AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #232 - Experience in taking a US-based coping intervention, Project TALC, and adapting it to the Zimbabwean context: observations on cross-cultural adaptations.
Authors: Presenting Author: Dr Danuta Kasprzyk - Battelle/University of Washington
Additional Authors: Dr. Sally Nyandiya Bundy, Dr. Danuta Kasprzyk, Dr. April Greek, Ms. Norest Beta, Mr. Stephen Machokoto, Ms. Rachel Gatsi, Mr. Tinashe Muromo,
Aim: Teens and Adults Learning to Communicate (TALC) was developed by Rotheram-Borus and targeted families HIV+ parents and is a coping skills-based intervention designed to enhance parents’ and their adolescent children’s cognitive, affective and behavioural skills via emotional regulation, problem solving, social support building, verbal and non-verbal assertiveness, and goal setting. In TALC, significant positive effects were shown in intervention vs. control families. Our goal was to adapt TALC to develop a psychosocial support program for parents with HIV/AIDS and their children living in Zimbabwe.
Method / Issue: Formative research established the feasibility and desirability of the intervention program. Information from several sources contributed to adaptation and development of the Parent’s Intervention Programme (PIP) and 2 Adolescent versions (APS: adolescents aware of parental status and NAPS: adolescents not aware of parental status). PIP addresses the meaning of being HIV+, disclosure, children’s needs, managing teens’ behaviour, risk reduction skills, positive emotional coping and child custody issues in 14 sessions. The teens’ program addresses the same coping issues, risk reduction skills, and family communication in 10 sessions. The style and format of TALC was maintained but some adaptations were incorporated.
Results / Comments: Results show parents are able to cope with fear, anger, & sadness in relation to HIV status; to shift from non-disclosure to disclosure; and recognized that corporal punishment while culturally acceptable is not the best way to change children’s behavior. At baseline, no difference in mean scores across study groups in the corporal punishment scale (á=.82; 3.14 coping; 3.14 capacity, p=.997) existed, but 6-month follow-ups showed the coping arm had a lower mean score (2.61 vs 3.15, p=.000). Change scores between baseline & 6-month showed an effect for parents attending coping vs. capacity arms (-0.53 vs. 0.02, p=.000). The concept and practice of ‘active listening’ proved difficult (‘foreign’, ‘not natural’) but verbal and non-verbal cues preceding ‘active listening’ worked. Family cohesion also increased by the 6-month survey; the coping arm had a higher mean score (4.62 coping & 4.44 capacity, p=.002). Distinguishing between assertiveness, aggressiveness and passiveness was easy, while practice was not. Relaxation sequences were used successfully but were adapted. Traditionally in Zimbabwe child custody issues are considered after a parent dies. This discussion proved upsetting, but by the end of custody sessions, parents went from avoidance to consideration of options. Results show prior to intervention, parent arms did not differ significantly in provisions for children’s future (68% of coping; 72% capacity reporting doing nothing (p=.494)), but at 6-months among those reporting doing nothing at baseline, 27% coping vs. 20% capacity parents reported now preparing (NS, p=.221). Among parents who had not made preparations at 6-months, those in the Coping vs. Capacity arms were more likely to report they had thought about it (85% vs. 60%; p=.000).
Discussion: The US-validated TALC intervention was successfully adapted, though particular dimensions of Zimbabwean culture, gender and individual health affected the adaptation. The spirit of TALC can be successfully adapted as evidenced by the effects of the three implemented intervention programs: PIP, APS and NAPS.
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