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Lindsay S, Cagliostro E, Stinson J, Leck J. A 4-Week Electronic-Mentoring Employment Intervention for Youth With Physical Disabilities: Pilot Randomized Controlled Trial. JMIR Pediatr Parent 2019; 2:e12653. [PMID: 31518302 PMCID: PMC6716490 DOI: 10.2196/12653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/07/2019] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Youth with disabilities are more likely to live in poverty and be unemployed compared with youth without disabilities. Such trends are often a result of a lack of support, inaccessible jobs, environmental barriers, and discriminatory attitudes toward people with disabilities. Youth with disabilities also face barriers in accessing vocational preparation programs. One encouraging way that could help address challenges that youth encounter is by providing support through electronic mentoring (e-mentoring). OBJECTIVE The objective of this study was to assess the feasibility of a 4-week Web-based peer e-mentoring employment intervention for youth with physical disabilities. METHODS We conducted a pilot randomized controlled trial (RCT) to evaluate our intervention, Empowering youth towards employment. Participants included youth aged 15 to 25 years who were randomly assigned to an experimental (mentored) or control (nonmentored) group. Our intervention involved having trained youth mentors (ie, near peers who also had a disability) lead Web-based discussion forums while offering peer support and resources, which involved 12 modules (3 topics a week for 4 weeks). Primary outcomes focused on implementation (ie, feasibility and acceptability), whereas secondary outcomes focused on effectiveness (ie, measures of self-determination, career maturity, and social support). RESULTS A total of 28 youth (mean age 19.62, SD 3.53; 14/28, 50% female) completed the RCT in 3 intervention groups and 2 control groups (intervention n=18, control n=10). Participants reported satisfaction with the program and that it was feasible and acceptable. Youth's mean engagement level with the program was 6.44 (SD 2.33) for the experimental group and 5.56 (SD 3.53) for controls. Participants in the intervention group did not demonstrate any significant improvements in social support, career maturity, or self-determination compared with those in the control group. No adverse events were reported. CONCLUSIONS The Empowering youth towards employment e-mentoring intervention needs further testing with a larger sample and different length of formats to understand how it may have an impact on employment outcomes for youth with disabilities. TRIAL REGISTRATION ClinicalTrials.gov NCT02522507; https://clinicaltrials.gov/ct2/show/NCT02522507 (Archived by WebCite at http://www.webcitation.org/77a3T4qrE).
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Affiliation(s)
- Sally Lindsay
- Department of Occupational Science and Occupational Therapy, University of Toronto and Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Elaine Cagliostro
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Jennifer Stinson
- Lawrence S Bloomberg Faculty of Nursing, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Joanne Leck
- Telfer School of Management, University of Ottawa, Toronto, ON, Canada
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Knight A, Vickery M, Faust L, Muscal E, Davis A, Harris J, Hersh AO, Rodriguez M, Onel K, Rubinstein T, Washington N, Weitzman ER, Conlon H, Woo JMP, Gerstbacher D, von Scheven E. Gaps in Mental Health Care for Youth With Rheumatologic Conditions: A Mixed Methods Study of Perspectives From Behavioral Health Providers. Arthritis Care Res (Hoboken) 2019; 71:591-601. [PMID: 29953741 DOI: 10.1002/acr.23683] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/26/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify behavioral health provider perspectives on gaps in mental health care for youth with rheumatologic conditions. METHODS Social workers (n = 34) and psychologists (n = 8) at pediatric rheumatology centers in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) completed an online survey assessing current practices and mental health care needs of youth with rheumatologic conditions. Responses were compared to a published survey of CARRA rheumatologists (n = 119). Thematic analysis of 20 semi-structured interviews with behavioral health providers was performed. RESULTS One-third of CARRA centers (n = 100) had no affiliated social worker or psychologist. Only 1 behavioral health provider reported current universal mental health screening at their rheumatology clinic, yet routine depression screening was supported by >85% of behavioral health providers and rheumatologists. Support for anxiety screening was higher among behavioral health providers (90% versus 65%; P < 0.01). Interviews illustrated a need for interventions addressing illness-related anxiety, adjustment/coping/distress, transition, parent/caregiver mental health, and peer support. Limited resources, lack of protocols, and patient cost/time burden were the most frequent barriers to intervention. Inadequate follow-up of mental health referrals was indicated by 52% of providers. More behavioral health providers than rheumatologists favored mental health services in rheumatology settings (55% versus 19%; P < 0.01). Only 7 social workers (21%) provided counseling/therapy, and interviews indicated their perceived underutilization of these services. CONCLUSION Behavioral health providers indicated an unmet need for mental health interventions that address illness-related issues affecting youth with rheumatologic conditions. Implementation of mental health protocols and optimizing utilization of social workers may improve mental health care for these youth.
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Affiliation(s)
- Andrea Knight
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Lauren Faust
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Eyal Muscal
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Alaina Davis
- Monroe Carell Junior Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Julia Harris
- Children's Mercy Kansas City, University of Missouri, Kansas City
| | | | - Martha Rodriguez
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Karen Onel
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Tamar Rubinstein
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Nina Washington
- Mississippi Center for Advanced Medicine, Madison, Mississippi
| | - Elissa R Weitzman
- Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Hana Conlon
- Columbia University Medical Center, New York, New York
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Abstract
New technologies can do more than just digitize health information; they can support multimedia platforms for patient education and health decision support. Technology can simplify the way health decisions are made by offering quick access to a vast amount of information that can be tailored to specific populations. Digital tools can increase knowledge and assist consumers in comparing health care alternatives. They are well received by patients because of the myriad features that render them visually appealing and entertaining, including audiovisual and interactive elements. To be effective, however, digital tools must be evidence based and developed following quality standards.
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Grace E, Raghavendra P, McMillan JM, Gunson JS. Exploring participation experiences of youth who use AAC in social media settings: impact of an e-mentoring intervention. Augment Altern Commun 2019; 35:132-141. [PMID: 30732476 DOI: 10.1080/07434618.2018.1557250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The contribution of cross-age peer e-mentoring on reported experiences of participation during online conversations using social media was explored in this pre-experimental study. Young people (n = 4, aged 13; 4-18;3 [years; months]) who used augmentative and alternative communication (AAC) participated in an e-mentoring intervention. Two mentors who also used AAC had regular conversations with the participants via Facebook 1 , email, or Skype 2 . It was predicted that the mentoring support would contribute to experiences of participation in online conversations outside of the e-mentoring intervention. Reported experiences of participation in online conversations with communication partners other than the mentor were measured at four time points. The Self-Reported Experiences of Activity Settings was used for this purpose because it consists of five domains: Personal Growth, Psychological Engagement, Social Belonging, Meaningful Interactions, and Choice and Control. These domains are associated with the construct of involvement in activity settings. Results showed varied scores between participants and across the domains. Reported experiences of choice and control increased slightly across time. Despite some variation in self-ratings, the participants reported experiencing choice and control, psychological engagement, and social belonging in online conversations. There is need for more research in this emerging area.
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Affiliation(s)
- Emma Grace
- a Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University , Adelaide , Australia
| | - Parimala Raghavendra
- a Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University , Adelaide , Australia
| | - Julie M McMillan
- b College of Education, Psychology, and Social Work, Flinders University , Adelaide , Australia
| | - Jessica Shipman Gunson
- c Health Sciences, College of Nursing and Health Sciences, Flinders University , Adelaide , Australia
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O’Sullivan G, O’Higgins S, Caes L, Saetes S, McGuire BE, Stinson J. Self-management needs of Irish adolescents with Juvenile Idiopathic Arthritis (JIA): how can a Canadian web-based programme meet these needs? Pediatr Rheumatol Online J 2018; 16:68. [PMID: 30409209 PMCID: PMC6225653 DOI: 10.1186/s12969-018-0287-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) affects over 1000 children and adolescents in Ireland, potentially impacting health-related quality-of-life. Accessible self-management strategies, including Internet-based interventions, can support adolescents in Ireland where specialist rheumatology care is geographically-centralised within the capital city. This study interviewed adolescents with JIA, their parents, and healthcare professionals to (i) explore the self-management needs of Irish adolescents; and (ii) evaluate the acceptability of an adapted version of a Canadian JIA self-management programme (Teens Taking Charge: Managing Arthritis Online, or TTC) for Irish users. METHODS Focus groups and interviews were conducted with Irish adolescents with JIA (N = 16), their parents (N = 13), and Irish paediatric healthcare professionals (HCPs; N = 22). Adolescents were aged 12-18 (Mage = 14.19 years), and predominantly female (62.5%). Participants identified the needs of adolescents with JIA and evaluated the usefulness of the TTC programme. Data were analysed using a thematic analysis approach. RESULTS Five themes emerged: independent self-management; acquiring skills and knowledge to manage JIA; unique challenges of JIA in Ireland; views on web-based interventions; and understanding through social support. Adolescents acknowledged the need for independent self-management and gradually took additional responsibilities to achieve this goal. However, they felt they lacked information to manage their condition independently. Parents and adolescents emphasised the need for social support and felt a peer-support scheme could provide additional benefit to adolescents if integrated within the TTC programme. All participants endorsed the TTC programme to gain knowledge about JIA and offered suggestions to make the programme relevant to Irish users. CONCLUSIONS There is scope for providing easily-accessible, accurate information to Irish families with JIA. The acceptability of adapting an existing JIA self-management intervention for Irish users was confirmed.
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Affiliation(s)
- Grace O’Sullivan
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Siobhán O’Higgins
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Line Caes
- Division of Psychology; Faculty of Natural Sciences, University of Stirling, Stirling, Scotland, UK
| | - Sophia Saetes
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Brian E. McGuire
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Jennifer Stinson
- The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Waite-Jones JM, Swallow V. Peer-based Social Support for Young-People with Juvenile Arthritis: Views of Young People, Parents/Carers and Healthcare Professionals within the UK. J Pediatr Nurs 2018; 43:e85-e91. [PMID: 30078727 DOI: 10.1016/j.pedn.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/27/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE A deeper understanding was sought of what peer-based social support means to young people with juvenile arthritis within the UK and ways in which it could be best provided. DESIGN AND METHODS A secondary analysis of underused, descriptively rich data relating to peer-based support contributed by young people with juvenile arthritis, their parents/carers and healthcare professionals from a qualitative study (seeking their views on a potential self-management mobile-app) was carried out using methods suggested by Interpretive Phenomenological Analysis. RESULTS Peer-based support can provide a new kind of 'normality' for young people with juvenile arthritis, including greater understanding, relief, reassurance, shared learning and increased self-efficacy. However, the risk of stigma through this shared identity suggests a need to offer various forms of access including using new electronic media. CONCLUSION AND IMPLICATIONS The evidence suggests that although desired, the potential social cost of identifying with peers living with juvenile arthritis is influenced by the way such support is provided, which in turn impacts on how readily it will be accessed. This suggests the need to provide various means of accessing peer-based contact, including electronic media, to ensure that young people with juvenile arthritis benefit. Therefore, when promoting and supporting peer-based social support, as far as possible, professionals need to individualise ways in which such support can be accessed because there is no 'one size fits all' approach.
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Affiliation(s)
| | - Veronica Swallow
- School of Healthcare, University of Leeds, Leeds, UK; Faculty of Science, Charles Sturt University, Bathurst, Australia.
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57
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Lindsay S, Kolne K, Cagliostro E. Electronic Mentoring Programs and Interventions for Children and Youth With Disabilities: Systematic Review. JMIR Pediatr Parent 2018; 1:e11679. [PMID: 31518310 PMCID: PMC6716434 DOI: 10.2196/11679] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/08/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Children and youth with disabilities experience many challenges in their development, including higher risk of poor self-esteem, fewer friendships, and social isolation. Electronic mentoring is a potentially viable approach for youth with disabilities to access social and peer support within a format that reduces physical barriers to accessing mentors. OBJECTIVE Our objective was to synthesize and review the literature on the impact of electronic mentoring for children and youth with disabilities. METHODS We conducted a systematic review, completing comprehensive searches of 7 databases from 1993 to May 2018. We selected articles for inclusion that were peer-reviewed publications, had a sample of children or youth with disabilities (≤25 years of age), and had empirical findings with at least one outcome focusing on the impact of electronic mentoring. Two reviewers independently applied the inclusion criteria, extracted the data, and rated the study quality before discussing the findings. RESULTS In the 25 studies meeting our inclusion criteria, 897 participants (aged 12-26, mean 17.4 years) were represented across 6 countries. Although the outcomes varied across the studies, of 11 studies testing significance, 9 (81%) reported a significant improvement in at least one of the following: career decision making, self-determination, self-advocacy, self-confidence, self-management, social skills, attitude toward disability, and coping with daily life. The electronic mentoring interventions varied in their delivery format and involved 1 or more of the following: interactive websites, virtual environment, email, mobile apps, Skype video calls, and phone calls. A total of 13 studies involved one-to-one mentoring, 6 had group-based mentoring, and 6 had a combination of both. CONCLUSIONS The evidence in this review suggests it is possible that electronic mentoring is effective for children and youth with disabilities. More rigorously designed studies are needed to understand the impact and effective components of electronic mentoring interventions.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Kendall Kolne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Elaine Cagliostro
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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Juvenile arthritis management in less resourced countries (JAMLess): consensus recommendations from the Cradle of Humankind. Clin Rheumatol 2018; 38:563-575. [PMID: 30267356 DOI: 10.1007/s10067-018-4304-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/03/2018] [Accepted: 09/16/2018] [Indexed: 01/03/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most prevalent chronic rheumatic disease in children and young people (CYP) and a major cause of pain and disability. The vast majority of the world's children and their families live in less resourced countries (LRCs) and face significant socioeconomic and healthcare challenges. Current recommendations for standards of care and treatment for children with JIA do not consider children living in less resourced countries. In order to develop appropriate recommendations for the care of CYP with JIA in less resourced countries a meeting of experienced pediatric rheumatologists from less resourced countries was convened with additional input from a steering group of international pediatric rheumatologists with experience in developing recommendations and standards of care for JIA. Following a needs assessment survey of healthcare workers caring for CYP with JIA in LRC, a literature review was carried out and management recommendations formulated using Delphi technique and a final consensus conference. Responses from the needs assessment were received from 121/483 (25%) practitioners from 25/49 (51%) less resourced countries. From these responses, the initial 84 recommendations were refined and expanded through a series of 3 online Delphi rounds. A final list of 90 recommendations was proposed for evaluation. Evidence for each statement was reviewed, graded, and presented to the consensus group. The degree of consensus, level of agreement, and level of evidence for these recommendations are reported. Recommendations arrived at by consensus for CYP with JIA in less resourced countries cover 5 themes: (1) diagnosis, (2) referral and monitoring, (3) education and training, (4) advocacy and networks, and (5) research. Thirty-five statements were drafted. All but one statement achieved 100% consensus. The body of published evidence was small and the quality of evidence available for critical appraisal was low. Our recommendations offer novel insights and present consensus-based strategies for the management of JIA in less resourced countries. The emphasis on communicable and endemic diseases influencing the diagnosis and treatment of JIA serves as a valuable addition to existing JIA guidelines. With increasing globalization, these recommendations as a whole provide educational and clinical utility for clinicians worldwide. The low evidence base for our recommendations reflects a shortage of research specific to less resourced countries and serves as an impetus for further inquiry towards optimizing care for children with JIA around the world.
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Higgins KS, Tutelman PR, Chambers CT, Witteman HO, Barwick M, Corkum P, Grant D, Stinson JN, Lalloo C, Robins S, Orji R, Jordan I. Availability of researcher-led eHealth tools for pain assessment and management: barriers, facilitators, costs, and design. Pain Rep 2018; 3:e686. [PMID: 30324177 PMCID: PMC6172815 DOI: 10.1097/pr9.0000000000000686] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Numerous eHealth tools for pain assessment and management have been developed and evaluated with promising results regarding psychometric properties, efficacy, and effectiveness. Although considerable resources are spent on developing and evaluating these tools with the aim of increasing access to care, current evidence suggests they are not made available to end users, reducing their impact and creating potential research waste. METHODS This study consisted of 2 components: (1) a systematic review of eHealth tools for pediatric pain assessment and/or management published in the past 10 years, and (2) an online survey, completed by the authors of identified tools, of tool availability, perceived barriers or facilitators to availability, grant funding used, and a validated measure of user-centeredness of the design process (UCD-11). RESULTS Ninety articles (0.86% of citations screened) describing 53 tools met inclusion criteria. Twenty-six survey responses were completed (49.06%), 13 of which (50.00%) described available tools. Commonly endorsed facilitators of tool availability included researchers' beliefs in tool benefits to the target population and research community; barriers included lack of infrastructure and time. The average cost of each unavailable tool was $314,425.31 USD ($3,144,253.06 USD total, n = 10). Authors of available tools were more likely to have followed user-centered design principles and reported higher total funding. CONCLUSION Systemic changes to academic and funding structures could better support eHealth tool availability and may reduce potential for research waste. User-centered design and implementation science methods could improve the availability of eHealth tools and should be further explored in future studies.
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Affiliation(s)
- Kristen S. Higgins
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Perri R. Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Christine T. Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Holly O. Witteman
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec City, Canada
- CHU de Québec, Québec City, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Colchester East Hands ADHD Clinic, Colchester East Hants Health Authority, Truro, Canada
| | - Doris Grant
- Industry Liaison and Innovation, Dalhousie University, Halifax, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Chronic Pain Program, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Chitra Lalloo
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Sue Robins
- Patient Advocate and Partner, Bird Communications, Vancouver, Canada
| | - Rita Orji
- Faculty of Computer Science, Dalhousie University, Halifax, Canada
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Navarro K, Wainwright E, Rodham K, Jordan A. Parenting young people with complex regional pain syndrome: an analysis of the process of parental online communication. Pain Rep 2018; 3:e681. [PMID: 30324173 PMCID: PMC6172825 DOI: 10.1097/pr9.0000000000000681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Parenting a young person with complex regional pain syndrome (CRPS) is associated with high levels of parental distress and numerous emotional, informational, and practical challenges. To meet these challenges, parents seek others undergoing similar experiences, both in face to face and online forums. OBJECTIVES The objective of this study was to conduct a qualitative analysis of online forum data to explore the process of parental forum communication regarding parenting a young person with CRPS in online spaces. METHODS A total of 107 forum posts relating to parenting a young person with CRPS were collected from 39 users across 2 public forums. Data were analyzed using thematic analysis. RESULTS Findings identified 2 themes: "the informal rules of exchanging and receiving network support" and "parents positioning themselves as experts." The first theme highlighted the varied nature of support sought and provided by parents in addition to social rules associated with the negotiation of this support. The second theme represented an understanding of how parents presented themselves as experts in their young person's pain, both in relation to fellow parents and health care professionals. CONCLUSION This study provided a novel insight into support and communicational exchanges between parents of young people with CRPS on online public forums. Findings identified the perceived usefulness of online spaces in terms of parents of young people with CRPS seeking and providing support. Further research can helpfully investigate how we might implement online peer mentoring to improve support further for parents.
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Affiliation(s)
- Kaedi Navarro
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Elaine Wainwright
- Department of Psychology, Bath Spa University, Bath, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Karen Rodham
- Department of Psychology, Staffordshire Centre for Psychological Research, Staffordshire University, Stoke on Trent, United Kingdom
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, United Kingdom
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Breakey VR, Bouskill V, Nguyen C, Luca S, Stinson JN, Ahola Kohut S. Online Peer-to-Peer Mentoring Support for Youth with Hemophilia: Qualitative Needs Assessment. JMIR Pediatr Parent 2018; 1:e10958. [PMID: 31518296 PMCID: PMC6715049 DOI: 10.2196/10958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/15/2018] [Accepted: 06/15/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To support adolescents through transition from pediatrics to adult care, health care providers and families help teens gain knowledge and develop self-management skills. Peer mentoring can provide meaningful support and has been associated with improved health outcomes in patients with other chronic conditions. Peer mentoring is an appealing way to provide support, but it is imperative to consider the unique needs of adolescents to ensure its success. OBJECTIVE The objective of our study was to identify the peer mentoring wants and needs of youth with hemophilia in order to guide the development of a new program. METHODS In this qualitative study, we interviewed a convenience sample of youth with hemophilia from 2 Canadian hemophilia treatment centers. Two iterative cycles of audiorecorded, semistructured individual interviews were conducted. Descriptive statistics and content analyses were used to organize data into categories that reflected emerging themes. RESULTS In total, we recruited 23 participants aged 12-20 years, with a mean age of 14.91 (2.57) years. When asked about program design, participants weighed the importance of flexibility in delivery (eg, Web-based, in person, text messaging [short message service]), content (eg, structured vs unstructured), frequency of sessions, and length of the program. Participants identified some potential challenges such as scheduling issues, comfort level for disease discussion, and discordant mentor-mentee personality types. The program was viewed as a positive medium for connecting peers with hemophilia. CONCLUSIONS Adolescents with hemophilia expressed interest in a peer mentoring program and provided valuable insight that will be applied in the development of a peer mentoring program for youth with hemophilia.
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Affiliation(s)
- Vicky R Breakey
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada.,Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Vanessa Bouskill
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Cynthia Nguyen
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stephanie Luca
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer N Stinson
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sara Ahola Kohut
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
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Caes L, Fisher E, Clinch J, Eccleston C. Current Evidence-Based Interdisciplinary Treatment Options for Pediatric Musculoskeletal Pain. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018; 4:223-234. [PMID: 30148046 PMCID: PMC6096755 DOI: 10.1007/s40674-018-0101-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW We review the prevalence of pediatric chronic musculoskeletal pain, the clinical need, the evidence for pharmacological, psychological, physical and, complementary approaches to pain management, and the possible future development of interdisciplinary and distance care. RECENT FINDINGS We summarize the Cochrane Systematic Reviews on pharmacological interventions, which show a lack of evidence to support or refute the use of all classes of medication for the management of pain. The trials for NSAIDs did not show any superiority over comparators, nor did those of anti-depressants, and there are no trials for paracetamol, or of opioid medications. There are studies of psychological interventions which show promise and increasing support for physical therapy. The optimal approach remains an intensive interdisciplinary programmatic treatment, although this service is not available to most. SUMMARY 1. Given the absence of evidence, a program of trials is now urgently required to establish the evidence base for analgesics that are widely prescribed for children and adolescents with chronic musculoskeletal pain. 2. Until that evidence becomes available, medicine review is an essential task in this population. 3. We need more examples and efficacy evaluations of intensive interdisciplinary interventions for chronic pain management, described in detail so that researchers and clinicians can unpack possible active treatment components. 4. Online treatments are likely to be critical in the future. We need to determine which aspects of treatment for which children and adolescents can be effectively delivered in this way, which will help reduce the burden of the large number of patients needing support from a small number of experts.
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Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK
| | - Jacqui Clinch
- Bristol Royal Children’s Hospital, University of Bristol and Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Experimental, Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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Ahola Kohut S, Stinson J, Forgeron P, Luca S, Harris L. Been There, Done That: The Experience of Acting as a Young Adult Mentor to Adolescents Living With Chronic Illness. J Pediatr Psychol 2018; 42:962-969. [PMID: 28340203 DOI: 10.1093/jpepsy/jsx062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/17/2016] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the perceived benefits and challenges of acting as a young adult peer mentor to adolescents with chronic illness. Methods A qualitative descriptive study, using interviews and a focus group, explored the perceptions of young adult peer mentors following participation in the iPeer2Peer program, a Skype-based peer-mentorship program for adolescents with chronic illness. Interviews and focus group data were transcribed and analyzed using inductive content analysis. Results Ten peer mentors (20.00 ± 1.49 years old, range 17-22 years; diagnosed with chronic pain [n = 4] or juvenile idiopathic arthritis [n = 6]) who mentored four mentees (±2.55 mentees, range = 1-10 mentees) participated. Four main categories were identified: social connection, personal growth, mentor role in mentee growth, and logistics of mentorship. Conclusions Acting as a peer mentor online is a feasible and rewarding experience that supports the mentor's own illness self-management, social connection, and personal growth.
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Affiliation(s)
- Sara Ahola Kohut
- The Hospital for Sick Children, Toronto, Canada.,University of Toronto
| | - Jennifer Stinson
- The Hospital for Sick Children, Toronto, Canada.,University of Toronto
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Ahola Kohut S, LeBlanc C, O'Leary K, McPherson AC, McCarthy E, Nguyen C, Stinson J. The internet as a source of support for youth with chronic conditions: A qualitative study. Child Care Health Dev 2018; 44:212-220. [PMID: 29082537 DOI: 10.1111/cch.12535] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adolescents living with chronic conditions often portray themselves as "healthy" online, yet use the Internet as one of their top sources of health information and social communication. There is a need to develop online support programs specific to adolescents with chronic conditions in order to provide a private space to discuss concerns. This paper endeavors to increase our understanding of the online support needs and wants of these adolescents and their interest in and preferences for an online support program. METHODS A qualitative descriptive study using semistructured interviews was completed. Stratified purposive sampling was utilized to ensure a representative sample based on age and diagnosis. English speaking adolescents (aged 12-18 years) diagnosed with a chronic condition were recruited from clinic and inpatient areas across 3 paediatric hospitals in Canada. RESULTS Thirty-three participants aged 15.3 ± 1.8 years (64% female) completed the study. The main topics identified were (a) the purpose of current online activity, (b) the benefits and challenges of existing online supports, and (c) a description of ideal online resources. The purpose of online activity was social networking, information, online gaming, and social support. When accessing health information online, participants prioritized websites that were easy to access and understand despite the trustworthiness of the site. The reported benefits and challenges varied across participants with many areas perceived as both a benefit and a challenge. The majority of participants were interested in participating in an online support program that included both accurate disease-related information and a community of other adolescents to provide social support. CONCLUSIONS Adolescents with chronic conditions are interested in online support that encompasses health information and social support that is flexible and easy to navigate. Findings can be used to develop or adapt existing online support programs for adolescents with chronic conditions to help increase engagement and utilization.
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Affiliation(s)
- S Ahola Kohut
- Medical Psychiatry Alliance, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - C LeBlanc
- Child Life Services, IWK Health Centre, Halifax, NS, Canada
| | - K O'Leary
- Child Life/Creative Arts Therapy, Hospital for Sick Children, Toronto, ON, Canada
| | - A C McPherson
- Bloorview Research Institute, Toronto, ON, Canada.,Dalla Lana School of Public Health & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - E McCarthy
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
| | - C Nguyen
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
| | - J Stinson
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Davis AM, Rubinstein TB, Rodriguez M, Knight AM. Mental health care for youth with rheumatologic diseases - bridging the gap. Pediatr Rheumatol Online J 2017; 15:85. [PMID: 29282086 PMCID: PMC5745617 DOI: 10.1186/s12969-017-0214-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022] Open
Abstract
Youth with rheumatologic diseases have a high prevalence of comorbid mental health disorders. Individuals with comorbid mental health disorders are at increased risk for adverse outcomes related to mental health as well as their underlying rheumatologic disease. Early identification and treatment of mental health disorders has been shown to improve outcomes, but current systems of care fall short in providing adequate mental health services to those in need. Pediatric rheumatologists are uniquely positioned to provide mental health screening and intervention for youth with rheumatologic diseases due to the frequency of patient encounters and ongoing therapeutic relationship with patients and families. However, additional training is likely required for pediatric rheumatologists to provide effective mental health care, and focusing efforts on providing trainees with mental health education is key to building competency. Potential opportunities for improved mental health education include development of clinical guidelines regarding mental health screening and management within pediatric rheumatology settings and incorporation of mental health didactics, workshops, and interdisciplinary clinic experiences into pediatric rheumatology fellowship curricula. Additional steps include mental health education for patients and families and focus on system change, targeting integration of medical and mental health care. Research is needed to better define the scope of the problem, determine effective strategies for equipping pediatric rheumatologists with skills in mental health intervention, and develop and implement sustainable systems for delivery of optimal mental health care to youth with rheumatologic diseases.
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Affiliation(s)
- Alaina M. Davis
- 0000 0004 1936 9916grid.412807.8Division of Pediatric Rheumatology, Vanderbilt University Medical Center, Monroe Carell Junior Children’s Hospital at Vanderbilt, 2200 Children’s Way, Doctor’s Office Tower 11240, Nashville, TN 37232 USA
| | - Tamar B. Rubinstein
- 0000000121791997grid.251993.5Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children’s Hospital at Montefiore/ Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467 USA
| | - Martha Rodriguez
- 0000 0000 9682 4709grid.414923.9Section of Pediatric Rheumatology, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Dr, Indianapolis, IN 46202 USA
| | - Andrea M. Knight
- 0000 0001 0680 8770grid.239552.aDivision of Rheumatology, The Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South St, Ste 10253, Philadelphia, PA 19146 USA ,0000 0001 0680 8770grid.239552.aThe Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, Center for Pediatric Clinical Effectiveness, 2716 South St, Ste 10253, Philadelphia, PA 19146 USA ,0000 0001 0680 8770grid.239552.aThe Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, PolicyLab, 2716 South St, Ste 10253, Philadelphia, PA 19146 USA
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Stinson J, Connelly M, Kamper SJ, Herlin T, Toupin April K. Models of Care for addressing chronic musculoskeletal pain and health in children and adolescents. Best Pract Res Clin Rheumatol 2017; 30:468-482. [PMID: 27886942 DOI: 10.1016/j.berh.2016.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 12/22/2022]
Abstract
Chronic musculoskeletal pain among children and adolescents is common and can negatively affect quality of life. It also represents a high burden on the health system. Effective models of care for addressing the prevention and management of pediatric musculoskeletal pain are imperative. This chapter will address the following key questions: (1) Why are pediatric-specific models of pain care needed? (2) What is the burden of chronic musculoskeletal pain among children and adolescents? (3) What are the best practice approaches for early identification and prevention of chronic musculoskeletal pain in children and adolescents? (4) What are the recommended strategies for clinical management of chronic pain, including pharmacological, physical, psychological and complementary, and alternative approaches? (5) What are the most effective strategies for implementing models of pain care across different care settings? (6) What are the research priorities to improve models of care for children and adolescents with chronic musculoskeletal pain?
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Affiliation(s)
- Jennifer Stinson
- The Hospital for Sick Children, Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Room 069715, Toronto, ON, M5G 0A4, Canada.
| | - Mark Connelly
- Division of Developmental and Behavioral Sciences, The Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - Steven J Kamper
- The George Institute, University of Sydney, PO Box M201 Missenden Rd, Camperdown, NSW 2050 Australia.
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
| | - Karine Toupin April
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, 401 Smyth Road Ottawa, Ontario, K1H 8L1, Canada.
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Parsons S, Thomson W, Cresswell K, Starling B, McDonagh JE. What do young people with rheumatic disease believe to be important to research about their condition? A UK-wide study. Pediatr Rheumatol Online J 2017; 15:53. [PMID: 28673355 PMCID: PMC5496376 DOI: 10.1186/s12969-017-0181-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/11/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The involvement of people of all ages including young people in research is now widely advocated but prioritisation of research topics is still driven largely by professional agendas. Evidence from adult literature has reported a mismatch between a researcher and patient generated list of research topics. There have been no studies to date exploring the priorities of young people with long term conditions other than in SLE. The study aimed to explore the research priorities of young people across the UK with respect to rheumatic conditions. METHODS Focus groups were undertaken with young people aged 11-24 years with rheumatic conditions recruited across the UK via members of the Barbara Ansell National Network for Adolescent Rheumatology BANNAR and relevant national charities. Data was analysed using a Framework approach. Participants discussed their beliefs about what should be researched in: Basic Science; Clinical Medicine; Health Services, Psychosocial, and Public Health. They were then invited to prioritize these areas in terms of how much funding they should receive. RESULTS Thirteen focus groups were held involving 63 participants (18 males: 45 females, mean age 16 years, range 10 to 24) in all four nations of the UK. Young people's research priorities were influenced by whether they felt research would achieve benefits for all or just some patients and long or short term goals. Another influence was whether participants felt that research areas were already well funded. Across all groups, Basic Science was a key priority and participants felt that psychosocial research should be prioritized more. Health Services Research was a lower priority, as the majority of participants were happy with their care. Clinical medicine was not a high priority as young people were happy with their medication or uncomfortable with trying new ones. Finally, for nearly all groups, Public Health was a low priority. Differences were also observed between the two age groups and across the geographically diverse focus groups. CONCLUSION Understanding young people's research priorities is important to develop research that is in tune with their needs. The results highlight the importance of considering the whole age range of adolescence and young adulthood as well as geographical diversity. The findings from this work will inform the future research of the Barbara Ansell National Network for Adolescent Rheumatology BANNAR in the UK.
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Affiliation(s)
- Suzanne Parsons
- 0000 0004 0417 0074grid.462482.ePublic Programmes Team, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Wendy Thomson
- 0000000121662407grid.5379.8Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK ,0000000121662407grid.5379.8NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Katharine Cresswell
- 0000 0004 0417 0074grid.462482.ePublic Programmes Team, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Bella Starling
- 0000 0004 0417 0074grid.462482.ePublic Programmes Team, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Janet E McDonagh
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. .,Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
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Lee JJ, Feldman BM. Clinical Trial Designs in Juvenile Idiopathic Arthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2017. [DOI: 10.1007/s40674-017-0066-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ahola Kohut S, Stinson J, Forgeron P, van Wyk M, Harris L, Luca S. A qualitative content analysis of peer mentoring video calls in adolescents with chronic illness. J Health Psychol 2016; 23:788-799. [PMID: 27682341 DOI: 10.1177/1359105316669877] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article endeavored to determine the topics of discussion during open-ended peer mentoring between adolescents and young adults living with chronic illness. This study occurred alongside a study of the iPeer2Peer Program. Fifty-two calls (7 mentor-mentee pairings) were audio recorded, transcribed verbatim, and analyzed using inductive coding with an additional 30 calls (21 mentor-mentee pairings) coded to ensure representativeness of the data. Three categories emerged: (1) illness impact (e.g., relationships, school/work, self-identity, personal stories), (2) self-management (e.g., treatment adherence, transition to adult care, coping strategies), and (3) non-illness-related adolescent issues (e.g., post-secondary goals, hobbies, social environments). Differences in discussed topics were noted between sexes and by diagnosis. Peer mentors provided informational, appraisal, and emotional support to adolescents.
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Affiliation(s)
- Sara Ahola Kohut
- 1 The Hospital for Sick Children, Canada.,2 University of Toronto, Canada
| | - Jennifer Stinson
- 1 The Hospital for Sick Children, Canada.,2 University of Toronto, Canada
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