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Prevention intervention focuses on African American boys and their fathers
Dads are taught communication skills
The 8-year-old REAL (responsible, empowered, aware, living) study includes an intervention that focuses on fathers and their roles in educating and guiding adolescent boys to safe decisions.
"With the REAL men project, the focus was on fathers who came to the intervention, but the sons didn't come until the very last day," says Colleen DiIorio, PhD, a professor at the Rollins School of Public Health, Emory University, in Atlanta, GA.
"The intervention was geared toward fathers, and the behavior we were trying to change was the sons,'" DiIorio says.
A previous program DiIorio studied was called Keeping It Real, and it was based on a social cognitive theory and directed toward mothers and their adolescents.
The mothers and adolescents would attend the sessions together, although there were breakout sessions in which the mothers formed one group and the adolescents another, DiIorio says.
By contrast, the REAL men intervention's focus was on teaching fathers' communication skills to facilitate change in their sons.
Investigators working on this intervention, beginning in the late 1990s, were unable to find any similar HIV interventions in the literature that focused on African American fathers and sons, DiIorio notes.
Participants attended seven sessions led by facilitators, including one with a master's degree in public health or a health education degree.
There were about 15 intervention groups and nearly 300 people, almost all African American, were recruited to participate, DiIorio says.
Outcomes have been encouraging, DiIorio says.
At a six-month follow-up, the intervention group had more children who were sexually abstinent, and condom use was significantly improved among those who were not sexually abstinent, DiIorio says.
The intervention's goals are to have adolescent boys delay the onset of sexual intercourse and to use condoms if they already are sexually active, DiIorio says.
"For the fathers, the goal was to increase the communication around sexual issues," she adds. "We measured their support in discussions they had with their sons about sexual issues and HIV prevention."
Intervention facilitators started by having discussions with fathers about communication skills, showing the men the different ways parents communicate with their children and adolescents and giving them directions in how to have an interactive conversation, DiIorio says.
"We talked about what's important and other very direct communication that might impede the message we are trying to give," DiIorio explains.
For example, a closed approach is a directive communication in which a child is told, "Don't run into the street," she says.
Open communication is when a parent sits down with a child and exchanges information, and that's the type of communication that is needed when the topic is sexuality, DiIorio says.
"You don't need to be directive," she adds. "You need to discuss not necessarily sexual intercourse, but other things that are related to sexuality issues, such as the music kids listen to and the things they see on TV."
The first and second sessions talked about skills related to open communication and how to keep a conversation open and keep it away from being directive, DiIorio says.
"By the third sessions we were into sexuality issues, and the fourth session was about HIV with very specific information about how it is transmitted," DiIorio says. "We encouraged the men to talk about their experiences with HIV, and most men knew somebody or knew somebody who knew somebody who had HIV."
This forum provided an opportunity for the men to have this discussion and to talk about some of the myths involving the disease, including myths that mosquitoes could transmit the virus, she notes.
"We played a game around those myths, like Jeopardy and the Millionaire's game," she says.
By the fifth and sixth session, the men were more comfortable discussing sexuality and their own adolescence, DiIorio says.
The fathers were taught how to respond appropriately to their sons if they were asked how someone could get HIV.
"As part of this intervention, we used videos of men talking to boys, primarily about sex," DiIorio says. "We took videos from television and movies and had 30-second or one minute-long clips of an interaction between a father and son about sexuality issues."
These were used to allow the group to evaluate what would be the best approach.
"We used some role-playing and had the men test out different ways they could talk with their sons," DiIorio says.
For instance, the men would role-play a scenario in which the boy says to his father, "Dad, I'd like to date," she says.
The father doesn't feel like the son is ready for dating, and the scenario plays out what the father's response would be.
In the seventh and last session the boys came with their fathers, and facilitators began the session with a version of the Newlywed Game in which the boys were asked a question and their answers were written on a board, and then the fathers were asked to answer the question the way their sons did, DiIorio says.
"This was to show that the fathers may think they know what their child would say, but the child might say something entirely different," DiIorio says. "It also showed how it's important to communicate by talking together, and this was very effective."
When researchers design HIV interventions for particular groups, it's important to maintain consistency as these interventions are used in different places or adapted for different populations, DiIorio says.
This was why investigators made significant changes to the Keep It Real intervention, which had been used with African American women and sons, when they turned it into an intervention for African American men and sons, she notes.
"You have to be really concerned about consistency when you present an intervention across different groups," DiIorio says. "We recruit a group and provide the intervention, and then we recruit a new group and have to make sure the intervention was the same for each group, even when we learned from one group to another that something wasn't working when we wanted it to."