Examining the Effect of Child Development Accounts (CDAs) on Self-Efficacy Among Children and Adolescents Orphaned By HIV/AIDS in Southwestern Uganda

Background: Children and adolescents orphaned by HIV/AIDS –hereafter orphaned children, especially those living in sub-Saharan Africa (SSA), experience multiple vulnerabilities. Parental death negatively affects the wellbeing of children by exacerbating economic hardships, psychological distress, leading to poor physical and mental health functioning, stigma and discrimination, and the loss of parental social support. Resiliency and self-efficacy traits are essential to coping with past and current vulnerabilities, as well as encouraging beliefs in one’s ability to overcome future obstacles. Previous research indicates that self-efficacy is correlated with psychological conditions such as depression, suicidality and self- esteem; and is associated with a number of pro-health behaviors. In addition, self-efficacy has been shown to positively predict educational motivation and success among youth. However, this research has been devoted to self-efficacy among children and adolescents in developed countries. Very limited research exists in developing countries, such as those in SSA, specifically targeting orphaned children. Yet, orphaned children are at a greater risk of lower self-efficacy compared to non-orphaned children. This study therefore, examines the effect of a family-based economic strengthening intervention that utilize child development accounts (CDAs), on self-efficacy among children orphaned by HIV/AIDS in southwestern Uganda.

Methods: This study utilizes longitudinal data from a NICHD funded study called Bridges to the Future (2011-2018), implemented in the southwestern region of Uganda. A total of 1410-orphaned children (n=621 boys and n=789 girls), average age = 12 years at study enrollment, participated in the study. Participants were randomly assigned, at the school level, to either the control condition (n=496) receiving bolstered usual care services for orphaned children (such as textbook, notebooks, school uniforms and food aid), or the treatment condition (n=914) receiving bolstered usual care services above, plus three intervention components: 1) economic strengthening in the form of a CDA, 2) workshops on financial management and microenterprise development, and 3) a mentorship program. Data collected at baseline, 12-months, and 24-months post intervention initiation were analyzed. Regression analyses were conducted to test the effect of the intervention on the overall measure of self-efficacy, and the intervention effect on each of the 5 domains of self-efficacy, related to home, school, neighborhood, social and the future, at 12 and 24-months follow-up.

Results: Controlling for participants’ demographic and household characteristics, orphaned children receiving a family-based economic strengthening intervention were more likely than children in the control condition to report a statistically significant increase in self-efficacy at 12-months (b=3.48, 95%CI=2.13, 4.84, p<.001) and at 24-months-follow-up (b= 4.26, 95%CI=2.63, 5.86, p<.001). In addition, significant findings were observed within 4 out of 5 domains of self-efficacy, related to home, school, neighborhood and the future.

Conclusions: Findings suggest that family-based economic strengthening has the potential to improve orphaned children’s beliefs in their ability to make health choices that could potentially translate into desired future outcomes. Incorporating economic strengthening components into future programming that target orphaned children, may be instrumental not only in alleviating economic hardships, but also improve children’s abilities in making both current and future health coping choices, in the face of multiple adversities.