Program

May 07, 2013

OVERVIEW

Keepin’ it R.E.A.L. (Responsible, Empowered, Aware, Living) is a set of community-based HIV prevention programs designed for African American adolescents ages 11-14 and their mothers.  The program includes two separate interventions: a social cognitive intervention (with sessions that include both mothers and adolescents) and a life skills intervention (with separate sessions for mothers and adolescents and an additional community component for the adolescents that involves worksite and college campus visits and community service activity).  Both interventions consist of seven biweekly sessions held over the course of three months.  The primary goals of Keepin’ it R.E.A.L. are to delay sexual initiation for adolescents who are not sexually active and to increase condom use among those who are sexually active.

An experimental evaluation of Keepin’ it R.E.A.L. revealed that, at a 24-month follow-up, those in the life skills group reported increased condom use at most recent sex (among those who were sexually active at baseline), compared with those in the control group.  Those in the social cognitive intervention demonstrated increased HIV knowledge, compared with those in both the control group and the life skills group. There were no program impacts on sexual initiation among those who were not sexually active at baseline.  Mothers in both intervention groups demonstrated increases in self-efficacy and in sex-related communication with their adolescent.

DESCRIPTION OF PROGRAM

Target population: African American adolescents ages 11-14.

The Keepin’ it R.E.A.L. evaluation includes two separate interventions: a social cognitive intervention and a life skills intervention.  Both consist of seven biweekly sessions with mothers and adolescents held over the course of three months.

With the social cognitive intervention, every other session is conducted with mothers and adolescents separately.  Each session includes a warm-up activity to promote group cohesion.  The first session then proceeds with an introduction to the program; the remaining six sessions proceed with discussions about sex, condoms, HIV, and person goal progress; discussions are complemented by group activities that include games, videos, and role-plays. Each session concludes with a take-home assignment and a goal-setting activity.

With the life skills intervention, all meetings are conducted with mothers and adolescents separately, except during the introduction in the first session and the dinner in the last session, which include both mothers and adolescents. The adolescent component begins with stress reduction exercises, then the remainder of the session is spent discussing problem behaviors such as tobacco, alcohol, and drug use; violence; and sexual initiation (including discussions of how common the behaviors are and the pros and cons of engaging in those behaviors) and building decision-making and communication skills regarding those behaviors. Sessions are interactive, with each including games and role-plays. At the end of each session, adolescents are provided with take-home activities.  In addition to these seven sessions, adolescents visit senior centers, college campuses, and worksites, and they engage in a community service activity. In the seventh session, adolescents rejoin their mothers for a dinner, and they present collages they have created over the course of the program.  While the adolescents complete their sessions, the mothers participate in a parenting component entitled, The Conscious Parenting Family Circles Parent Support Process, which promotes a sense of community through sharing experiences, expertise, and life learning that the mothers bring to the group. Sessions include a relaxation activity, followed by discussions of adolescent problem behaviors, story-telling, and problem-solving, and conclude with moments of reflection.

EVALUATION OF PROGRAM

DiIorio, C., Resnicow, K., Thomas, S., Wang, D. T., Dudley, W. N., Van Marter, D. F., & Lipana, J. (2002). Keepin’ it REAL!: Program description and results of baseline assessment. Health education & behavior, 29(1), 104-123.

DiIorio, C., Resnicow, K., McCarty, F., De, A. K., Dudley, W. N., Wang, D. T., & Denzmore, P. (2006). Keepin’ it REAL!: Results of a mother-adolescent HIV prevention program. Nursing research, 55(1), 43-51.

Evaluated population: The evaluated sample included 582 adolescents and 470 mothers (110 of whom had more than one adolescent in the evaluated sample) from Boys and Girls Club of America sites in a large Southeastern city.  The adolescents ranged in age from 11 to 14 years, with a mean of 12.2 years.  More than half (60 percent) were male, and nearly all (98 percent) were African American.  The mean age of the mothers was 37.9; two-thirds of the mothers were “single” parents (not married, divorced, widowed, or separated), and most of the adolescents (90 percent) lived with their mother at the time of the evaluation.  At baseline, roughly one-tenth of the adolescents had initiated sexual intercourse.

Approach: Each of 11 Boys and Girls Club of America sites was randomized into either the control group (n=4) or one of the two intervention groups (social cognitive group n=4, life skills group n=3).  The control group attended a one-hour HIV prevention session, with a 20-minute video, followed by a group discussion.  Because mothers of adolescents participated in the program along with the adolescents, this created nesting of participants; as such, the evaluation was a randomized cluster design, with nesting.  Analyses address school-based clustering, but not clustering of mothers.  Participants in each group were assessed at baseline, and at 4-, 12-, and 24-months post-baseline.

Adolescent outcomes measured included intimate sexual behaviors (which included behaviors ranging from hand-holding to touching genitals of another person), sexual initiation, condom use (at most recent sex, in the past three months, and in the past six months to a year), intentions to have sex, involvement in possible sexual situations (for example, being in a private place with a member of the opposite sex without adult supervision), and communication about sex. Mother outcomes measured included comfort talking about sex and HIV knowledge.

Results: There were no program impacts on sexual initiation among those who were not sexually active at baseline for either of the two interventions. Mothers in the social cognitive group had higher HIV knowledge than those in the control group or the life skills group; they also talked about more sex-related topics with their adolescent than mothers in the control group. Mothers in both intervention groups demonstrated increased in comfort with talking with their adolescent about sex and in intent to talk with their adolescent about sex.

SOURCES FOR MORE INFORMATION

References

DiIorio, C., Resnicow, K., Thomas, S., Wang, D. T., Dudley, W. N., Van Marter, D. F., & Lipana, J. (2002). Keepin’ it REAL!: program description and results of baseline assessment. Health education & behavior, 29(1), 104-123.

DiIorio, C., Resnicow, K., McCarty, F., De, A. K., Dudley, W. N., Wang, D. T., & Denzmore, P. (2006). Keepin’ it REAL!: Results of a mother-adolescent HIV prevention program. Nursing research, 55(1), 43-51.

KEYWORDS: Adolescents; Males and Females (Co-ed); Black/African American; Urban; Community-based; Parent or Family Component; Sexual Activity; Parent-Child Relationship; Condom Use and Contraception

Program information last updated on 5/7/13. 

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