Empowering parents for human immunodeficiency virus prevention: Health and sex education at home

Abstract

Background: Improving health literacy amongst human immunodeficiency virus (HIV)-positive mothers could strengthen child and adolescent HIV prevention. The Amagugu intervention included health literacy materials to strengthen maternal communication and has demonstrated success in low-resource HIV-endemic settings.Objectives: Our aims were to (1) evaluate whether Amagugu materials improved health literacy leading to changes in parental behaviour towards communicating on topics such as HIV, health behaviours and sex education, and (2) explore what additional information and materials mothers would find helpful.Method: The Amagugu evaluation included 281 HIV-positive mothers and their HIV-uninfected children (6–10 years). Process evaluation data from exit interviews were analysed using content analysis and logistic regression techniques.Results: Of 281 mothers, 276 (98.0%) requested more educational storybooks: 99 (35.2%) on moral development/future aspirations, 92 (32.7%) on general health, safety and health promotion, and 67 (23.8%) on HIV and disease management. Compared to baseline, mothers reported that the materials increased discussion on the risks of bullying from friends (150; 53.4%), teacher problems (142; 50.5%), physical abuse (147; 52.3%) and sexual abuse (126; 44.8%). Most mothers used the ‘HIV Body Map’ for health (274; 97.5%) and sex education (267; 95.0%). The use of a low-cost doll was reported to enhance mother–child communication by increasing mother–child play (264; 94.3%) and maternal attentiveness to the child’s feelings (262; 93.6%).Conclusion: Parent-led health education in the home seems feasible, acceptable and effective and should be capitalised on in HIV prevention strategies. Further testing in controlled studies is recommended.

‘A difficult conversation’: community stakeholders’ and key informants’ perceptions of the barriers to talking about sex and HIV with adolescents and young people in KwaZulu-Natal, South Africa

“…This perpetuates poor communication cycles, entrenches traditional social norms concerning adolescents' and young people's sexuality, and affects adults' perceived self-confidence. In this study., a perceived lack of capacity, including the skills and ability to overcome fears and embarrassment were barriers to honest conversations about SRH (Edwards et al 2020). Gender norms that suggest that these discussions should be facilitated by a parent or caregiver of the same gender may also mean that some caregivers feel unable to have conversations with children or young people of the opposite sex.…”

“…Concerns regarding discomfort associated with caregiver sex/gender could be alleviated by leveraging traditional norms, particularly related to raising children communally with other family or community members identified to fulfil the task (Bhana, Crewe, and Aggleton 2019). These positive interactions could lead to changes in how adolescents and young people engage with their own children one day (Edwards et al 2020).…”

Print-based storybook in the mother tongue for teaching COVID-19 prevention in the Philippines

“…Effecting health behaviour change through acceptable instructional material like a storybook was a topic of previous studies (Agustina et al, 2018;Conrad et al, 2020;Edwards et al, 2020;Harrison et al, 2016;Kalembo et al, 2019;Pulimeno et al, 2020). Particularly, the works of Kalembo et al (2019) and Edwards et al (2020) highlighted the significance of using the mother tongue in producing health literacy material.…”

“…Reports have shown that healthcare professionals have used children's stories for therapeutic purposes, precluding harmful behaviours and addictions or dealing with psychosomatic disorders (Pulimeno et al, 2020). It has been used to change health behaviours related to human immunodeficiency virus (HIV) status (Edwards et al, 2020;Kalembo et al, 2019); overweight and disability (Harrison et al, 2016); eating and physical activity behaviours (Bellows et al, 2013); early childhood nutrition and parenting intervention (Agustina et al, 2018); avoidance of contaminated objects (Conrad et al, 2020); mental state references (Farkas et al, 2020); self-awareness (Rahimah & Izzaty, 2018); culturally valued qualities and behaviours related to achievement (Suprawati et al, 2014); formation of identities (Watson et al, 2015); disasters (Damayanti et al, 2020); and even road safety (Ahmad et al, 2018). Hartling et al (2010) identified the challenges in making stories which include keeping the authenticity of the story against being evidence-based, addressing consumers' use of the web as the source of health information and striking a balance between being concise, comprehensive and widely applicable, taking into account story length, reading level, narrative mode, depiction of various demographics and exposures to the disease, illustrations and layout.…”