Overview
Keepin’ it R.E.A.L. is a mother-adolescent pregnancy and STD/HIV prevention program. The evaluated program was implemented with Boys and Girls Clubs. For two years the program increased condom use by youth in the program
The goal of the program is to promote the delay of sexual intercourse (abstinence) among teens and to enhance communication about sex between mothers and their teen children.
Program Description
Keepin’ it R.E.A.L. consists of two community-based HIV prevention interventions for mothers and their adolescents. For both interventions, the mothers and adolescents meet seven times over a 14 week period. Each session lasts for a total of 2 hours. This program was evaluated in 11 Boys and Girls Clubs of America sites in metro Atlanta. Participants were recruited and data were collected between 1996 and 2001.
Population Served
The Keepin’ it R.E.A.L. program serves primarily African American youth aged 11 to 14 years and their mothers.
Setting
Keepin’ it R.E.A.L is a community-based program that was evaluated in an urban setting.
Goals
The Keepin’ it R.E.A.L. program aims to delay the initiation of sexual intercourse among teens and to enhance communication about sex between mothers and their teen children.
Type of Intervention
Keepin’ it R.E.A.L. consists of two intervention programs. For the evaluation, participants were randomly assigned to one of three conditions: 1) the control group who received an initial HIV education session; 2) the social cognitive theory group (SCT) intervention who received seven, 2- hour sessions; the mothers and adolescents attended four sessions together and three separately; and 3) the life skills (LSK) group was guided by problem behavior theory which posits that problem behaviors co-occur within adolescents and are based on common underlying psychological attributes or predisposition; mothers and adolescents attended each session separately.
For both the SCT and LSK intervention, the sessions were designed to be interactive and include role-plays, demonstrations, and other activities. Take-home activities were also included with each session. For the SCT intervention, participants had to set a personal goal that would be set by the next session. For the LSK intervention, participants have take-home activities assigned at the end of each group session. Within the LSK intervention, participants also visited senior centers and participated in community service activities with the goal of increasing community involvement. Participants in the LSK intervention took an overnight trip to a historically black college or university in order to enhance future time perspective and showcase successful role models.
For the mothers, those in the LSK intervention attended sessions that were based on the Conscious Parenting Family Circles Parent Support Process which emphasized the expertise and life-learning that mothers have and bring to the group. The group was viewed as an opportunity to build community through shared experience.
Main Messages
Keepin’ it R.E.A.L. aims to increase sexual abstinence and communication between mothers and adolescents.
Operation/Logistics
Length of intervention: Both of the interventions implemented in Keepin’ it R.E.A.L. occurred over 14 weeks and consisted of seven total meetings which were two hours each.
Size of program: A total of 582 adolescents and their mothers participated in the evaluation of the Keepin’ it R.E.A.L. program. A total of 470 mothers enrolled in the program, and 110 had more than one adolescent in the study.
Components of intervention: The evaluation consisted of two interventions. The first based on the social cognitive theory and the second based on problem behavior theory, called the life skills program. Both interventions consisted of seven, two hour meetings with both mothers and adolescents. The meetings occurred over a 14 week period.
Evaluation
Type
The experimental evaluation of Keepin’ it R.E.A.L. included 582 adolescents and 470 mothers in metro Atlanta. The evaluation used intent to treat analyses which were conducted using a mixed model, repeated measure analysis of variance.
Population
The adolescents in the Keepin’ it R.E.A.L. program ranged from 11 to 14 years. Most of the participants (60%) were boys and African American (98%). Almost 90% lived with their biological mothers and almost half (46%) lived with their biological, step, or adoptive father. The mean age of the mothers was 38 years, and most were African American and single.
Components
Instruments and frequency: Self-report data were collected at baseline, and at 4, 12, and 24 months after the baseline assessment.
Outcomes measured: Among adolescents, the evaluation instrument included measures of sexual behavior, intentions to have sex and use condoms, sexual possibility situations, self-efficacy for abstinence, outcome expectations, and communication about sex. Among mothers, the evaluation included self-reported measures of self-efficacy, outcome expectations, and communication about sex. The instrument included self-report measures of comfort talking about sex and HIV knowledge for both mothers and adolescents.
Findings
Before the start of the program, 31 percent of program participants reported having had sexual intercourse, compared to 26 percent of students in the control group.
Sexual experience: Overall, no differences were found regarding sexual initiation between teens in the intervention groups and teens in the control groups. Over the two years, the number of adolescents who report intimate behavior and those who initiate intercourse increased over time. Adolescents in all three groups also reported increases in their confidence to say no or to feel more confident saying no to sex. However, adolescents in the LSK group who were sexually active showed greater increase in condom use than in either of the two other groups. The authors suggest that the number of adolescents using condoms should be interpreted with caution because the number of sexually active adolescents at any given time is small.
Analyses show that for mothers, both their level of self-efficacy and their comfort talking with their adolescent about sex increased over time. These percentages were greater for mothers in both intervention groups.
Evaluator Viewpoints
The authors believe that the intervention’s modest results may have been diluted by the assessment and the marketing of the program. The evaluator suggests that the information given at the baseline and about the intent of the program might have been enough to encourage mothers to talk to their teens. Furthermore, in all groups, the percentage of teens who had not initiated sex was relatively high as was condom use at last sex which makes program effects more difficult to detect.
Contact Information and Resources
Program and Evaluation Contact
Colleen Dilorio, Ph.D., R.N., FAAN
Department of Behavioral Sciences and Health Education
Rollins School of Public Health, Emory University
1520 Clifton Road, NE, Room 262
Atlanta, GA 30032
Email: cdilori@sph.emory.edu
RESOURCES
Dilorio, C., Resnicow, K., McCarty, F, De, A.K., Dudley, W.N., Wang, D.T., and Denzmore, P. (2006). Keepin’ It R.E.A.L.! Nursing Research, 55(1):43-51.