Does response shift bias invalidate asking patients if they are better or worse?

Self-Care Mobile Application for South Korean Pregnant Women at Work: Development and Usability Study

Background

Pregnant women at work often encounter barriers to participating in prenatal education or conducting appropriate self-care practices due to their working conditions.

Purpose

We aimed at developing a mobile-based intervention application (SPWW) for Korean pregnant women at work and testing its usability and preliminary effects to enhance their self-care practices.

Patients and Methods

The application was developed and tested with thirty-one pregnant women at work and thirteen women's healthcare providers. The instruments used in this study were a modified Health Practices in Pregnancy Questionnaire II and a System Usability Scale. Descriptive analyses and t-tests were performed using SPSS 25.0. The participants' open-ended answers were analyzed using ATLAS. ti 8.

Results

We developed the application focusing on four self-care topics: healthy diet, physical activity, sufficient rest, and stress management. After using the application for two weeks, participants' levels of exercise (p = 0.006), adequate fluid intake (p = 0.002), and limiting daily caffeine intake (p = 0.048) significantly improved. In addition to good usability scores, the suggestions for improvement made by the participants included diversifying the educational materials and adding individually customizable functions to the application.

Conclusion

The application developed in this study enhanced self-care practices of pregnant women at work and showed adequate levels of usability. We expect the developmental process and details of the application provided in this study to serve as a sample guide for future studies.

Family impact and economic burden among caregivers of children with chronic kidney disease in Assiut, Egypt

Background

Chronic disease greatly increases children’s dependency on parents/caregivers (usually mothers) as they face new problems associated with caring for a child with chronic disease. Thus, chronic kidney disease (CKD) presents a burden for children and their families that last throughout life in different aspects. This study aimed to assess family impact and economic burden of chronic kidney disease (CKD) in children on their families.

Methods

A cross-sectional study was carried out on 250 caregivers of children with CKD attending tertiary care hospital/health insurance clinics in Assiut, Egypt using PedsQL™ family impact module (FIM) for assessing family impact and economic burden between January and May 2018.

Results

Seventy six percent of caregivers shared paying for treatment with health insurance while 14% paid the total expenses out of their pockets. Although the majority (87.2%) of caregivers suffered different degrees of financial hardship, more than 60% of them had no coping strategy. The regression module showed that responding caregiver, degree of financial hardship, treatment modality, and socioeconomic class were significant predictors of total FIM (β = 0.38, P < 0.001; β = 0.28, P < 0.001; β = 0.22, P < 0.001; β = 0.13, P = 0.006 respectively).

Conclusion

Most caregivers were involved in paying for treatment of their children either totally or sharing with health insurance and suffered different degrees of financial hardship. Mothers, caregivers with great financial hardship, and caregivers of children on dialysis had the lowest scores of PedsQL™ FIM. There is a high need for expansion of health insurance umbrella to reduce financial hardship together with continued multidimensional support to families.

Testing for response shift in treatment evaluation of change in self-reported psychopathology amongst secondary psychiatric care outpatients

OBJECTIVES

If patients change their perspective due to treatment, this may alter the way they conceptualize, prioritize, or calibrate questionnaire items. These psychological changes, also called "response shifts," may pose a threat to the measurement of therapeutic change in patients. Therefore, it is important to test the occurrence of response shift in patients across their treatment.

METHODS

This study focused on self-reported psychological distress/psychopathology in a naturalistic sample of 206 psychiatric outpatients. Longitudinal measurement invariance tests were computed across treatment in order to detect response shifts.

RESULTS

Compared with before treatment, post-treatment psychopathology scores showed an increase in model fit and factor loading, suggesting that symptoms became more coherently interrelated within their psychopathology domains. Reconceptualization (depression/mood) and reprioritization (somatic and cognitive problems) response shift types were found in several items. We found no recalibration response shift.

CONCLUSION

This study provides further evidence that response shift can occur in adult psychiatric patients across their mental health treatment. Future research is needed to determine whether response shift implies an unwanted potential bias in treatment evaluation or a desired cognitive change intended by treatment.