A therapeutic education programme for diabetic children: recreational, creative methods, and use of puppets

Effectiveness of play therapy in enhancing psychosocial outcomes in children with chronic illness: A systematic review

PROBLEM

To examine the nature, quality, and effectiveness of Play Therapy (PT) interventions in children with chronic health conditions (CHC) and to identify the measures used to evaluate psychosocial outcomes.

ELIGIBILITY CRITERIA

Systematic searches of the databases: Medline complete, PsycINFO, CINHAL, Embase and Sport Discuss were conducted to identify peer reviewed papers reporting original studies published in English between January1990 - April 2020. Studies testing any type of PT or Filial Therapy (FT) with children with CHC aged between 3 and 11 years, or their parents if FT, where outcomes were primarily psychosocial were eligible.

SAMPLE AND RESULTS

The title and abstract search identified 6742 papers and six studies (three each for PT and FT) including two randomized control trials were identified as eligible for review. All FT interventions involved group-based training, while only one PT study used a group format. Outcomes for children included emotional and behavioural issues including anxiety, depression, and self-concept and while constructs were broadly comparable across studies, the measures used differed. Sample size ranged between 4 and 58. Two studies suggested positive impact of PT on depression, with one finding improvements in self-concept. Three studies with sample sizes less than 30 found no effect.

CONCLUSION

With varied study designs, and small sample sizes, current evidence regarding the effectiveness of PT in improving psychosocial outcomes for children with chronic illnesses is inconclusive.

IMPLICATIONS

The field should move from small underpowered studies to randomized trials with comprehensive protocols and larger sample sizes.

Play, art, music and exercise therapy impact on children with diabetes

Diabetes mellitus (DM) is a global public health issue. Type 1 diabetes (T1D) is the predominant diabetes type in children and always requires insulin therapy. The incidence rate of newly diagnosed T1D in children continues to increase in Ireland Roche et al. (Eur J Pediatr 175(12):1913-1919, 2016) and worldwide Patterson et al. (Diabetologia 62(3):408-417, 2019). The objective of this study was to conduct a literature review of the effects of various non-pharmacological therapeutic modalities on the control of diabetes in children. A literature review was performed using PubMed, Medline, Embase and Cochrane library to evaluate play, art, music and exercise therapy in the treatment of DM using the keywords: "paediatric", "diabetes", "play therapy", "art therapy", "music therapy" and "exercise therapy". These search terms initially returned 270 cases, which resulted in a total of 11 papers being reviewed after eliminating duplicate or irrelevant papers. Literature review showed that all therapies have a positive impact on the child, but there is limited research looking at the impact of therapy on quantitative measures such as HbA1c or 'time in range'.

Play interventions for paediatric patients in hospital: a scoping review

OBJECTIVE

Play is a non-invasive, safe and inexpensive intervention that can help paediatric patients and their families manage difficult aspects of being ill or hospitalised. Although play has existed in hospitals for decades, research on hospital play interventions is scarce. This review aimed to categorise and synthesise the last 20 years of research on hospital play interventions.

DESIGN

Scoping review.

DATA SOURCES

PubMed, CINAHL, CENTRAL, ERIC and PsycINFO (1 January 2000- 9 September 2020).

STUDY SELECTION AND DATA EXTRACTION

We systematically searched for original peer-reviewed articles, written in English, on hospital play interventions in paediatric patients (0-18 years) in non-psychiatric settings. Two reviewers independently screened titles and abstracts, reviewed full text of relevant articles and extracted data. We thematically synthesised the data from the included studies, and a descriptive analysis, based on a developed framework, is presented.

RESULTS

Of the 297 included articles, 78% came from high-income countries and 56% were published within the last 5 years. Play interventions were carried out across all ages by various healthcare professionals. Play interventions served different roles within four clinical contexts: A) procedures and diagnostic tests, B) patient education, C) treatment and recovery and D) adaptation. Across these contexts, play interventions were generally facilitated and purpose-oriented and had positive reported effects on pain, stress, and anxiety.

CONCLUSIONS

Play in hospitals is an emerging interdisciplinary research area with a significant potential benefit for child and family health. Future research should further describe principles for play in hospitals. High-quality studies investigating short-term and long-term effects are needed to guide when and how to best integrate play in hospitals.

Digesting science: Developing educational activities about multiple sclerosis, prevention and treatment to increase the confidence of affected families

BACKGROUND

The majority of information sources for children of people with multiple sclerosis (MS) are paper, or text, based and require high levels of literacy.

OBJECTIVE

To develop educational activities to inform children who have a parent with MS about a number of aspects around MS and to improve the confidence levels of both parents and children to discuss MS.

METHODS

A structured interactive event, Digesting Science (DS), was developed. This covers the effect MS can have on: vision, bladder function, walking, the mechanisms of action of disease-modifying treatments, the potential importance of vitamin D supplementation, and risk factors for developing MS. Qualitative and semi-quantitative feedback and other data were collected from event questionnaires and a follow-up online survey.

RESULTS

In total, 86 DS events have been delivered internationally, reaching approximately 345 families affected by MS. Confidence ratings around discussing MS improved in 57/77 families (74%; 95% CI: 62.6-83.1) following a DS event. 39/87 (45%) families who attended DS events reported taking vitamin D prior to the event, and 48/87 (55%) were not supplementing. Of those not taking vitamin D supplements, 71% now take vitamin D supplements, 6% have not changed their behaviour, and the remainder were unsure.

CONCLUSION

Educational activities that explain complex neurological diseases to children can be developed and successfully implemented at an international level. These activities give families the confidence to discuss the impact of MS on their lives and also have the potential to change health-related behaviour.

IMPLICATIONS FOR PRACTICE

Creative approaches to health behaviour communication can inform children of parents with MS and may affect their behaviour with the aim of potentially reducing their risk of developing MS in the future. Now more than ever, we need educational resources that can facilitate conversations within families that can respond to health information needs in a timely manner.

Arts-based interventions to promote transition outcomes for young people with long-term conditions: A review

Objectives

To conduct a systematic review of arts-based interventions promoting transition from paediatric to adult services for young people (Note: The term young people refers to adolescents and young adults.) with long-term conditions and to explore their effectiveness.

Interventions

Arts-based interventions included studies of young people who were actively participating in the intervention rather than passive observers. Visual arts interventions included film/video production, time-based media, photography, animation, sculpture, audio, installation, sound recordings, painting, textiles, print, mixed media, multimedia. Arts-based interventions included creative writing, poetry, dance, choreography and storytelling.

Main outcome measures

We included all outcome measures relevant to transition and any chronic condition. These included: self-care knowledge and skills, autonomy, continuity of care, adherence to treatment and attendance at appointments.

Results

Seven studies reported arts-based interventions promoting outcomes that are relevant to transition. These studies showed that arts-based interventions may influence young people with long-term conditions self-esteem, confidence and self-expression. The findings must be treated with caution as the evidence was weak with studies using qualitative measures and of poor methodological quality.

Conclusions

There is a need for further research of arts-based interventions for children and adolescents with long-term conditions that incorporate objective measurements or validated tools to assess outcomes relevant to the transition process.

The role of theories in interventions targeting preteens with Type 1 diabetes: A critical literature review

BACKGROUND

Theory-based interventions have been recommended to target relevant issues and improve outcomes in children and adolescents with Type 1 diabetes. Furthermore, the timing of interventions has been recognized as key to improving outcomes, suggesting a need to focus on preteens (9-12 years old) with Type 1 diabetes. The aim of the present study was to identify the theories that inform interventions targeting preteens with Type 1 diabetes and to analyse the studies for their understandings of theory.

METHODS

We conducted a systematic literature review of intervention studies targeting preteens with Type 1 diabetes to identify the theoretical frameworks applied. Seven databases across different scientific disciplines were searched for papers published between 1995 and 2018.

RESULTS

Twenty-four studies were included in the review. Of these, 14 were categorized as theory-inspired and 10 as theory-related studies. Social cognitive theory appeared most frequently. Most studies did not provide a rationale for their choice and application of theory to inform interventions. The studies were characterized by use of adult-centric theories and a focus on the relationships between children and their parents.

CONCLUSIONS

The present review shows variations and limitations in the description and application of theories across interventions targeting preteens with Type 1 diabetes. This emphasizes the need for future studies to address for what reason and how a certain theory or method is applied. We suggest that interventions might benefit from using theories that are centred on the needs and experiences of children, target family dynamics that include all important family members, and address the mutually constitutive relationship between interventions and the social context in which they are implemented.

Use of puppets to teach resourcefulness skills to women who self-injure: An exploratory study

BACKGROUND

Self-injurious behavior (SIB), when frequent and repetitive, can lead to risk behaviors resulting in accidental or intentional suicide. Psychoeducation about resourcefulness can be critical to interrupt the cycle of self-injury. Therapeutic puppetry provides a safe and secure vehicle for expressing feelings without fear of retaliation.

OBJECTIVES

Determine the outcome of a resourcefulness psychoeducation program, utilizing hand puppets as a teaching tool, on the measure of resourcefulness for adult women who self-injure.

METHODS

A psychoeducation program, utilizing hand puppets as a teaching tool, was offered to women during psychiatric hospitalization. Participants completed the Resourcefulness Scale (RS) pre and post intervention. A program evaluation to determine the effectiveness of hand puppets was completed. Acceptability and feasibility of the program was evaluated.

RESULTS

Sixteen participants completed the program. Results showed a statistically insignificant increase in scores. The program evaluation revealed agreement that resourcefulness learning was accomplished. Participants reported that hand puppets were helpful in practicing resourcefulness skills. Majority of participants recommended continuation of the program.

Educational Workshop using games improves self-monitoring of blood glucose among children

Objective:

to evaluate the effectiveness of an educational workshop using games to improve self-monitoring of blood glucose techniques for school children with type 1 diabetes.

Method:

a quasi-experimental study was conducted with school children who attended two outpatient clinics of a university hospital. Data were collected by systematic observation of the self-monitoring of blood glucose (SMBG) technique before and after the intervention. Data analysis consisted of verifying changes while performing the technique, using pre- and post-intervention compliance rates using statistical tests. The sample consisted of 33 children. Each child participated in one session; 17 educational workshops were conducted in total.

Results:

we found an increased frequency of SMBG, changing lancets, rotation of puncture sites, as well as calibration and periodic checking of date and time of the glucose meter. Comparisons pre- and post-intervention showed that the average number of steps in accordance with the SMBG technique increased from 5.30 to 6.58, whereas the steps “Changing the lancet of the lancing device”, “Pressing the puncture site” and “Disposing of materials used in a needlestick container” showed statistically significant differences.

Conclusion:

the educational workshop was effective, as it improved children’s performance of the SBMG technique.

Estratégias lúdicas de coleta de dados com crianças com câncer: revisão integrativa

As crianças são as melhores fontes de informação sobre suas experiências e opiniões; e as pesquisas qualitativas têm privilegiado desenvolver e aplicar técnicas que deem vozes a elas e facilitem a sua aproximação com o pesquisador. Objetivou-se identificar, mediante revisão integrativa da literatura, recursos lúdicos utilizados na coleta de dados de pesquisas qualitativas com crianças com câncer e suas formas de aplicação. Realizaram-se buscas sistematizadas em bases de dados eletrônicas e biblioteca virtual, que, somadas a uma amostra não sistematizada, abrangendo o período de 2000 a 2010, totalizaram 15 estudos. Identificaram-se os recursos de desenho, brinquedo terapêutico, fantoche, fotografia e dinâmicas de criatividade e sensibilidade que, associados ou não à entrevista, mostraram-se facilitadores da coleta de dados, direta ou indiretamente, ampliando a interação com as crianças e permitindo maior expressão de seus sentimentos. São apresentadas vantagens e limitações da utilização desses recursos, contribuindo-se para o planejamento de pesquisas com crianças.

Diabetes mellitus tipo 1: evidências da literatura para seu manejo adequado, na perspectiva de crianças

O estudo objetivou identificar as evidências disponíveis, na literatura, que abordem, na perspectiva de crianças, os fatores relevantes para o adequado manejo do diabetes mellitus tipo 1. Realizou-se uma revisão integrativa, nas bases de dados PubMed, CINAHL, LILACS, CUIDEN e PsycINFO, com as palavras-chave diabetes mellitus tipo 1, criança, prevenção e controle, fatores desencadeantes, emergências, autocuidado, aprendizagem e educação em saúde, no período de 1998 a 2008. Dos artigos levantados, selecionaram-se 19, e sua análise permitiu a identificação das categorias: vivendo com o diabetes; autocuidado e perfil glicêmico; atuação da família, amigos e profissionais de saúde; e escola. As evidências apontam que a criança aprecia o apoio recebido por seus familiares os quais têm relação direta com o preparo para o autocuidado. Outros membros externos à sua rede também são valorizados. A escola é um espaço que merece atenção, bem como a experiência particular de cada criança e a educação em saúde.

Using puppetry to elicit children's talk for research

Although puppets have been employed by various disciplines in clinical and community (e.g. homes and schools) environments, little has been written about their use as a communication tool in research. In this article, a critical review of the literature is undertaken integrating the use of puppets in a qualitative research study exploring children's perspectives on and responses to a camp for children with cancer. Methodological considerations and ethical issues of using puppets as a data collection technique are discussed. Although some limitations exist, using puppets in interviews with children appear to help them to identify, clarify and verbalize their feelings.

Pontos básicos de um programa de educação ao paciente com diabetes melito tipo 1

O número de portadores de diabetes melito tipo 1 (DM1) está aumentando globalmente, entretanto, a maior parte dos pacientes apresenta controle glicêmico insatisfatório. Esta revisão na literatura foi realizada com três questões de pesquisa: Quais as recomendações e diretrizes de educação em diabetes existentes? Existem evidências para recomendar a adaptação de determinado programa segundo a faixa etária dos pacientes? Os programas de educação são efetivos na melhora dos níveis de HbA1c? Foram revisados 40 artigos, publicados entre 2000 e 2007, sobre educação em DM1 em crianças, adolescentes, adultos e usuários de bomba de infusão contínua de insulina, além de incluir o resumo das diretrizes da IDF, da ADA, da SBD, da AADE, do IDC, e outras peculiaridades para o contexto de saúde pública e privada. O portador de diabetes e sua família devem ser treinados a fazer decisões efetivas de autocuidado em sua rotina diária. O aprimoramento do paciente no automanejo aproxima o valor da HbA1c ao adequado para sua faixa etária. A educação individual e a em grupo apresentam equivalência na melhora do controle metabólico. Existe uma correlação positiva entre o tempo de educação e o controle da glicemia.