Family support as a mediator of change in sexual risk-taking attitudes among orphaned adolescents in rural Uganda

Abstract

Purpose: Prior studies demonstrated the effect of family-based economic empowerment intervention Suubi on reducing attitudes approving sexual risk-taking behavior among orphaned adolescents in Uganda. To understand mechanisms of change, the article examines the effect of Suubi intervention on family support variables and their role in mediating the change in adolescents' attitudes toward sexual risk-taking.

Methods: The Suubi study used a cluster-randomized experimental design with three waves, and included 283 orphaned adolescents from 15 primary schools in Rakai, Uganda. First, using mixed-effects models, the study tested for the effect of intervention on family support variables. Second, using mediation analysis, the study examined whether the change in sexual risk-taking attitudes was mediated by the change in family support.

Results: Compared with adolescents from the control group, at wave 2, adolescents in the treatment group reported higher levels of perceived support from caregivers, were more willing to talk to caregivers about their problems, and felt more comfortable talking about sexual risk behaviors with their caregivers. Mediation analysis demonstrated that the improvement in perceived support from caregivers at wave 2 accounted for 16.8% of the reduction in adolescents' attitudes toward sexual risk-taking behavior at wave 3 (z = -2.21, p < .05).

Conclusions: A family-based economic empowerment intervention Suubi may have the potential to increase family support to orphaned adolescents. Interventions aimed at strengthening existing social networks and improving connectedness with surviving family members may be critical in preventing sexual risk-taking behavior among orphaned adolescents in Uganda, which is characterized by low resources.

Trial registration: ClinicalTrials.gov NCT01163695.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Hypothesized mediation model between the family-based economic empowerment intervention Suubi and attitudes toward sexual risk-taking as its outcome. The model described in Figure 1 includes the following: a = direct effect of the Suubi intervention on perceived family support and family communication among orphaned adolescents; b = direct effect of perceived family support and family communication on adolescents' sexual risk-taking attitudes; c = total effect of intervention on outcome, including the direct effect of the intervention and indirect effect (through the mediator); c' = effect of the Suubi intervention on adolescents' sexual risk-taking attitudes adjusting for the mediators -- perceived family support and family communication.