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Eva JJ, Kassab YW, Neoh CF, Ming LC, Wong YY, Abdul Hameed M, Hong YH, Sarker MMR. Self-Care and Self-Management Among Adolescent T2DM Patients: A Review. Front Endocrinol (Lausanne) 2018; 9:489. [PMID: 30459707 PMCID: PMC6232899 DOI: 10.3389/fendo.2018.00489] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 08/06/2018] [Indexed: 01/30/2023] Open
Abstract
Uncontrolled hyperglycaemia can lead to macro- and microvascular complications. Adolescents with T2DM develop similar complications as in adults, including cardiovascular disease, stroke, myocardial infarction, renal insufficiency, and chronic renal failure. Although regular medical follow-up is essential to avoid long-term complications, patients with diabetes mellitus need to perform holistic self-care activities such as opting for a healthy diet, physical activity, self-monitoring, and proper medication. To the best of our knowledge, only a limited number of studies have focused on self-care activities and self-management, including self-care practices, supportive networks, and self-care education programs in adolescent with T2DM. Some of the studies focused on the appreciation of self-care in adolescents with T2DM. This review aimed to analyse self-care and self-management among adolescents with T2DM, and discuss the impact of self-care and self-management on glycaemic control. The difficulties faced by adolescents in self-managing their disease are also highlighted. Such information is essential for healthcare providers in promoting self-care practices among adolescents with T2DM. A thorough search of the literature was performed using three databases: Medline, Google Scholar, and Scopus. The articles focused on self-care and self-management of adolescents patients with T2DM aged between 12 and 19 years old were included. Findings from this review reveal that healthy food adaptation, adequate physical activity, proper medication practices, and regular glucose monitoring are the most common self-care practices. Parental involvement and clinician encouragement also contribute toward the practice of self-care and self-management among the adolescents with T2DM. In conclusion, independent self-management regimens and supportive networks for appropriate administration are vital factors to enhance clinical outcomes of adolescents with T2DM.
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Affiliation(s)
- Jafrin Jahan Eva
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Yaman Walid Kassab
- Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia
| | - Chin Fen Neoh
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
- Collaborative Drug Discovery Research Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Long Chiau Ming
- School of Pharmacy, KPJ Healthcare University College, Negeri Sembilan, Malaysia
- Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Yuet Yen Wong
- Faculty of Pharmacy, Universiti Teknologi MARA, Bertam, Malaysia
| | | | - Yet Hoi Hong
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Lee SY, Shin H. [Self-Management Experiences of the Adolescents with Chronic Kidney Disease]. J Korean Acad Nurs 2018; 48:266-278. [PMID: 29968683 DOI: 10.4040/jkan.2018.48.3.266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to develop a substantive theory on self-management conducted by the adolescents with chronic kidney disease from their lived experience. METHODS Data was collected through in-depth interviews from May to December in 2015 with thirteen adolescents with chronic kidney disease. The data collected were analyzed on the basis of Strauss and Corbin's grounded theory. RESULTS The core of the category found in this study was "overcoming the unstable sense of self-control and integrating disease experience into their life". The causal conditions triggering the central phenomenon were "restriction in daily life" and "manifestation and aggravation of symptom". The central phenomenon in the experience of self-management within the adolescents with chronic kidney disease was "unstable sense of self control". The intervening condition for unstable self control were "micro system support" and "motivational resources". This study found that the adolescents with chronic kidney disease followed a series of strategies when they faced the central phenomenon, including; passive coping, reappraisal of illness, active coping, compliance with treatment, controlling physical activity, and adjusting school life. With these strategic approaches, the adolescents with chronic kidney disease could maintain their active lifestyles and achieve their health behaviors. The process of self-management by these adolescents passed through four phases; limited experience caused by diseases, effort for normalization, reorganizing their daily lives, and integration with daily lives and self-management. CONCLUSION This Study explored the process and experience of self-management of adolescents with chronic kidney disease. These findings can be used for basis for developing substantive theory and nursing intervention strategy for adolescents with chronic kidney diseases.
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Affiliation(s)
- Sug Young Lee
- Hanil University & Presbyterian Theological Seminary, Wanju, Korea
| | - Heesun Shin
- College of Nursing, Dankook University, Cheonan, Korea.
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Janin MMH, Ellis SJ, Lum A, Wakefield CE, Fardell JE. Parents' Perspectives on Their Child's Social Experience in the Context of Childhood Chronic Illness: A Qualitative Study. J Pediatr Nurs 2018; 42:e10-e18. [PMID: 30220375 DOI: 10.1016/j.pedn.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/20/2018] [Accepted: 06/23/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE Many children suffer from a serious chronic illness. These children have greater risks of developing psychosocial difficulties, associated with school absenteeism and missed social opportunities. Through parents' perspectives, this study aimed to gain a holistic understanding of children's social experience in the context of chronic illness. DESIGN AND METHODS We conducted semi-structured interviews with parents of a child with a serious chronic illness exploring their child's school experience. Two researchers coded social experiences using an iterative process, involving regular team discussions. Theoretical thematic analysis and content analysis were both performed, using the social ecological model as a theoretical framework. RESULTS Forty-nine parents participated (43 mothers, 6 fathers; child mean age 11.51 years; 21 female children, 28 male children; 6 different chronic illness groups). According to parents, the main facilitators to the social experience of their children involved parents themselves, the school, social networks and peers, as they were all able to provide social support and opportunities for social development. However, peers were also a source of bullying and peer pressure, and sometimes lacked understanding and empathy. CONCLUSIONS As shown by the social ecological model, social functioning between chronically-ill children and their peers can be influenced by many factors. More specifically, parents have expressed their ability for promoting positive experiences between their children and their peers. Practice Implications Considering the complexity of social functioning, future research and interventions should provide holistic support for children with chronic illnesses.
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Affiliation(s)
- Madeleine Marie Hortense Janin
- Kids Cancer Centre, Sydney Children's Hospital, Randwick 2031, NSW, Australia; School of Women's and Children's Health, UNSW Medicine, Sydney 2052, NSW, Australia.
| | - Sarah Jane Ellis
- Kids Cancer Centre, Sydney Children's Hospital, Randwick 2031, NSW, Australia; School of Women's and Children's Health, UNSW Medicine, Sydney 2052, NSW, Australia.
| | - Alistair Lum
- Kids Cancer Centre, Sydney Children's Hospital, Randwick 2031, NSW, Australia; School of Women's and Children's Health, UNSW Medicine, Sydney 2052, NSW, Australia.
| | - Claire Elizabeth Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick 2031, NSW, Australia; School of Women's and Children's Health, UNSW Medicine, Sydney 2052, NSW, Australia.
| | - Joanna Elizabeth Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick 2031, NSW, Australia; School of Women's and Children's Health, UNSW Medicine, Sydney 2052, NSW, Australia.
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Differences in Self-Perception and School Adjustment According to Time-Use Profiles of Adolescents with Chronic Diseases. ADONGHAKOEJI 2018. [DOI: 10.5723/kjcs.2018.39.4.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Brigden A, Barnett J, Parslow RM, Beasant L, Crawley E. Using the internet to cope with chronic fatigue syndrome/myalgic encephalomyelitis in adolescence: a qualitative study. BMJ Paediatr Open 2018; 2:e000299. [PMID: 30167477 PMCID: PMC6109806 DOI: 10.1136/bmjpo-2018-000299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/22/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Adolescents are increasingly using online resources for health purposes. Previous studies suggest that online provision of information about chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is neither balanced nor consistent with evidence-based practice. However, little is known about how adolescents with CFS/ME use the internet for their condition and whether this is helpful or harmful. METHODS Nine indepth, semistructured, qualitative interviews were conducted with young people (aged 12-17) recruited from a specialist paediatric CFS/ME service. Interviews explored the types of online resources accessed, motivations for doing so and how resource use related to patterns of coping. RESULTS Around the time of diagnosis, participants focused on gathering facts about CFS/ME and therefore used official resources (eg, National Health Service sites) that were considered reliable. This transitioned to exploring patient-led and peer-led spaces: health forums, Facebook and YouTube. Participants accessed these regularly, over the long term, and valued these sites for the personal stories, emotional content and interactive technology. Patient-led and peer-led sites supported coping, encouraging active behavioural management, providing social support and addressing stigmatised aspects of the condition. CFS/ME put a strain on normal adolescent life, such as identity and friendships. Online resources allowed participants to adapt and maintain a sense of normality. CONCLUSIONS Adolescents who use the internet find online resources helpful in seeking information and social support for their condition. Healthcare services should improve their online resources to meet the needs of younger users, providing evidence-based content in ways that are relevant to adolescents and that can meet the needs for social support, as well as providing information.
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Affiliation(s)
- Amberly Brigden
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julie Barnett
- Department of Psychology, University of Bristol, Bristol, UK
| | - Roxanne Morin Parslow
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucy Beasant
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Crawley
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
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56
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Sleep and its relationship to health-related quality of life in children and adolescents with inactive juvenile idiopathic arthritis. EGYPTIAN RHEUMATOLOGIST 2018. [DOI: 10.1016/j.ejr.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Adolescents’ experiences of living with sickle cell disease: An integrative narrative review of the literature. Int J Nurs Stud 2018; 80:20-28. [DOI: 10.1016/j.ijnurstu.2017.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022]
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Kupper F, Peters LWH, Stuijfzand SM, den Besten HAA, van Kesteren NMC. Usefulness of Image Theater Workshops for Exploring Dilemmas in Diabetes Self-Management Among Adolescents. Glob Qual Nurs Res 2018; 5:2333393618755007. [PMID: 29568791 PMCID: PMC5858610 DOI: 10.1177/2333393618755007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 11/12/2017] [Accepted: 11/17/2017] [Indexed: 11/18/2022] Open
Abstract
Diabetes treatment involves a demanding self-management regime that is particularly challenging to adolescents. There is a need for qualitative research into the specific contexts in which adolescents attempt to balance self-management demands with the needs and desires of adolescent life. This study investigates the usefulness of image theater, a participatory form of theater using the body as an expressive tool, to articulate these dilemmas in daily life contexts. We performed a qualitative analysis of two image theater workshops with 12- to 18-year-old adolescents living with diabetes. Our results show three areas of application: (a) unraveling the contextual complexity of lived experience, (b) the articulation of implicit understandings and underlying motives, and (c) the playful exploration of new behavior. We conclude that image theater is a promising method, especially with respect to the opportunities of a more contextual and action-oriented understanding of the trade-offs made in self-management provide for diabetes education and counseling.
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Affiliation(s)
- Frank Kupper
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Louk W H Peters
- Regional Public Health Services South-Limburg, Heerlen, The Netherlands
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Maor D, Mitchem K. Hospitalized Adolescents’ Use of Mobile Technologies for Learning, Communication, and Well-Being. JOURNAL OF ADOLESCENT RESEARCH 2018. [DOI: 10.1177/0743558417753953] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hospitalized adolescents experience significant needs beyond medical treatment. They require emotional support for anxiety and stress, educational support for learning, and social support to reduce isolation. This qualitative study explored the use of mobile technologies to connect students to their schools, classmates, and families in an effort to reduce their isolation and disrupted schooling experiences. We conducted in-depth interviews with 18 hospitalized adolescents aged 12 to 18, 29 teachers, and four parents about the affordances of mobile technologies. We found that mobile technology use in a hospital school was critical to engage adolescents in learning and keep them up-to-date with schoolwork. Mobile technologies should be available and accessible in hospital for adolescent patients for the purpose of meeting their learning, communication, and well-being needs. In particular, mobile technology should be used as a therapeutic tool to overcome hospitalized adolescents’ social isolation and improve their well-being.
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Affiliation(s)
- Dorit Maor
- Murdoch University, Murdoch, Western Australia, Australia
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Rasmussen GS, Kragballe K, Maindal HT, Lomborg K. Experience of Being Young With Psoriasis: Self-Management Support Needs. QUALITATIVE HEALTH RESEARCH 2018; 28:73-86. [PMID: 29192872 DOI: 10.1177/1049732317737311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Psoriasis is a long-term condition with a possibly cumulative life course impairment. Young people struggle to minimize its effects on appearance and functioning. To date, the self-management needs of adolescents suffering from psoriasis have been underinvestigated. Using focus groups and individual interviews, we present an interpretive description of young people's experiences of living with psoriasis, the challenges they face, and the support they need to relieve suffering and come to terms with their condition. This process is characterized by loneliness, the self-imposition of limitations, and the lack of personalized knowledge and communication skills to manage the impact of disease and society's reactions. Our study provides insight into needs of early interventions tailored to address condition, role, and emotional management, involving parent education, peer support, storytelling, and roles for professionals. We argue that further research should involve young people, their parents, and professionals in the development and evaluation of interventions.
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Affiliation(s)
| | | | | | - Kirsten Lomborg
- 2 Aarhus University, Aarhus, Denmark
- 4 Metropolitan University College, Copenhagen, Denmark
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Measuring Outcomes of Psychological Well-Being within Paediatric Health Settings. Healthcare (Basel) 2017; 6:healthcare6010001. [PMID: 29286344 PMCID: PMC5872208 DOI: 10.3390/healthcare6010001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 12/03/2022] Open
Abstract
There are many widely used, validated patient reported outcome measures for physical and mental health. However, capturing outcomes from young people living with chronic health conditions presents a challenge, needing to take the complex interplay of physical and mental health into consideration. The authors found that regularly used outcome measures for child and adolescent emotional well-being in paediatric settings largely fall into two groups: paediatric quality of life and child and adolescent mental health measures. The applicability and potential for use of these measures within this context is discussed. Whilst offering some utility, neither approach leaves sufficient space for young people’s individual experiences of illness and treatment. The scope of using alternative qualitative approaches that capture the rich stories and experiences of young people living with chronic illnesses is considered.
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MacDonald K. Using poetry to explore normalcy as a coping mechanism for young people with cystic fibrosis. J Res Nurs 2017. [DOI: 10.1177/1744987117732615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Living with chronic illness can lead to a spiral of losses including social capital, mobility, physical health and self-worth. One method of coping with a long-term condition is normalcy: psychological bracketing of the illness as a means of coping, and may include the embodiment of treatment as part of the norm. This paper explores the concept of normalcy in young people with cystic fibrosis, disseminated through poetry. The theme of normalcy emerged in a study exploring the experiences of young ‘expert patients’ in partnership with their healthcare team. Observations of outpatient consultations between 10 young people with cystic fibrosis (CF), two carers and the CF team ( n = 11) and subsequent interviews were undertaken to explore perceptions of partnership. Once findings emerged from the original study these were recrafted into poems as an alternative means of dissemination. The poetry from ‘what’s in a norm?’ reflects the young people’s voices and the writer’s interpretation of how normalcy has become embedded into their ways of being. Minimising the impact of CF in this sample was commonplace. Normalcy as a concept emerged strongly in young people with CF in this study. Almost exclusively young people viewed the range of treatments and symptoms as not significant. Further probing revealed a very different picture, one of heavy treatment burden and symptom management. Normalcy may serve as a positive means of coping with the burden of disease. Dissemination of research findings through poetry can enhance nurses’ empathic understanding and provide holistic interpretation of events rather than just summative findings.
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Affiliation(s)
- Kath MacDonald
- Senior Lecturer in Nursing, Queen Margaret University School of Health Sciences, Edinburgh, UK
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Carter B, Ford K, Bray L, Water T, Arnott J, Tichanow C, Dickinson A. "It's not who I am": Children's experiences of growing up with a long-term condition in England, Australia, and New Zealand. J SPEC PEDIATR NURS 2017; 22. [PMID: 28950047 DOI: 10.1111/jspn.12197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/06/2017] [Accepted: 08/27/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Most studies of growing up with a long-term condition focus on older children and adolescents and are condition-specific. Relatively few studies address the experiences of children in middle childhood or consider their experience across a range of conditions, countries, and health settings. This study aimed to explore children's perceptions and understandings of how their lives are shaped (or not) by a long-term condition and its associated management. DESIGN AND METHODS A qualitative, participatory methodology using autodriven photoelicitation interviews (PEIs) with 45 purposively recruited children (6-12 years) with long-term conditions (e.g., hemophilia, arthritis, Crohn's disease), from England, New Zealand, and Australia was utilized. PEI facilitated the construction of inductively derived understandings of the children's experiences as the children had control over creating and then selecting which photographs to discuss with the researcher. RESULTS Interpretive thematic analysis of the interviews and content analysis of the photographs resulted in an overarching theme, "It's not who I am …" but it is part of me, and three subthemes: getting on with my life; the special value of family, friendship, support, and comfort; and things that get in the way of getting on. Across all ages and the three countries, the children actively projected their self-concept as "well" children and they strove, through their photographs and their accompanying explanations of their lives, to emphasize that they were "normal" children. They were active social agents who demonstrated their capacity to shape parts of their lives interdependently with their parents and the requirements of their condition. PRACTICE IMPLICATIONS Pediatric nurses should be aware of the importance that children with long-term conditions place on projecting and protecting their sense of being normal and ensure that when they engage with children that they take account of the children's understandings and efforts to live a life constrained but not limited by the condition.
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Affiliation(s)
- Bernie Carter
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | - Karen Ford
- Centre for Education and Research, Royal Hobart Hospital, Hobart, Australia
| | - Lucy Bray
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | - Tineke Water
- Auckland University of Technology, Auckland, New Zealand
| | - Janine Arnott
- School of Health, University of Central Lancashire, Preston, UK
| | - Cassandra Tichanow
- Paediatric Outpatient Clinic, Royal Hobart Hospital, Hobart, Tasmania, Australia
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Sattoe JNT, Hilberink SR, van Staa A. How to define successful transition? An exploration of consensus indicators and outcomes in young adults with chronic conditions. Child Care Health Dev 2017; 43:768-773. [PMID: 28074484 DOI: 10.1111/cch.12436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/02/2016] [Accepted: 11/17/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this short report, we use data from a previous cohort study to explore the relationship between five out of eight consensus indicators for successful transition and patient-reported outcomes in young adulthood. METHODS Data came from a 6-year cohort study that consisted of a survey among 518 young adults with various chronic conditions and a review of their electronic patient records. Associations between five indicators for successful transition and background variables and patient-reported outcomes were explored with Spearman's r. Significant variables were included in stepwise (logistic) regression analyses with transition outcomes as dependent variables. RESULTS The indicators relate to some extent to better healthcare-related transition outcomes, but not to autonomy in participation. The explained variance of the models varied from 9.7% to 26.4%. The change in explained variance after adding indicators varied from 2% to 16%. CONCLUSIONS The challenge of translating the definition of transition into holistic indicators remains. The current consensus indicators are a good start, but there is more to transition than transfer.
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Affiliation(s)
- J N T Sattoe
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - S R Hilberink
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - A van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Bradley-Klug K, Shaffer-Hudkins E, Lynn C, Jeffries DeLoatche K, Montgomery J. Initial development of the Health Literacy and Resiliency Scale: Youth version. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17538068.2017.1308689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kathy Bradley-Klug
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, FL, USA
| | - Emily Shaffer-Hudkins
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Courtney Lynn
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, FL, USA
| | - Kendall Jeffries DeLoatche
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, FL, USA
| | - Jessica Montgomery
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, FL, USA
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Nilsson C, Lindberg B, Skär L, Söderberg S. Meanings of balance for people with long-term illnesses. Br J Community Nurs 2017; 21:563-567. [PMID: 27809585 DOI: 10.12968/bjcn.2016.21.11.563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to elucidate meanings of balance in everyday life for people with long-term illnesses living at home. People living with long-term illnesses are in need of help and support to manage their daily lives. Twelve adults with extensive needs for help and support were interviewed. A phenomenological hermeneutic interpretation was used to analyse the interview texts. The findings show that balance in everyday life for people with long-term illnesses means striving for independence through care and support in their surroundings. It was also important to be able to choose how their lives would be and to be with others who listened and understood them for who they are. By building a relationship with patients at an early stage of their illnesses, nursing staff have an opportunity to understand what people who are living at home with long-term illnesses need in order to achieve balance in their everyday lives.
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Affiliation(s)
- Carina Nilsson
- Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Birgitta Lindberg
- Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Lisa Skär
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Siv Söderberg
- Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden
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Strinnholm Å, Winberg A, Hedman L, Rönmark E, Lindh V. Reintroduction failure is common among adolescents after double-blind placebo-controlled food challenges. Acta Paediatr 2017; 106:282-287. [PMID: 27859574 DOI: 10.1111/apa.13673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/01/2016] [Accepted: 11/09/2016] [Indexed: 11/29/2022]
Abstract
AIM There has been a lack of research on adolescents who undergo double-blind placebo-controlled food challenges. The aim of this study was to investigate food allergic adolescents' experiences and consequences of double-blind placebo-controlled food challenges. METHODS This qualitative, descriptive interview study included 17 adolescents aged 14-15 years with total elimination of cows' milk, hens' eggs or cod due to food allergies. The participants, who were initially identified from a large population-based cohort study, were interviewed 18 months after completing their challenges. RESULTS The double-blind placebo-controlled food challenge proved to be a complex experience for the adolescents, involving fear of potential reactions and the hope that the food could be reintroduced. Experiences during the challenge were described in three themes: facing fears in a secure environment, being hesitant but curious about unknown tastes and waiting for unknown food reactions. Experiences after the challenge were described in two themes: gaining control and freedom and continuing old habits. A negative challenge was not consistently associated with the reintroduction of the challenged food. CONCLUSION This study highlighted the importance of considering the adolescents' expectations and experiences of the challenge and the reintroduction process to ensure desirable changes in their dietary habits. Follow-ups should be performed regardless of the outcome of challenges.
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Affiliation(s)
- Å Strinnholm
- Department of Public Health and Clinical Medicine Occupational and Environmental Medicine The OLIN Unit Umeå University Umeå Sweden
- Department of Nursing Umeå University Umeå Sweden
| | - A Winberg
- Department of Clinical Sciences Pediatrics Umeå University Umeå Sweden
| | - L Hedman
- Department of Public Health and Clinical Medicine Occupational and Environmental Medicine The OLIN Unit Umeå University Umeå Sweden
- Division of Nursing Department of Health Science Luleå University of Technology Luleå Sweden
| | - E Rönmark
- Department of Public Health and Clinical Medicine Occupational and Environmental Medicine The OLIN Unit Umeå University Umeå Sweden
| | - V Lindh
- Department of Nursing Umeå University Umeå Sweden
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Hart RI, McDonagh JE, Thompson B, Foster HE, Kay L, Myers A, Rapley T. Being as Normal as Possible: How Young People Ages 16-25 Years Evaluate the Risks and Benefits of Treatment for Inflammatory Arthritis. Arthritis Care Res (Hoboken) 2016; 68:1288-94. [PMID: 27040737 PMCID: PMC5042182 DOI: 10.1002/acr.22832] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 12/08/2015] [Accepted: 01/05/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore how young people (ages 16-25 years) with inflammatory arthritis evaluate the risks and benefits of treatment, particularly treatment with biologic therapies. METHODS This qualitative study involved in-depth interviews (n = 44) with young people, trusted others (e.g., parents), and health professionals; audio-recordings (n = 4) of biologic therapy-related consultations; and focus groups (n = 4). Analysis used techniques from grounded theory (open and focused coding, constant comparison, memoing, and mapping). RESULTS Young people aspired to live what they perceived as a "normal" life. They saw treatment as presenting both an opportunity for and a threat to achieving this. Treatment changes were therefore subject to complex and ongoing evaluation, covering administration, associated restrictions, anticipated effects, and side effects. Information sources included expert opinion (of professionals and other patients) and personal experience. Previous treatments provided important reference points. Faced with uncertain outcomes, young people made provisional decisions. Both trusted others and health professionals expressed concern that young people were too focused on short-term outcomes. CONCLUSION Young people value treatment that helps them to live a "normal" life. There is more to this than controlling disease. The emotional, social, and vocational consequences of treatment can be profound and lasting: opportunities to discuss the effects of treatment should be provided early and regularly. While making every effort to ensure understanding of the long-term clinical consequences of taking or not taking medication, the wider impact of treatment should not be dismissed. Only through understanding young people's values, preferences, and concerns can a sustainable balance between disease control and treatment burden be achieved.
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Affiliation(s)
| | | | - Ben Thompson
- Newcastle Hospitals NHS Foundation TrustNewcastle‐upon‐TyneUK
| | - Helen E. Foster
- Newcastle Hospitals NHS Foundation Trust and Newcastle UniversityNewcastle‐upon‐TyneUK
| | - Lesley Kay
- Newcastle Hospitals NHS Foundation TrustNewcastle‐upon‐TyneUK
| | - Andrea Myers
- Northumbria Healthcare NHS Foundation TrustNorth ShieldsUK
| | - Tim Rapley
- Newcastle UniversityNewcastle‐upon‐TyneUK
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Knowles RL, Tadic V, Hogan A, Bull C, Rahi JS, Dezateux C. Self-Reported Health Experiences of Children Living with Congenital Heart Defects: Including Patient-Reported Outcomes in a National Cohort Study. PLoS One 2016; 11:e0159326. [PMID: 27487183 PMCID: PMC4972252 DOI: 10.1371/journal.pone.0159326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/30/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding children's views about living with congenital heart defects (CHDs) is fundamental to supporting their successful participation in daily life, school and peer relationships. As an adjunct to a health and quality of life outcomes questionnaire, we asked school-age children who survived infant heart procedures to describe their experiences of living with CHDs. METHODS In a UK-wide cohort study, children aged 10 to 14 years with CHDs self-completed postal questionnaires that included an open question about having a 'heart problem'. We compared the characteristics of children with more and less severe cardiac diagnoses and, through collaborative inductive content analysis, investigated the subjective experiences and coping strategies described by children in both clinical severity groups. RESULTS Text and/or drawings were returned by 436 children (246 boys [56%], mean age 12.1 years [SD 1.0; range 10-14]); 313 had less severe (LS) and 123 more severe (MS) cardiac diagnoses. At the most recent hospital visit, a higher proportion of the MS group were underweight (more than two standard deviations below the mean for age) or cyanosed (underweight: MS 20.0%, LS 9.9%; cyanosed: MS 26.2%, LS 3.5%). Children in the MS group described concerns about social isolation and feeling 'different', whereas children with less severe diagnoses often characterised their CHD as 'not a big thing'. Some coping strategies were common to both severity groups, including managing health information to avoid social exclusion, however only children in the LS group considered their CHD 'in the past' or experienced a sense of survivorship. CONCLUSIONS Children's reported experiences were not dependent on their cardiac diagnosis, although there were clear qualitative differences by clinical severity group. Children's concerns emphasised social participation and our findings imply a need to shift the clinical focus from monitoring cardiac function to optimising participation. We highlight the potential for informing and evaluating clinical practice and service provision through seeking patient-reported outcomes in paediatric care.
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Affiliation(s)
- Rachel Louise Knowles
- Life Course Epidemiology and Biostatistics Section, Population Policy and Practice Programme, UCL Institute of Child Health, University College London, London, United Kingdom
| | - Valerija Tadic
- Life Course Epidemiology and Biostatistics Section, Population Policy and Practice Programme, UCL Institute of Child Health, University College London, London, United Kingdom
| | - Ailbhe Hogan
- Life Course Epidemiology and Biostatistics Section, Population Policy and Practice Programme, UCL Institute of Child Health, University College London, London, United Kingdom
| | - Catherine Bull
- Cardiac Unit, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Jugnoo Sangeeta Rahi
- Life Course Epidemiology and Biostatistics Section, Population Policy and Practice Programme, UCL Institute of Child Health, University College London, London, United Kingdom
| | - Carol Dezateux
- Life Course Epidemiology and Biostatistics Section, Population Policy and Practice Programme, UCL Institute of Child Health, University College London, London, United Kingdom
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Nunes HEG, Gonçalves ECDA, Vieira JAJ, Silva DAS. Clustering of Risk Factors for Non-Communicable Diseases among Adolescents from Southern Brazil. PLoS One 2016; 11:e0159037. [PMID: 27434023 PMCID: PMC4951139 DOI: 10.1371/journal.pone.0159037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 06/27/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the simultaneous presence of risk factors for non-communicable diseases and the association of these risk factors with demographic and economic factors among adolescents from southern Brazil. METHODS The study included 916 students (14-19 years old) enrolled in the 2014 school year at state schools in São José, Santa Catarina, Brazil. Risk factors related to lifestyle (i.e., physical inactivity, excessive alcohol consumption, smoking, sedentary behaviour and unhealthy diet), demographic variables (sex, age and skin colour) and economic variables (school shift and economic level) were assessed through a questionnaire. Simultaneous behaviours were assessed by the ratio between observed and expected prevalences of risk factors for non-communicable diseases. The clustering of risk factors was analysed by multinomial logistic regression. The clusters of risk factors that showed a higher prevalence were analysed by binary logistic regression. RESULTS The clustering of two, three, four, and five risk factors were found in 22.2%, 49.3%, 21.7% and 3.1% of adolescents, respectively. Subgroups that were more likely to have both behaviours of physical inactivity and unhealthy diet simultaneously were mostly composed of girls (OR = 3.03, 95% CI = 1.57-5.85) and those with lower socioeconomic status (OR = 1.83, 95% CI = 1.05-3.21); simultaneous physical inactivity, excessive alcohol consumption, sedentary behaviour and unhealthy diet were mainly observed among older adolescents (OR = 1.49, 95% CI = 1.05-2.12). Subgroups less likely to have both behaviours of sedentary behaviour and unhealthy diet were mostly composed of girls (OR = 0.58, 95% CI = 0.38-0.89); simultaneous physical inactivity, sedentary behaviour and unhealthy diet were mainly observed among older individuals (OR = 0.66, 95% CI = 0.49-0.87) and those of the night shift (OR = 0.59, 95% CI = 0.43-0.82). CONCLUSION Adolescents had a high prevalence of simultaneous risk factors for NCDs. Demographic (gender and age) and economic (school shift) variables were associated with the most prevalent simultaneous behaviours among adolescents.
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Affiliation(s)
- Heloyse Elaine Gimenes Nunes
- Federal University of Santa Catarina, Research Center in Kinanthropometry and Human Performance, Florianópolis, Santa Catarina, Brasil
| | | | - Jéssika Aparecida Jesus Vieira
- Federal University of Santa Catarina, Research Center in Kinanthropometry and Human Performance, Florianópolis, Santa Catarina, Brasil
| | - Diego Augusto Santos Silva
- Federal University of Santa Catarina, Research Center in Kinanthropometry and Human Performance, Florianópolis, Santa Catarina, Brasil
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Living a normal life in an extraordinary way: A systematic review investigating experiences of families of young people's transition into adulthood when affected by a genetic and chronic childhood condition. Int J Nurs Stud 2016; 62:44-59. [PMID: 27450665 DOI: 10.1016/j.ijnurstu.2016.07.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The transition into adulthood is a developmental stage within the life cycle. A chronic childhood condition can disrupt this transition and create major challenges for both the young person and his or her family. Little is known about families' experiences when living with a rare genetic disease. Therefore, the purpose of this literature review was to understand experiences of families living with a chronic childhood disease during transition into adulthood by integrating evidence. METHOD A systematic review using an integrative approach to data inclusion and analysis comprising qualitative, quantitative and other methodological studies about a range of genetic and chronic childhood diseases was undertaken to identify relevant information. Databases searched were PubMed, Cochrane Library, PsychINFO, CINAHL, and AMED, using the search terms (1) family, caregivers, young adult, adolescent; (2) adolescent development, transitional programs, transition to adult care; (3) muscular dystrophy, spinal muscular atrophy, cystic fibrosis, haemophilia and sickle cell disease. Study findings were critically appraised and analyzed using critical interpretive synthesis. RESULTS A total of 8116 citations were retrieved. 33 studies remained following the removal of duplicates, papers unrelated to genetic childhood conditions and families' experiences of the transition into adulthood. Findings provided three perspectives: (1) the young person's perspective on how to "live a normal life in an extraordinary way" and "manage a chronic and life threatening disease"; (2) the parent perspective on the "complexity of being a parent of a chronically ill child" and "concerns about the child's future" and (3) the sibling perspective on "concerns about the siblings future". As a consequence of the genetic childhood condition, during the ill family members' transition into adulthood all family members were at risk for psychosocial difficulties as they mutually influenced each other. Previous research focused predominately on the individual illness experience, and less emphasis was put on the family perspective. CONCLUSIONS Young people and their family members experienced multiple challenges and not only for the ill individual but also there were consequences and health risks for the whole family system. Therefore, a family systems perspective to research and care is indicated to assist affected families to cope with their complex life and health situation.
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72
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Genuis SK, Bronstein J. Looking for “normal”: Sense making in the context of health disruption. J Assoc Inf Sci Technol 2016. [DOI: 10.1002/asi.23715] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shelagh K. Genuis
- School of Public Health; University of Alberta; 3-094 ECHA, 11405 87 Avenue Edmonton AB T6G 1C9 Canada
| | - Jenny Bronstein
- Department of Information Science; Bar-Ilan University; Ramat Gan 52900 Israel
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73
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Lindberg B, Söderberg S. Standing on their own feet: Experiences of young people living with Type 1 diabetes when entering adulthood — A qualitative study. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/20573316.2016.1170406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Birgitta Lindberg
- Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Siv Söderberg
- Department of Nursing Sciences, Mid Sweden University, Campus, Östersund, Sweden
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Apers S, Rassart J, Luyckx K, Oris L, Goossens E, Budts W, Moons P. Bringing Antonovsky's salutogenic theory to life: A qualitative inquiry into the experiences of young people with congenital heart disease. Int J Qual Stud Health Well-being 2016; 11:29346. [PMID: 26942908 PMCID: PMC4778384 DOI: 10.3402/qhw.v11.29346] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 01/29/2023] Open
Abstract
Objective Antonovsky coined sense of coherence (SOC) as the central concept of his salutogenic theory focusing on the origins of well-being. SOC captures the degree to which one perceives the world as comprehensible, manageable, and meaningful. Life events and resources are considered to be the building blocks of a person's SOC. However, mainly quantitative studies have looked into the role of life events and resources. Therefore, the present study aims to gain a deeper insight into the experiences of patients with congenital heart disease (CHD) regarding resources and life events. Method For this qualitative study, patients were selected from the sample of a preceding study on development of SOC (n = 429). In total, 12 young individuals with CHD who had either a weak (n = 6) or strong SOC (n = 6) over time were interviewed (8 women, median age of 20 years). Data analysis was based on the constant comparative method as detailed in the Qualitative Analysis Guide of Leuven. Commonalities and differences between patients from both groups were explored. Results The following themes emerged: (1) self-concept; (2) social environment; (3) daytime activities; (4) life events and disease-related turning points; (5) stress and coping; and (6) illness integration. Additionally, the degree of personal control was identified as an overarching topic that transcended the other themes when comparing both groups of patients. Conclusion These results may have implications for the structure and content of interventions improving well-being in young people with CHD.
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Affiliation(s)
- Silke Apers
- Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium
| | - Jessica Rassart
- School Psychology and Child and Adolescent Development, KU Leuven-University of Leuven, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Koen Luyckx
- School Psychology and Child and Adolescent Development, KU Leuven-University of Leuven, Leuven, Belgium
| | - Leen Oris
- School Psychology and Child and Adolescent Development, KU Leuven-University of Leuven, Leuven, Belgium
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, KU Leuven-University of Leuven, Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, Gothenburg University, Gothenburg, Sweden;
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75
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Sims-Gould J, Race D, Hamilton L, MacDonald H, Mulpuri K, McKay H. 'I fell off and landed badly': Children's experiences of forearm fracture and injury prevention. J Child Health Care 2016; 20:98-108. [PMID: 25326540 PMCID: PMC5059151 DOI: 10.1177/1367493514551311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Forearm fractures are one of the most common injuries sustained by children. Our descriptive study addressed, from the perspective of a child, the following research objectives: (1) to describe their fracture experience and (2) to describe how fractures might be prevented. Photovoice is a unique research strategy by which people create and discuss photographs. This technique has been used to elicit the perspectives of those whose voices are often 'not heard' in research, like children. Participants were recruited from a larger three-year prospective trial and included 10 boys (12.3 ± 1.6 years) and 7 girls (11.3 ± 1.6 years). We asked participants to take pictures to explain where their injury occurred (place), what they were doing at the time (context) and how the fracture had happened (mechanism). We also used semi-structured interview techniques. The following key themes emerged from our interviews: (1) the built environment as a key factor that 'caused' their fracture, (2) the fracture experienced as a journey not an event and (3) strategies to prevent fractures. A simple clinical step to potentially reduce subsequent fractures will be for clinicians to have a brief conversation with their young patients and to listen to the child's personal preventive strategies.
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Affiliation(s)
- Joanie Sims-Gould
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas Race
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Heather MacDonald
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Kishore Mulpuri
- Department of Orthopaedic Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Heather McKay
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Tricco AC, Soobiah C, Antony J, Cogo E, MacDonald H, Lillie E, Tran J, D'Souza J, Hui W, Perrier L, Welch V, Horsley T, Straus SE, Kastner M. A scoping review identifies multiple emerging knowledge synthesis methods, but few studies operationalize the method. J Clin Epidemiol 2016; 73:19-28. [PMID: 26891949 DOI: 10.1016/j.jclinepi.2015.08.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/05/2015] [Accepted: 08/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To systematically identify, define, and classify emerging knowledge synthesis methods through a scoping review. STUDY DESIGN AND SETTING MEDLINE, CINAHL, EMBASE, PsycINFO, the Cochrane Methodology Register, the Cochrane Database of Systematic Reviews, Social Sciences Abstracts, Library and Information Science Abstracts, Philosopher's Index, and Education Resources Information Center were searched to identify articles reporting emerging knowledge synthesis methods across the disciplines of health, education, sociology, and philosophy. Two reviewers independently selected studies and abstracted data for each article. RESULTS In total, 409 articles reporting on 25 knowledge synthesis methods were included after screening of 17,962 titles and abstracts and 1,010 potentially relevant full-text articles. Most of the included articles were an application of the method (83.9%); only 3.7% were seminal articles that fully described the method (i.e., operationalized the steps). Most of the included articles were published after 2005. The methods were most commonly used across the fields of nursing, health care science and services, and health policy. CONCLUSION We found a lack of guidance on how to select a knowledge synthesis method. We propose convening an international group of leaders in the knowledge synthesis field to help clarify emerging approaches to knowledge synthesis.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada
| | - Charlene Soobiah
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Jesmin Antony
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Elise Cogo
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Heather MacDonald
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Erin Lillie
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Judy Tran
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Jennifer D'Souza
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Wing Hui
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Laure Perrier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Vivian Welch
- Bruyère Research Institute, 85 Primrose Avenue, Ottawa, Ontario K1R 6M1, Canada
| | - Tanya Horsley
- Research Unit, Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario K1S 5N8, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada; Department of Geriatric Medicine, Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada.
| | - Monika Kastner
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada
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Benson A, Lambert V, Gallagher P, Shahwan A, Austin JK. "I don't want them to look at me and think of my illness, I just want them to look at me and see me": Child perspectives on the challenges associated with disclosing an epilepsy diagnosis to others. Epilepsy Behav 2015; 53:83-91. [PMID: 26520881 DOI: 10.1016/j.yebeh.2015.09.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/15/2015] [Accepted: 09/20/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Disclosure of a concealable stigmatized identity, such as epilepsy, to those external to the nuclear family can be complex. Among children living with epilepsy (CWE), diagnosis disclosure has been identified as a quality-of-life issue and a source of psychosocial distress. Despite this, limited empirical evidence exists regarding the disclosure experiences of CWE. This study aimed to identify the contextual factors that act as challenges for CWE when disclosing their epilepsy diagnosis to others external to the nuclear family. METHOD This qualitative exploratory study consisted of individual interviews with 29 CWE (aged 6-16 years; mean age=11.17 years; S.D.=2.85). Participants were recruited from a tertiary referral unit in the neurology department of a pediatric hospital and through a national epilepsy association. Interviews were audiotaped and transcribed verbatim. Data were thematically analyzed. FINDINGS The five main challenges to epilepsy diagnosis disclosure for children were: 1) CWE's desire for normalcy, 2) out of sight but in the mind, 3) contending with negative responses to disclosure, 4) the complexity of epilepsy, and 5) self and others' perceptions of epilepsy. DISCUSSION These findings provide valuable insight into the factors that present difficulties and impede epilepsy diagnosis disclosure among CWE. Such knowledge is important in informing engagements between health-care professionals (HCPs) and CWE. In particular, HCPs should remain cognisant of the challenges CWE face as they: (i) strive for normalcy and (ii) grapple with comprehending their complex neurological condition. Tackling such disclosure challenges could serve to enhance life quality, improve CWE's openness with others about epilepsy, and consequently work toward reducing epilepsy-related misconceptions and stigma.
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Affiliation(s)
- Ailbhe Benson
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland
| | - Veronica Lambert
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland.
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland
| | - Amre Shahwan
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - Joan K Austin
- Indiana University School of Nursing, Indiana University Purdue University Indianapolis, 3040 N Ramble Road West, Bloomington, IN 47408, USA
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Khair K, Meerabeau L, Gibson F. Self-management and skills acquisition in boys with haemophilia. Health Expect 2015; 18:1105-13. [PMID: 23711015 PMCID: PMC5060849 DOI: 10.1111/hex.12083] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is an increasing prevalence of children/young people with long-term conditions (LTC) in the UK due to improvements in health-care management and delivery. These children are often involved, from an early age, in their own care and management; yet, there are little data to support how or when they develop the necessary skills and knowledge to become competent at this care. OBJECTIVE This study aimed to understand self-management of haemophilia, from a child's perspective, in the 21st century in the UK where intensive prophylactic therapy is given from early childhood. DESIGN A qualitative study using grounded theory to evaluate life-experiences of children and young people with haemophilia. SETTING AND PARTICIPANTS Thirty boys aged 4-16 with severe haemophilia treated at a single paediatric haemophilia care centre were interviewed at home or in a focus group. INTERVENTION/VARIABLES Multimethod qualitative research including age-appropriate research tools (draw and write, photo-elicitation and interviews) to facilitate data collection from children. RESULTS Boys develop self-management skills over time. They learn from health-care professionals, their parents and other family members with haemophilia. DISCUSSION Self-management skills (bleed recognition, self-infusion, self and medicines management, pain and risk management and conceptualizing preventative therapy) are developed through experiential learning and individualized education, and not through formalized expert patient programmes. CONCLUSION The boys in this study have benefited from early prophylactic factor replacement therapy. They develop skills in haemophilia and self-management at a relatively young age and are experts in their own haemophilia care.
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Affiliation(s)
- Kate Khair
- Great Ormond Street Hospital for Children NHS Foundation Trust LondonLondonUK
- University of GreenwichLondonUK
| | | | - Faith Gibson
- Great Ormond Street Hospital for Children NHS Foundation Trust and London South Bank UniversityLondonUK
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Cartwright T, Fraser E, Edmunds S, Wilkinson N, Jacobs K. Journeys of adjustment: the experiences of adolescents living with juvenile idiopathic arthritis. Child Care Health Dev 2015; 41:734-43. [PMID: 25287720 DOI: 10.1111/cch.12206] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is one of the most common diseases of childhood causing pain, swelling of joints and reduced mobility. Previous research has focused on the challenges and psychosocial impact of JIA, but there has been limited attention given to how young people adjust and adapt to living with a long-term condition such as JIA. The aim of this qualitative study was therefore to explore adolescents' experiences of living with JIA, with particular focus on the process of adjustment. METHODS Ten adolescents (7 female, 3 male) aged 13-17 years with good treatment adherence were recruited from an adolescent arthritis clinic. In-depth interviews were conducted, and data were analysed by two researchers independently using interpretative phenomenological analysis. RESULTS These adolescents described the physical and psychosocial 'burden of living with JIA' and the challenges faced by an underlying preoccupation 'to be a normal teenager'. However, their accounts also revealed ways in which they regained agency and developed 'resilience through taking control' over their lives. This resilience helped the adolescents re-establish a sense of well-being through an ongoing process of 'acceptance and self-growth'. CONCLUSIONS Although much research has adopted a deficit model that focuses on adjustment problems, the current study highlights the resourcefulness of young people in managing the challenges of living with a long-term condition. These experiences of successful adjustment can be used as the basis of positive, strength-based intervention approaches for adolescents with arthritis to enhance resilience and well-being.
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Affiliation(s)
- T Cartwright
- Department of Psychology, University of Westminster, London, UK
| | - E Fraser
- Medical Paediatric Psychology Service, Crosshouse Hospital, Kilmarnock, Scotland
| | - S Edmunds
- Department of Psychology, University of Westminster, London, UK
| | - N Wilkinson
- Oxford Paediatric and Adolescent Rheumatology Centre (OxPARC), Nuffield Orthopaedic Centre, Oxford, UK
| | - K Jacobs
- Oxford Paediatric and Adolescent Rheumatology Centre (OxPARC), Nuffield Orthopaedic Centre, Oxford, UK.,Department of Paediatric Psychology, The Children's Hospital, Oxford, UK
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Al-Yateem N, Attia AKN, AL-Yafei T, Mohammed A, Mahmood B. The impact of a school nurse intervention on adolescents' knowledge about healthy eating. ACTA ACUST UNITED AC 2015. [DOI: 10.12968/bjsn.2015.10.6.280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nabeel Al-Yateem
- Assistant Professor, University of Sharjah, College of Health Sciences, Department of Nursing, United Arab Emirates
| | - Amal Kadry Nicola Attia
- Professor of Nursing, University of Sharjah, College of Health Sciences, Department of Nursing, United Arab Emirates
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Hart RI, Foster HE, McDonagh JE, Thompson B, Kay L, Myers A, Rapley T. Young people's decisions about biologic therapies: who influences them and how? Rheumatology (Oxford) 2015; 54:1294-301. [PMID: 25661469 PMCID: PMC4473768 DOI: 10.1093/rheumatology/keu523] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/03/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Young people with inflammatory arthritis can have severe disease warranting biologic therapy. They face complex treatment decisions, with profound consequences. This study aimed to explore the influence of individuals outside the care team (trusted others) on the treatment decisions made by young people, in particular their decisions about biologic therapies. METHODS Young people (16-25 years of age) with inflammatory arthritis and experience of treatment decision making were recruited from three NHS Hospital Trusts. Twenty-five were interviewed, plus 11 trusted others identified by young people as being involved in their decision making, as well as 6 health professionals. The data were analysed using coding, memoing and mapping techniques and the findings were tested through a series of focus groups. RESULTS Young people initially emphasized their decisional autonomy, typically describing people other than health professionals as limited in influence. However, discussions revealed the involvement--in deliberation and enactment--of a range of other people. This cast of trusted others was small and largely consistent; mothers played a particularly prominent role, providing cognitive, practical and emotional support. Members of the wider cast of trusted others were involved in more limited but still significant ways. CONCLUSION Young people claim autonomy but other people enable this. The network of relationships in which they are embedded is distinctive and evolving. Mothers play a supporting role well into early adulthood; in contrast, partners are involved in far more limited ways. As such, the applicability of adult models of decision making is unclear. This must be taken into account if the support provided by professionals is to be optimally tailored to young people's needs.
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Affiliation(s)
- Ruth I Hart
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Helen E Foster
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Janet E McDonagh
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Ben Thompson
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Lesley Kay
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Andrea Myers
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Institute of Cellular Medicine, Newcastle University, Newcastle, School of Immunity and Infection, University of Birmingham, Birmingham, Musculoskeletal Services, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, and Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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Ichikawa CRDF, Bousso RS, Misko MD, Mendes-Castillo AMC, Bianchi ERF, Damião EBC. Cultural adaptation of the Family Management Measure among families of children and adolescents with chronic diseases. Rev Lat Am Enfermagem 2015; 22:115-22. [PMID: 24553711 PMCID: PMC4292687 DOI: 10.1590/0104-1169.2978.2379] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 09/23/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to perform the cultural adaptation of the Family Management Measure into the Brazilian Portuguese language. METHOD the method complied with international recommendations for this type of study and was composed of the following steps: translation of the instrument into the Portuguese language; reaching consensus over the translated versions; assessment by an expert committee; back translation; and pretest. RESULTS these stages enabled us to obtain conceptual, by-item, semantic, idiomatic, and operational equivalences, in addition to content validation. CONCLUSION the Family Management Measure is adapted to the Brazilian Portuguese language and that version is named Instrumento de Medida de Manejo Familiar.
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Affiliation(s)
- Carolliny Rossi de Faria Ichikawa
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, LondrinaPR, Brazil, MSc, Assistant Professor, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Regina Szylit Bousso
- Universidade de São Paulo, Escola de Enfermagem, São PauloSP, Brazil, PhD, Associate Professor, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maira Deguer Misko
- Universidade Federal de São Carlos, São Carlos, Brazil, PhD, Professor, Universidade Federal de São Carlos, São Carlos, Brazil
| | | | - Estela Regina Ferraz Bianchi
- Universidade de São Paulo, Escola de Enfermagem, São PauloSP, Brazil, PhD, Associate Professor, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Elaine Buchhorn Cintra Damião
- Universidade de São Paulo, Escola de Enfermagem, São PauloSP, Brazil, PhD, Professor, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
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Lambert V, Keogh D. Striving to live a normal life: a review of children and young people's experience of feeling different when living with a long term condition. J Pediatr Nurs 2015; 30:63-77. [PMID: 25450440 DOI: 10.1016/j.pedn.2014.09.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/10/2014] [Accepted: 09/13/2014] [Indexed: 11/15/2022]
Abstract
This paper presents a review of findings from qualitative studies on children's experience of feeling different when living with the long term conditions; diabetes, epilepsy and asthma. Following electronic database and hand searches of reference lists of identified papers, eighteen studies were selected for inclusion in the review. These studies revealed three common themes; participation in everyday life-restrictions and adjustments; treatment regimens-constraining and enabling; and communication-disclosure, stigma and support. Across these themes it was evident that children felt different physically and socially and they grappled constantly with balancing the dilemma of feeling and acting normal or feeling, being and revealing difference.
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Affiliation(s)
- Veronica Lambert
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland.
| | - Deborah Keogh
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland
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Meaux JB, Green A, Nelson MK, Huett A, Boateng B, Pye S, Schmid B, Berg A, LaPorte K, Riley L. Transition to Self-Management after Pediatric Heart Transplant. Prog Transplant 2014; 24:226-33. [DOI: 10.7182/pit2014911] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Context Little is known about adolescent transition to self-management after heart transplant. This gap in knowledge is critically important because the consequences of poor self-management are costly and life-threatening, often resulting in nonadherence, rejection, repeated hospitalizations, and poor quality of life. Objective To explore how adolescents and parents perceive their roles in self-management, and how adolescents integrate self-management into their daily lives and navigate the transition from parent-dominated to self-management. Design Qualitative descriptive design, using online focus groups. Setting Online focus groups using itracks, an online qualitative software program. Participants A purposive sample of 4 adolescents, 13 to 21 years old, who were at least 6 months posttransplant, and of 6 parents of adolescent heart transplant recipients. Results Several parallel themes emerged from the parent and adolescent online focus groups. Managing medications was the predominant theme for both parents and adolescents. For the remaining themes, parents and adolescents expressed similar ideas that were categorized into parallel themes, which included staying on top of things/becoming independent, letting them be normal/being normal, and worries and stressors. Conclusions The transition to self-management after heart transplant was a clear goal for both parents and adolescents. The transition is a shared responsibility between parents and adolescents with a gradual shift from parent-directed to self-management. The process of transition was not linear or smooth, and in several instances, parents described efforts to transfer responsibility to the adolescent only to take it back when complications arose. Additional research with a larger sample is needed in order to fully understand adolescent heart transplant recipients' transition to self-management.
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Affiliation(s)
- Julie B. Meaux
- University of Central Arkansas, Conway (JBM), Arkansas Children's Hospital (AG, MKN, AH, SP, BS) and University of Arkansas for Medical Sciences (AG, BB), Little Rock, Arkansas, Children's Healthcare of Atlanta (AB, KL, LR), Georgia
| | - Angela Green
- University of Central Arkansas, Conway (JBM), Arkansas Children's Hospital (AG, MKN, AH, SP, BS) and University of Arkansas for Medical Sciences (AG, BB), Little Rock, Arkansas, Children's Healthcare of Atlanta (AB, KL, LR), Georgia
| | - Mary Kathryn Nelson
- University of Central Arkansas, Conway (JBM), Arkansas Children's Hospital (AG, MKN, AH, SP, BS) and University of Arkansas for Medical Sciences (AG, BB), Little Rock, Arkansas, Children's Healthcare of Atlanta (AB, KL, LR), Georgia
| | - Amy Huett
- University of Central Arkansas, Conway (JBM), Arkansas Children's Hospital (AG, MKN, AH, SP, BS) and University of Arkansas for Medical Sciences (AG, BB), Little Rock, Arkansas, Children's Healthcare of Atlanta (AB, KL, LR), Georgia
| | - Beatrice Boateng
- University of Central Arkansas, Conway (JBM), Arkansas Children's Hospital (AG, MKN, AH, SP, BS) and University of Arkansas for Medical Sciences (AG, BB), Little Rock, Arkansas, Children's Healthcare of Atlanta (AB, KL, LR), Georgia
| | - Sherry Pye
- University of Central Arkansas, Conway (JBM), Arkansas Children's Hospital (AG, MKN, AH, SP, BS) and University of Arkansas for Medical Sciences (AG, BB), Little Rock, Arkansas, Children's Healthcare of Atlanta (AB, KL, LR), Georgia
| | - Barbara Schmid
- University of Central Arkansas, Conway (JBM), Arkansas Children's Hospital (AG, MKN, AH, SP, BS) and University of Arkansas for Medical Sciences (AG, BB), Little Rock, Arkansas, Children's Healthcare of Atlanta (AB, KL, LR), Georgia
| | - Alex Berg
- University of Central Arkansas, Conway (JBM), Arkansas Children's Hospital (AG, MKN, AH, SP, BS) and University of Arkansas for Medical Sciences (AG, BB), Little Rock, Arkansas, Children's Healthcare of Atlanta (AB, KL, LR), Georgia
| | - Kelci LaPorte
- University of Central Arkansas, Conway (JBM), Arkansas Children's Hospital (AG, MKN, AH, SP, BS) and University of Arkansas for Medical Sciences (AG, BB), Little Rock, Arkansas, Children's Healthcare of Atlanta (AB, KL, LR), Georgia
| | - Linda Riley
- University of Central Arkansas, Conway (JBM), Arkansas Children's Hospital (AG, MKN, AH, SP, BS) and University of Arkansas for Medical Sciences (AG, BB), Little Rock, Arkansas, Children's Healthcare of Atlanta (AB, KL, LR), Georgia
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Moreira MCN, Gomes R, Sá MRCD. Doenças crônicas em crianças e adolescentes: uma revisão bibliográfica. CIENCIA & SAUDE COLETIVA 2014; 19:2083-94. [DOI: 10.1590/1413-81232014197.20122013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 11/22/2013] [Indexed: 11/22/2022] Open
Abstract
O artigo analisa artigos publicados entre 2003 e 2011 enfocando discussões sobre condições crônicas ou doenças crônicas de crianças e adolescentes. Metodologicamente conjuga a revisão de literatura a uma análise de conteúdo temática com vistas a identificar quais os elementos que caracterizam doenças crônicas em crianças e adolescentes e as especificidades geradas por essas condições. A revisão resultou na descrição do conjunto dos artigos, caracterizando-os quanto ano de publicação, país, tipo de estudo, população e condição de cronicidade abordada. A análise de conteúdo temática gerou dois temas: Definição de Doença Crônica e Formas de se lidar com as doenças crônicas em crianças e adolescentes. Destaca-se como conclusão que as transições etárias quando uma doença é diagnosticada e tratada desde a infância, vai passar por transformações que incluem a maneira como se dá o seu fluxo entre os serviços e as mudanças que envolvem processos de alta, de tomada de decisão e de construção de rede que inclua família, hospital, escola e sistema de garantia de direitos.
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Shepherd JM. Younger children's nursing students are uniquely placed to provide emotional care for young people in hospital and promote for them a sense of normalcy. NURSE EDUCATION TODAY 2014; 34:1034-1039. [PMID: 24119952 DOI: 10.1016/j.nedt.2013.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 08/12/2013] [Accepted: 09/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To highlight the emotional impact of being in the hospital for young people and to explore the impact of the care by younger student nurses on promoting a sense of "normalcy" for them. BACKGROUND Adolescence is strongly influenced by peer relationships and is a unique period in life that requires the achievement of many developmental tasks. An important task of adolescent is developing relationships with peers and feeling part of a recognised peer group. Young people prefer engaging in conversation with people of their own age because they feel less likely to be judged by their peers. DESIGN Heideggerian hermeneutic phenomenological study. METHOD A Heideggerian phenomenological study was undertaken. Individual unstructured interviews were conducted with eleven younger student nurses (aged l7 years and 5 months-l8 years and 11 months) and nine young people with a chronic illness (aged 13 years and 7 months-18 years and 1 month). The data was collected in 2009. RESULTS Young people in the hospital with a chronic illness experienced moments in time when they had nothing to think about but the business of getting better. During unique caring interactions, younger children's nursing students were able to help them temporarily forget about their illness and promote for them a sense of normalcy. CONCLUSIONS Younger children's nursing students are in a unique position to engage in ontological caring interactions with the young people due to their similarity in age and stage of development. They are uniquely placed to help the young people reintegrate back into their known "lifeworlds" and promote for them a sense of "normalcy". RELEVANCE TO CLINICAL PRACTICE Clinical staff need to be alerted to the emotional distress caused to young people during long periods of time in the hospital. Practitioners and nurse educators should be facilitating younger student nurses to interact with the young people in a therapeutic way and the care delivered to young people in the hospital should promote a sense of normalcy for them.
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Affiliation(s)
- Jean M Shepherd
- School of Health & Social Care, Department of Family Care and Mental Health, University of Greenwich, Avery Hill Campus, Avery Hill Road, London SE9 2UG, England.
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87
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Hughes M, Murphy M. Evaluation of a pilot national online asthma e-learning program for secondary school students. ACTA ACUST UNITED AC 2014; 37:136-46. [PMID: 24745661 DOI: 10.3109/01460862.2014.902405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Ireland has the fourth highest incidence of asthma in the world, with Irish children losing on average 10 days of school per annum due to their asthma. It is highly probable that a large percentage of students in each class in Irish schools have asthma and are required to manage symptoms during the out-of-home period. Young people with chronic illnesses such as asthma find themselves labelled and marginalized due to a lack of awareness of others about their condition. AIMS AND OBJECTIVES Young people who feel supported by their peers have been shown to have higher levels of self-efficacy and fewer exacerbations of their asthma symptoms. METHODS An on-line asthma e-learning program was developed to provide support to teenagers who have asthma, and help them inform their classmates and friends about asthma. A quasi-experimental approach was used to pilot the educational intervention. RESULTS The results of the pilot demonstrate that the program is effective. Teenagers who have asthma found the e-learning program to be informative and relevant to them. The increase in awareness of asthma among teenagers who did not have asthma is shown to influence their confidence in assisting their peers who are experiencing asthma symptoms.
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Affiliation(s)
- Mary Hughes
- Asthma Society of Ireland and School of Nursing and Midwifery, University College Cork , Ireland and
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89
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Apers S, Luyckx K, Moons P. Quality of life in adult congenital heart disease: what do we already know and what do we still need to know? Curr Cardiol Rep 2014; 15:407. [PMID: 23955787 DOI: 10.1007/s11886-013-0407-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Quality of life (QOL) is a key outcome in patients with congenital heart disease (CHD) because CHD has become a chronic condition accompanied by lifelong impairments. Recently, published studies on QOL in adults with CHD have reported inconsistent findings. Patients' QOL seems to depend on multiple factors and is not solely determined by their heart defect and various medical or demographic characteristics. For instance, evidence suggests that a strong sense of coherence might be an important pathway to improve QOL. However, studies on QOL and its determinants are characterized by important methodological differences and limitations, making it impossible to draw firm conclusions. To fill the gaps in the current evidence base, longitudinal and international research is needed. Furthermore, the research field on QOL in CHD should move on from observational studies to interventional research to guide health professionals in improving QOL.
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Affiliation(s)
- Silke Apers
- Centre for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium.
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Hamall KM, Heard TR, Inder KJ, McGill KM, Kay-Lambkin F. The Child Illness and Resilience Program (CHiRP): a study protocol of a stepped care intervention to improve the resilience and wellbeing of families living with childhood chronic illness. BMC Psychol 2014; 2:5. [PMID: 25945251 PMCID: PMC4416421 DOI: 10.1186/2050-7283-2-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/26/2014] [Indexed: 11/27/2022] Open
Abstract
Background Families of children living with chronic illness are more vulnerable to mental health problems, however this can be ameliorated by a family’s resilience. The Child Illness and Resilience Program (CHiRP) will develop and evaluate a parent-focussed family intervention designed to increase the resilience and wellbeing of families living with childhood chronic illness. Methods/Design The study will be conducted in an Australian regional paediatric hospital and will use a stepped care intervention that increases in intensity according to parental distress. All parents of children discharged from the hospital will receive a family resilience and wellbeing factsheet (Step 1). Parents of children attending selected outpatient clinics will receive a family resilience and wellbeing activity booklet (Step 2). Parents who receive the booklet and report psychological distress at three-month follow-up will be randomised to participate in a family resilience information support group or waitlist control (Step 3). The Step 3 control group will provide data to compare the relative effectiveness of the booklet intervention alone versus the booklet combined with the group intervention for distressed parents. These participants will then receive the information support group intervention. All parents in Step 2 and 3 will complete baseline, post-intervention and six month follow up assessments. The primary outcomes of the study will be changes in scores between baseline and follow-up assessments on measures of constructs of family resilience, including parental wellbeing, family functioning, family beliefs and perceived social support. Qualitative feedback regarding the utility and acceptability of the different intervention components will also be collected. Discussion It is hypothesised that participation in the CHiRP intervention will be associated with positive changes in the key outcome measures. If effective, CHiRP will provide an opportunity for the health sector to deliver a standardised stepped care mental health promotion intervention to families living with childhood chronic illness. Trial registration Australian clinical Trials Registry ACTRN 12613000844741 Universal Trial Number (UTN): 1111-1142-8829
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Affiliation(s)
- Katrina M Hamall
- Hunter Institute of Mental Health, Hunter New England Local Health District, Newcastle, Australia ; School of Medicine and Public Health, University of Newcastle, PO Box 833, Newcastle, NSW 2300 Australia
| | - Todd R Heard
- School of Medicine and Public Health, University of Newcastle, PO Box 833, Newcastle, NSW 2300 Australia ; Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | - Kerry J Inder
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia
| | - Katherine M McGill
- Hunter Institute of Mental Health, Hunter New England Local Health District, Newcastle, Australia
| | - Frances Kay-Lambkin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia ; Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia
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Wells F, Ritchie D, McPherson AC. 'It is life threatening but I don't mind'. A qualitative study using photo elicitation interviews to explore adolescents' experiences of renal replacement therapies. Child Care Health Dev 2013; 39:602-12. [PMID: 22676493 DOI: 10.1111/j.1365-2214.2012.01399.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Renal replacement therapy (RRT) transforms the life prospects of young people with established renal failure. However, these treatments can have significant physiological and psychological implications for adolescents as they prepare to transition into adulthood. Health policies increasingly emphasize children and youth's active participation and consultation as users of health services, yet studies infrequently seek their experiences directly. METHODS Adolescents receiving RRT in a large UK teaching hospital took photographs illustrating the impact of their condition and treatment on their lives. Qualitative photo elicitation interviews were conducted to explore the significance of the images and the young person's experiences. Interviews were analysed using descriptive thematic analysis. RESULTS Ten young people aged 13-17 years participated. Themes identified were: (1) understanding and acceptance of treatment; (2) living in a non-functioning body; (3) impact upon daily life; (4) sources of support. Young people found treatments challenging and experienced significant impact on relationships and daily routines. Yet, health was prioritized over body image and participants demonstrated great emotional resilience. Young people valued support from family and friends, although were wary of disclosing their condition in case it resulted in being highlighted as different. Young people reported hospital staff as being caring and professional, but their biggest virtue appeared to be their willingness to treat the young people as 'normal'. CONCLUSIONS Young people engaged readily with the research, and frankly described the impact of RRT on their everyday lives. Service providers must ensure that adolescents' developmental needs are met as traditional tasks of adolescence may lose priority. However, it is also clear that young people's ability to cope with treatments should not be underestimated.
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Affiliation(s)
- F Wells
- Queen's Medical Centre, Nottingham, UK
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93
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Lugasi T, Achille M, Blydt-Hansen T, Clermont MJ, Geoffroy L, Legault L, Phan V, Bell LE. Assessment of identity and quality of life in diabetic and renal transplant adolescents in comparison to healthy adolescents. J Clin Psychol Med Settings 2013; 20:361-72. [PMID: 23645186 DOI: 10.1007/s10880-012-9344-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Identity development represents a central task of adolescence. Identity achievement is characterized by a coherent sense of who one is following a period of exploration and can help navigate the challenges of adulthood. This study examined identity within a quality of life (QOL) context in 85 adolescents with a renal transplant or with Type 1 diabetes in comparison to 90 healthy controls. Results revealed significant differences in ideological identity, with patients showing higher levels of diffusion and controls showing higher levels of foreclosure. No differences with respect to interpersonal identity, QOL, perceived control over the QOL domains, and perceived opportunities for growth and development were found. Future research should assess identity and QOL over a longer period of time to determine whether differences between chronically ill and healthy young adults can be detected.
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Affiliation(s)
- Tziona Lugasi
- Department of Psychology, Université de Montréal, C.P. 6128 Succ. Centre-Ville, Montreal, QC, H3C 3J7, Canada.
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Quick VM, Byrd-Bredbenner C, Neumark-Sztainer D. Chronic illness and disordered eating: a discussion of the literature. Adv Nutr 2013; 4:277-86. [PMID: 23674793 PMCID: PMC3650496 DOI: 10.3945/an.112.003608] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This paper describes the prevalence of eating disorders and disordered eating behaviors, the reasons why these practices are endorsed, and the potential consequences in youths and young adults with selected diet-related chronic health conditions (DRCHCs) and provides recommendations for eating disorder prevention interventions and research efforts. Although it remains unclear whether the prevalence of eating disorders is higher in those with DRCHCs compared with the general population, overall findings suggest that young people with DRCHCs may be at risk of endorsing disordered eating behaviors that may lead to diagnosis of an eating disorder and other health problems over the course of their treatment. Thus, health care providers should be aware that young people with DRCHCs may be at risk of eating disorders and carefully monitor psychological changes and the use of unhealthy weight control methods. It is also important to develop and evaluate theory-based interventions and disease-specific eating disorder risk screening tools that are effective in halting the progression of eating disorders and negative health outcomes in young people with chronic health conditions.
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Affiliation(s)
- Virginia M. Quick
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Epidemiology, Statistics, and Prevention Research, NIH, DHHS, Bethesda, MD
| | | | - Dianne Neumark-Sztainer
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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Sharif MO, Callery P, Tierney S. The Perspectives of Children and Young People Living with Cleft Lip and Palate: A Review of Qualitative Literature. Cleft Palate Craniofac J 2013; 50:297-304. [DOI: 10.1597/12-054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To explore the experiences of children and young people with cleft lip and/or palate (CL/P) in relation to being treated for and living with this condition. Design A systematic review of qualitative research. Electronic databases and hand-searching were employed to identify relevant studies. The review centered on studies examining the views or experiences of young patients first-hand. Any study using a qualitative/mixed method design was eligible for inclusion. Results From 184 potential references, 38 papers were read in full, from which only two studies of young people met all the review's inclusion criteria. Common reasons for exclusion were not being a qualitative study, not focusing on CL/P, or data coming from parents only. A further two papers provided a retrospective account of childhood with CL/P from interviews with adults. Their suitability for the review's aims was limited, but they were discussed. Conclusions This review demonstrates that there is a paucity of evidence about the experiences of young people living with CL/P. No studies of children and only two studies of young people met all inclusion criteria. Identified papers implied that more attention is needed within families and services to help young people manage everyday difficulties such as bullying and self-consciousness due to facial difference.
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Affiliation(s)
- Mohammad Owaise Sharif
- National Institute for Health Academic, Orthodontics, School of Dentistry, the University of Manchester; Higher Cambridge Street, Manchester, U.K
| | - Peter Callery
- Children's Nursing, the School of Nursing, Midwifery and Social Work the University of Manchester, U.K.; Higher Cambridge Street, Manchester, U.K
| | - Stephanie Tierney
- The School of Nursing, Midwifery and Social Work, the University of Manchester; Higher Cambridge Street, Manchester
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Apers S, Moons P, Goossens E, Luyckx K, Gewillig M, Bogaerts K, Budts W. Sense of coherence and perceived physical health explain the better quality of life in adolescents with congenital heart disease. Eur J Cardiovasc Nurs 2013; 12:475-83. [DOI: 10.1177/1474515113477955] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Silke Apers
- Centre for Health Services and Nursing Research, and Department of Public Health and Primary Care, KU Leuven, Belgium
- Joint first authors
| | - Philip Moons
- Centre for Health Services and Nursing Research, and Department of Public Health and Primary Care, KU Leuven, Belgium
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
- Joint first authors
| | - Eva Goossens
- Centre for Health Services and Nursing Research, and Department of Public Health and Primary Care, KU Leuven, Belgium
- Research Foundation, Flanders, Belgium
| | - Koen Luyckx
- Research Foundation, Flanders, Belgium
- School Psychology and Child and Adolescent Development, KU Leuven, Belgium
| | - Marc Gewillig
- Paediatric Cardiology, University Hospitals Leuven, Belgium
| | - Kris Bogaerts
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Belgium, and Hasselt University, Belgium
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
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Al-Yateem N. Child to adult: transitional care for young adults with cystic fibrosis. ACTA ACUST UNITED AC 2013; 21:850-4. [PMID: 23252167 DOI: 10.12968/bjon.2012.21.14.850] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Managing the transitional care needs of young adults with a complex chronic illness such as cystic fibrosis (CF) as they move from a child-orientated to adult setting has been reported in the literature as challenging and stressful, and may impart additional risks to the young person's health. However, in the Republic of Ireland, which has the highest incidence of CF in the world, the current services provided for children during this transitional period are still reported as underdeveloped. The aim of the author's research was to explore and understand the experience of young people before and after their transitional care, and the factors that both contribute to and hinder that experience. A qualitative approach guided by phenomenological tradition, and using in-depth interviews. The findings suggest that there are a range of needs required for patients during this transitional period, including the need for information, interventions that decrease the negative feelings associated with transition (e.g. distress, anxiety, uncertainty), structured service, and an approach to care that focuses on young adults. The author concludes that health professionals in the clinical setting who have responsibility for young adults in transitional care should focus on these needs to provide a more relevant and effective transition service.
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Affiliation(s)
- Nabeel Al-Yateem
- School of Nursing and Midwifery, National University of Ireland-Galway
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98
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Brouwer AM, Salamon KS, Olson KA, Fox MM, Yelich-Koth SL, Fleischman KM, Hains AA, Davies WH, Kichler JC. Adolescents and type 2 diabetes mellitus: a qualitative analysis of the experience of social support. Clin Pediatr (Phila) 2012; 51:1130-9. [PMID: 23034947 DOI: 10.1177/0009922812460914] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Research on how adolescents with type 2 diabetes mellitus (T2DM) understand and use social support is limited. Therefore, we explored how adolescents with T2DM experience and perceive social support. METHODS Adolescents with T2DM were interviewed, and data were qualitatively analyzed using Consensual Qualitative Research methodology. RESULTS Four themes emerged: support for nondiabetes and diabetes-specific behaviors, feelings of belonging, and disclosure. All participants expressed emotional and self-care-specific support. For some, disclosure and a sense of belonging with others who had diabetes often led to support elicitation. Participants also expressed a fear of disclosing their diabetes to others. DISCUSSION Adolescents with T2DM value tangible and emotional support for behaviors both related and not related to diabetes. Fear of disclosure was a typical experience with disclosure often limited to close friends and family. Recommendations for health professionals to assist adolescents in promoting appropriate disclosure and means of requesting support are discussed.
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99
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Developing a conceptual model of teenage and young adult experiences of cancer through meta-synthesis. Int J Nurs Stud 2012; 50:832-46. [PMID: 23044049 DOI: 10.1016/j.ijnurstu.2012.09.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 09/09/2012] [Accepted: 09/10/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To systematically identify and analyse published research exploring teenage and young adult experience of cancer to inform the development of a patient-reported outcome survey intended to explore if a correlation exists between specialist cancer care and quality of life for young people with cancer. DESIGN Systematic review and meta-synthesis. DATA SOURCES Medline, CINAHL Plus and PsycInfo were searched for literature published between 1987 and 2011. REVIEW METHODS Search terms included those for: population (e.g. teen, young adult); intervention (e.g. cancer); outcome (e.g. experience); and study type (e.g. qualitative). INCLUSION CRITERIA adolescents and young adults were both represented; diagnosis of cancer; published in English; and used qualitative methods to report an aspect of the cancer experience. Studies were excluded if they were reporting: palliative care experience; secondary data; or proxy views, i.e. parent or health professional perspective. Methodological quality was assessed using Cesario criteria and meta-synthesis involved deconstruction and decontextualising findings to identify common themes. RESULTS Three hundred and fifteen studies were identified, 17 fulfilled the inclusion criteria. Of these, most (59%), were assessed as being high quality, none were rated poor. Nine common themes were identified: psychosocial function, importance of peers, experience of healthcare, importance of support, impact of symptoms, striving for normality, impact of diagnosis, positive experiences, and financial consequences. CONCLUSIONS The conceptual model developed from the meta-synthesis depicts the mediators and consequences of cancer care that impact on young people's quality of life after a cancer diagnosis. The model highlights areas that require further exploration.
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Affiliation(s)
- James M Perrin
- MGH Center for Child and Adolescent Health Policy, Boston, MA, USA
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