Participation in healthcare behavior by adolescents with epilepsy and factors that influence it during the transition period: A cross-sectional study in China

Barriers and facilitators of nurse-led self-management support for adolescents with epilepsy: A mixed-methods study in transition preparation

Aims

To gain insight into the readiness for evidence-based practice of self-management support during transition for adolescents with epilepsy among pediatric nurses, and to explore the promoting and hindering factors.

Design

A mixed-methods design with an explanatory sequential approach was employed.

Setting

Three specialty children's hospitals in southwest regions of China.

Methods

In phase 1, a total of 126 participants were included in the Survey of Clinical Readiness of Evidence-Based Nursing Assessment (CREBNA) from Dec 2022 to Feb 2023. Total scale and subscale scores were calculated. In phase 2, we developed the interview outline based on the analysis of the quantitative results. In-depth interviews (n = 15) were conducted from Feb 2023 to Apr 2023 to explain and supplement the quantitative phase results.

Results

The total score of CREBNA indicated that teams have good readiness and capacity for implementation of evidence-based nursing practice Compared with the norm. The scores of the three subscales of evidence factors, organizational environment, and promoting factors were normal. In subsequent interviews and integration, we extracted four themes based on the Knowledge-To-Action (KTA) framework: 1. organization barriers (incentive mechanism, interdisciplinary cooperation process, information aids); 2. operational barriers (Exemplary evidence-based practice, time pressure, gaps in patient and family understanding of evidence); 3. individual-level barriers (evidence-based and professional knowledge reserve, professional autonomy, shared decision-making roles, dependence on habitual clinical behaviors); and 4. facilitating factors (leadership commitment, self-management identity, transition service needs, patient- and family-centered care culture). A conceptual model was constructed based on the KTA.

Conclusion

It is feasible to carry out evidence-based practice of nurse-led self-management support in transition preparation. Nursing researchers and managers should carry out knowledge selection and tailoring based on barriers at the organizational, operational, and individual levels to promote favorable factors and improve the smooth transition of adolescents with chronic diseases.

Behavioral Dilemmas and Support Requirements of Self-Management for Chinese Adolescents with Epilepsy During Transition Readiness: A Mixed-Methods Study

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.

The impact of infectious disease prevention behavior on quality of life: A moderated mediation model

Objective

To explore the mechanism of infectious disease prevention behavior on quality of life, and to investigate the mediating role of self-efficacy and the moderating role of family structure.

Methods

A total of 3015 subjects were selected by multistage stratified cluster sampling.

Results

Infectious disease prevention behavior had a significant positive predictive effect on the quality of life (β = 0.08, p < 0.001), The self-efficacy of family members had a partial mediating effect on the relationship between infectious disease prevention behavior and quality of life (β = 0.01, p < 0.001). Compared to nuclear family, conjugal family (β = 0.05, p < 0.001) and single-parent family (β = 0.04, p < 0.01) could regulate the relationship between infectious disease prevention behavior and the quality of life, stem family (β = -1.53, p < 0.05), conjugal family (β = 1.63, p < 0.05), and collective family (β = -1.37, p < 0.05) could regulate the relationship between infectious disease prevention behavior and self-efficacy, conjugal family (β = 0.00, p < 0.001) could regulate the relationship between self-efficacy and quality of life.

Conclusion

Infectious disease prevention behavior can affect the quality of life through self-efficacy. Different family structures play a regulatory role in different paths, and a regulatory mediation model is established.

Transition to adult care in epilepsy: A systematic review

The transfer from paediatric to adult care can be a complex process in children with epilepsy. Inadequate care during this phase can affect long-term medical and psychosocial outcomes. The aim of this study was to review studies on transitional care from paediatric to adult healthcare for young persons with epilepsy in order to synthesize evidence for best practice. We undertook a systematic review following PRISMA guidelines and employed narrative synthesis. A total of 36 articles were included, of which 11 were interventional studies and 25 observational studies. Study quality was rated as 'good' for only four studies. Interventions included joint or multidisciplinary clinics, education (patient and health professional education) and extended service provision (Saturday clinics, peer-groups). All studies observed a positive effect experienced by the participants, regardless of intervention type. Observational studies showed that transition plans/programmes are asked for but frequently not existing or not adapted to subgroups with intellectual disability or other neurodevelopmental conditions. The results of this systematic review on transitional care in epilepsy suggest that a planned transition process likely enhances medical and psychosocial outcomes for young people with epilepsy, but the body of evidence is limited and there are significant gaps in knowledge of what efficacious transition constitutes. More studies are needed employing qualitative and quantitative methods to further explore the needs of young people with epilepsy and their families but also robust study designs to investigate the impact of interventions on medical and psychosocial outcomes.

Mediating effects of coping styles on the relationship between family resilience and self-care status of adolescents with epilepsy transitioning to adult healthcare: A cross-sectional study in China

PURPOSE

This study aimed to explore the relationship between family resilience, coping styles, and self-care among Chinese adolescents with epilepsy.

DESIGN AND METHODS

A total of 1238 adolescents with epilepsy in nine tertiary hospitals in China participated in a cross-sectional survey conducted from May 2018 to March 2020. Structural equation modeling was used to analyze the mediating effect.

RESULTS

The total scores for family resilience and coping styles were positively correlated with the total self-care status score of adolescents with epilepsy during their transition (r = 0.209, 0.202, P < 0.01). Family resilience was positively correlated with coping style (r = 0.450, P < 0.01). The modified model's fit index included χ²/df = 1.970, P = 0.001, RMSEA = 0.054, TLI = 0.973, CFI = 0.978, GFI = 0.941, AGFI = 0.917, NFI = 0.956, and IFI = 0.978. The confidence interval (CI) was 0.004-0.140 for the indirect effect and 0.033-0.306 for the direct effect.

CONCLUSIONS

The self-care status of adolescents with epilepsy during the transitional period is closely related to coping style and family resilience. Coping style mediates family resilience and self-care status.

PRACTICE IMPLICATIONS

Healthcare teams should pay attention to the coping ability of adolescents with epilepsy to help them transition smoothly and to improve family functioning. This study provides a theoretical basis for establishing transitional care programs for adolescents with chronic illnesses. The significant mediating effect of coping style should be emphasized in modalities of healthcare that include patient participation.