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Gray W, Dorriz P, Kim H, Partain L, Benekos E, Carpinelli A, Zupanc M, Grant K, Weiss M. Adult Provider Perspectives on Transition and Transfer to Adult Care: A Multi-Specialty, Multi-Institutional Exploration. J Pediatr Nurs 2021; 59:173-180. [PMID: 33932647 DOI: 10.1016/j.pedn.2021.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify barriers that transcend multiple adult care specialties and identify potential solutions. DESIGN AND METHODS Twenty-one adult care providers practicing in the specialty areas of internal medicine, family medicine, gastroenterology, endocrinology, and neurology participated in one of six semi-structured focus group interviews. Data were coded and analyzed according to the Socio-ecological Model of Adolescent/Young Adult Readiness for Transition (SMART). RESULTS Three themes and one subtheme emerged from the data. These fell within the beliefs/expectations, knowledge, access/insurance, and relationships (subtheme) domains of the SMART model. Family beliefs/expectations regarding the provider role, difficulty accessing reliable information, and limited access to mental health and behavioral providers reportedly affect providers' ability to provide optimal health care. CONCLUSIONS Adult providers identified several barriers affecting their ability to care for newly transferred patients. Increased education of families and improved methods of communication between providers were recommended. Barriers related to access and insurance are common and require larger systems-level collaborations between health care systems and payor sources. PRACTICAL IMPLICATIONS Some recommendations (e.g., educating families on the distinct roles of the PCP vs. specialist, highlighting new treatment opportunities in adult care, conveying trust and endorsing the new provider), represent concrete steps pediatric providers can immediately take to improve transfer. Other steps will require forging bridges across the pediatric and adult care world to expand patient access to medical, mental health, and behavioral services.
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Affiliation(s)
- Wendy Gray
- Children's Health of Orange County, Orange, CA, United States of America.
| | - Parasto Dorriz
- Children's Health of Orange County, Orange, CA, United States of America
| | - Hanae Kim
- Children's Health of Orange County, Orange, CA, United States of America
| | - Lauren Partain
- Children's Health of Orange County, Orange, CA, United States of America
| | - Erin Benekos
- Children's Health of Orange County, Orange, CA, United States of America
| | - Anne Carpinelli
- Children's Health of Orange County, Orange, CA, United States of America
| | - Mary Zupanc
- Children's Health of Orange County, Orange, CA, United States of America
| | - Kenneth Grant
- Children's Health of Orange County, Orange, CA, United States of America
| | - Michael Weiss
- Children's Health of Orange County, Orange, CA, United States of America
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Deatrick JA, Kazak AE, Madden RE, McDonnell GA, Okonak K, Scialla MA, Barakat LP. Using qualitative and participatory methods to refine implementation strategies: universal family psychosocial screening in pediatric cancer. Implement Sci Commun 2021; 2:62. [PMID: 34090525 PMCID: PMC8180116 DOI: 10.1186/s43058-021-00163-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 05/20/2021] [Indexed: 12/13/2022] Open
Abstract
Background Children with cancer and their families are at risk for short- and long-term psychosocial difficulties. Screening for psychosocial risk remains inconsistent, leading to inequitable access to psychosocial services. The Psychosocial Assessment Tool (PAT) is an evidence-based caregiver report screener of family psychosocial risk ready for implementation in a nationwide cluster randomized trial that will test two implementation strategies across 18 pediatric cancer centers. The current study, conducted in preparation for the trial, solicited the perspectives of key stakeholders about two proposed implementation strategies identified during previous research which focus on health equity and screening of all families (universal screening). Results were used to refine the implementation strategies for testing in the subsequent trial. Methods Semi-structured interviews with 19 key stakeholders (parents, health care providers, pediatric oncology organizations, and pediatric healthcare leaders) were conducted regarding the two implementation strategies. Strategy I is a training webinar; Strategy II is training + implementation enhanced resources, which includes a champion at each site and monthly peer support consultation calls. Data were analyzed using directed content analysis with deductively derived codes based on the Interactive Systems Framework and inductive codes based on emerging data. Results Stakeholder interviews provided rich data to rigorously modify the proposed implementation strategies. Implementation strategies were modified in consistent with these recommendations: engaging providers by framing family psychosocial screening as an opportunity for more efficient and effective practice; setting clear expectations about the importance of screening 100% of children and their families to achieve the goal of universal screening, equity of care, and reduction of disparities; and adapting successful strategies for systematic implementation of screening to ensure optimal engagement with children and their families throughout their care. Conclusions Stakeholder input strengthened implementation strategies by suggesting modifications that emphasized health equity and reduction in health disparities. Using implementation science methods to build on a long-standing program of research provided practical insights about immediate needs of families and historical insights regarding structural inequities such as language differences and access to services. Resulting strategies address all levels of the social ecology for children’s cancer care, including the patient, family, provider, healthcare system, and community. Trial registration NCT04446728 June 23, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00163-4.
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Affiliation(s)
- Janet A Deatrick
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Anne E Kazak
- ABPP Center for Healthcare Delivery Science, Nemours Pediatric Healthcare System, Rockland Center One, 1701 Rockland Road, Wilmington, USA. .,Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, USA.
| | - Rebecca E Madden
- Divison of Oncology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Glynnis A McDonnell
- ABPP Center for Healthcare Delivery Science, Nemours Pediatric Healthcare System, Rockland Center One, 1701 Rockland Road, Wilmington, USA
| | - Katherine Okonak
- ABPP Center for Healthcare Delivery Science, Nemours Pediatric Healthcare System, Rockland Center One, 1701 Rockland Road, Wilmington, USA
| | - Michele A Scialla
- ABPP Center for Healthcare Delivery Science, Nemours Pediatric Healthcare System, Rockland Center One, 1701 Rockland Road, Wilmington, USA
| | - Lamia P Barakat
- Divison of Oncology, The Children's Hospital of Philadelphia, Philadelphia, USA.,Department of Pediatrics, Perelman/School of Medicine of the University of Pennsylvania, Philadelphia, USA
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53
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Hilliard ME, Minard CG, Marrero DG, de Wit M, DuBose SN, Verdejo A, Jaser SS, Kruger D, Monzavi R, Shah VN, Wadwa RP, Weinstock RS, Thompson D, Cao VT, Anderson BJ. Health-related quality of life in parents and partners of people with type 1 diabetes: Development and validation of type 1 diabetes and life (T1DAL) measures. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2021; 39:234-247. [PMID: 33900103 PMCID: PMC8376806 DOI: 10.1037/fsh0000507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Despite the significant impact of type 1 diabetes (T1D) on family, few instruments are available to assess health-related quality of life (HRQOL) among family members of people with T1D. This study aimed to develop and evaluate the psychometric properties of new measures of diabetes-specific HRQOL for parents and partners of people with T1D. We report on the multistep development and validation process for the self-report Type 1 Diabetes and Life (T1DAL) measures, with versions for parents of youth age <8, 8-11, 12-17, and 18-25 years, and for partners of people age ≥18 years with T1D. METHOD First, we conducted qualitative interviews (total parents/partners n = 38) to develop draft measures and piloted them (total n = 20). Next, we tested the measures' psychometric properties. Participants (total across versions n = 813) at six T1D Exchange Clinic Network sites completed the appropriate T1DAL measure and validated measures of related constructs. We then reduced each T1DAL measure to 20-30 items in length based on psychometric data and participant feedback. Eleven participants reviewed the final measures via cognitive debriefing. RESULTS The T1DAL measures for parents and partners demonstrated good internal consistency (α = .80-.88) and test-retest reliability (r = .73-.86). Correlations with measures of general quality of life, generic and diabetes-specific HRQOL, and diabetes burden demonstrated construct validity. Factor analyses identified 3-4 subscales/measure. Participants reported being satisfied with the shortened measures, which took 5-10 minutes to complete. DISCUSSION The new T1DAL measures for parents and partners of people with T1D are reliable, valid, and ready for use in research and clinical settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | - Davida Kruger
- Division of Endocrinology, Diabetes, Bone and Mineral Disorders
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Bates CR, Pallotto IK, Moore RM, Fornander MJ, Covitz LM, Dreyer Gillette ML. Family rules, routines, and caregiver distress during the first year of pediatric cancer treatment. Psychooncology 2021; 30:1590-1599. [PMID: 34019721 DOI: 10.1002/pon.5736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A new diagnosis of pediatric cancer may disrupt family functioning. The current study aimed to describe changes in family rules and routines during the first year of pediatric cancer treatment, and to explore associations with demographics, illness factors, and caregiver distress. METHODS This exploratory mixed-methods, cross-sectional study examined 44 primary caregivers of youth in treatment for a new cancer diagnosis in 2019 and 2020, before the onset of the COVID-19 pandemic. Caregivers completed validated questionnaires assessing demographic and child illness characteristics, psychosocial distress, and cancer-related stressors, and participated in a semi-structured interview about family rules and routines. RESULTS Caregivers reported changes in bedtime, mealtime, and school routines, relaxed behavioral expectations and rules around screen time, and new rules and routines around treatment, medications, and infection control. Caregivers with elevated levels of psychosocial distress reported more changed routines than caregivers with low levels of psychosocial distress. Caregivers who endorsed more cancer-related stressors reported more new rules and routines than those who reported fewer cancer-related stressors. Demographic and illness factors were not significantly associated with the number of changed, new, or stable family rules and routines. CONCLUSIONS Families may relax rules and routines during the first several months of diagnosis, and this may be related to side effects of treatment and limited caregiver capacity. The long-term impact of changes in family rules and routines during cancer treatment warrants further study given that accommodating parenting strategies have been associated with adverse short- and long-term child health and behavior outcomes.
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Affiliation(s)
- Carolyn R Bates
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Isabella K Pallotto
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rachel M Moore
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.,University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Mirae J Fornander
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.,University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Lynne M Covitz
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.,University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Meredith L Dreyer Gillette
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.,University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.,Center for Children's Healthy Lifestyles and Nutrition, Kansas City, Missouri, USA
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55
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Pho AT, Mangal S, Bakken S. Human Papillomavirus Vaccination Among Transgender and Gender Diverse People in the United States: An Integrative Review. Transgend Health 2021; 7:303-313. [PMID: 36033213 PMCID: PMC9398477 DOI: 10.1089/trgh.2020.0174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective This integrative review explores the barriers to and facilitators for human papillomavirus (HPV) vaccination among adult transgender and gender diverse (TGD) people in the United States. Data Source A systematic search of electronic databases included PubMed/MEDLINE, CINAHL, and EMBASE from 1985 to 2020. Inclusion and Exclusion Criteria Inclusion criteria included studies from the United States that described HPV vaccination barriers or facilitators and included adult TGD participants, both quantitative and qualitative studies. Exclusion criteria were studies that reported only HPV vaccine prevalence, non-English/non-U.S. studies, and studies limited to pediatric populations. Data Extraction Two investigators used Covidence software to screen studies and manage data extraction. Quality of the quantitative studies was appraised using a checklist proposed by the Joanna Briggs Institute (JBI); qualitative studies were appraised using quality criteria informed by the literature. Data Synthesis The Social Ecological Model guided the review to organize barriers to and facilitators for HPV vaccination at the patient-, provider-, and system-levels. Results Database searches and hand-searching yielded 843 citations. After screening, eight articles were retained in the review. Seven were cross-sectional studies and one was a qualitative focus-group. All retained quantitative studies met six of the eight JBI quality checklist items. Conclusion The low proportion of TGD participants in the retained studies highlights a gap in knowledge about HPV vaccination among this population. Future studies of HPV vaccination should recruit TGD people to better represent their perspectives.
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Affiliation(s)
- Anthony T. Pho
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sabrina Mangal
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, School of Nursing, Columbia University, New York, New York, USA
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56
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O'Sullivan EJ, O'Grady A, Pawlak K, Kearney JM. A Qualitative Exploration of the Attitudes and Experiences of Polish Breastfeeding Mothers in Ireland. J Hum Lact 2021; 37:370-379. [PMID: 33030993 DOI: 10.1177/0890334420959028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breastfeeding rates in Ireland are among the lowest in the world. Improving the prevalence of breastfeeding is an objective of the Irish Health Service Executive, with the recognition that this would improve public health. Polish people represent the largest immigrant group in Ireland, and Polish women are more likely to initiate breastfeeding than Irish women. RESEARCH AIMS This study had two aims: (1) to describe the breastfeeding experiences and attitudes among Polish mothers living in Ireland, and (2) to explore similarities and differences in infant feeding experiences, attitudes, and beliefs among Polish and Irish women, as perceived by Polish women. METHODS Semi-structured interviews were conducted in Polish with Polish mothers (N = 16) who had lived in Ireland for 10 years or less. Interviews were audio recorded, transcribed, and translated into English. Data were analyzed using qualitative thematic analysis. Coding was a cyclical process; codes were amended and refined through iterative reading of the transcripts. Themes were developed through categorization of codes and via in-depth discussion between two analysts. RESULTS Three major themes were developed after analyzing the data. First, there is no universal correct way to provide support for infant feeding; women would like individualized support based on their infant-feeding decisions. Second, breastfeeding is an inherent part of Polish culture and formula feeding is part of Irish culture. Finally, the Irish social environment is supportive of breastfeeding and breastfeeding in public is acceptable in Ireland. CONCLUSIONS Although the Irish social environment is supportive of breastfeeding, the infant-formula culture is a barrier to breastfeeding. Future research should explore ways to change societal attitudes towards breastfeeding in Ireland.
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Affiliation(s)
- Elizabeth J O'Sullivan
- 8819 School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Agnieszka O'Grady
- 8819 School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Karolina Pawlak
- 8819 School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - John M Kearney
- 8819 School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
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57
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Sood E, Wysocki T, Alderfer MA, Aroian K, Christofferson J, Karpyn A, Kazak AE, Pierce J. Topical Review: Crowdsourcing as a Novel Approach to Qualitative Research. J Pediatr Psychol 2021; 46:189-196. [PMID: 33236059 DOI: 10.1093/jpepsy/jsaa096] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To describe a novel, five-phase approach to collecting qualitative data from hard-to-reach populations using crowdsourcing methods. METHODS Drawing from experiences across recent studies with type 1 diabetes and congenital heart disease stakeholders, we describe five phases of crowdsourcing methodology, an innovative approach to conducting qualitative research within an online environment, and discuss relevant practical and ethical issues. RESULTS Phases of crowdsourcing methodology are: (I) Preparing; (II) Forming Crowds; (III) Collecting Crowdsourced Data; (IV) Coding and Analyzing Crowdsourced Data; and (V) Generating and Disseminating Findings. Iterative feedback from stakeholders is obtained in all five phases. Practical and ethical issues include accessing diverse stakeholders, emotional engagement of crowd participants, responsiveness and transparency of crowdsourcing methodology, and limited personal contact with crowd participants. CONCLUSIONS Crowdsourcing is an innovative, efficient, feasible, and timely approach to engaging hard-to-reach populations in qualitative research.
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Affiliation(s)
- Erica Sood
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children.,Division of Behavioral Health, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Karen Aroian
- University of Central Florida, College of Nursing
| | | | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Jessica Pierce
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Division of Behavioral Health, Department of Pediatrics, Nemours Children's Hospital.,Department of Pediatrics, College of Medicine, University of Central Florida
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Berlin KS, Klages KL, Banks GG, Rybak TM, Ankney RL, Semenkovich K, Keenan ME, Ellis DA, Diaz-Thomas AM, Alemzadeh R, Eddington AR. Toward the Development of a Culturally Humble Intervention to Improve Glycemic Control and Quality of Life among Adolescents with Type-1 Diabetes and Their Families. Behav Med 2021; 47:99-110. [PMID: 31580213 DOI: 10.1080/08964289.2019.1660299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Type-1 Diabetes (T1D) is a prevalent and costly disorder associated with substantial morbidity that differentially impacts low-income and/or minority adolescents and their families. The primary study objective was to develop a guiding model to inform culturally humble interventions for Mid-southern youth with T1D presenting with multiple correlates of suboptimal glycemic control and their families. In order to develop a clinic specific guiding model, conceptualizations of health, the need/type of intervention thought to be most helpful, the optimal structure, and strategies to improve the cultural/regional fit was ascertained from (A) youth with T1D (n = 13) and caregivers (n = 11) via qualitative interviews and, (B) pediatric endocrinologists and nurse practitioners (n = 6), and (C) nurses, diabetes educators, dietitians, and social workers (n = 9) via focus groups. Qualitative themes were synthesized to guide the treatment development model whereby Quality of Life and Glycemic Control would be directly enhanced by interventions to promote Coping, Support, Education, and Improved Psychosocial Functioning and indirectly through improved Adherence and T1D Autonomy delivered in a culturally humble way that affirms youths' T1D identify. These finding suggest that existing evidence-based treatments may provide a great fit for low-income, and/or minority youth with T1D and their families living in the mid-south, provided these interventions are delivered in culturally humble manner.
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Affiliation(s)
- Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
| | | | | | - Tiffany M Rybak
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | | | - Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | | | - Ramin Alemzadeh
- Department of Pediatrics, University of Tennessee Health Science Center
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
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Hilliard ME, Marrero DG, Minard CG, Cao VT, de Wit M, DuBose SN, Verdejo A, Jaser SS, Kruger D, Monzavi R, Shah VN, Wadwa RP, Weinstock RS, Thompson D, Anderson BJ. Design and psychometrics for new measures of health-related quality of life in adults with type 1 diabetes: Type 1 Diabetes and Life (T1DAL). Diabetes Res Clin Pract 2021; 174:108537. [PMID: 33189791 DOI: 10.1016/j.diabres.2020.108537] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
AIMS To use a three-phase process to develop and validate new self-report measures of diabetes-specific health-related quality of life (HRQOL) for adults with type 1 diabetes. We report on four versions of the Type 1 Diabetes and Life (T1DAL) measure for people age 18-25, 26-45, 46-60, and over 60 years. METHODS We first conducted qualitative interviews to guide measure creation, then piloted the draft measures. We evaluated psychometric properties at six T1D Exchange Clinic Network sites via completion of T1DAL and validated measures of related constructs. Participants completed the T1DAL again in 4-6 weeks. We used psychometric data to reduce each measure to 23-27 items in length. Finally, we obtained participant feedback on the final measures. RESULTS The T1DAL-Adult measures demonstrated good internal consistency (α = 0.85-0.88) and test-retest reliability (r = 0.77-0.87). Significant correlations with measures of general quality of life, generic and diabetes-specific HRQOL, diabetes burden, self-management, and glycemic control demonstrated validity. Factor analyses yielded 4-5 subscales per measure. Participants were satisfied with the final measures and reported they took 5-10 min to complete. CONCLUSIONS The strong psychometric properties of the newly developed self-report T1DAL measures for adults with type 1 diabetes make them appropriate for use in clinical research and care.
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Affiliation(s)
- Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States.
| | - David G Marrero
- University of Arizona Health Sciences, Tucson AZ, United States
| | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Viena T Cao
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Davida Kruger
- Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Medical Center, Detroit, MI, United States
| | - Roshanak Monzavi
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - R Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ruth S Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
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Tatum KL, Valenzuela JM, Amirniroumand RA, Brochu PM. Parents' Perceptions of and Responses to School-Based Body Mass Index Screening Programs-A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2021; 91:331-344. [PMID: 33655546 DOI: 10.1111/josh.13003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/11/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Evidence for the effectiveness of state-mandated body mass index (BMI) screening programs in the United States has been inconclusive, and potential unintended consequences of the programs have been debated. The present review aims to understand parents' perceptions of and responses to school-based BMI screening, and to highlight racial/ethnic differences. METHODS We systematically identified studies published January 2003-May 2019 examining parent and/or youth perceptions of and/or responses to US school-based BMI screening. RESULTS A total of 16 studies were included in the review. Studies suggested that while parents largely found BMI screening helpful, they held concerns regarding stigma, lack of privacy, and unhealthy behaviors and attitudes resulting from school-based screening. Furthermore, parents did not frequently follow-up with health care providers, although they reported some healthy behavior changes. CONCLUSIONS Our review highlights existing parent perceptions of school-based BMI screening including the potential for healthy behavior change and important concerns regarding weight-stigma and disturbed eating attitudes/behaviors. Additionally, racial/ethnic differences in screening preferences and experiences were found. Limitations of existing literature included a need to understand youths' experiences and a lack of standardized, reliable outcomes research. Implications for future research and the role of parents, schools, and providers are discussed.
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Affiliation(s)
- Kristina L Tatum
- Doctoral Student, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
| | - Jessica M Valenzuela
- Associate Professor, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
| | - Roya A Amirniroumand
- Doctoral Student, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
| | - Paula M Brochu
- Assistant Professor, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
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Geirhos A, Lunkenheimer F, Holl RW, Minden K, Schmitt A, Temming S, Baumeister H, Domhardt M. Involving patients' perspective in the development of an internet- and mobile-based CBT intervention for adolescents with chronic medical conditions: Findings from a qualitative study. Internet Interv 2021; 24:100383. [PMID: 33816129 PMCID: PMC8008172 DOI: 10.1016/j.invent.2021.100383] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/05/2021] [Accepted: 03/07/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE A user-centered approach is critical for increasing the adherence to and effectiveness of an internet- and mobile-based intervention program. Therefore, potential future intervention users were involved in the development of an internet- and mobile-based cognitive behavioral therapy program (iCBT) for adolescents and young adults (AYA) with chronic medical conditions and comorbid symptoms of anxiety or depression. We aimed to identify challenges and coping strategies of the intended target group, as well as their needs and preferred intervention characteristics for an iCBT program. METHODS Twenty AYA (aged 14-20, 60% females) with either type 1 diabetes (55%), juvenile idiopathic arthritis (25%) or cystic fibrosis (20%) were interviewed in condition-specific focus groups (4-11 participants per group) either via videoconferencing or face-to-face. Transcript verbatim data was analyzed using content analysis. RESULTS Frequently reported disease-specific burdens were among others fear of disease progression, non-acceptance of disease and stressful incidents related to and aversions against medical therapy. Most frequently reported coping strategies included, seeking social support and accepting the disease. Recommendations for the content of an iCBT for comorbid symptoms of anxiety and depression comprised: dealing with disease-related fears and getting advice on health-promoting lifestyles. iCBT characteristics considered preferable by participants were: providing individual feedback by a real-person; implementation of a feature to monitor treatment progress; youthful and varied content presentation; time per session not exceeding 1 h; non-involvement of parents. A mobile-based reminder feature was considered useful, and individual tailoring and self-determination of iCBT content was considered desirable. CONCLUSIONS The findings highlight important patient perspectives and age-specific recommendations which can help design more optimal iCBT interventions for AYA with chronic medical conditions.
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Affiliation(s)
- Agnes Geirhos
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Straße 16, 89081 Ulm, Germany,Corresponding author at: Ulm University, Faculty of Engineering, Computer Science and Psychology, Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Lise-Meitner-Straße 16, 89081 Ulm, Germany.
| | - Frederike Lunkenheimer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Straße 16, 89081 Ulm, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany,German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764 Munich, Neuherberg, Germany
| | - Kirsten Minden
- Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany,German Rheumatism Research Centre, Charitéplatz 1, 10117 Berlin, Germany
| | - Andreas Schmitt
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764 Munich, Neuherberg, Germany,Research Institute of the Diabetes Academy Mergentheim, Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
| | - Svenja Temming
- Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Straße 16, 89081 Ulm, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Straße 16, 89081 Ulm, Germany
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Experiences of patients with haemorrhoidal disease – a qualitative study. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Purpose To obtain a better understanding of the patients’ experiences with haemorrhoidal disease’ impact on their daily life and results of treatment by performing a qualitative study.
Method Individually interviews were conducted among patients with haemorrhoidal disease between 2016 and 2017. Each interview was recorded using an audio recorder and transcribed verbatim. A semi-structured interview guide was used with pre-specified topics, based on a previous conducted literature review. Transcripts were coded and the analysis consisted highlighting passages in the text and assigning each passage a code representing the predefined themes from the interview guide. This resulted in a three-level theme hierarchy: overarching theme, mid-level sub-theme and issues.
Results Fifteen participants underwent individual interviews of whom thirteen were conducted by telephone. The mean age was 60.7 years (35–78); five of them were female (33.3%). Pain and blood loss were the most frequently reported symptoms. Participants indicated that these symptoms were directly associated with emotional burden, daily adjustments and social impact. Before diagnosis with haemorrhoidal disease blood loss resulted in feelings of fear and next in embarrassment during social activities. In daily life participants needed to get up early, used sanitary pads for blood loss and anal ice sticks to reduce pain. Participants were often not completely satisfied with the process and outcome of treatment.
Conclusion This first qualitative study provides detailed insight into the patients’ experiences with haemorrhoidal disease, impact on daily life and results of treatment. This information may be used in daily practice to create awareness among clinicians.
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Skedgell KK, Cao VT, Gallagher KA, Anderson BJ, Hilliard ME. Defining features of diabetes resilience in emerging adults with type 1 diabetes. Pediatr Diabetes 2021; 22:345-353. [PMID: 33034097 DOI: 10.1111/pedi.13136] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/12/2020] [Accepted: 10/04/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Emerging adulthood presents unique challenges for type 1 diabetes (T1D) management. Barriers to achieving optimal diabetes outcomes have been studied but less is known about how emerging adults overcome these challenges. Characterizing emerging adults' protective factors may help guide T1D care during this developmental period. We anticipated identifying social, cognitive, and behavioral protective factors and were open to additional themes. METHODS We analyzed transcripts from semi-structured qualitative interviews with 62 emerging adults (age 18-24 years) with T1D using hybrid thematic analysis. Interviews queried about participants' perspectives on diabetes management challenges, how they overcome challenges, and diabetes resilience. RESULTS We categorized responses into three types of protective factors: (a) Social: Interpersonal strategies such as obtaining tangible support (especially from parents) and emotional support from friends, medical professionals, and community leaders. (b) Cognitive: Believing one can live a "normal" life with T1D, benefit-finding, and viewing diabetes management as an important part of life. (c) Behavioral: Proactively planning for diabetes challenges, maintaining a consistent routine while allowing for flexibility, balancing diabetes and non-diabetes activities, and using diabetes-specific and general technologies to support self-management. CONCLUSIONS The adaptive approaches emerging adults with T1D use to handle the challenges of diabetes include seeking interpersonal support, managing their thoughts about T1D, and taking specific actions to prevent or resolve challenges. Helping emerging adults identify and strengthen their protective factors has potential to affect clinical outcomes. Strengths-based assessment and clinical attention to protective factors may prepare adolescents to successfully manage the challenges of transition to adult care.
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Affiliation(s)
- Kyleigh K Skedgell
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Viena T Cao
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Katherine A Gallagher
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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David JG, Daly BP, Chute D, Katz-Buonincontro J, Clemente I, Lipstein EA. Use of language in the medical decision-making process for biologic therapy: Youth and parent perspectives. Child Care Health Dev 2021; 47:208-217. [PMID: 33274460 DOI: 10.1111/cch.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/12/2020] [Accepted: 11/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Youth with chronic illnesses and their parents make complex medical decisions and also need to develop medical decision-making skills for transition of care to adult care. The use of inclusive (e.g. 'we decided …') and exclusive (e.g. 'they decided …') language in youth and parents' medical decision-making experiences provides insights into perceptions of engagement. This study assessed youth and parents' perceptions of engagement in medical decision-making about biologic therapy. METHODS This exploratory mixed-methods secondary analysis of semistructured interview data included youth with juvenile idiopathic arthritis (JIA) and Crohn's disease (CD) and parents. Iterative qualitative coding of interviews generated themes. Exploratory analyses of variance (ANOVAs) and analyses of covariance (ANCOVAs) investigated differences in language use between youth and parents. RESULTS Parents used more inclusive language in perceptions of medical decision-making experiences than youth, which exploratory analyses found significant (p < 0.05). Youth used more exclusive language than parents in perceptions of medical decision-making. CONCLUSION This research suggests that youth with chronic illnesses perceived limited engagement in medical decision-making, with parents perceiving higher engagement. This presents challenges for youth as they prepare for the transition to adult care. Future research should assess how inclusive and exclusive language use impacts psychosocial and health outcomes.
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Affiliation(s)
- Jennie G David
- Department of Psychology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brian P Daly
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Douglas Chute
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | | | | | - Ellen A Lipstein
- UC Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Butler AM, Hilliard ME, Titus C, Rodriguez E, Al-Gadi I, Cole-Lewis Y, Thompson D. Barriers and Facilitators to Involvement in Children's Diabetes Management Among Minority Parents. J Pediatr Psychol 2021; 45:946-956. [PMID: 31995219 DOI: 10.1093/jpepsy/jsz103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This study aimed to describe parents' perceptions of the factors that facilitate or are barriers to their involvement in children's type 1 diabetes (T1D) management among African American and Latino parents. METHODS African American and Latino parents (N = 28) of 5- to 9-year-old children with T1D completed audio-recorded, semi-structured interviews that were transcribed and analyzed using thematic analysis. Themes were identified that aligned with the theoretically-derived Capability-Opportunity-Motivation-Behavior (COM-B) framework. RESULTS Parents described Capability-based facilitators of parent involvement, including positive stress management, religious/spiritual coping, organizational/planning skills, and diabetes knowledge. Capability-based barriers included child and parent distress. Interpersonal relationships, degree of flexibility in work environments, and access to diabetes technologies were both Opportunity-based facilitators and barriers; and Opportunity-based barriers consisted of food insecurity/low financial resources. Parents' desire for their child to have a "normal" life was described as both a Motivation-based facilitator and barrier. CONCLUSIONS African American and Latino families described helpful and unhelpful factors that spanned all aspects of the COM-B model. Reinforcing or targeting families' unique psychological, interpersonal, and environmental strengths and challenges in multilevel interventions has potential to maximize parental involvement in children's diabetes management.
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Affiliation(s)
| | | | | | | | - Iman Al-Gadi
- Baylor College of Medicine/Texas Children's Hospital
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Ramirez-Hernandez D, Stolwyk RJ, Chapman J, Wong D. The experience and acceptability of smartphone reminder app training for people with acquired brain injury: a mixed methods study. Neuropsychol Rehabil 2021; 32:1263-1290. [PMID: 33563100 DOI: 10.1080/09602011.2021.1879875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Smartphones are useful compensatory memory aids, yet training on how to use them is seldom offered as part of rehabilitation for acquired brain injuries (ABIs). We aimed to explore the experience and acceptability of a smartphone training intervention in 26 people with ABI who participated in a pilot randomized controlled trial comparing three skills training approaches. Participants completed questionnaire ratings and a semi-structured interview, six weeks post-training. Most participants rated the training as enjoyable (80.8%) and reasonable in duration (88.5%). Others reported that more than one training session was needed to learn the app (34.6%). Five themes were identified from qualitative data through thematic analysis: (1) Attitudes and pre-existing factors, (2) Experiencing the intervention, (3) Tailoring the intervention to the individual, (4) Facilitators and barriers to implementation and (5) Enhancing smartphone use in everyday life. These themes were juxtaposed with a theoretical framework of acceptability, which indicated that some elements (e.g., having a structured session and a supportive trainer) contributed to the acceptability of the intervention by minimizing training burden and increasing self-efficacy. Tailoring the training to the individual's technological skills and lifestyle, providing post-training resources and involving family members were identified as factors that could improve intervention acceptability.
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Affiliation(s)
- Diana Ramirez-Hernandez
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Jodie Chapman
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Dana Wong
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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The Development of Health Self-Management Among Adolescents With Chronic Conditions: An Application of Self-Determination Theory. J Adolesc Health 2021; 68:394-402. [PMID: 32713740 DOI: 10.1016/j.jadohealth.2020.05.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the study was to better understand the progressive development of health self-management among adolescents and emerging adults (AEAs) with chronic medical conditions in order to identify opportunities to prepare AEA for transition to adult-based care. METHODS Twenty-three AEA aged 17-20 years with renal, inflammatory bowel, or rheumatologic diseases, and their parents, completed individual semistructured interviews describing each AEA's health self-management. Self-Determination Theory was used to frame interview questions, including the constructs of competence, autonomy, and autonomy support. Transcripts were analyzed using directed content analysis. RESULTS Four themes emerged: Development of Competence in Self-Management; Autonomy: Motivations to Self-Manage; Ways Important Others Support or Hinder Independence; and Normal Adolescent Development. AEA's competency and autonomy increased as they progressed from lack of knowledge about self-management to having knowledge without doing tasks, and, ultimately, to independent completion of tasks. Motivations to self-manage included avoiding sickness/weakness and wanting to engage in activities. Parents and providers supported AEA's autonomy through teaching and transferring responsibility. Parental fear/lack of trust in AEA's ability to self-manage hindered development of AEA's autonomy, producing anxiety. Normal adolescent development impacted timing of self-management task mastery. CONCLUSIONS As AEA gain competence in increasingly complex self-management tasks, they assume greater responsibility for managing their health. Competence and autonomy are facilitated by a feedback loop: AEA successful self-management increased parent trust, enabling the parent to transfer responsibility for more complex tasks. Conversely, parents' fear of the AEA doing wrong hinders transfer of responsibility, limiting competence and autonomy. Health-care providers play an important role in fostering autonomy.
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Kiessling B, Maxwell KB, Buckley J. The sedimented social histories of environmental cleanups: An ethnography of social and institutional dynamics. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2021; 278:111530. [PMID: 33161299 PMCID: PMC10416316 DOI: 10.1016/j.jenvman.2020.111530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 06/11/2023]
Abstract
The scrutiny of environmental cleanups within the United States has been a growing area of interest for social scientists. Scholars have used case studies and modeling to analyze struggles for environmental justice and the economics of stigma associated with Superfund sites. This research has primarily analyzed community perspectives on remediation and removal, such as local strategies for participating in cleanup decisions. There has been less work on analyzing organizational perspectives on the social and institutional dynamics at play during cleanups. Our study addresses this gap by analyzing insights gained through interviewing U.S. Environmental Protection Agency staff who do cleanup work in brownfields, Superfund, and emergency response. This ethnographic research excavates the sedimented layers of social histories of contaminated sites: local and regional contexts, institutional power and authority, and stakeholder relationships and networks. It interrogates how these sedimented social histories affect cleanup decisions, including the temporal and spatial boundaries of sites themselves. We find that the making of relationships is as important to cleanup strategies and outcomes as the scientific and technical aspects of cleanup are. This finding highlights the importance of tools and resources to excavate these social histories during environmental remediation, removal, and decontamination work.
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Affiliation(s)
- Brittany Kiessling
- United States Environmental Protection Agency, 1200 Pennsylvania Ave. NW, Washington, DC, 20004, USA.
| | - Keely B Maxwell
- United States Environmental Protection Agency, 1200 Pennsylvania Ave. NW, Washington, DC, 20004, USA
| | - Jenifer Buckley
- United States Environmental Protection Agency, 1200 Pennsylvania Ave. NW, Washington, DC, 20004, USA
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Oros SM, Christon LM, Barth KS, Berini CR, Padgett BL, Diaz VA. Facilitators and barriers to utilization of medications for opioid use disorder in primary care in South Carolina. Int J Psychiatry Med 2021; 56:14-39. [PMID: 32726568 PMCID: PMC10954352 DOI: 10.1177/0091217420946240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Utilization of medications for opioid use disorder (MOUD) has not been widely adopted by primary care providers. This study sought to identify interprofessional barriers and facilitators for use of MOUD (specifically naltrexone and buprenorphine) among current and future primary care providers in a southeastern academic center in South Carolina. METHOD Faculty, residents, and students within family medicine, internal medicine, and a physician assistant program participated in focus group interviews, and completed a brief survey. Survey data were analyzed quantitatively, and focus group transcripts were analyzed using a deductive qualitative content analysis, based upon the theory of planned behavior. RESULTS Seven groups (N = 46) completed focus group interviews and surveys. Survey results indicated that general attitudes towards MOUD were positive and did not differ significantly among groups. Subjective norms around prescribing and controllability (i.e., beliefs about whether prescribing was up to them) differed between specialties and between level of training groups. Focus group themes highlighted attitudes about MOUD (e.g., "opens the flood gates" to patients with addiction) and perceived facilitators and barriers of using MOUD in primary care settings. Participants felt that although MOUD in primary care would improve access and reduce stigma for patients, prescribing requires improved provider education and an integrated system of care. CONCLUSIONS The results of this study provide an argument for tailoring education to specifically address the barriers primary care prescribers perceive. Results promote the utilization of active, hands-on learning approaches, to ultimately promote uptake of MOUD prescribing in the primary care setting in South Carolina.
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Affiliation(s)
- Sarah M Oros
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Lillian M Christon
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly S Barth
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Carole R Berini
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Bennie L Padgett
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Vanessa A Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
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Mulligan S, Guerin S, McKiernan A, Brown A, Hartnett M, Gray D, Kiernan G. The core features and outcomes of a specialised camp programme for children with life-limiting conditions and their families: A qualitative multi-perspective approach. J Child Health Care 2020; 24:515-528. [PMID: 31594387 DOI: 10.1177/1367493519875593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous research has reported that the families of children with enduring and life-limiting health conditions are at risk of negative psychosocial effects. Adjunct to medical interventions, specialist camp programmes have been developed to promote familial adjustment. However, limited research has been carried out in this area. The aim of this study was to describe the core features and outcomes of a specialised camp programme for children with life-limiting conditions (LLC) and their family. Semi-structured interviews were conducted with four professionals, three volunteers involved in facilitating the programme and two mothers representing families that attended the programme. Multiple perspectives were sought to gain a detailed understanding of the programme and outcomes. Data were analysed through an inductive thematic approach. There was considerable overlap among participant groups on the core features and outcomes of the programme. Thematically, core features are described in terms of familial togetherness, peer interaction, safety and positive experiences. Noted outcomes include lasting memories, continued peer relations for parents and siblings and enhancement of relationships between family members and professionals. Findings suggest that specialised camp programmes may provide families of children with LLC with positive experiences that support adjustment, although further research is required.
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Affiliation(s)
- Shane Mulligan
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - Suzanne Guerin
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | | | - Anna Brown
- LauraLynn, Ireland's Children's Hospice, Dublin, Ireland
| | | | - Dee Gray
- LauraLynn, Ireland's Children's Hospice, Dublin, Ireland
| | - Gemma Kiernan
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
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Abawi O, Welling MS, van den Eynde E, van Rossum EFC, Halberstadt J, van den Akker ELT, van der Voorn B. COVID-19 related anxiety in children and adolescents with severe obesity: A mixed-methods study. Clin Obes 2020; 10:e12412. [PMID: 32920993 PMCID: PMC7685119 DOI: 10.1111/cob.12412] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022]
Abstract
Recent studies report negative mental health effects of the COVID-19 related lockdown measures in general paediatric cohorts. Since obesity is a risk factor for COVID-19 in adults, children (including adolescents) with obesity might perceive themselves to be vulnerable. Using a combined quantitative and qualitative approach, we explored COVID-19 related anxiety in paediatric patients with severe obesity in the Netherlands using semi-structured telephone interviews and the Paediatric Quality of Life Inventory (PedsQL) questionnaire, which had also been completed by the study population at baseline in the year prior to the COVID-19 outbreak. In total, 75 families participated in the semi-structured telephone interviews during the lockdown, April 2020. Characteristics of included patients were: median age 10.5 years (interquartile range = 7.6-15.2); 52% female; mean BMI standard deviation score 3.8 (SD = 1.0). COVID-19 related anxiety was reported for 24/75 (32%) children. The mean decrease in PedsQL score between baseline visit and COVID-19 outbreak did not differ between children for whom anxiety was reported vs those for whom it was not (mean change -10.3 ± 36.5 vs -3.3 ± 24.4, P = .54). Self-imposed strict quarantine measures were taken by 19/75 (25%) families. During follow-up, several families reported that the previous contact alleviated their anxiety. In conclusion, healthcare professionals should address possible COVID-19 related anxiety in children with severe obesity. Addressing COVID-19 related anxiety could mitigate its potential negative effects.
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Affiliation(s)
- Ozair Abawi
- Obesity Center CGG, Erasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Department of Pediatrics, Division of EndocrinologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Mila S. Welling
- Obesity Center CGG, Erasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Department of Pediatrics, Division of EndocrinologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Emma van den Eynde
- Obesity Center CGG, Erasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Elisabeth F. C. van Rossum
- Obesity Center CGG, Erasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Department of Internal Medicine, Division of EndocrinologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Jutka Halberstadt
- Department of Health SciencesFaculty of Science, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Erica L. T. van den Akker
- Obesity Center CGG, Erasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Department of Pediatrics, Division of EndocrinologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Bibian van der Voorn
- Obesity Center CGG, Erasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Department of Pediatrics, Division of EndocrinologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Department of Internal Medicine, Division of EndocrinologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
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Hilliard ME, Minard CG, Marrero DG, de Wit M, Thompson D, DuBose SN, Verdejo A, Monzavi R, Wadwa RP, Jaser SS, Anderson BJ. Assessing Health-Related Quality of Life in Children and Adolescents with Diabetes: Development and Psychometrics of the Type 1 Diabetes and Life (T1DAL) Measures. J Pediatr Psychol 2020; 45:328-339. [PMID: 31665389 DOI: 10.1093/jpepsy/jsz083] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To develop and validate new measures of diabetes-specific health-related quality of life (HRQOL) for people with type 1 diabetes (T1D) that are brief, developmentally appropriate, and usable in clinical research and care. Here we report on the phases of developing and validating the self-report Type 1 Diabetes and Life (T1DAL) measures for children (age 8-11) and adolescents (age 12-17). METHODS Measure development included qualitative interviews with youth and parents (n = 16 dyads) followed by piloting draft measures and conducting cognitive debriefing with youth (n = 9) to refine the measures. To evaluate the psychometric properties, children (n = 194) and adolescents (n = 257) at three T1D Exchange Clinic Network sites completed the age-appropriate T1DAL measure and previously validated questionnaires measuring related constructs. Using psychometric data, the investigators reduced the length of each T1DAL measure to 21 and 23 items, respectively, and conducted a final round of cognitive debriefing with six children and adolescents. RESULTS The T1DAL measures for children and adolescents demonstrated good internal consistency (α = 0.84 and 0.89, respectively) and test-retest reliability (r = 0.78 and 0.80, respectively). Significant correlations between the T1DAL scores and measures of general quality of life, generic and diabetes-specific HRQOL, diabetes burden, and diabetes strengths demonstrated construct validity. Correlations with measures of self-management (child and adolescent) and glycemic control (adolescent only) demonstrated criterion validity. Factor analyses indicated four developmentally specific subscales per measure. Participants reported satisfaction with the measures. CONCLUSIONS The new T1DAL measures for children and adolescents with T1D are reliable, valid, and suitable for use in care settings and clinical research.
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Affiliation(s)
- Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - Charles G Minard
- Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine
| | | | - Maartje de Wit
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine
| | | | | | - Roshanak Monzavi
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of University of Southern California
| | - R Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
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73
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Lim PS, Lang AC, Davies WH. Parent Ethical Concerns About Patient Feedback Measures to Improve Pediatric Clinical Care. J Empir Res Hum Res Ethics 2020; 16:46-53. [PMID: 33118456 DOI: 10.1177/1556264620969327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are limited studies evaluating parental willingness to complete patient feedback measures to improve pediatric clinical care. Parents were randomly assigned to read a vignette that varied by parent satisfaction and type of feedback measure. Parents were generally willing to participate in the hypothetical research study aimed to improve their child's clinical care. Parents in the dissatisfied condition invited to participate in a potentially identifiable interview, compared to an anonymous survey, reported they would be less likely to respond honestly and more likely to feel obligated to participate. Researchers aiming to improve pediatric clinical care should be encouraged to use patient feedback measures that collect potentially identifiable information; however, researchers must consider the potential impact of parent satisfaction on feedback.
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Affiliation(s)
- Paulina S Lim
- 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Amy C Lang
- 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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74
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Cromwell CA, Edwards B, March AL. Improving Access to Palliative Care at a VHA Hospital. Am J Hosp Palliat Care 2020; 38:320-325. [PMID: 33030019 DOI: 10.1177/1049909120963079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Explore veteran-specific factors impacting the acceptance of palliative care services at a Veterans Health Administration hospital. METHODS Prospective, focused one-on-one interviews were conducted with 18 inpatient veterans with an initial consult to receive palliative care services. Domains impacting reception of outpatient palliative care management were evaluated including knowledge deficit, emotional barriers, physical barriers, psychosocial barriers, and physical support. Themes and trends from interview responses were analyzed using a qualitative directed content analysis approach. RESULTS The following themes were discovered to influence veteran participation in outpatient palliative care: Knowledge Deficit, Environmental Factors, Positive Patient Satisfaction, Openness to Technology, and Resiliency. Characteristics of veterans interviewed included an average age of 71 with an average distance from the hospital of 59 miles. CONCLUSION The identification of factors impacting veteran access to palliative care will be used to guide interventions and improve receipt of services. Care of seriously ill veterans may be substantially improved by facilitating access to palliative care.
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Affiliation(s)
| | | | - Alice L March
- 20120Central Texas Veterans Health Care System, Temple, TX, USA
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75
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McDonald KP, Connolly J, Roberts SD, Ford MK, Westmacott R, Dlamini N, Tam EWY, Williams T. The Response to Stress Questionnaire for Parents Following Neonatal Brain Injury. J Pediatr Psychol 2020; 45:1005-1015. [PMID: 32968809 DOI: 10.1093/jpepsy/jsaa059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The Response to Stress Questionnaire-Brain Injury (RSQ-BI) was adapted utilizing a patient-oriented approach, exploring parental stress, coping, and associated mental health outcomes in parents of children with neonatal brain injury. The contributions of social risk, child adaptive functioning, and brain injury severity were also explored. METHODS Using a mixed-method design, this study explored adapted stressor items on the RSQ-BI. Parents and clinicians engaged in semistructured interviews to examine key stressors specific to being a parent of a child with neonatal brain injury. The adapted RSQ-BI was piloted in a parent sample (N = 77, child mean age 1 year 7 months) with established questionnaires of social risk, child adaptive functioning, severity of the child's injury, coping style, and parent mental health. Descriptive statistics and correlations examined parent stress, coping, and their association with parent mental health. RESULTS The final RSQ-BI questionnaire included 15 stressors. Factor analysis showed stressors loaded onto two factors related to (a) daily role stressors and (b) brain injury stressors. Using the RSQ-BI, parents reported brain injury stressors as more stressful than daily role stressors. When faced with these stressors, parents were most likely to engage in acceptance-based coping strategies and demonstrated lower symptoms of parent depression and anxiety. CONCLUSIONS The RSQ-BI provides a valuable adaptation to understand both stressors and coping specific to being a parent of a child with neonatal brain injury. Relevant interventions that promote similar coping techniques are discussed for future care and research.
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Affiliation(s)
- Kyla P McDonald
- Division of Neurology, Department of Psychology, The Hospital for Sick Children.,Department of Psychology, York University
| | | | - Samantha D Roberts
- Division of Neurology, Department of Psychology, The Hospital for Sick Children.,Department of Psychology, York University
| | - Meghan K Ford
- Division of Neurology, Department of Psychology, The Hospital for Sick Children.,Medical Psychiatry Alliance, The Hospital for Sick Children
| | - Robyn Westmacott
- Division of Neurology, Department of Psychology, The Hospital for Sick Children.,Department of Pediatrics, The University of Toronto
| | - Nomazulu Dlamini
- Division of Neurology, Department of Psychology, The Hospital for Sick Children.,Department of Pediatrics, The University of Toronto
| | - Emily W Y Tam
- Department of Pediatrics, The University of Toronto.,Division of Neurology, Department of Pediatrics, The Hospital for Sick Children
| | - Tricia Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children.,Medical Psychiatry Alliance, The Hospital for Sick Children.,Department of Pediatrics, The University of Toronto
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76
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Croucher L, Mertan E, Shafran R, Bennett SD. The Use of Mumsnet by Parents of Young People With Mental Health Needs: Qualitative Investigation. JMIR Ment Health 2020; 7:e18271. [PMID: 32880583 PMCID: PMC7499161 DOI: 10.2196/18271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are high rates of mental health needs in children in the United Kingdom, and parents are increasingly seeking help for their children's needs. However, there is not enough access to child and adolescent mental health services and parents are seeking alternative forms of support and information, often from web-based sources. Mumsnet is the largest web-based parenting forum in the United Kingdom, which includes user-created discussions regarding child mental health. OBJECTIVE This qualitative investigation aimed to explore the emergent themes within the narratives of posts regarding child mental health on Mumsnet and to extrapolate these themes to understand the purpose of Mumsnet for parents of children and young people with mental health needs. METHODS A total of 50 threads from Mumsnet Talk Child Mental Health were extracted. Following the application of inclusion and exclusion criteria, 41 threads were analyzed thematically using the framework approach, a form of qualitative thematic analysis. RESULTS In total, 28 themes were extracted and organized into 3 domains. These domains were emotional support, emotional expression, and advice and information. The results suggested that parents of children with mental health needs predominantly use Mumsnet to offer and receive emotional support and to suggest general advice, techniques, and resources that could be applied outside of help from professional services. CONCLUSIONS This paper discusses the future of health information seeking. Future research is required to establish initiatives in which web-based peer-to-peer support and information can supplement professional services to provide optimum support for parents of children with mental health needs.
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Affiliation(s)
- Lauren Croucher
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Elif Mertan
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Roz Shafran
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sophie D Bennett
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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77
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Kazak AE, Deatrick JA, Scialla MA, Sandler E, Madden RE, Barakat LP. Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): study protocol for a cluster-randomized comparative effectiveness trial. Implement Sci 2020; 15:60. [PMID: 32727493 PMCID: PMC7391817 DOI: 10.1186/s13012-020-01023-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 01/07/2023] Open
Abstract
Background Childhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g., economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation. Method The PAT will be implemented across a national sample of 18 pediatric cancer programs ranging in size (annual new patients) in a mixed methods, comparative effectiveness study, guided by the Interactive Systems Framework for Dissemination and Implementation, comparing two implementation strategies. It is hypothesized that implementation will be more successful at the patient/family, provider, and institutional level when training (strategy I) is combined with implementation expanded resources (strategy II). There are three aims: (1) Refine the two implementation strategies using semi-structured qualitative interviews with 19 stakeholders including parent advocates, providers, pediatric oncology organization representatives, healthcare industry leaders; (2) Compare the two theoretically based and empirically informed strategies to implement the PAT in English and Spanish using a cluster-randomized controlled trial across 18 sites. Stratified by size, sites will be randomized to cohort (3) and strategy (2). Outcomes include adoption and penetration of screening (patient/family), staff job satisfaction/burnout (provider), and cost-effective use of resources consistent with family risk (institution); (3) Based on the results of the trial and feedback from the first and second aim, we will develop and disseminate a web-based PAT Implementation Toolkit. Discussion Use of the PAT across children’s cancer programs nationally can achieve the assessment standard and inform equitable delivery of psychosocial care matched to family need for all patients. Trial Registration ClinicalTrials.gov, NCT04446728, registered 23 June 2020
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Affiliation(s)
- Anne E Kazak
- Nemours Children's Health System, Wilmington, DE, USA. .,Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Janet A Deatrick
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Eric Sandler
- Nemours Children's Clinic, Jacksonville, FL, USA
| | | | - Lamia P Barakat
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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Li PP, Mackey G, Callender C, Dave JM, Olvera N, Alford S, Thompson D. Culinary Education Programs for Children in Low-Income Households: A Scoping Review. CHILDREN-BASEL 2020; 7:children7050047. [PMID: 32414003 PMCID: PMC7278796 DOI: 10.3390/children7050047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/13/2020] [Accepted: 05/06/2020] [Indexed: 11/16/2022]
Abstract
Child obesity in the United States is at an all-time high, particularly among underserved populations. Home-cooked meals are associated with lower rates of obesity. Helping children develop culinary skills has been associated with improved nutrition. The purpose of this study is to report results from a scoping review of culinary education interventions with children from low-income families. Three databases and hand searches of relevant articles were examined. Retained articles met inclusionary criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, as appropriate. A data extraction template was developed. Data were independently extracted and verified. Only nine out of 370 articles met the inclusionary criteria and were included in the review. Most interventions were school-based, used a quasi-experimental design, and recruited minority children. Children-only was the primary intervention focus. Primary outcomes were mostly psychosocial from child self-report. Most interventions focused on children only and were guided by Social Cognitive Theory. Most reported stakeholder involvement; however, type and degree varied. All had an in-person component; only one used technology. Few reported training program leaders. Culinary education programs for children from low-income families could benefit from a broader theoretical grounding, program leader training, and greater parental involvement.
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Affiliation(s)
- Priscilla P. Li
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street Houston, TX 77030, USA; (P.P.L.); (G.M.); (C.C.); (J.M.D.)
| | - Guisela Mackey
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street Houston, TX 77030, USA; (P.P.L.); (G.M.); (C.C.); (J.M.D.)
| | - Chishinga Callender
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street Houston, TX 77030, USA; (P.P.L.); (G.M.); (C.C.); (J.M.D.)
| | - Jayna M. Dave
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street Houston, TX 77030, USA; (P.P.L.); (G.M.); (C.C.); (J.M.D.)
| | - Norma Olvera
- Psychological, Health, and Learning Sciences Department, University of Houston, 3657 Cullen Boulevard Room 491, Houston, TX 77204, USA;
| | - Shana Alford
- Common Threads, 222 W. Merchandise Mart Plaza, Suite 1212, Chicago, IL 60654, USA;
| | - Debbe Thompson
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street Houston, TX 77030, USA; (P.P.L.); (G.M.); (C.C.); (J.M.D.)
- Correspondence: ; Tel.: +1-713-798-7076
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Psihogios AM, Schwartz LA, Ewing KB, Czerniecki B, Kersun LS, Pai ALH, Deatrick JA, Barakat LP. Adherence to Multiple Treatment Recommendations in Adolescents and Young Adults with Cancer: A Mixed Methods, Multi-Informant Investigation. J Adolesc Young Adult Oncol 2020; 9:651-661. [PMID: 32392434 DOI: 10.1089/jayao.2020.0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This mixed methods study sought to assess adolescent and young adult (AYA) adherence to three cancer treatment recommendations (medications, diet, physical activity), and determine the individual, family, and health system factors associated with suboptimal adherence. Methods: In Stage 1, 72 AYA-caregiver dyads completed a validated adherence interview and surveys about individual and family functioning. Matched providers (n = 34 who reported on 61 AYAs) completed global adherence ratings through survey. In Stage 2, a subset (n = 31) completed qualitative interviews. Results: Medication adherence was higher (M = 94.8%) than diet (M = 73.9%) and physical activity (M = 55.4%), although ≥50% demonstrated "Imperfect Adherence" for each subtask. Univariately, AYAs who missed a medication had more depressive symptoms, worse health-related quality of life (HRQOL), and more medication barriers; their families had more financial stress, worse family functioning, and lower self-efficacy. The odds of adhering to medications were lower with worse HRQOL (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.02-1.15) and family functioning (OR = 0.18; 95% CI, 0.04-0.91). The odds of adhering to physical activity and diet were lower with worse family functioning (OR = 0.09; 95% CI, 0.01-0.91) and more barriers (OR = 0.24, CI: 0.10-0.61), respectively. Qualitative themes further supported multilevel influences on AYA adherence. Conclusions: Adherence challenges were identified across medications, diet, and physical activity. Multilevel contextual factors were associated with suboptimal adherence, including poorer HRQOL and family functioning. Findings support the need to improve clinical adherence assessment and develop contextually tailored interventions.
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Affiliation(s)
- Alexandra M Psihogios
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Psychiatry and Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kylie B Ewing
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bryn Czerniecki
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leslie S Kersun
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ahna L H Pai
- Center for the Promotion of Adherence and Self-Management, Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Janet A Deatrick
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lamia P Barakat
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Psychiatry and Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Family Management in Childhood Attention Deficit Hyperactivity Disorder: A Qualitative Inquiry. J Pediatr Nurs 2020; 52:82-90. [PMID: 32005539 DOI: 10.1016/j.pedn.2019.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/02/2019] [Accepted: 09/21/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to better understand how caregivers and families manage childhood Attention Deficit Hyperactivity Disorder (ADHD) in their everyday lives and explore family management factors most relevant to child outcomes, including the child's daily life, condition management effort, condition management ability, and view of condition impact. DESIGN AND METHODS Cross-sectional data from caregivers (N = 50) of children with ADHD (ages 5-12 years) within a large northeastern city were collected, analyzed, and interpreted using directed content analysis and qualitative methods. This inquiry was part of a larger mixed method study which examined the impact of family management on childhood ADHD and how family management factors were related to children's level of impairment across a spectrum of child functioning. RESULTS Thematic summaries based on qualitative descriptive methods highlighted four aspects of family management including: 1) how caregivers contextualized their child's condition in everyday family life, 2) the significant effort required by caregivers to manage their child's ADHD, 3) how caregivers perceived their ability to manage their child's condition, and 4) the impact of ADHD on their child and family's future. CONCLUSIONS Family management is an important concept within pediatric literature and may be extended to further research and practice changes for children with ADHD and their caregivers. PRACTICE IMPLICATIONS Pediatric nurses are at the forefront of working with children and families. Understanding caregiver perspectives in regard to family management is important for strengthening collaborative partnerships with families and improving the care of children with ADHD.
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81
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Chlebowski C, Hurwich-Reiss E, Wright B, Brookman-Frazee L. Using stakeholder perspectives to guide systematic adaptation of an autism mental health intervention for Latinx families: A qualitative study. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1194-1214. [PMID: 31816103 PMCID: PMC7261618 DOI: 10.1002/jcop.22296] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/27/2019] [Accepted: 11/18/2019] [Indexed: 05/30/2023]
Abstract
Embedded within a Hybrid Type 1 randomized effectiveness-implementation trial in publicly funded mental health services, the current study identified stakeholder recommendations to inform cultural adaptations to An Individualized Mental Health Intervention for Autism Spectrum Disorder (AIM HI) for Latinx and Spanish-speaking families. Recommendations were collected through focus groups with therapists (n = 17) and semi-structured interviews with Latinx parents (n = 29). Relevant themes were identified through a rapid assessment analysis process and thematic coding of interviews. Adaptations were classified according to the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to facilitate fit, acceptability, and sustained implementation of AIM HI and classify the content, nature, and goals of the adaptations. Recommended adaptations were classified through FRAME as tailoring training and intervention materials, changing packaging or materials, extending intervention pacing, and integrating supplemental training strategies. Goals for adaptations included improving fit for stakeholders, increasing parent engagement, and enhancing intervention effectiveness. The current study illustrates the process of embedding an iterative process of intervention adaptation within a hybrid effectiveness-implementation trial. The next steps in this study are to integrate findings with implementation process data from the parent trial to develop a cultural enhancement to AIM HI and test the enhancement in a Hybrid Type 3 implementation-effectiveness trial.
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Affiliation(s)
- Colby Chlebowski
- Department of Psychiatry, University of California San Diego, San Diego, California
- Child and Adolescent Services Research Center, San Diego, CA
| | - Eliana Hurwich-Reiss
- Department of Psychiatry, University of California San Diego, San Diego, California
- Child and Adolescent Services Research Center, San Diego, CA
| | - Blanche Wright
- Department of Psychology, University of California Los Angeles, Los Angeles, California
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California San Diego, San Diego, California
- Child and Adolescent Services Research Center, San Diego, CA
- Autism Discovery Institute, Rady Children's Hospital, San Diego, CA
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82
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Woo K, Dowding DW. Decision-making Factors Associated With Telehealth Adoption by Patients With Heart Failure at Home: A Qualitative Study. Comput Inform Nurs 2020; 38:204-214. [PMID: 31929355 PMCID: PMC7138739 DOI: 10.1097/cin.0000000000000589] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Telehealth has been reported to be effective in helping patients with heart failure manage their symptoms at home. Despite this, the adoption rate for telehealth among home care patients with heart failure is low, and there is limited research on reasons for this. This study was undertaken to explore factors associated with patients' decisions to adopt telehealth at home. A qualitative descriptive study underpinned by the Unified Theory of Acceptance Use of Technology model was conducted using semi-structured telephone interviews with patients with heart failure (N = 20) referred for telehealth. Interviews were analyzed using a mixture of deductive and inductive coding. Among the theoretical model elements, the perceived usefulness of the technology (performance expectancy), the availability of clinical/technical support (facilitating conditions), and the opinion of other individuals important to the patient (social influence) were associated with telehealth initiation. However, the ease of use (effort expectancy) was not an associated factor. Other factors such as experience, knowledge, confidence, satisfaction, and attitudes were also associated with the decision. Identification of factors related to higher telehealth initiation rates can be used to inform individualized care planning by nurses. Knowledge of such associations can inform referral process to improve the efficiency and utilization of telehealth.
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Affiliation(s)
- Kyungmi Woo
- Author Affiliations: Columbia University School of Nursing (Dr Woo), New York, NY; and Division of Nursing, Midwifery and Social Work, University of Manchester (Dr Dowding), United Kingdom
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Abstract
Families coping with sickle cell disease (SCD) often face heightened psychosocial risk factors, and research in pediatric SCD has often focused more on this area than resiliency factors. The aim of this study was to gain a better understanding of family resiliency in SCD based on caregiver perspectives. A secondary qualitative analysis was conducted with data from a mixed-methods study of caregivers of youth with SCD (n=22). Qualitative analyses involved coding based on 2 resiliency frameworks, organizing coding categories into themes, and systematically reintegrating these themes into a conceptualization that reflected family resiliency. Themes aligned well with the resiliency frameworks and related to family belief systems and meaning-making around SCD (acceptance of SCD, positive attitude, religious faith), family organization and adaptation (flexibility, stability, social supports), and the importance of communication and problem-solving. Study findings emphasize the importance of assessing resilience in families of youth with SCD and suggest the potential clinical benefits of developing psychosocial interventions based on family strengths.
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84
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Atkins R, Deatrick JA, Gage GS, Earley S, Earley D, Lipman TH. Partnerships to Evaluate the Social Impact of Dance for Health: A Qualitative Inquiry. J Community Health Nurs 2020; 36:124-138. [PMID: 31291771 DOI: 10.1080/07370016.2019.1630963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: The purpose of this study is to determine the social impact and meaning of "Dance for Health" for participants who attended this community driven, intergenerational, physical activity dance program. Methods:This study employed a descriptive, qualitative design and utilized a participatory action research approach to obtain pilot data on fourteen participants between the ages 18 to 75. One focus group discussion with 13 participants and an individual interview with a female participant was conducted. Data collection took place in the community where intervention sessions were held. Audiotapes from one focus group discussion and one in depth individual interview were transcribed by a professional transcription service. The NVIVO computer program was used to organize the data. Directed content analysis of the data took place utilizing primary and secondary coding, category and theme development. Results: Three broad themes emerged representing the social impact of Dance for Health and included: (1) Enhancing the Well-being of the Individual, (2) Fostering Interpersonal Relationships and Connections, (3) Fostering Connections with the Community. Conclusion: A participatory action research approach facilitates successful collaborations between community organizations and academic institutions and can be used to evaluate the impact of physical activity programs on urban community residents. Participants experienced interpersonal and social benefits from regular attendance at the "Dance for Health" program, subsequently contributing to program sustainability. Focused attention to social determinants of physical activity participation can improve physical activity maintenance in residents who reside in under-resourced communities.
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Affiliation(s)
- Rahshida Atkins
- a Rutgers The State University School of Nursing-Camden , Camden , NJ , USA
| | - Janet A Deatrick
- b Professor Emerita of Nursing , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
| | - Gale S Gage
- c Department of Nursing , Essex County College , Newark , NJ , USA
| | | | | | - Terri H Lipman
- e Assistant Dean for Community Engagement, Miriam Stirl Endowed Term Professor of Nutrition, Professor of Nursing of Children , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
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85
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Haileselassie M, Redae G, Berhe G, Henry CJ, Nickerson MT, Tyler B, Mulugeta A. Why are animal source foods rarely consumed by 6-23 months old children in rural communities of Northern Ethiopia? A qualitative study. PLoS One 2020; 15:e0225707. [PMID: 31914130 PMCID: PMC6948827 DOI: 10.1371/journal.pone.0225707] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 11/10/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Animal source foods provide high-quality protein and essential micronutrients within the human diet and are of particular significance for the health and development of children. Despite the availability of domestic livestock in rural households of Ethiopia, the diets of children are often monotonous and mainly cereal-based with low energy and nutrient density. OBJECTIVE Explore barriers and facilitators for the consumption of animal source foods among 6-23 months old children from the rural communities of Northern Ethiopia. METHODS A community-based exploratory qualitative study design was conducted in July through September 2018. A total of eight focus group discussions (56 individuals) and twenty-four qualitative interviews were conducted with mothers who are lactating, fathers, health extension workers, nutrition, and agriculture experts. Purposive sampling technique was used to include study participants based on their potential relevance in delivering a wealth of information. Thematic analysis strategies, a method for identifying, analyzing, and reporting themes within data, were used to code and grouped into related families and synthesize the qualitative data. RESULTS Consumption of animal source foods among 6-23 months old children was very low and the home-reared livestock and their products were mainly used for market purposes. Animal products are consumed during special societal occasions since they are considered as luxury food rather than an essential part of daily children's diet. Lack of nutrition knowledge, high cost of animal source foods, mothers' workload to herd livestock, low household income, low milk production, the poor linkage between health and agriculture sectors, and social norms and beliefs were identified as common barriers. While the presence of nutrition experts, cooking demonstrations, in-kind credit programs, livestock ownership, and government-led stunting reduction programs were the facilitators for the consumption of animal source foods in the study communities. CONCLUSIONS Reduced consumption of animal source foods inadvertently impacted dietary diversity of 6-23 months old children from the study communities. Thus, strengthening social and behavior change communication to promote the consumption of animal source foods, creating opportunities for women to own small livestock for household consumption and provide nutrition education on dietary restriction of animal source foods during religious periods among 6-23 months old children in the rural communities of Northern Ethiopia are recommended.
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Affiliation(s)
- Mekonnen Haileselassie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Tigray National Regional State, Bureau of Science and Technology, Mekelle, Tigray, Ethiopia
| | - Getachew Redae
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gebretsadik Berhe
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Carol J. Henry
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Michael T. Nickerson
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Bob Tyler
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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86
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Pihlaskari AK, Anderson BJ, Eshtehardi SS, McKinney BM, Marrero DG, Thompson D, Hilliard ME. Diabetes disclosure strategies in adolescents and young adult with type 1 diabetes. PATIENT EDUCATION AND COUNSELING 2020; 103:208-213. [PMID: 31447195 DOI: 10.1016/j.pec.2019.08.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Adolescence and young adulthood have social and developmental challenges that can impact type 1 diabetes (T1D) management. New relationships (e.g. friends, schoolmates, dating partners, teachers, employers) introduce opportunities for disclosure of T1D status. Characterizing how adolescents and young adults (AYAs) disclose having T1D to others may help inform clinical strategies to help AYAs ensure their safety by obtaining social support. METHODS As part of a study about diabetes health-related quality of life across the lifespan, transcriptions of semi-structured qualitative interviews with AYAs with T1D (n = 16, age 12-25 years, mean age 18.7 ± 4.9, 38% female) were coded to derive themes related to T1D disclosure. RESULTS Participants described three disclosure strategies: (1) Open Disclosure: shares T1D status in straightforward, direct manner and readily requests diabetes-related support; (2) Disclosure Hesitancy: reluctant to tell others about or actively hides having T1D; (3) Passive Disclosure: discloses T1D via other people (e.g., parents) or through others' observation of T1D management tasks. CONCLUSION AYAs may benefit from guidance in approaches to informing others about having T1D in different contexts. Identifying individuals' use of these strategies can inform education and intervention strategies aimed at engaging AYAs in healthy T1D-related disclosure to seek and receive support.
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Affiliation(s)
- Andrea K Pihlaskari
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave Suite 940, Houston, TX 77030, United States.
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave Suite 940, Houston, TX 77030, United States.
| | - Sahar S Eshtehardi
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave Suite 940, Houston, TX 77030, United States.
| | - Brett M McKinney
- Diabetes Translational Research Center, Indiana University School of Medicine, 410 West 10th St. Suite 2000A, Indianapolis, IN 46202, United States.
| | - David G Marrero
- Diabetes Translational Research Center, Indiana University School of Medicine, 410 West 10th St. Suite 2000A, Indianapolis, IN 46202, United States.
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, United States.
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave Suite 940, Houston, TX 77030, United States.
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Atkins R, Luo R, Wunnenberg M, Ayres C, Lipman TH, Pena-Cardinali V, Hayes L, Deatrick JA. Contributors to Depressed Mood in Black Single Mothers. Issues Ment Health Nurs 2020; 41:38-48. [PMID: 31424976 DOI: 10.1080/01612840.2019.1631414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Participants: A convenience sample of 210 community dwelling Black single mothers ages 18 to 45, who reside in U.S. urban communities.Methods: A descriptive, cross-sectional design was employed. Participants responded to an open-ended question that asked about reasons for depressed mood. A directed approach to content analysis was used to categorize the responses based on existing theoretical formulations and empirical findings about the causes of depression in women. Percentages and frequencies were used to describe the results of the analysis.Findings: A total of 319 usable responses were provided. Collectively and individually the most frequent responses were consistent with Social/Environmental factors such as lack of financial resources (n = 115; 36.05%), followed by Psychological factors such as general cognitive/emotional feelings of stress (n = 60; 18.81%), and parenting stressors or daily hassles (n = 40; 12.54%). Physiologic factors such as a having physiologic or medical conditions were reported less often (n = 14; 4.39%).Conclusions/Implications: Social/Environmental and Psychological factors contribute to depressed mood more often than Physiological factors in Black single mothers. Depression prevention efforts should target the social determinants of mental health in Black single mothers who should be connected with appropriate financial, psychological, educational and social service resources in the community.
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Affiliation(s)
- Rahshida Atkins
- School of Nursing-Camden, Rutgers The State University, Camden, New Jersey, USA
| | - Rufan Luo
- Department of Psychology, Rutgers, The State University of New Jersey-Camden, Camden, New Jersey, USA
| | - Mary Wunnenberg
- School of Nursing-Camden, Rutgers The State University, Camden, New Jersey, USA
| | - Cynthia Ayres
- School of Nursing-Camden, Rutgers The State University, Camden, New Jersey, USA
| | - Terri H Lipman
- School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania, USA
| | | | - Latisha Hayes
- School of Nursing-Camden, Rutgers The State University, Camden, New Jersey, USA
| | - Janet A Deatrick
- School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania, USA
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88
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O'Sullivan TA, Jefferson CG. A Review of Strategies for Enhancing Clarity and Reader Accessibility of Qualitative Research Results. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:7124. [PMID: 32292189 PMCID: PMC7055402 DOI: 10.5688/ajpe7124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/26/2019] [Indexed: 06/11/2023]
Abstract
Objective. To characterize elements of the results section of qualitative research reports that make findings more accessible to readers. Methods. Two analytical methods were used for this review. First, published reviews and textbooks written by experts outlining how to evaluate qualitative research were retrieved and reviewed to identify common elements that enhance clarity of the results section. In the second analysis, the authors analyzed the results sections of a subset of qualitative studies to identify, from a reader's point of view, aspects that enhanced and detracted from communication of the results. Findings. Four elements improve accessibility of the results section for readers of qualitative research reports. Content, the first element, describes what information the reader should look for in the results section. Style of results, the second element, identifies wording choices that improve reader accessibility and understanding. Narrative flow, the third element, describes a results section that flows smoothly and logically. Structural cohesiveness, the final element, outlines effective organization of the results section. Results. While authors take several approaches to the presentation of results in qualitative research reports, some strategies appear to be more common and effective than others. The efficient presentation of results can impact a reader's assessment of the quality and credibility of a study. Identified content and stylistic elements should be considered by authors hoping to make the results of their qualitative research more accessible and comprehensible to readers.
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Sørensen KE, Dreyer P, Rasmussen M, Simonsen CZ, Andersen G. Experiences and needs of patients on the endovascular therapy pathway after acute ischaemic stroke: Being helpless and next to yourself. Nurs Open 2020; 7:299-306. [PMID: 31871714 PMCID: PMC6917975 DOI: 10.1002/nop2.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/08/2019] [Accepted: 09/08/2019] [Indexed: 11/08/2022] Open
Abstract
Aims To explore the experiences and needs of patients on the endovascular therapy pathway. Design A qualitative design using a phenomenological-hermeneutic approach. Methods Semi-structured interviews and participant observations were carried out. Data were collected from April 2016-January 2017. Data were analysed using Ricoeur's theory of interpretation, capturing meaning and ensuring comprehensive understanding. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline. Results The findings of this study show that the impact of stroke goes far beyond physical disability. During the structural analysis, four themes were identified: (1) Acute admission to a stroke unit - an overwhelming and blurred experience. (2) Being helpless and next to yourself. (3) The important care when you worry about dying. (4) Poststroke feelings of loneliness and uncertainty.
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Affiliation(s)
| | - Pia Dreyer
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhus NDenmark
| | - Mads Rasmussen
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhus NDenmark
| | | | - Grethe Andersen
- Department of NeurologyAarhus University HospitalAarhus NDenmark
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90
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Habboush Y, Stoner A, Torres C, Beidas S. Implementing a clinical-educator curriculum to enrich internal medicine residents' teaching capacity. BMC MEDICAL EDUCATION 2019; 19:459. [PMID: 31829204 PMCID: PMC6907213 DOI: 10.1186/s12909-019-1888-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/25/2019] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Physicians-in-training (residents) are typically the primary educators for medical students during clinical clerkships. However, residents are not formally trained to teach or to assess their teaching. The aim of this study was to assess the implementation of a clinical educator rotation aimed at developing residents' competencies related to clinical teaching. METHODS A mixed-methods approach was used to develop and assess the clinical educator rotation at a teaching community hospital. Internal medicine residents who participated in the rotation and consented to the research were assigned to the clinical educator trainee (CET) group, the remaining residents were assigned to the control group. Osteopathic medical students rotating in the medicine service line were invited to participate. The study used descriptive and qualitative analyses to measure primary and secondary outcomes. RESULTS The primary outcome measure showed a positive change in resident knowledge, skills and behaviors in communication, reflection, feedback, precepting, and facilitation. Medical student perceptions of resident teaching skills confirmed the observed changes in CETs. Some CETs continued to practice and build their capacity for teaching after completing the rotation. Qualitatively, we derived four common themes among the data; communication, professional engagement, practice-based learning, and systems-based learning. CONCLUSION Resident teaching capacity was enriched after completing the clinical educator rotation. Other benefits included: enhanced patient communication and education, increased resident confidence, personal satisfaction with training, work life-balance and enhanced career satisfaction. Future research should focus on curricular content, faculty development, and delivery assessment. In addition, research efforts should identify appropriate emerging technologies to include in the curriculum for enhancing teaching capacity.
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Affiliation(s)
- Yacob Habboush
- Department of Internal Medicine, Orange Park Medical Center, 2001 Kingsley Avenue, Orange Park, 32073, FL, USA
| | - Alexis Stoner
- Department of Preventive Medicine and Public Health, Edward Via College of Osteopathic Medicine, Spartanburg, SC, USA
| | - Claribel Torres
- Department of Research and Sponsored Programs, Jacksonville University, Jacksonville, FL, USA
| | - Sary Beidas
- Department of Internal Medicine, Orange Park Medical Center, 2001 Kingsley Avenue, Orange Park, 32073, FL, USA.
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91
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Gray WN, Schaefer MR, Resmini-Rawlinson A, Wagoner ST. Barriers to Transition From Pediatric to Adult Care: A Systematic Review. J Pediatr Psychol 2019; 43:488-502. [PMID: 29190360 DOI: 10.1093/jpepsy/jsx142] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/05/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Transition research in each disease group is developing in its own "silo." A comprehensive review of barriers to transition within and across chronic illness groups is needed to facilitate information sharing and larger-scale efforts to overcome barriers and improve patient care. This study systematically reviews and identifies the barriers to transition from pediatric to adult care across pediatric illness populations. Methods Medline, CINAHL, PsychINFO, Social Services Abstracts, Web of Science, and the Cochrane library databases were searched. Peer-reviewed English articles presenting original data on barriers to transition to adult care, focused on a specific pediatric chronic illness population, and conducted in the United States were included. Study design, population, and barriers were extracted. Barriers were categorized according to the Socioecological Model of Adolescent/Young Adult Readiness to Transition. Articles were evaluated for study quality. Results Fifty-seven articles were included. The most common barriers to transition fell within the "Relationships" domain (e.g., difficulties letting go of long-standing relationships with pediatric providers) followed by "Access/Insurance" (e.g., difficulty accessing/finding qualified practitioners, insurance issues), and "Beliefs/Expectations" (e.g., negative beliefs about adult care). Barriers related to "Knowledge" (e.g., limited patient/caregiver knowledge about medication/illness and the transition process) and "Skills/Efficacy" (e.g., lack of self-management skills) were also common. While relationship barriers were commonly reported by all, some barriers varied by transfer status (pre- vs. posttransfer). Conclusions Each chronic illness group experiences illness-specific challenges but certain barriers transcend chronic illness populations. Suggestions to overcome these barriers are provided.
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92
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Halo or horn? A qualitative study of mothers’ experiences with feeding children during the first year following bariatric surgery. Appetite 2019; 142:104366. [DOI: 10.1016/j.appet.2019.104366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/21/2022]
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93
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Coburn S, Rose M, Streisand R, Sady M, Parker M, Suslovic W, Weisbrod V, Kerzner B, Kahn I. Psychological Needs and Services in a Pediatric Multidisciplinary Celiac Disease Clinic. J Clin Psychol Med Settings 2019; 27:433-443. [DOI: 10.1007/s10880-019-09673-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Segraves RT, Balon R. Editorial Commentary on How to Improve Your Chance to Publish in This and Other Journals. JOURNAL OF SEX & MARITAL THERAPY 2019; 46:197-199. [PMID: 31535932 DOI: 10.1080/0092623x.2019.1665271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Richard Balon
- Case Western Reserve University Cleveland , Ohio Wayne State University Detroit, Michigan
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95
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Kanstrup M, Jordan A, Kemani MK. Adolescent and Parent Experiences of Acceptance and Commitment Therapy for Pediatric Chronic Pain: An Interpretative Phenomenological Analysis. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E101. [PMID: 31500227 PMCID: PMC6770081 DOI: 10.3390/children6090101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
Abstract
Pediatric chronic pain is common and can be related to reduced functioning in many domains for the young person and their parents. Existing psychological treatments such as Acceptance and Commitment Therapy (ACT) have shown to be effective, but improvements are needed. Qualitative approaches can help improve our understanding of treatment processes and outcomes. The aim of the present qualitative interview study was to explore the lived experiences of young people and parents who had participated in ACT for pediatric chronic pain. Four young persons and four parents were interviewed, and data was analyzed using Interpretative Phenomenological Analysis (IPA). Three themes were generated, each comprising two subthemes: (1) 'Warning system', which included experiences from being offered this psychological intervention, and the alternative explanations provided for pain; (2) 'Change and challenges', which suggested the importance of the values-based work, and of individual adaptation; and (3) 'A common language' in which the interaction with others and new ways to communicate around the pain experience were described. Findings highlight the importance of pain education, formulating and acting in line with personal values, and communication around the pain experience, as well as the need for developmental and individual adaptations of interventions.
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Affiliation(s)
- Marie Kanstrup
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77 Stockholm, Sweden.
- Functional Area Medical Psychology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Abbie Jordan
- Centre for Pain Research, University of Bath, Bath, BA2 7AY, UK.
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
| | - Mike K Kemani
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77 Stockholm, Sweden.
- Functional Area Medical Psychology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
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96
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Hilliard ME, Levy W, Anderson BJ, Whitehouse AL, Commissariat PV, Harrington KR, Laffel LM, Miller KM, Van Name M, Tamborlane WV, DeSalvo DJ, DiMeglio LA. Benefits and Barriers of Continuous Glucose Monitoring in Young Children with Type 1 Diabetes. Diabetes Technol Ther 2019; 21:493-498. [PMID: 31287721 PMCID: PMC6708264 DOI: 10.1089/dia.2019.0142] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Continuous glucose monitoring (CGM) has potential to address challenges of type 1 diabetes (T1D) management for young children. CGM use is increasing, yet remains underutilized. Characterizing parents' experiences with CGM can inform clinical strategies to help parents make decisions about diabetes management, overcome obstacles to initiating and sustaining CGM use, and maximize benefits of CGM use in their children's diabetes care. Methods: Transcripts from semistructured qualitative interviews with 55 parents of children aged 1 to <8 years, with T1D duration ≥6 months, and whose child currently or previously used CGM were coded and analyzed to derive themes about their experiences with CGM. Results: Participants were 88% mothers and the mean child age was 5.0 ± 1.5 years. Parents described benefits of CGM use: decreased worry about glucose excursions, improved sleep, increased sense of safety with children who cannot recognize or express symptoms of hypo- or hyperglycemia, and greater comfort with other caregivers, especially using remote monitoring functionality when away from children. Challenges included painful insertions, wearing multiple devices on small bodies, disruptive alerts, data gaps due to lost signals, skin/adhesive problems, and difficulty interpreting the amount of information generated by CGM. For some, the challenges outweighed potential benefits and they stopped CGM use. Conclusions: CGM may address unique challenges of T1D in young children and increase parental comfort with diabetes management, yet there are multiple barriers to initiating or maintaining CGM use. Education and behavioral support to address these benefits and barriers may equip caregivers with skills to address challenges of CGM use.
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Affiliation(s)
- Marisa E. Hilliard
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | - Wendy Levy
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | - Barbara J. Anderson
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | | | | | | | | | | | | | | | - Daniel J. DeSalvo
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | - Linda A. DiMeglio
- Indiana University School of Medicine, Pediatric Endocrinology/Diabetology, Indianapolis, IN
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Wu YP, Deatrick JA, McQuaid EL, Thompson D. A Primer on Mixed Methods for Pediatric Researchers. J Pediatr Psychol 2019; 44:905-913. [PMID: 31260042 PMCID: PMC6705711 DOI: 10.1093/jpepsy/jsz052] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/16/2019] [Accepted: 05/31/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To provide a primer on conducting and analyzing mixed methods research studies, and to provide guidance on the write-up of mixed methods research. METHODS A question and answer format is used to provide an overview of mixed methods research study designs, tasks and considerations related to conducting and analyzing mixed methods studies, and recommendations for the write-up of results for mixed methods studies. RESULTS Individuals who conduct mixed methods research are encouraged to delineate the quantitative, qualitative, and mixed methods features of the research and how these features fit with the overall study questions. Research teams will benefit from including individuals with expertise in qualitative, quantitative, and mixed methods research. Data integration should be a central component to the analysis and write-up of mixed methods research. CONCLUSIONS Increasing the use of mixed methods research in the field of pediatric psychology will contribute to advances in observational studies with children and families, intervention development and evaluation, and creation of new tools and assessments that aim to optimize child and family health outcomes.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah
- Cancer Control and Population Sciences, Huntsman Cancer Institute
| | | | - Elizabeth L McQuaid
- Departments of Psychiatry and Human Behavior and Pediatrics, Brown University, and
| | - Deborah Thompson
- Department of Pediatrics-Nutrition, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine
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98
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Herrmann LL, Deatrick JA. Experiences and Perceptions of Hospitalization and Recovery of Older Adults and Their Caregivers Following Traumatic Brain Injury: "Not Knowing". Res Gerontol Nurs 2019; 12:227-238. [PMID: 31283828 DOI: 10.3928/19404921-20190610-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/22/2019] [Indexed: 11/20/2022]
Abstract
The purpose of the current study is to describe the experience and perceptions of older adults and their caregivers following hospitalization for mild or moderate traumatic brain injury (TBI). Qualitative analysis of data obtained in individual semi-structured interviews with older adults and their caregivers (N = 11, five dyads and one individual) was performed to capture the perceptions and experiences of the survivor and their caregivers about the acute injury, hospitalization, and recovery. Data were collected over a 2-month period following discharge from the hospital. Open coding and constant comparative analysis generated codes that were revised throughout the analysis and reformulated into thematic descriptions. As a result, seven interrelated themes were identified. These findings can be used to implement interventions focused on recovery, communication, teaching, patient outcomes, and satisfaction. [Res Gerontol Nurs. 2019; 12(5):227-238].
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Cushing CC, Fedele DA, Patton SR, McQuaid EL, Smyth JM, Prabhakaran S, Gierer S, Koskela-Staples N, Ortega A, Fleming KK, Nezu AM. Responsive Asthma Care for Teens (ReACT): development protocol for an adaptive mobile health intervention for adolescents with asthma. BMJ Open 2019; 9:e030029. [PMID: 31434777 PMCID: PMC6707700 DOI: 10.1136/bmjopen-2019-030029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Asthma is a leading cause of youth morbidity in the USA, affecting >8% of youth. Adherence to inhaled corticosteroids (ICS) can prevent asthma-related morbidity; however, the typical adolescent with asthma takes fewer than 50% of their prescribed doses. Adolescents are uniquely vulnerable to suboptimal asthma self-management due to still-developing executive functioning capabilities that may impede consistent self-regulation and weaken attempts to use problem solving to overcome barriers to ICS adherence. METHODS AND ANALYSIS The aims of this project are to improve adherence to ICS as an important step towards better self-management among adolescents aged 13-17 years diagnosed with asthma by merging the efficacious behaviour change strategies found in behavioural health interventions with scalable, adaptive mobile health (mHealth) technologies to create the Responsive Asthma Care for Teens programme (ReACT). ReACT intervention content will be developed through an iterative user-centred design process that includes conducting (1) one-on-one interviews with 20 teens with asthma; (2) crowdsourced feedback from a nationally representative panel of 100 adolescents with asthma and (3) an advisory board of youth with asthma, a paediatric pulmonologist and a behavioural health expert. In tandem, we will work with an existing technology vendor to programme ReACT algorithms to allow for tailored intervention delivery. We will conduct usability testing of an alpha version of ReACT with a sample of 20 target users to assess acceptability and usability of our mHealth intervention. Participants will complete a 4-week run-in period to monitor their adherence with all ReACT features turned off. Subsequently, participants will complete a 4-week intervention period with all ReACT features activated. The study started in October 2018 and is scheduled to conclude in late 2019. ETHICS AND DISSEMINATION Institutional review board approval was obtained at the University of Kansas and the University of Florida. We will submit study findings for presentation at national research conferences that are well attended by a mix of psychologists, allied health professionals and physicians. We will publish study findings in peer-reviewed journals read by members of the psychology, nursing and pulmonary communities.
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Affiliation(s)
- Christopher C Cushing
- Clinical Child Psychology Program and Schiefelbusch Institute for LifeSpan Studies, University of Kansas
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Susana R Patton
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - Joshua M Smyth
- Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Selina Gierer
- Division of Allergy and Immunology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Adrian Ortega
- Clinical Child Psychology Program and Schiefelbusch Institute for LifeSpan Studies, University of Kansas
| | | | - Arthur M Nezu
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
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Preferences for cancer survivorship care among adolescents and young adults who experienced healthcare transitions and their parents. J Cancer Surviv 2019; 13:620-631. [DOI: 10.1007/s11764-019-00781-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/26/2019] [Indexed: 11/26/2022]
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