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A cluster randomized controlled trial to evaluate a resilience-based intervention for caregivers of HIV-affected children in China

Harrison, Sayward E.a; Li, Xiaominga; Zhang, JiaJiab; Zhao, Junfengc; Zhao, Guoxiangd

doi: 10.1097/QAD.0000000000002181
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Objectives: The Child-Caregiver-Advocacy Resilience (ChildCARE) intervention aims to enhance the psychosocial wellbeing of children affected by parental HIV by providing programing at three levels: child, caregiver, and community. The objective of the current study was to evaluate the intervention's efficacy in improving mental health and parenting outcomes for participating caregivers.

Design: A cluster randomized controlled trial was used to evaluate initial efficacy of the intervention.

Methods: A total of 790 caregivers of children affected by parental HIV were recruited from Henan, China. Caregivers and their children were randomly assigned to one-of-four intervention arms (control, child-only, child + caregiver, child + caregiver + community) to evaluate the multiple components of ChildCARE. Those assigned to receive the caregiver intervention participated in five 2-h intervention sessions designed to improve their parenting skills and enhance their ability to cope with daily stressors. Caregivers reported on their mental health and parenting behaviors at baseline, 12, 24, and 36 months, with mixed effect modeling used to examine intervention effects.

Results: Caregivers who participated in the intervention reported decreased anxiety and parental stress at 12 months (P < 0.05). Participants also reported increased use of structured parenting skills (i.e., parental demandingness) at 12 and 24 months (P < 0.05). However, by 36 months, they reported significantly lower levels of parental competence (P < 0.01) than those assigned to the control condition.

Conclusion: Preliminary findings suggest that the caregiving component of ChildCARE yields initial improvements in some key parenting and mental health outcomes. However, the challenges of caring for children affected by HIV are complex and may require more intensive intervention to yield marked, positive changes across key caregiver outcomes.

aDepartment of Health Promotion, Education, and Behavior

bDepartment of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA

cInternational Research Center for Physical and Psychological Health of Vulnerable Populations, College of Educational Sciences, Henan University, Kaifeng

dDepartment of Psychology, Henan Normal University, Xinxiang, Henan, China.

Correspondence to Sayward E. Harrison, PhD, Department of Health Promotion, Education, and Behavior, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA. E-mail: harri764@mailbox.sc.edu

Received 26 March, 2018

Revised 11 February, 2019

Accepted 12 February, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.