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Thomsen EL, Koppelhus JC, Boisen KA, Hanghøj S, Hansson H, Esbensen BA. Nurses' and physicians' perspectives on implementation barriers and facilitators in a transfer program for parents of adolescents with chronic illness. J Adv Nurs 2024; 80:3278-3297. [PMID: 38212971 DOI: 10.1111/jan.16026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Abstract
AIM To identify barriers and facilitators impacting the implementation of a comprehensive transfer program aimed at parents of adolescents with chronic illness in clinical practice. DESIGN A real-time, qualitative process evaluation. METHODS Individual interviews were conducted with 10 nurses and seven physicians from paediatric and adult outpatient clinics: Nephrology, hepatology, neurology, and rheumatology. Data were analysed through the lens of normalization process theory. RESULTS Themes were framed within the theory's four components. (1) Coherence: Healthcare professionals' views on their core tasks and on the parents' role influenced their perception of the program. (2) Cognitive participation: A named key worker, autonomy, and collaboration impacted healthcare professionals' involvement in the program. (3) Collective action: Department prioritization and understanding of the program's aim were key factors in its successful delivery. (4) Reflective monitoring: Participants experienced that the program helped parents during transfer but questioned if the program was needed by all families. CONCLUSION We identified three barriers: Healthcare professionals' lack of understanding of the parental role during transfer, top-down decisions among nurses, and physicians' uncertainty about their role in joint consultations. Facilitators: Healthcare professionals' understanding of the program's purpose and expected effect, the nurses' significant role as named keyworkers, and good collaboration across paediatric and adult departments. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Implementation strategies should be developed before implementing a transfer program in clinical practice. IMPACT Implementing a parental transfer program in clinical practice can be challenging. Therefore, for successful implementation, it is crucial to identify barriers and facilitators. Barriers and facilitators exist at the personal, professional, and organizational levels, and it is important to understand them. The results of this qualitative study could support the implementation of transfer programs in other settings. REPORTING METHOD Consolidated criteria for reporting qualitative studies (COREQ). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Nurses' and physicians' experiences of ownership of the transfer program is essential for successful implementation. Clinics should appoint a named keyworker, preferably a nurse, as the driving force during the implementation of a transfer program. Nurses and physicians should receive training about the purpose, justification, and expected effect of a transfer program before implementation.
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Affiliation(s)
- Ena Lindhart Thomsen
- Department of Paediatrics and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Johanne Cecilie Koppelhus
- Department of Paediatrics and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Arntz Boisen
- Department of Paediatrics and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Signe Hanghøj
- Department of Paediatrics and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Helena Hansson
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bente Appel Esbensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research (COPECARE), Center of Rheumatology and Spine Disorders, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Bowen AE, Holtman S, Reich J, Simon SL. Supporting healthy sleep: a qualitative assessment of adolescents with type 1 diabetes and their parents. J Pediatr Psychol 2024:jsae055. [PMID: 38994904 DOI: 10.1093/jpepsy/jsae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVE Poor sleep health is common in adolescence due to a combination of physiological, psychosocial, and environmental factors. Adolescents with type 1 diabetes (T1D) may be at increased risk for poor sleep health due to physiological and behavioral aspects of diabetes and its management. This article describes a qualitative analysis of interviews with adolescents with T1D and their parents about facilitators and barriers to sleep health and family strategies to balance teens' sleep with competing demands. METHODS Separate interviews were conducted with 20 adolescents with T1D and 20 parents. Interviews were recorded and transcribed verbatim and analyzed thematically. Participants were on average 15.8 ± 1.2 years old, 45% female, and 85% non-Hispanic White. RESULTS Overnight diabetes management was the most frequently reported barrier to sleep. Families reported different strategies for taking responsibility of overnight diabetes management, which differentially impacted sleep. Families worked to balance diabetes management and sleep with other aspects of adolescent life, including school demands, social activities, and electronics use. Facilitators to healthy sleep identified by families included diabetes assistive technology and maintaining a consistent sleep/wake schedule. Both adolescents and parents voiced beliefs that their diabetes care team is not able to help with sleep health. CONCLUSIONS Pediatric psychologists should be aware of the specific sleep barriers experienced by adolescents with T1D and their parents. A focus on overnight diabetes management strategies may facilitate psychologists' support of families in the adolescent's transition to independent diabetes management. Research is needed on the impact of optimizing sleep health in adolescents with T1D.
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Affiliation(s)
- Anne E Bowen
- Division of Pediatrics, Department of Pulmonology and Sleep Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Sydney Holtman
- Division of Pediatrics, Department of Pulmonology and Sleep Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer Reich
- Department of Sociology, University of Colorado Denver, Denver, CO, United States
| | - Stacey L Simon
- Division of Pediatrics, Department of Pulmonology and Sleep Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Pulmonology and Sleep Medicine, Children's Hospital Colorado, Aurora, CO, United States
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Forsberg J, Lööf G, Burström Å. Young adults' perception of transition from paediatric to adult care. Acta Paediatr 2024; 113:1612-1620. [PMID: 38568009 DOI: 10.1111/apa.17231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/05/2024] [Accepted: 03/27/2024] [Indexed: 06/12/2024]
Abstract
AIM Medical advancements will lead to more children with long-term illnesses and/or disabilities undergoing the transition to adult care. Previous studies show that many young adults are unprepared for this transition, and might suffer from loss of follow-up. This study aimed to investigate the post-transfer experiences of the transition among young adults with long-term illnesses and/or disabilities. METHODS A qualitative descriptive design was used. Three semi-structured focus group interviews were conducted with 15 participants (18-25 years of age) recruited via patient organisations focusing on children and young adults with disabilities and/or long-term illnesses. The interviews were analysed with conventional content analysis. RESULTS One theme emerged: limbo, defined as an indefinite experience without knowing when or even if something would happen, or whether they would be overlooked. The theme rested on four categories: transition experiences, organisational aspects, influence on daily life, and self-management. CONCLUSION Areas for improvement were identified across the entire transition that is, in the preparation, transfer, and post-transfer stages. Our findings indicate a limited understanding among healthcare providers (HCPs) that the transition continues until the young adult has been fully integrated into adult care.
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Affiliation(s)
| | - Gunilla Lööf
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Burström
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
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Sisk BA, Antes AL, Bereitschaft C, Bourgeois F, DuBois JM. Providing Adolescents with Access to Online Patient Portals: Interviews with Parent-Adolescent Dyads. J Pediatr 2024; 270:114015. [PMID: 38492914 DOI: 10.1016/j.jpeds.2024.114015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To identify perceived benefits, problems, facilitators, and barriers to adolescent online patient portal use. STUDY DESIGN Qualitative, semi-structured interviews with dyads of parents and adolescents with or without chronic illness. The study team purposively sampled for racial and ethnic minorities and fathers. Three team members then performed thematic analysis of the transcripts, with subsequent dyadic analysis of themes represented by related parents and adolescents. RESULTS We performed 102 interviews with 51 dyads of parents and adolescents (26 with chronic illness, 25 without chronic illness). Nearly all participants believed that adolescents should be permitted portal access. We identified 4 themes related to portal benefits: improves adolescent's knowledge of health; supports medical self-management and autonomy; strengthens communication and relationships; and supports parental influence. We identified 4 themes related to portal problems: misunderstanding or confusion; emotional distress; strain on relationships; and irresponsible use of portal. Facilitators of portal use included severity of illness, adolescent's curiosity, and ease of technology use. Barriers included lack of awareness or interest, complexity of information, and access difficulties. Twenty adolescents (39%) did not know they could access the portal, and 23 (45%) lacked interest in portals. Parents and adolescents seldom used the portal as a collaborative tool, and instead were engaging with the portal independently. CONCLUSION Parents and adolescents perceive several benefits and problems with portal use, but many adolescents lack interest in using portals. Adolescent portals represent an underutilized resource to engage adolescents in their care.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Bioethics Research Center, General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
| | - Alison L Antes
- Bioethics Research Center, General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Christine Bereitschaft
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Fabienne Bourgeois
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - James M DuBois
- Bioethics Research Center, General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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Pitts L, Patrician PA, Landier W, Kazmerski T, Fleming L, Ivankova N, Ladores S. Parental entrustment of healthcare responsibilities to youth with chronic conditions: A concept analysis. J Pediatr Nurs 2024; 76:1-15. [PMID: 38309191 DOI: 10.1016/j.pedn.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Chronic health conditions impact nearly 40% of children in the United States, necessitating parents/caregivers to entrust healthcare responsibilities to youth aging into adulthood. Understanding the parental entrustment process may lead to tailored transition support; however, the concept lacks conceptual clarity, limiting its research and practical applications. DESIGN AND METHODS Rodgers' evolutionary concept analysis method was used to clarify the parental entrustment of healthcare responsibilities to youth with chronic health conditions. PubMed, CINAHL, and PsycINFO databases were searched without date restrictions, including full-text, English-language, primary source articles related to parent-child healthcare transition preparation. Following title, abstract, and full-text screenings, data were analyzed using a hybrid thematic approach to identify antecedents, attributes, and consequences. RESULTS Forty-three studies from August 1996 to September 2023 were identified. Antecedents encompass social cues and readiness factors, while attributes involve a) responsibility transfer, support, and facilitation, b) a dynamic process, c) balancing trust and fear, d) navigating conflict, and e) parental letting go. Consequences entail shifts in parental and adolescent roles. Parental entrustment is an iterative process wherein parents guide their maturing child through responsibility transfer via facilitation, support, conflict navigation, and trust building. CONCLUSION The clarified concept underscores the role of parents/caregivers in empowering youth to manage their health. Introducing a working definition and conceptual model contributes to understanding the processes families navigate in the larger landscape of healthcare transition. PRACTICE IMPLICATIONS This clarification holds implications for clinicians and policymakers, offering insights to enhance support and guidance for families navigating healthcare transition.
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Affiliation(s)
- Leslie Pitts
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Patricia A Patrician
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Wendy Landier
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama Heersink School of Medicine, Division of Pediatric Hematology/Oncology, 1600 7th Avenue South, Lowder 512, Birmingham, AL 35233, United States.
| | - Traci Kazmerski
- The University of Pittsburg Medical Center Children's Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University Center, 120 Lytton St.-Suite M060, Pittsburgh, PA 15213, United States.
| | - Louise Fleming
- The University of North Carolina at Chapel Hill, School of Nursing, 105 Carrington Hall, Chapel Hill, NC 37599, United States.
| | - Natalyia Ivankova
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama at Birmingham, School of Health Professions, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Sigrid Ladores
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
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Sisk B, Antes AL, Bereitschaft C, Enloe M, Bourgeois F, DuBois J. Guiding Principles for Adolescent Web-Based Portal Access Policies: Interviews With Informatics Administrators. JMIR Pediatr Parent 2024; 7:e49177. [PMID: 38466976 DOI: 10.2196/49177] [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: 05/19/2023] [Revised: 11/17/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Web-based patient portals are tools that could support adolescents in managing their health and developing autonomy. However, informatics administrators must navigate competing interests when developing portal access policies for adolescents and their parents. OBJECTIVE We aimed to assess the perspectives of informatics administrators on guiding principles for the development of web-based health care portal access policies in adolescent health care. METHODS We interviewed informatics administrators from US hospitals with ≥50 dedicated pediatric beds. We performed a thematic analysis of guiding principles for developing and implementing adolescent portal access policies. RESULTS We interviewed 65 informatics leaders who represented 63 pediatric hospitals, 58 health care systems, 29 states, and 14,379 pediatric hospital beds. Participants described 9 guiding principles related to three overarching themes: (1) balancing confidentiality and other care needs, (2) balancing simplicity and granularity, and (3) collaborating and advocating. Participants described the central importance of prioritizing the health and safety of the adolescent while also complying with state and federal laws. However, there were differing beliefs about how to prioritize health and safety and what role parents should play in supporting the adolescent's health care. Participants also identified areas where clinicians and institutions can advocate for adolescents, especially with electronic health record vendors and legislators. CONCLUSIONS Informatics administrators provided guiding principles for adolescent portal access policies that aimed to balance the competing needs of adolescent confidentiality and the usefulness of the portal. Portal access policies must prioritize the adolescent's health and safety while complying with state and federal laws. However, institutions must determine how to best enact these principles. Institutions and clinicians should strive for consensus on principles to strengthen advocacy efforts with institutional leadership, electronic health record vendors, and lawmakers.
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Affiliation(s)
- Bryan Sisk
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, MO, United States
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, St Louis, MO, United States
| | - Alison L Antes
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, MO, United States
| | - Christine Bereitschaft
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, St Louis, MO, United States
| | - Madi Enloe
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, St Louis, MO, United States
| | - Fabienne Bourgeois
- Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - James DuBois
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, MO, United States
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Vo DX, Tabi K, Bhullar M, Johnson A, Locke J, Wang S, Stewart SE, Marshall SK. Mindful awareness and resilience skills for adolescents (MARS-A): a mixed-methods study of a mindfulness-based intervention for a heterogeneous adolescent clinical population. Int J Adolesc Med Health 2024; 36:25-35. [PMID: 38298033 DOI: 10.1515/ijamh-2023-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Mindful Awareness and Resilience Skills for Adolescents (MARS-A) is a mindfulness-based intervention adapted for the adolescent population. While previous studies have explored the benefits of MARS-A in various single-diagnosis populations, the aim of this study was to assess MARS-A for a heterogenous clinical adolescent population with mental health and/or chronic diagnoses, focusing on the underlying suffering present in all these conditions rather than its effects on a single diagnosis itself. METHODS Qualitative data was collected through interviews to understand post-intervention participant perspectives and experiences. Quantitative data was collected through measures to investigate preliminary secondary outcomes. RESULTS After participating in MARS-A, participants reported qualitative benefits in enhanced well-being, including coping with difficult emotions and managing sleep and/or pain. Quantitative results showed a reduction in functional disability, psychological distress, perceived stress, and depressive symptoms; increase in positive affect; and benefit in coping with pain and chronic conditions. CONCLUSIONS MARS-A shows great potential in a heterogeneous clinical adolescent population.
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Affiliation(s)
- Dzung X Vo
- Centre for Mindfulness, BC Children's Hospital, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
- BC Children's Hospital, Vancouver, Canada
- Division of Adolescent Health and Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Katarina Tabi
- Centre for Mindfulness, BC Children's Hospital, Vancouver, Canada
- BC Reproductive Mental Health Program, BC Women's Hospital and Health Centre, Vancouver, Canada
- Department of Psychiatry, The University of British Columbia, Vancouver, Canada
| | - Manreet Bhullar
- Centre for Mindfulness, BC Children's Hospital, Vancouver, Canada
- BC Reproductive Mental Health Program, BC Women's Hospital and Health Centre, Vancouver, Canada
| | - Andrea Johnson
- School of Social Work, The University of British Columbia, Vancouver, Canada
| | - Jake Locke
- BC Children's Hospital, Vancouver, Canada
| | - Sophia Wang
- Centre for Mindfulness, BC Children's Hospital, Vancouver, Canada
- BC Reproductive Mental Health Program, BC Women's Hospital and Health Centre, Vancouver, Canada
| | - S Evelyn Stewart
- Centre for Mindfulness, BC Children's Hospital, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Psychiatry, The University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Research Institute, Vancouver, Canada
| | - Sheila K Marshall
- Division of Adolescent Health and Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- School of Social Work, The University of British Columbia, Vancouver, Canada
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Day J, Hames A, Earl M, Simpson A, Joshi D, Pissas E, Samyn M. Self-management skills in a UK sample of young people with chronic liver disease. Pediatr Transplant 2023; 27:e14614. [PMID: 37807641 DOI: 10.1111/petr.14614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND We aimed to assess self-management skills and adherence behaviors in young people post-liver transplant and compare these with those of young people with autoimmune liver disease and other forms of chronic liver disease. METHOD As part of our specialist multidisciplinary clinic, n = 156 young people (aged 16-25 years) completed the Liver Self-Management Questionnaire (an adaptation of the Developmentally Based Skills Checklist for adolescents post-liver transplant and modified for us across liver disease type and within the United Kingdom). Those taking medication (n = 128) also completed a service-designed questionnaire regarding adherence. The statistical significance of group differences was assessed with non-parametric analyses. RESULTS Young people post-liver transplant were less likely to report managing their condition independently than those with autoimmune liver disease or those with other forms of chronic liver disease. They also reported higher adherence (93%) compared to those with autoimmune liver disease (77%) and those with other forms of chronic liver disease (85%). However, the vast majority of self-management and adherence behaviors were comparable between young people post-transplant and those with autoimmune liver disease/other forms of chronic liver disease. CONCLUSION Our data are in line with existing data from US samples and also extend these findings to include those with other forms of chronic liver disease. These data highlight the importance of individualized care for young adults, regardless of condition type or healthcare setting, and of clinicians managing their expectations regarding what is considered appropriate condition management in early adulthood.
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Affiliation(s)
- Jemma Day
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Anna Hames
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Megan Earl
- Paediatric Liver, Gastroenterology & Nutrition Centre, King's College Hospital, London, UK
| | - Anna Simpson
- Institute of Psychiatry, Psychology & Neuroscience, King's College Hospital, London, UK
| | - Deepak Joshi
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Eleanna Pissas
- Paediatric Liver, Gastroenterology & Nutrition Centre, King's College Hospital, London, UK
| | - Marianne Samyn
- Paediatric Liver, Gastroenterology & Nutrition Centre, King's College Hospital, London, UK
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Yamaguchi M, Honda J, Fukui M. Effects of Parental Involvement on Glycemic Control in Adolescents With Type 1 Diabetes Mellitus: A Scoping Review. JOURNAL OF FAMILY NURSING 2023; 29:382-394. [PMID: 37211777 DOI: 10.1177/10748407231171842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is typically diagnosed in pediatric patients. Transitioning from supported management in childhood to self-management in adolescence is an important step. Parental psychosocial influence is a possible factor in adolescents' disease control. This review summarized the effects of parental involvement on glycemic control in adolescents with T1DM by focusing on hemoglobin A1c (HgbAIc). A scoping review per the Guidance for Systematic Scoping Reviews was conducted with the following inclusion criteria: (a) studies in English, (b) focused on adolescents with T1DM, (c) outcomes included HgbAIc, and (d) focused on parental influence of children with T1DM. Of 476 articles, 14 were included. The study outcomes were classified based on direct or indirect influence. "Parental support for adherence" and "parental conflict" significantly affected HgbAIc control. This study provides current evidence on parental influence on glycemic control in adolescents.
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Affiliation(s)
| | | | - Minae Fukui
- Mukogawa Women's University, Nishinomiya, Japan
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Cui C, Zhou H, Chen W, Li S, Zheng X. Behavioral Dilemmas and Support Requirements of Self-Management for Chinese Adolescents with Epilepsy During Transition Readiness: A Mixed-Methods Study. Patient Prefer Adherence 2023; 17:2605-2619. [PMID: 37905160 PMCID: PMC10613408 DOI: 10.2147/ppa.s429890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
Objective The study aimed to describe and explore the behavioral dilemmas and support-requirement characteristics of self-management for epileptic adolescents during transition readiness. Methods A convergent mixed-methods study was conducted. Patients (N=654) in eight hospitals in China completed a demographic and disease characteristics questionnaire and measures of epilepsy transition readiness, self-management of epilepsy, and perceived social support, and 17 patients and family care-givers were interviewed simultaneously. Results Adolescents with epilepsy (AWEs) had low levels of self-management and transition readiness, and moderate levels of social support. Multivariate linear regression showed that age, antiepileptic drug type, comorbidities, family structure, transition readiness, and social support were statistically significant in the regression model (p<0.05). Seven themes emerged in the qualitative analysis related to self-management behavioral dilemmas, and 11 themes emerged for support requirements. The findings from the qualitative and quantitative analyses were combined to create a conceptual model based on the SMART framework and the social cognitive theory. Conclusion The findings indicate that the state of self-management behaviors of Chinese AWEs is not promising. The influential factors and characteristics are complex and systematic. Practice Implications This study provides insights into the self-management practices of AWEs in China and expands previous self-management and transitional readiness strategies and models.
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Affiliation(s)
- Cui Cui
- Department of Nursing Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People’s Republic of China
| | - Hengyu Zhou
- School of Nursing, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wenjin Chen
- Neurology Department of Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People’s Republic of China
| | - Shuangzi Li
- Neurology Department of Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People’s Republic of China
| | - Xianlan Zheng
- Department of Nursing Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People’s Republic of China
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Sisk BA, Antes AL, Bereitschaft C, Enloe M, Lin S, Srinivas M, Bourgeois F, DuBois JM. Engaging Adolescents in Using Online Patient Portals. JAMA Netw Open 2023; 6:e2330483. [PMID: 37610751 PMCID: PMC10448298 DOI: 10.1001/jamanetworkopen.2023.30483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/14/2023] [Indexed: 08/24/2023] Open
Abstract
Importance Many health care systems offer adolescents access to health information through online patient portals, but few studies have explored how to engage adolescents in using and benefiting from online portals. Objective To determine how US children's hospitals have attempted to encourage adolescent portal use, barriers to engaging adolescents, and ideal future goals for engagement. Design, Setting, and Participants This qualitative study performed structured qualitative interviews with informatics administrators from children's hospitals across the US between February and July 2022. Informatics administrators were employed by US health care systems that managed a children's hospital with at least 50 dedicated pediatrics beds. Data analysis was performed from November 2022 to January 2023. Main Outcomes and Measures This study used thematic analysis of (1) current steps that health care systems had taken to engage adolescents in using their online patient portals and (2) barriers to engaging adolescents and ideal future goals and outcomes of engagement. Results Among 58 total interviews with 65 informatics administrators who represented 63 hospitals across 58 health care systems, 6 themes of approaches to engaging adolescents in portal use were identified: (1) promoting and educating adolescents about portal enrollment, (2) establishing workflows to support enrollment, (3) seeking and incorporating feedback, (4) creating a culture or environment supporting engagement, (5) increasing portal utility, and (6) limited efforts. Barriers to engaging adolescents in portal use related to either (1) stakeholder investment, interest, and capabilities or (2) intersecting technical, ethical, and legal factors. Participants identified 4 ideal future efforts to engage adolescents: (1) develop adaptable private means of communication with adolescents, (2) use adolescent-centric user design, (3) enhance promotion and education about portal use, and (4) simplify and adapt workflows to encourage enrollment. Participants described 3 ideal outcomes of this future engagement: (1) provide education about current health, (2) prepare for transition to adulthood, and (3) improve digital health education of adolescents. Conclusions and Relevance In this qualitative study of informatics administrators, children's hospitals across the US were found to have varying degrees of efforts to engage adolescents in using their portals. Most of these efforts focused on supporting adolescent enrollment, but fewer efforts focused on making the portal useful and interesting to adolescents.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Alison L Antes
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Christine Bereitschaft
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Madi Enloe
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Sunny Lin
- General Medical Sciences, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Meghana Srinivas
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Fabienne Bourgeois
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - James M DuBois
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
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12
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Ouimet F, Fortin J, Bogossian A, Padley N, Chapdelaine H, Racine E. Transitioning from pediatric to adult healthcare with an inborn error of immunity: a qualitative study of the lived experience of youths and their families. Front Immunol 2023; 14:1211524. [PMID: 37600793 PMCID: PMC10432858 DOI: 10.3389/fimmu.2023.1211524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/27/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Transition from pediatric to adult healthcare is a multifaceted and consequential process with important health implications for youth. Although research on transition has grown significantly, research on transition for patients living with an inborn error of immunity (IEI) is scarce. We undertook a qualitative study to better understand the perspectives of youths and parents in an outpatient immunology clinic. Methdos Semi-structured interviews were conducted with 9 youths, 6 parents and 5 clinicians, all recruited from the same clinic. All youths recently transferred to adult care with or without an established diagnosis of IEI. Interviews were transcribed verbatim and thematic analysis was conducted. Two sets of themes were generated. The first set captured the positive and negative aspects experienced during transition, as well as recommendations to facilitate the process. The second set focused on key topics discussed in the interviews that were merged into overarching themes. Results Perspectives of participants were clustered into 6 overarching themes: (1) lack of knowledge about IEIs; (2) scattered transitions; (3) changing healthcare teams; (4) approaching an unknown environment; (5) transitioning to adulthood; (6) assuming responsibility for the management of the condition. Overall, the challenges encountered with respect to these themes had profound clinical and humanistic implications for patients such as generating significant distress. Discussion We discuss the unique challenges of the youths in our study in comparison to common problems reported by youths with chronic illness in the broader transition literature (for example: the change of healthcare team, the lack of information about the transition process and navigating the adult care system, growth towards self-management and the co-occurring developmental transition to adulthood). There is an urgency to attend to the specific problems created by the rarity of IEIs and related lack of knowledge about them as well as the need for multidisciplinary cross-clinic care during transition and beyond.
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Affiliation(s)
- François Ouimet
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Justine Fortin
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Aline Bogossian
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- École de travail social, Faculté des arts et des sciences, Université de Montréal, Montréal, QC, Canada
| | - Nicole Padley
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Hugo Chapdelaine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Faculté de médecine, Université de Montréal, Montréal, QC, Canada
- Département de médecine et Département de médecine sociale et préventive, Université de Montréal, Montréal, QC, Canada
- Division of Experimental Medicine, McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
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Lunkenheimer F, Mutter A, Vogelmann P, Baumeister H. Posttraumatic stress symptoms in adolescents and young adults with a chronic somatic disease: a mixed-methods study. Child Adolesc Psychiatry Ment Health 2023; 17:80. [PMID: 37365570 DOI: 10.1186/s13034-023-00630-x] [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: 12/29/2022] [Accepted: 03/29/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Adolescents and young adults (AYA) with a chronic somatic disease (CD) have a 3-fold higher risk of post-traumatic stress disorder (PTSD) than healthy controls. In addition, elevated post-traumatic stress symptoms (PTSS) have a negative impact on CD severity, treatment adherence, health problems and functional impairment. However, a more detailed understanding of this comorbidity is lacking. METHODS AYA with type 1 diabetes mellitus, juvenile idiopathic arthritis or cystic fibrosis (12-21 years of age) and elevated anxiety and/or depression symptoms, as well as their reference persons (≥ 18 years of age), completed online questionnaires in self- or observer report. The most stressful event related to the CD was reported descriptively. Questionnaires were used to assess PTSS, anxious and depressive symptoms, actual overall health, coping, personal growth and social support. Qualitative content analysis, linear regression models and correlations were used for mixed methods analysis. RESULTS According to the reports of n = 235 AYA (mean age 15.61; 73% girls) and n = 70 reference persons, four categories were identified as the most stressful events due to CD: (1) psychological burden (40% of AYA / 50% of reference persons); (2) CD self-management (32% / 43%); (3) social burden (30% / 27%); and (4) physical impairment (23% / 16%). 37% of AYA reported clinically relevant PTSS due to CD. The best predictors of PTSS severity were anxious-depressive symptoms, emotional coping, personal growth and current overall health (F(4, 224) = 59.404, R² = 0.515, p < .001). Of all categories, psychological (β = 0.216, p = .002) and social burden (β = 0.143, p = .031) showed significant association with the severity of PTSS (F(4, 230) = 4.489, R² = 0.072, p = .002). The more categories the most stressful event addressed, the higher was the PTSS symptom severity (r = .168, p = .010). CONCLUSIONS Many AYA showed clinically relevant PTSS and reported experiencing stressful events in several areas of life through their CD. The association between the stressful event categories and other variables could help identify AYA with CD who need psychological interventions the most. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00016714, registered on 25/03/2019 and DRKS00017161, registered on 17/09/201.
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Affiliation(s)
- Frederike Lunkenheimer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany.
| | - Agnes Mutter
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
| | - Pauline Vogelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
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Lee J, Kim E, Chung M, Yeom I. Validity and reliability of the Korean caregiver contribution to self-care chronic illness inventory. Sci Rep 2023; 13:7808. [PMID: 37183194 PMCID: PMC10183459 DOI: 10.1038/s41598-023-35084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/12/2023] [Indexed: 05/16/2023] Open
Abstract
The contribution of caregivers to self-care for chronically ill patients is important for improving patient outcomes. The Caregiver Contribution to Self-Care Chronic Illness Inventory (CC-SC-CII) has been used to assess caregivers' contributions to three distinct aspects of self-care (maintenance, monitoring, and management) globally. This study aimed to examine the psychometrics of the Korean version of the CC-SC-CII with 230 family caregivers (mean age = 49.8 years, 70% women) of patients with chronic illness. We demonstrated that the CC-SC-CII-Korean has good reliability with acceptable internal consistency and construct validity for all three factors using confirmatory factor analysis. The CC-SC-CII-Korean is a reliable and valid instrument to measure the contributions of Korean caregivers to the self-care of patients with chronic illnesses.
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Affiliation(s)
- Juhee Lee
- Mo-Im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Centre of Korea: A JBI Affiliated Group, College of Nursing, Yonsei University, Seoul, Republic of Korea
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Eunyoung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Misook Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Insun Yeom
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea.
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Johansen SK, Kanstrup AM, Haseli K, Stenmo VH, Thomsen JL, Rathleff MS. Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study. JMIR Hum Factors 2023; 10:e44462. [PMID: 37115609 PMCID: PMC10182461 DOI: 10.2196/44462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents' self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, it remains unclear how mHealth apps should be designed to act as tools for supporting individual and collaborative management of adolescents' knee pain in a general practice setting. OBJECTIVE The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents' everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making. METHODS Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain. RESULTS Overall, 38% (9/24) young adults with chronic knee pain since adolescence, 25% (6/24) parents, and 38% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants' roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making. CONCLUSIONS An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 silver-bullet principles for consolidating mHealth core features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance.
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Affiliation(s)
- Simon Kristoffer Johansen
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | | | - Kian Haseli
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | - Visti Hildebrandt Stenmo
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | - Janus Laust Thomsen
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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16
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Haig-Ferguson A, Wallace V, Davis C. The lived experience of adults and parents: Transitioning from paediatric to adult health care with oesophageal atresia and tracheo-oesophageal fistula. J Clin Nurs 2023; 32:1433-1442. [PMID: 35460126 DOI: 10.1111/jocn.16333] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/26/2022] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
AIM AND OBJECTIVE To explore the experience of healthcare transition from paediatric to adult health care for adults born with oesophageal atresia and tracheo-oesophageal fistula (OA/TOF) and parents. BACKGROUND OA/TOF is a rare and chronic health condition that can require lifelong medical follow-up and management. There is evidence to suggest that transitioning from paediatric to adult health care can be problematic for people with rare and chronic conditions, including OA/TOF. The previous literature suggests that the experience of transitioning with a rare condition is more complex than transitioning with a common chronic condition. DESIGN The current study was a qualitative, cross-sectional, survey-based study. METHODS Data were collected through an online survey. Parents of children born with OA/TOF (n = 23) and adults born with OA/TOF (n = 16) were recruited through a UK-based OA/TOF patient charity. Data from six open-ended questions were analysed using a hybrid approach combining elements of inductive and deductive thematic analyses. Throughout the research process, the SRQR were followed. RESULTS Five themes were constructed during the analysis, reflecting the experience of parents and adults transitioning from paediatric to adult health care: thrown into the unknown; a cultural shift; stepping back and stepping up; 'no transition as such'; and living with uncertainty. CONCLUSIONS The findings suggested that a formalised, managed healthcare transition is not commonly experienced by people born with OA/TOF and parents. RELEVANCE TO CLINICAL PRACTICE We recommend a formalised healthcare transition process in OA/TOF, including preparation for transition and having a named key worker to manage the multidisciplinary transition process. The results also highlighted the need for adults born with OA/TOF to have access to a specialist health service with knowledge and understanding of issues related to OA/TOF.
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Affiliation(s)
| | - Vuokko Wallace
- Department of Clinical Psychology, University of Bath, Bath, UK
| | - Cara Davis
- Department of Clinical Psychology, University of Bath, Bath, UK
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17
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Nightingale R, Kirk S, Swallow V, McHugh GA. Supporting the parent-to-child transfer of self-management responsibility for chronic kidney disease: A qualitative study. Health Expect 2023; 26:683-692. [PMID: 36562551 PMCID: PMC10010075 DOI: 10.1111/hex.13693] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION As children with long-term conditions (LTCs) mature, they are usually expected to assume responsibility from their parents for self-management of their condition. Little is known about what supports families with this handover of responsibility, including the role of healthcare professionals (HCPs). This study aimed to explore what supports young people with chronic kidney disease (CKD) to assume self-management responsibility and parents to relinquish control. METHODS A qualitative study, using a grounded theory approach was conducted. Individual and dyadic interviews and focus groups were carried out with 16 young people aged 13-17 years old with CKD, 13 parents, and 20 HCPs. Participants were recruited from two UK children's renal units. FINDINGS Building and maintaining trust, fostering positivity, learning from mistakes, forming partnerships and individualized support, facilitated the transfer of self-management responsibility. However, HCPs' focus on developing partnerships with young people meant some parents felt excluded, highlighting uncertainty around whether support should be child- or family-centred. Although tailored support was identified as critical, aspects of local service provision appeared to impact on HCPs' capacity to implement individualized approaches. CONCLUSION This study has identified what supports the handover of responsibility, and, importantly, HCPs' current, and potential role in helping young people to assume responsibility for managing their LTC. Further research is needed to explore how HCPs' involvement balances child- and family-centred care, and how HCPs can adopt personalized, strengths-based approaches to help ensure the support that families receive is tailored to their individual needs. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery.
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Affiliation(s)
- Ruth Nightingale
- Language and Cognition Department, UCL Division of Psychology and Language Science, University College London, London, UK
| | - Sue Kirk
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Gretl A McHugh
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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18
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Sayegh CS, Iverson E, Newman C, Tanaka D, Olshansky EF, Wijaya C, Belzer M. Designing an mHealth Roadmap for the Journey to Self-Management: A Qualitative Study with Adolescents and Young Adults Living with Chronic Illness. Chronic Illn 2023; 19:65-80. [PMID: 34904870 DOI: 10.1177/17423953211067436] [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] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Adolescents and young adults (AYA) with chronic illnesses often struggle with illness self-management. The objective of this study is to understand how AYA with various chronic illnesses develop self-management skills and which mobile health (mHealth) strategies they believe could be helpful. METHODS Semi-structured interviews were conducted with patients, between 16 to 20 years old, living with at least one chronic illness (N = 19), between 2018 and 2019 in Los Angeles, CA. Three coders completed thematic coding to understand how AYA develop and maintain self-management skills, to inform the development of mHealth interventions appropriate across a variety of chronic conditions. RESULTS Results suggest that AYA develop self-management skills through several strategies, including (1) getting organized, (2) making it work for me and (3) keeping the right mentality. AYA described developing these strategies through: (1) receiving social support, (2) accessing helpful tools and technologies, and (3) going through a maturation process. They provided recommendations for mHealth intervention developers. DISCUSSION The results suggest that an appealing mHealth intervention could support AYA patients in proactively acquiring self-management skills and prevent having to rely on trial and error or uneven access to guidance and support. Interventions should be responsive to individual technology preferences and practices.
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Affiliation(s)
- Caitlin S Sayegh
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,USC University Center for Excellence in Developmental Disabilities, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ellen Iverson
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Clarissa Newman
- Department of Population and Public Health Sciences, 12223University of Southern California, Los Angeles, California, USA
| | - Diane Tanaka
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ellen F Olshansky
- 115162Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA.,Sue & Bill Gross School of Nursing, 8788University of California Irvine, Los Angeles, California, USA
| | - Clarisa Wijaya
- Department of Psychology, 5116University of Southern California, Los Angeles, California, USA
| | - Marvin Belzer
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Courtwright SE, Jones J, Barton A, Peterson K, Eigen K, Feuerstein J, Pawa A, Pawa A, Northridge J, Pall H. Including Voices of Adolescents With Chronic Conditions in the Redesign of Children's Mental Health Systems: Implications for Resource Allocation. J Pediatr Health Care 2023. [PMID: 36863886 DOI: 10.1016/j.pedhc.2023.01.004] [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] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Adolescents with chronic conditions have disparate mental health outcomes. This study aimed to explore the perspectives of adolescents with chronic conditions on mental health system redesign to improve outcomes. METHOD Within an interpretive phenomenological approach, semistructured interviews with 17 adolescents aged 10-20 years with chronic conditions were conducted. Purposive sampling and recruitment occurred at three ambulatory sites. Data were analyzed using inductive and deductive thematic analysis until information saturation was achieved. RESULTS Four themes were identified: (1) Brushed off: I need to be heard, (2) I need someone I can really talk to and trust, (3) They need to reach out to us. Check in on us, and (4) the school nurse is for physical illness only. DISCUSSION Mental health system redesign should be considered for adolescents with chronic conditions. The findings can inform future research to test innovative health care delivery models to reduce mental health disparities in this vulnerable population.
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Affiliation(s)
- Suzanne E Courtwright
- Suzanne E. Courtwright, Postdoctoral Research Fellow, College of Nursing, University of Colorado, Aurora, CO; Center for Healthcare Delivery Research and Innovations, Columbia University School of Nursing, New York, NY.
| | - Jacqueline Jones
- Jacqueline Jones, Professor of Nursing, Assistant Dean and PhD Program Director, College of Nursing, University of Colorado, Aurora, CO
| | - Amy Barton
- Amy Barton, Professor, Senior Associate Dean for Faculty and Students, Daniel and Janet Mordecai Endowed Chair in Rural Health Nursing, College of Nursing, University of Colorado, Aurora, CO
| | - Kerry Peterson
- Kerry Peterson, Associate Professor, Specialty Director of the PMHNP program, University of Colorado, Aurora, CO
| | - Karen Eigen
- Karen Eigen, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Pediatric Emergency Medicine Physician, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Jessica Feuerstein
- Jessica Feuerstein, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Pediatrician, Departments of Emergency Medicine and Adolescent Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, and Pediatrician; Department of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anil Pawa
- Anil Pawa, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Chair of Pediatrics, and Professor, Section Chief, Primary Care Pediatrics, Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Neptune, NJ
| | - Akhil Pawa
- Akhil Pawa, Research Assistant, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Research Assistant, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Jessica Northridge
- Jessica Northridge, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Section Chief, Adolescent Medicine, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Harpreet Pall
- Harpreet Pall, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Chair of Pediatrics, and Professor, Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Neptune, NJ
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20
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Mohammadi F, Zahra Masoumi S, Oshvandi K, Bijani M, Nikrouz L. Death anxiety, resilience, and family cohesion in parents of children and adolescents in the end stages of life. Front Psychol 2023; 14:1057003. [PMID: 36844349 PMCID: PMC9950632 DOI: 10.3389/fpsyg.2023.1057003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023] Open
Abstract
Purpose Adolescents in the end stages of life impose a lot of psychological stress on other family members, which may affect their resilience and quality of life. So, the aim of the present study was to investigate death anxiety, family adaptability and cohesion, and resilience in the parents of children and adolescents who were at the end stages of life. Methods This is a cross-sectional study. Two hundred and ten parents were selected by convenience sampling and completed the questionnaires such as demographics survey, the death anxiety scale, Connor-Davidson resilience scale, family adaptability, and cohesion scale. Data were analyzed by descriptive statistics (frequency, percentage, mean, and standard deviation), independent t-test, ANOVA, and multiple linear regressions. The significance level was set at p < 0.05. Result The findings showed that death anxiety in parents of children and adolescents in the end stages of life has a significant inverse correlation with family adaptability and cohesion (p < 0.001, r = -0.92) and resilience (p < 0.001, r = -0.90). The variables of family adaptability and cohesion, resilience, number of children, the children's illness duration, and marital status can predict 61.34% of the death anxiety variance in these parents. Conclusion The parents of children and adolescents in end stages of life reported high death anxiety and moderate family adaptability and cohesion, but low resilience. Accordingly, pediatric nurses and healthcare policymakers should develop comprehensive support plans for these parents to facilitate their adaptation and increase their family adaptability and cohesion.
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Affiliation(s)
- Fateme Mohammadi
- Chronic Diseases (Home Care) Research Center and Autism Spectrum Disorders Research Center, Department of Nursing, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Midwifery, School of Nursing and Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Khodayar Oshvandi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mother and Child Care Research Center, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Mostafa Bijani
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran,*Correspondence: Mostafa Bijani,
| | - Leila Nikrouz
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
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Town R, Hayes D, March A, Fonagy P, Stapley E. Self-management, self-care, and self-help in adolescents with emotional problems: a scoping review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-022-02134-z. [PMID: 36641785 PMCID: PMC9840811 DOI: 10.1007/s00787-022-02134-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 12/22/2022] [Indexed: 01/16/2023]
Abstract
This study aimed to review the existing published and grey literature describing the concepts of self-management, self-care, and self-help, and to capture strategies or techniques related to these concepts, for adolescents with emotional problems. Emotional problems are rising amongst adolescents, yet timely access to specialist mental health treatment is limited to those with greater severity of mental health difficulties. Self-management, self-care, and self-help strategies may be used by adolescents with emotional problems both in terms of those waiting for treatment and to prevent relapse. Given the overlap in existing definitions and the lack of clarity around these concepts in an adolescent mental health context, a scoping review of the literature is warranted to provide clarity. Eligible studies were those involving adolescents aged 10 to 19 years with symptoms of emotional problems. Studies referenced self-management, self-care, or self-help, not involving a professional, in this population. Quantitative, qualitative, economic, and mixed methods studies, as well as systematic, scoping, and literature reviews, from 2000 onwards and in the English language, were eligible for inclusion. A systematic search was conducted of both published and grey literature. Databases searched included PsycINFO, Medline, Embase, Web of Science, and CINAHL Plus. Mednar was also searched for unpublished studies and grey literature. Tables of themes, terms, and associated strategies are presented alongside a thematic analysis of the results. 62 articles were included. These were 20 quantitative studies, 14 systematic reviews, 10 qualitative studies, five review papers, four book chapters, four mixed methods studies, two dissertations, two meta-analyses and one scoping review and systematic review. Most of the included articles referenced self-help (n = 51), followed by self-management (n = 17) and self-care (n = 6). A total of 12 themes were identified from a reflexive thematic analysis of descriptions (and associated strategies) of self-management, self-help, or self-care in included texts. This scoping review provides clarity on the similarities and differences between how these concepts are discussed, and the strategies which are associated with each of these concepts in the relevant literature. Implications for policy and intervention development for adolescents' self-management, self-help, and self-care of their mental health are discussed. There is considerable overlap in both the ways in which these concepts are described, and the strategies or approaches proposed in relation to them, supporting previous research suggesting these strategies should be grouped under a single term, such as "self or community approaches." More research is needed for self-management, self-help, and self-care amongst marginalized groups as these adolescents may have the highest unmet need for mental health support.
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Affiliation(s)
- Rosa Town
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Daniel Hayes
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Anna March
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Emily Stapley
- Evidence Based Practice Unit, Anna Freud Centre and University College London, London, UK
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22
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Roberts KJ, Hafez SA, Snethen J, Binns HJ, Knafl KA. Perceptions of Weight Management: Interviews with Adolescents with Severe Obesity and Their Mothers. Child Obes 2022; 18:219-227. [PMID: 34762511 DOI: 10.1089/chi.2021.0181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Adolescence is a challenging time for families, which is intensified when managing a chronic health condition. In adolescents with severe obesity, little is known about how adolescent/mother dyads approach management. Our study aims to (1) explore similarities/differences in adolescent/mother dyads' perceptions of weight management behaviors and (2) describe their experiences with successes and challenges related to weight management. Methods: This was a qualitative descriptive analysis of interviews from 21 adolescent/mother dyads. Conventional content analysis was used to identify themes characterizing dyads' weight management efforts. Results: Two patterns of perceptions were identified across the dyads specific to weight management behaviors: collaborative (dyads agreed) and conflicting (dyads disagreed). Weight management themes with collaborative perceptions were food preferences; food and emotion; the adolescent is active; exercise is not enjoyable; the family is active together; and stopping medications. Weight management themes with conflicting perceptions were responsibility for initiating and maintaining exercise, motivation and willingness to exercise, and responsibility for medications. Dyads had collaborative pattern responses on perceptions of success and challenges. Themes related to successes were weight loss and supportive relationships. Themes related to challenges were inconsistent daily routines and schedules, and unsupportive relationships. Conclusions: Dyads responded with collaborative or conflicting perceptions to weight management behaviors and with collaborative responses to success and challenges. Sustaining healthy habits was difficult from the perspectives of dyads. For youth with severe obesity, providing care that recognizes and addressees issues youth and their families experience may require improved and innovative interventions.
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Affiliation(s)
- Karyn J Roberts
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.,Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shahad Amr Hafez
- Batterjee Medical College for Sciences and Technology, Jeddah, Saudi Arabia
| | - Julia Snethen
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Helen J Binns
- Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kathleen A Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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23
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Daae E, Feragen KB, Sitek JC, von der Lippe C. It's more than just lubrication of the skin: parents' experiences of caring for a child with ichthyosis. Health Psychol Behav Med 2022; 10:335-356. [PMID: 35402085 PMCID: PMC8986293 DOI: 10.1080/21642850.2022.2053685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The ichthyoses are a group of genetic skin disorders, characterized by excessive amounts of dry, thickened skin, which may be fragile, inelastic and prone to fissures and infection. Skin care is time consuming and demanding, and, usually performed by the parents. Methods: We aimed to explore parental experience of caring for a child with ichthyosis, and collected data using semistructured interview, and thematic analysis. Results: Our analysis revealed four main themes: Parents' and others' reactions to the child's difference, Experiences with healthcare services, It's all skin care, and Impact on relationships. Conclusion: After birth of a child with severe ichthyosis, the parents experienced emotional distress and stigmatization due to the different appearance of the skin and healthcare professionals' lack of knowledge. Skin care caused pain in the child, was time consuming, and caused financial burdens. This study can guide healthcare professionals on where to focus future efforts in meeting the clinical and psychological needs of parents caring for a child with ichthyosis.
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Affiliation(s)
- Elisabeth Daae
- Center for Rare Disorders, Oslo University Hospital HF, Oslo, Norway
| | | | - Jan C Sitek
- Department of Dermatology, Oslo University Hospital HF, Oslo, Norway
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24
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Myers C, Apondi E, Toromo JJ, Omollo M, Bakari S, Aluoch J, Sang F, Njoroge T, Morris Z, Kantor R, Braitstein P, Nyandiko WM, Wools-Kaloustian K, Elul B, Vreeman RC, Enane LA. "Who am I going to stay with? Who will accept me?": family-level domains influencing HIV care engagement among disengaged adolescents in Kenya. J Int AIDS Soc 2022; 25:e25890. [PMID: 35192747 PMCID: PMC8863355 DOI: 10.1002/jia2.25890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/01/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV (ALHIV, ages 10-19) have developmentally specific needs in care, and have lower retention compared to other age groups. Family-level contexts may be critical to adolescent HIV outcomes, but have often been overlooked. We investigated family-level factors underlying disengagement and supporting re-engagement among adolescents disengaged from HIV care. METHODS Semi-structured interviews were performed with 42 disengaged ALHIV, 32 of their caregivers and 28 healthcare workers (HCW) in the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya, from 2018 to 2020. Disengaged ALHIV had ≥1 visit within the 18 months prior to data collection at one of two sites and nonattendance ≥60 days following their last scheduled appointment. HCW were recruited from 10 clinics. Transcripts were analysed through thematic analysis. A conceptual model for family-level domains influencing adolescent HIV care engagement was developed from these themes. RESULTS Family-level factors emerged as central to disengagement. ALHIV-particularly those orphaned by the loss of one or both parents-experienced challenges when new caregivers or unstable living situations limited support for HIV care. These challenges were compounded by anticipated stigma; resultant non-disclosure of HIV status to household members; enacted stigma in the household, with overwhelming effects on adolescents; or experiences of multiple forms of trauma, which undermined HIV care engagement. Some caregivers lacked finances or social support to facilitate care. Others did not feel equipped to support adolescent engagement or adherence. Regarding facilitators to re-engagement, participants described roles for household disclosure; and solidarity from caregivers, especially those also living with HIV. Family-level domains influencing HIV care engagement were conceptualized as follows: (1) adolescent living situation and contexts; (2) household material resources or poverty; (3) caregiver capacities and skills to support adolescent HIV care; and (4) HIV stigma or solidarity at the household level. CONCLUSIONS Family-level factors are integral to retention in care for ALHIV. The conceptual model developed in this study for family-level influences on care engagement may inform holistic approaches to promote healthy outcomes for ALHIV. Developmentally appropriate interventions targeting household relationships, disclosure, HIV stigma reduction, HIV care skills and resources, and economic empowerment may promote adolescent engagement in HIV care.
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Affiliation(s)
- Courtney Myers
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Judith J Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark Omollo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Salim Bakari
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tabitha Njoroge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Zariel Morris
- Indiana University-Purdue University-Indianapolis, Indiana University, Indianapolis, Indiana, USA
| | - Rami Kantor
- Division of Infectious Diseases, Department of Medicine, Brown University Apert Medical School, Providence, Rhode Island, USA
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Winstone M Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Indiana University Center for Global Health, Indianapolis, Indiana, USA
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Rachel C Vreeman
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.,Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Arnhold Institute for Global Health, New York, New York, USA
| | - Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana University Center for Global Health, Indianapolis, Indiana, USA
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Biagioli V, Spitaletta G, Kania V, Mascolo R, Gawronski O, Liburdi A, Manzi G, Salata M, Vellone E, Tiozzo E, Dall'Oglio I. Instruments Measuring Self-Care in Children and Young Adults With Chronic Conditions: A Systematic Review. Front Pediatr 2022; 10:832453. [PMID: 35419323 PMCID: PMC8995847 DOI: 10.3389/fped.2022.832453] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Children and young adults (CYAs) with chronic conditions need to engage in self-care to improve their quality of life. This study aimed to retrieve the literature on instruments to assess self-care in CYAs living with chronic conditions and evaluate the psychometric proprieties of the instruments retrieved. A systematic literature review was conducted on six databases to identify peer-reviewed papers that described or used an evaluation instrument of self-care in CYAs with chronic conditions. Twenty-three articles describing 11 instruments of self-care were identified. Five instruments (45.45%) were developed for specific diseases, while six (54.54%) for various chronic illnesses. Most of the instruments were focused on treatment adherence within self-care maintenance (i.e., behaviors to maintain illness stability), excluding the monitoring of clinical parameters or the management of exacerbations. This review provides an overview of available instruments that measure self-care in CYAs with chronic conditions, which health professionals could use for patient education.
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Affiliation(s)
- Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giuseppina Spitaletta
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valeria Kania
- Department of Paediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rachele Mascolo
- Pediatric Semi-Intensive Care Area/Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annachiara Liburdi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Manzi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michele Salata
- Rheumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Valero-Moreno S, Lacomba-Trejo L, Montoya-Castilla I, Pérez-Marín M. Is mHealth a useful therapy for improving physical or emotional health in adolescents with cystic fibrosis? A systematic review. CURRENT PSYCHOLOGY 2021; 42:1-14. [PMID: 34840486 PMCID: PMC8610788 DOI: 10.1007/s12144-021-02452-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
Cystic fibrosis (CF) is a rare disease that severely compromises health and interferes with the lives of those who suffer from it and is especially challenging in adolescence. The use of tools such as MHealth may benefit the physical and psychological health of adolescents with CF. Therefore, this study aims to examine the benefits of MHealth in adolescents with CF through a systematic review. A search of the scientific literature following the PRISMA guidelines was conducted in the ProQuest Central, PubMed, Web Of Science, Embase and ínDICE databases, resulting in 186 studies, of which seven were selected (based on inclusion and exclusion criteria). Two blinded evaluators conducted the searches, the selection and data extraction process and the quality evaluation of the studies. The agreement between evaluators was excellent in all cases (Kappa ranged from .78 to .96). 214 pediatric CF patients (61.71% female) participated in the final analysis. The mean age was 12.76 years. The studies evaluated different types of mHealth tools, with greater homogeneity in the independent and dependent variables. The quality of the studies analyzed was poor, since these had small samples selected for convenience, conducted non-experimental and low-quality designs, recorded few variables, and their statistical analyses were not sufficiently robust. Further research is needed in this field, improving research designs and considering physical and psychological adjustment variables, as well as patients and family members in the process of health improvement.
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Affiliation(s)
- Selene Valero-Moreno
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain
| | - Laura Lacomba-Trejo
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibánez, 21, 46010 Valencia, Spain
| | - Inmaculada Montoya-Castilla
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibánez, 21, 46010 Valencia, Spain
| | - Marian Pérez-Marín
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibánez, 21, 46010 Valencia, Spain
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PAINSTORIES - Exploring the Temporal Developments in the Challenges, Barriers, and Self-Management Needs of Adolescents with Longstanding Knee Pain: A Qualitative, Retrospective Interview Study with Young Adults Experiencing Knee Pain Since Adolescence. THE JOURNAL OF PAIN 2021; 23:577-594. [PMID: 34718151 DOI: 10.1016/j.jpain.2021.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/28/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
Patient education is essential to enable rehabilitation and self-management of longstanding knee pain in adolescents. Currently, a lack of insights into the socio-cognitive processes governing adolescents' self-management remains an obstacle for enhancing treatment efficacy. This study developed a conceptual model for integrating adolescents' challenges and barriers into future treatments. We conducted semi-structured retrospective interviews with 14 young adults (age 21-25 years) with knee pain since adolescence (9 years mean duration). Temporal developments in participants' knee pain were captured through a memorization exercise. Data was analyzed via the General Inductive Approach. Themes were organized into a matrix, extracting a conceptual model, which was tested with eight new participants. The analysis identified seven themes. Further interpretation, via the matrix, organized these within a four-stage trajectory of; gaining awareness, knowledgeability, contextual application and reconceptualization, each with different challenges and dilemmas, participants had to overcome to progress their self-management. Testing the conceptual model, confirmed stages and highlighted acceptance as key to overcoming barriers. The study described adolescents' integration of self-management as proximal and inquiry-based, with acceptance, driving increasingly complex management behaviors. We hypothesize future interventions may benefit from exploring supporting adolescents' inquiries into their knee pain at different stages of the trajectory. PERSPECTIVE: This study presents a conceptual model and vocabulary for optimizing patient education concepts, to target the challenges, barriers and needs of adolescents with knee pain at different stages of their mastery journey. We believe our findings may inform reflections among clinicians and researchers, and development of more effective education interventions.
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Meyer S, Naveh G. Mobile Application for Promoting Gluten-Free Diet Self-Management in Adolescents with Celiac Disease: Proof-of-Concept Study. Nutrients 2021; 13:nu13051401. [PMID: 33919430 PMCID: PMC8143340 DOI: 10.3390/nu13051401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 12/24/2022] Open
Abstract
Celiac disease (CD) is a chronic disease treated by maintaining and managing a lifelong restrictive gluten-free diet. The purpose of this study was to develop a mobile application, Plan My C-Day, to promote self-management skills among youth with CD during adolescence—a time when decreased adherence often occurs—and examine its usability among adolescents with CD. Plan My C-Day contains three simulations of activities involving eating out and actions to take when preparing for these events. It was developed and pilot tested by 13 adolescents with CD. Application use and user perception data were collected and analyzed. Participants chose 160 actions within the simulations. For over 75% of participants, the time to complete the simulation decreased from the first to the third (last) simulation by an average of 50%. The average reported usability perception was 3.71 on a scale of 1 to 5, with system ease of use and ease of learning obtaining the highest scores. This study demonstrated that the Plan My C-Day mobile application’s self-management content, features, and functions operated well and that the simulations were easy to understand and complete. Further development will include the option to add self-created activities and adaptation to different languages and cultures.
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Affiliation(s)
- Sonya Meyer
- Department of Occupational Therapy, Ariel University, Ariel 40700, Israel
- Correspondence: ; Tel.: +972-52-336-8057
| | - Gali Naveh
- Department of Industrial Engineering and Management, Shamoon College of Engineering, Beer-Sheva 8410802, Israel;
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29
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Sezer TA, Çavuşoğlu H, Düzova A. Self-management program for adolescents with chronic kidney disease: A randomized controlled trial. J Ren Care 2020; 47:146-159. [PMID: 33373118 DOI: 10.1111/jorc.12357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is important to develop self-management behaviours in adolescents to prevent chronic kidney disease progression. OBJECTIVES This study evaluates the effect of a self-management program that was developed based on individual and family self-management theory to aid adolescents with chronic kidney disease in the acquisition of competencies in the management of their disease. DESIGN This is a randomized controlled study. PARTICIPANTS The study was conducted with 20 intervention and 20 control patients, who were treated at two hospitals in Ankara between December 2018 and May 2019. MEASUREMENTS Self-Management Assessment Form, Paediatric Quality of Life Inventory-Adolescent Form and clinical parameters. A training program, specific to chronic kidney disease, was administered over three sessions in a group training setting when the patients came to the clinic for follow-up. After the training program was completed, the patients were monitored for three months through home visits once every two weeks, totalling six visits. RESULTS Following the application of self-management training, a statistically significant difference was found self-management knowledge and behaviours, quality of life and anxiety mean scores of intervention and control group (p <.05), a significant decrease in only blood urea nitrogen among the clinical parameters when compared to the control group. CONCLUSIONS In this study, a self-management training program was developed based on Individual and Family Self-Management Theory, aiming to have a positive effect on the self-management behaviours of adolescents in the cognitive and psychosocial domains.
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Affiliation(s)
- Tufan Aslı Sezer
- Nursing Department, Faculty of Nursing, Ankara University, Ankara, Turkey
| | - Hicran Çavuşoğlu
- Head of Pediatric Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Ali Düzova
- Department of Pediatric Nephrology, İhsan Doğramacı Children Hospital, Hacettepe University, Ankara, Turkey
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30
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Lee D, Jeong DC, Chung NG, Lee S. Factor analysis of the Korean version of the Illness Cognition Questionnaire for adolescents with chronic illness. Int J Nurs Pract 2020; 27:e12889. [PMID: 33314524 PMCID: PMC8244091 DOI: 10.1111/ijn.12889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/27/2020] [Accepted: 08/23/2020] [Indexed: 01/28/2023]
Abstract
Aim The purpose of this study was to examine the reliability and validity of the Korean version of the Illness Cognition Questionnaire. Methods A total of 237 adolescent Participants ages 13–20 years were collected from two hospitals for purposes of the study. The participants were diagnosed with blood cancer, congenital heart disease, paediatric rheumatoid arthritis, multiple sclerosis and diabetes mellitus. Results The Illness Cognition Questionnaire is composed of three subscales and 18 items. Exploratory factor analysis and confirmatory factor analysis were performed for all 18 items. The data used in the exploratory factor analysis were obtained from 126 adolescents with blood cancer. The data used for confirmatory factor analysis were obtained from 111 adolescents who had chronic diseases. The three‐factor model of 18 items showed general fitness close to the standard but not a very good fit. Conclusions This study indicated that the Korean version of the Illness Cognition Questionnaire is reasonable to use for Korean adolescents with chronic illness. The authors recommend that the meaning of Item 10 be clarified from ‘I have learned to accept the limitations imposed by my illness’ to ‘I have learned to positively accept the limitations imposed by my illness’. What is already known about this topic?
Illness cognition is the process of evaluating the meaning of a negative event. Illness cognition has a significant impact on patients' quality of life because it is inherently involved in long‐term stresses caused by chronic or serious illnesses.
What this paper adds?
The Korean version of the Illness Cognition Questionnaire is reliable and valid. The Korean version of Illness Cognition Questionnaire consisted of three categories of disease awareness: acceptance, helplessness and perceived benefits The meaning of Item 10 in the Illness Cognition Questionnaire Korean version needs to be clarified as ‘I have learned to positively accept the limitations imposed by my illness’.
The implications of this paper:
The Korean version of the Illness Cognition Questionnaire can be used for adolescent participants experiencing serious or chronic illnesses. The Korean version of the Illness Cognition Questionnaire can be used in developing the psychological intervention for adolescents with chronic illness.
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Affiliation(s)
- Dasuel Lee
- College of Nursing, The Catholic University of Korea, Seoul, South Korea
| | - Dae-Chul Jeong
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sunhee Lee
- College of Nursing, The Catholic University of Korea, Seoul, South Korea
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Cui C, Li SZ, Zheng XL, Cheng WJ, Ting W. Participation in healthcare behavior by adolescents with epilepsy and factors that influence it during the transition period: A cross-sectional study in China. Epilepsy Behav 2020; 113:107576. [PMID: 33232895 DOI: 10.1016/j.yebeh.2020.107576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Given the importance of adolescents' participation in the care of their chronic diseases during their transitional period in the healthcare system, the present study investigated the degree of participation in healthcare behavior by Chinese adolescents with chronic epilepsy and identified factors that should be addressed by health interventions. METHODS The study used a convenience sample of 1238 adolescent patients with epilepsy, who were hospitalized in 17 tertiary A-level children or maternal and child specialty hospitals in China between January 2017 and March 2020. Several scales were used to measure their degree of participation in healthcare behavior and the factors that influence it. Data collection was conducted after uniform training of the investigators. The adolescents who met the inclusion and exclusion criteria could scan the QR code of the questionnaire via a mobile phone. RESULTS The age of the participants ranged from 12.2 to 17.8 years (mean 14.2 years), and the sample had a male-to-female ratio of 1.25:1. The patients' average total score of participation in healthcare behavior was 125.58 (SD = 12.25), which was lower than the norm for China. Their scores on the six dimensions of participation were highest for information interaction, followed in descending order by medical decision-making, treatment and care, appeal, diagnosis and treatment decision-making, and questioning supervision. Multiple linear regression found significant associations between health-care participation and five personal and disease variables (gender, age, course of disease, number of comorbid diseases, type of family structure), self-efficacy, and coping styles (cognitive-palliative and acceptance), which explained 52.1% of the variance in patients' total scores on participating in healthcare behavior. CONCLUSIONS The participation of young Chinese patients with epilepsy in transitional healthcare behavior needs to be improved. Participation was positively associated with being female, a longer course of disease, fewer comorbidities, and living in a nuclear family. Patients who used cognitive-palliative and acceptance coping styles and those who had higher self-efficacy also had significantly higher levels of participation in healthcare behavior. The study provides useful reference points for adolescents with chronic disease to participate in healthcare programs, in order to achieve a smooth transition from childhood to adulthood.
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Affiliation(s)
- Cui Cui
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Shuang-Zi Li
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xian-Lan Zheng
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Jin Cheng
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wang Ting
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
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Stern A, Winning A, Ohanian D, Driscoll CFB, Starnes M, Glownia K, Holmbeck GN. Longitudinal associations between neuropsychological functioning and medical responsibility in youth with spina bifida: The moderational role of parenting behaviors. Child Neuropsychol 2020; 26:1026-1046. [PMID: 32308112 PMCID: PMC7544676 DOI: 10.1080/09297049.2020.1751098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
For youth with spina bifida (SB), the transfer of medical responsibilities from parent- to self-management is an important component of autonomy development. Youth with SB are at risk for neurocognitive impairments with inattention and executive dysfunction, which may impact their ability to take responsibility for medical tasks. However, adaptive parenting may buffer against the negative impact of executive/attentional dysfunction on levels of medical responsibility. Thus, this study examined the moderating roles of parenting behaviors and child age on the longitudinal associations between neuropsychological functioning and medical responsibility in youth with SB. Participants were recruited as part of a larger, longitudinal study. Youth with SB (N = 89, Mage = 11.10 years) completed a neuropsychological battery of executive functioning and attention measures at Time 1 (T1). Parents reported on youth's executive functioning/attention skills at T1, and child medical responsibility two years later at Time 2 (T2). Observational methods were used to assess parenting behaviors (warmth, behavioral and psychological control) at T1. Attention and cognitive shifting skills at T1 were positively related to child medical responsibility at T2. Two-way interactions between planning/organizing skills and paternal acceptance, and planning/organizing skills and paternal psychological control, were found. A three-way interaction between cognitive shifting skills, maternal acceptance, and child age was found. When conceptualizing risk factors for low medical responsibility in youth with SB, it is important to consider the family context beyond individual, cognitive factors. The results are discussed within the wider context of social-ecological models of medical responsibility.
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Affiliation(s)
- Alexa Stern
- Psychology Department, Loyola University Chicago , Chicago, IL, USA
| | - Adrien Winning
- Psychology Department, Loyola University Chicago , Chicago, IL, USA
| | - Diana Ohanian
- Psychology Department, Loyola University Chicago , Chicago, IL, USA
| | | | - Meredith Starnes
- Psychology Department, Loyola University Chicago , Chicago, IL, USA
| | - Karen Glownia
- Psychology Department, Loyola University Chicago , Chicago, IL, USA
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Abstract
PURPOSE OF REVIEW The current review summarizes extant knowledge regarding the prevalence of depression in youth-onset type 2 diabetes (T2D) and how depression might impact glycemic control through stress-related behavioral and physiological mechanisms. The current review also discusses depression intervention studies in adult-onset T2D, as there are no such studies in youth-onset T2D, and provides recommendations for clinical research. RECENT FINDINGS The prevalence of elevated depression symptoms in youth-onset T2D is approximately 20%. Some studies suggest depression may negatively impact glycemic control through inadequate medication adherence and disordered eating, but there is a dearth of studies investigating associations with depression and physical activity/sedentary time, sleep, and stress-related physiological mechanisms. In adult-onset T2D, evidence-based behavioral interventions tailored to address diabetes-related issues have shown positive effects for depression and glycemic control. Future research is needed to characterize the epidemiology of depression in youth-onset T2D and test interventions to improve depression, glycemic control, and health outcomes in this specific pediatric population.
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Affiliation(s)
- Lauren D Gulley
- Department of Human Development and Family Studies, College of Health and Human Sciences, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, USA.
- Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine/Anschutz Medical Campus and Children's Hospital Colorado, 13123 E 16th Avenue, B265, Aurora, CO, 80045, USA.
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, College of Health and Human Sciences, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, USA
- Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine/Anschutz Medical Campus and Children's Hospital Colorado, 13123 E 16th Avenue, B265, Aurora, CO, 80045, USA
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
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