CAREGIVER WELLBEING, FAMILY FUNCTIONING, AND CHILD COGNITIVE DEVELOPMENT AMONG HIV-AFFECTED FAMILIES IN UGANDA

Background. Caregivers living with HIV and their HIV-affected children face numerous health risks, and both parenting and the overall family context play an important role in child neurodevelopment. The goal of this research was to explore characteristics of caregivers and families in an HIV-affected low-resource context. Our objectives were threefold: first, to gain an understanding of women’s perceptions of their parenting abilities in rural eastern Uganda; second, to examine the measurement of parenting confidence in this context; and third, to examine associations between parenting confidence, family-level characteristics, and child cognitive function. Method. Qualitative in-depth interview and focus group data were collected from a subsample of caregivers (n=43) drawn from the treatment as usual arm of a parenting intervention trial and analyzed using thematic analysis. The factor structure of the Parenting Sense of Competence Scale (PSOC) was examined using Confirmatory Factor Analysis and correlates of parenting confidence were assessed using multivariate linear regression among a larger subsample from the trial (n=155). Within this subsample, random intercept linear regression models were used to examine associations between caregiver-level characteristics (parenting confidence, depression, and anxiety), family-level characteristics (wealth, family dysfunction), and child cognitive functioning among families of preschool-age and school-age children. Interactions between caregiver parenting confidence and mental health, parenting confidence and family dysfunction, and family dysfunction and wealth were tested. Results. Caregivers described parenting confidence in terms of maintaining a positive attitude, having a plan, and keeping the family together in spite of the challenges associated with parenting in an HIV-affected low-resource context. Two- and three-factor models of the PSOC did not fit the data well in this sample; acceptable fit was found for a one factor model. Caregiver parenting confidence was associated with depression, anxiety, family dysfunction, and family wealth. No significant associations were found between caregiver parenting confidence and social support. We found caregiver parenting confidence, depression, family dysfunction, and family wealth to be associated with child cognitive function. An interaction effect was detected between family dysfunction and wealth on child cognitive function among school-age children. Discussion. Qualitative and quantitative examination of parenting confidence among HIV-affected female caregivers in eastern Uganda contributed to both the definition and measurement of the construct. In a context of multiple adversities, caregiver wellbeing, family wealth, and family function are associated with child cognitive functioning, suggesting that family-level factors may be particularly important for child outcomes