、父母监督、家庭惯例和适当的育儿)，以及有针对性的自我照顾技能(社会支持、披露、处理感觉到的耻辱)；C.心理健康指标和身体健康指标的产妇结果；D.儿童心理健康指标、行为问题、自我概念和应对的结果；以及E.家庭结果(家庭功能、亲子关系)。我们现在正处于艾滋病毒流行的第三个十年，除了预防或坚持用药外，对感染艾滋病毒的妇女几乎没有其他干预措施；这项研究将是评估的第一步，这项干预措施将帮助艾滋病毒阳性母亲在应对艾滋病毒的同时应对育儿压力。试点数据将导致未来申请进行干预的全面试验，以测试疗效。 公共卫生相关性：R01的目的是对孩子为6-14岁的艾滋病毒感染母亲进行育儿干预的试点测试。我们现在正处于艾滋病毒流行的第三个十年，除了预防或坚持服药外，对艾滋病毒携带者妇女几乎没有其他干预措施；这项研究将试行一项干预措施，帮助艾滋病毒阳性母亲在应对艾滋病毒的同时应对育儿压力。这项研究将使我们能够研究MLH后的母亲和儿童在干预中获得技能，以确定技能使用是否随着时间和实践的增加而增加，并为随后进行干预的全面试验提供必要的信息。

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.