The effectiveness of a caregiver-directed intervention promoting development in HIV-positive children on caregivers' self-efficacy: A randomised controlled trial

Master Thesis


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University of Cape Town

Background: Caregiver self-efficacy (CSE) supports the capabilities of caregivers to engage in parenting activities including stimulating development in their children. Human immunodeficiency virus (HIV) remains a prevalent concern in South Africa, even with the use of antiretroviral treatment. Children with HIV are compromised in their health and development which adds to the general stress of families rearing HIV-positive children. Stress has a negative effect on CSE. However, studies indicate that CSE can be improved through parent-mediated intervention. Caregivers’ engagement in the intervention may grow their skills to promote development in their HIV-positive children. This may have a positive influence on CSE. Occupational therapists working in governmental paediatric HIV clinics developed a play-informed, caregiver-implemented, home-based intervention (PICIHBI) for HIV affected families to be implemented. This study evaluates the effectiveness of PICIHBI on CSE. Aim: The aim of the study is to determine if the CSE levels in a group of caregivers of HIV-positive children aged 6 months to 8 years 0 months on ART, after receiving play-informed caregiver-implemented home-based intervention (PICIHBI) are not inferior to CSE levels in an equivalent group of caregivers with children receiving conventional one-on-one occupational therapy. Method: The study applied a pragmatic, randomised control trial with caregiver-child dyads attending the antiretroviral clinic at Groote Schuur Hospital, Cape Town. The control group received conventional child-directed occupational therapy on an individual basis and the experimental group received caregiver-directed, PICIHBI in a group format. The Parenting Self-Efficacy Measure (P-SEMI), Parenting Sense of Competency (PSOC) scale, and the General Self-Efficacy Scale (GSE) measured self-efficacy at baseline, half way and at the end of the yearlong, monthly interventions. Results: Sixty-four caregiver-child dyads were recruited and assessed at baseline. Thirty-nine dyads were retained in the study, completing the measures at all three test points. Results revealed that baseline CSE was high for both groups. There was a significant change (p < .001) in the P-SEMI total scale in both groups from baseline to mid-test and mid-test to post-test. In both groups the CSE scores decreased from baseline to mid-test and then increased from mid-test to post-test. There was not a significant difference in CSE results between baseline and post-test on the P-SEMI total scale for either groups. There were no significant differences between test points for the other scales and subscales for both groups. Conclusion: The results suggest that PICIHBI has a non-inferior effect on CSE to that of conventional occupational therapy. This suggests that PICIHBI is comparable to conventional occupational therapy and could be implemented as an alternative intervention without comprising the effects on CSE. Employing PICIHBI as an alternative intervention could provide a number of benefits including the development of caregiver skills, a larger reach within the population, and contextually driven intervention that is embedded in children’s home environments. Various influencing factors are proposed to explain the patterns of CSE demonstrated in the groups. Neither group showed a significant increase in CSE from baseline to post-test and thus further investigation and intervention development is required to specifically demonstrate enhanced CSE in this context. Intervention attendance for both groups was poor. This is the first investigation on the effects of PICIHBI on CSE which can inform further research to develop best occupational therapy practice in the vast population of HIV affected families.