Models and theories in studies on educating and counseling children about physical health: a systematic review

Examining Children's Experiences of Visiting Their Pediatrician: Insights into Communication, Actions, and Emotions

The way children experience a medical visit lays the groundwork for their health education and fosters trust and comfort in healthcare relationships. This study employed a retrospective and narrative-based design to analyze how children perceived their experiences of visits to their doctor, how they describe their emotions, and how they portray the different relationships within the doctor-caregiver-patient triad. Three hundred fifty students (50.75% female, 8-13 years, Mage = 10.5, SD = 5.93, 77.95% from primary school) completed a booklet comprising different narrative activities. The booklet underwent quantitative content analysis according to gender and school level. Children reported that the doctors primarily addressed their caregivers when asking for and delivering health-related information, while their role was mostly passive. Meeting with friendly doctors and being in a welcoming environment were associated with a positive medical experience, while negative emotions and encounters with unsympathetic practitioners contributed to negative experiences. Most respondents wanted to talk privately with their doctors at their next visit. Some examples and practices are discussed to enable healthcare practitioners to create an environment where children are heard and valued, and their involvement during consultation processes is enhanced.

Understanding Treatment Adherence With the Health Belief Model in Children With Cystic Fibrosis

Objective. Children’s health beliefs are significantly related to their adherence; however, pediatric literature has rarely tested health-related theories as a whole. The goal of the present study was to evaluate the use of the health belief model (HBM) in understanding children’s adherence, both globally and to individual treatment components. Method. Thirty-three patient–parent dyads completed questionnaires regarding health beliefs and adherence to medical regimens. Results. Multiple linear regressions found a significant relationship among the HBM variables and reports of global adherence for children and parents. For children, the HBM variables were significantly related to adherence to aerosol medications, aerosol antibiotics, metered dose inhalers, and vitamins. For parents, the HBM variables were significantly related to children’s adherence to airway clearance, oral antibiotics, and vitamins. Paired sample t tests found children and parents had significantly discrepant heath beliefs. Conclusion. These findings provide further support for the HBM in evaluating pediatric adherence, with evidence that barriers and cues to action may be targets for early intervention. Future research using this model to identify a comprehensive way to assess, understand, and elicit change in the adherence to medical regimens for youth with chronic illness would be beneficial.

Systematic searching for theory to inform systematic reviews: is it feasible? Is it desirable?

BACKGROUND

In recognising the potential value of theory in understanding how interventions work comes a challenge - how to make identification of theory less haphazard?

OBJECTIVES

To explore the feasibility of systematic identification of theory.

METHOD

We searched PubMed for published reviews (1998-2012) that had explicitly sought to identify theory. Systematic searching may be characterised by a structured question, methodological filters and an itemised search procedure. We constructed a template (BeHEMoTh - Behaviour of interest; Health context; Exclusions; Models or Theories) for use when systematically identifying theory. The authors tested the template within two systematic reviews.

RESULTS

Of 34 systematic reviews, only 12 reviews (35%) reported a method for identifying theory. Nineteen did not specify how they identified studies containing theory. Data were unavailable for three reviews. Candidate terms include concept(s)/conceptual, framework(s), model(s), and theory/theories/theoretical. Information professionals must overcome inadequate reporting and the use of theory out of context. The review team faces an additional concern in lack of 'theory fidelity'.

CONCLUSIONS

Based on experience with two systematic reviews, the BeHEMoTh template and procedure offers a feasible and useful approach for identification of theory. Applications include realist synthesis, framework synthesis or review of complex interventions. The procedure requires rigorous evaluation.

Information needs in parents of children with a rheumatic disease

BACKGROUND AND OBJECTIVE

Incorporating the patient's perspective and expectations into the delivery of health care has become an important indicator of today's quality of medical care. Our aim was consequently to explore the information needs of parents of children with juvenile idiopathic arthritis and other rheumatic diseases.

MATERIALS AND METHODS

Cross-sectional, anonymous survey using a purpose-designed questionnaire, which separately assessed sources of information and topics. With respect to sources, we also asked about their degree of helpfulness, and regarding topics, we also asked about further interests (information needs). The questionnaire was sent to 146 families continuously attending our paediatric rheumatology outpatient clinic. The response rate was 79.5%. The mean age of the children was 6.9 +/- 4.3 years, 69% were girls and disease duration averaged 2.6 +/- 4.3 years. Mean Child Health Assessment Questionnaire score as a measure of functional disability was 0.259 (+/-0.45; range 0.0-2.13).

RESULTS

Regarding sources, those with a professional medical background were appreciated, while information from friends and family members, in particular, was not. Overall, parents considered themselves well-informed. Parents had frequently received information on core domains of medical aspects. They described deficits related to psychosocial impact, to (vocational) education and to complementary therapy. However, their interest in further information was high almost irrespective of the amount of prior information.

CONCLUSION

For further tailored information and support strategies it should be taken into account that even for topics largely covered by usual medical advice, residual interest and information needs of parents remain high.

Improvement in cancer-related knowledge following use of a psychoeducational video game for adolescents and young adults with cancer

PURPOSE

Adolescents with chronic illnesses have been shown to have management and treatment issues resulting in poor outcomes. These issues may arise from non-interest in self care and illness knowledge. A video game, "Re-Mission," was developed to actively involve young people with cancer in their own treatment. Re-Mission provides opportunities to learn about cancer and its treatment.

METHOD

The efficacy of Re-Mission was investigated in a multi-site, randomized, controlled study with 375 adolescent and young adult cancer patients. Participants received either a regular commercial game (control) or both the regular game plus Re-Mission (Re-Mission group). Participants were given a mini-PC with the games installed and requested to play for an hour each week for 3 months. A test on cancer-related knowledge was given prior to game play (baseline) and again after 1 and 3 months. At 3 months the Re-Mission group also rated the acceptability and credibility of Re-Mission.

RESULTS

Analyses of the knowledge test scores showed that whereas scores of both groups improved significantly over the follow-up periods, the scores of the Re-Mission group improved significantly more. The size of this effect was related to usage of Re-Mission. Credibility scores were negatively correlated with level of knowledge but not with change in knowledge level at 1 month or 3 months.

CONCLUSIONS

The results indicate a specific effect of Re-Mission play on cancer knowledge that is not attributable to patients' expectations. It is concluded that video games can be an effective vehicle for health education in adolescents and young adults with chronic illnesses.