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Clark OE, Smith ZR, Hilderbrand T, Holmbeck GN. Growth of condition-related knowledge among youth with spina bifida: associations with neurocognitive functioning and self-management skills. J Pediatr Psychol 2024; 49:449-458. [PMID: 38216130 PMCID: PMC11258814 DOI: 10.1093/jpepsy/jsad097] [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: 08/16/2023] [Revised: 11/28/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE This study aims to characterize the growth in condition-related knowledge in youth with spina bifida (SB), identify neurocognitive predictors of growth, and examine associations between growth in knowledge and subsequent levels of medical self-management skills. METHODS Participants were recruited from a larger longitudinal study involving 140 youth with SB and caregivers, who completed questionnaires and interviews every 2 years over 8 years. The current study included the youth report of condition-related knowledge and medical self-management skills. Youth attention and executive functioning were assessed via parent and teacher reports and performance-based assessment. Latent growth curves were conducted in Mplus Version 8 (Múthen, L. K., & Múthen, B. O. [1998]. Mplus User's Guide. [Eighth]. Muthén & Muthén) to examine change over time in youth-reported condition-related knowledge. Neurocognitive variables were included as predictors of growth in knowledge and regression analyses were used to predict medical self-management skills from growth in condition-related knowledge. RESULTS Youth condition-related knowledge increased linearly. Better youth performance on working memory and attention performance-based tasks predicted a higher intercept for condition-related knowledge at T1, but not slope. Teacher and parent reports of inattention and executive dysfunction were not consistent predictors of intercept and growth. Slope of condition-related knowledge was not predictive of subsequent youth self-management skills. CONCLUSIONS Youth with SB gain condition-related knowledge over time. However, executive dysfunction and inattention may impede gains in condition-related knowledge. Thus, executive functioning supports, attention-related interventions, and psychoeducation may support condition-related knowledge gains and later medical self-management skills, but further research assessing family and cultural factors is needed.
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Affiliation(s)
- Olivia E Clark
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Zoe R Smith
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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Levy S, Wynd AHD, Motee A. "Crafting a 'TransitionOmeter': A Proposed Framework for Developing and Honing Capabilities of Young People Transitioning to Adult Healthcare Services.". Compr Child Adolesc Nurs 2024; 47:86-97. [PMID: 38713540 DOI: 10.1080/24694193.2024.2348830] [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: 01/05/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024]
Abstract
This paper focuses on an innovative approach to preparing children and young people, with Spina Bifida, to move from child-centered to adult-oriented healthcare systems. Reflecting on our role in delivering a national nurse led service, we set to identify and critique international transition tools in use for this population. Specifically, we aimed to identify the core capabilities and indicators of progression to successful transition, so that holistic interventions could be planned to match the needs of individuals and their carers. There were two phases to the study, initially focusing on a systematic literature review on transition tools and the specific items that these tools captured, including skills, abilities and behaviors. Phase two culminated in the articulation of a segmented and incremental "road map", aligned with facets deemed essential for a successful healthcare transition. The reporting of the literature review (phase one) followed the PRISMA guidelines and shaped the qualitative element of the study (phase two) through the use of semi-structured interviews and thematic analysis. The search strategy yielded 11 studies, which were then manually searched for other relevant literature, adding a further 14 articles. The review analyzed 7 specific tools for spina bifida and 8 generic tools, which were deemed appropriate for this group of patients. A comprehensive list of core capabilities was then articulated and framed to fit a progression timeline. Specific interventions were formulated to explore ways to co-produce resources that could enhance and support a planned transition to adult-focused services. Our proposed mapping of capabilities and progression could shape other transition programs, where nurses work collaboratively with young people, carers and other members of a team. More work is needed to further explore and embed the framework that, as we did, could be digitized and shared with all stakeholders involved in the transition process.
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Affiliation(s)
- Sharon Levy
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Hwang CK, Harris KT, Wood D. Barriers to Transitional Care in Spina Bifida. Urol Clin North Am 2024; 51:187-196. [PMID: 38609191 DOI: 10.1016/j.ucl.2024.01.006] [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] [Indexed: 04/14/2024]
Abstract
The health care needs children with spina bifida evolve over their lifetime; continued, regular contact with appropraitely trained, multidisciplinary providers is crucial to a patient's health and quality of life. Substantial research has been conducted to improve the transition process starting at an early age; however, there continue to be strong barriers to successful transition. This article reviews key aspects of the care of patients with spina bifida, the impact of inadequate transition to adult care, barriers to transition, and offers a potential vision for the future.
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Affiliation(s)
- Catalina K Hwang
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA
| | - Kelly T Harris
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA
| | - Dan Wood
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA.
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Ridosh MM, Adams W, Payne AD, Hilderbrand TL, Magaña F, Sawin KJ, Holmbeck GN. Contextual predictors of self-management and independence trajectories in adolescents and young adults with spina bifida. Dev Med Child Neurol 2024. [PMID: 38494664 DOI: 10.1111/dmcn.15900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 01/30/2024] [Accepted: 02/09/2024] [Indexed: 03/19/2024]
Abstract
AIM To examine socioeconomic, condition-related, and neuropsychological predictors of self-management trajectories in adolescents and young adults with spina bifida. METHOD In this longitudinal study, participants completed the Adolescent/Young Adult Self-Management and Independence Scale interview. Socioeconomic status (SES), shunt status, lesion level, and executive functioning were assessed. Growth in self-management was estimated using linear mixed-effects models. RESULTS Participants (n = 99) were aged 18 to 27 years. Approximately half (52.5%) were female and White; 15.2% were Black; and 32.3% Hispanic or Latino. Although none of the predictors were associated with growth in self-management from ages 18 to 27 years (p > 0.05), several factors were associated with the intercept at age 18 years for total self-management. Higher SES at baseline predicted a higher total self-management score at age 18 years (b = 0.03, standard error [SE] = 0.01; p < 0.001). On average, participants at age 18 years with a shunt scored lower than those without a shunt (b = -0.90, SE = 0.32; p = 0.01); those with a thoracic lesion scored lower than those with lower lesion levels (lumbar: b = -1.22, SE = 0.34; sacral: b = -1.20, SE = 0.36; p = 0.001 for both). Better parent-reported and teacher-reported executive functions predicted higher total self-management (metacognitive: b = -0.03, SE = 0.01; behavioral regulation: b = -0.04, SE = 0.01; p < 0.05 for both). INTERPRETATION On average, all participants improved in self-management over time. Additionally, baseline superiority in self-management for adolescents and young adults without a shunt, less severe lesions, better executive functions, and higher SES persisted over time.
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Affiliation(s)
- Monique M Ridosh
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - William Adams
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Allison D Payne
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | | | - Fabiola Magaña
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Kathleen J Sawin
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA
- Self-Management Science Center, School of Nursing, College of Health Professions and Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Ridosh MM, Adams W, Magaña F, Sawin KJ, Holmbeck GN. Trajectories of self-management and independence in youth with spina bifida: Demographic predictors of growth. Child Care Health Dev 2023; 49:508-517. [PMID: 36206540 PMCID: PMC10079778 DOI: 10.1111/cch.13065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/30/2022] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this study was to examine the trajectories of condition and independent living self-management in youth with spina bifida (SB). METHODS A diverse sample of adolescents and young adults (AYAs) with SB completed the Adolescent/Young Adult Self-Management and Independence Scale (AMIS-II) across four time points. Parents reported on demographic characteristics including age, sex, race/ethnicity, and family income. Growth in self-management and its subscales (condition and independent living) were estimated using linear mixed-effect models as a function of respondents' demographics. RESULTS This study included 99 respondents age 18 to 27 years old. About half were female (52.5%) and White (52.5%); 15.2% were Black, and about a third were Hispanic/Latino (32.3%). Eighty-seven AYAs (87.9%) had myelomeningocele. The lesion level was 31.3% sacral, 48.5% lumbar and 18.2% thoracic. A third of the families earned less than 50K. Overall, self-management growth was dependent on age, sex, and race/ethnicity, but not income. Growth in condition self-management depended on sex; only males demonstrated increasing growth ( β ̂ = 0.11, p < 0.001). Black participants endorsed higher increasing total and condition self-management when compared with White ( β ̂ diff = 0.17 and 0.17, respectively, both p < 0.05) and Hispanic/Latino ( β ̂ diff = 0.18 and 0.21, respectively, both p = 0.02) respondents. CONCLUSION This study provides evidence of differences in growth of self-management by demographic/social determinants of health. Possible reasons for differences are discussed. Predictors of changes in self-management behaviours over time in young adults with SB can identify subgroups in need of further study.
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Affiliation(s)
- Monique M Ridosh
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - William Adams
- Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, USA
| | - Fabiola Magaña
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - Kathleen J Sawin
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, Wisconsin, USA
- Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Grayson N Holmbeck
- Department of Psychology, Loyola University Chicago, Chicago, Illinois, USA
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Driscoll CFB, Holmbeck GN. Self-Management in Youth With Spina Bifida: Associations With Parent Factors in the Context of a Summer Camp Intervention. J Pediatr Psychol 2023; 48:51-66. [PMID: 35751436 DOI: 10.1093/jpepsy/jsac058] [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: 11/15/2021] [Revised: 05/16/2022] [Accepted: 06/10/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To investigate cross-sectional and longitudinal associations between parent factors and self-management for youth with spina bifida (SB). METHODS Participants were 89 camper-parent dyads recruited for a summer camp program for youth with SB (Myouthage = 12.2 years); 48 of these families participated across 2 years. Campers and parents completed assessments at Time 1 (pre-camp) and Time 3 (post-camp) for one or two summers. Parents reported on demographics, their own adjustment, perceptions, attitudes, and behaviors, and youth condition-related responsibility and task mastery. Youth also reported on condition-related responsibility. Hierarchical multiple regression analyses and multilevel modeling were used to examine relationships between parent factors and youth self-management. RESULTS Parents' expectations for future goal attainment were positively associated with camper responsibility and task mastery, and these associations were moderated by camper age (only significant for older campers). When examining changes over one summer, parental expectations for the future were significantly associated with changes in campers' condition-related task mastery. When examining trajectories across summers, parental perception of child vulnerability was negatively associated with the slope of condition-related responsibility and parents' expectations for future goal attainment were positively associated with the slope of task mastery. CONCLUSIONS Parent perceptions and behaviors may be important targets for assessment and intervention when promoting condition-related independence for youth with SB.
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Affiliation(s)
- Colleen F Bechtel Driscoll
- Department of Child and Adolescent Psychiatry, NYU Langone Health, USA.,Department of Psychology, Loyola University Chicago, USA
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Flewelling KD, Wengryn DM, Buchanan CL, Beltran GP, Vemulakonda VM, Hecht SL. Unexpected challenges faced by caregivers of children with neurogenic bladder: A qualitative study. J Pediatr Urol 2022; 18:502.e1-502.e9. [PMID: 35810140 DOI: 10.1016/j.jpurol.2022.06.005] [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: 01/15/2022] [Revised: 05/16/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Management of the neurogenic bladder is variable, complex, and often requires a demanding bladder care regimen which may present caregiver burdens that are unique among chronic disease. While research into patient quality of life is increasing, parallel study of the caregiver experience is scant. Existing research primarily comprises survey data using validated instruments originally developed for non-urologic conditions, such as dementia. These surveys may detect high caregiver burden and decreased quality of life amongst caregivers but are limited in their ability to understand the underlying causes. OBJECTIVE To characterize the experience of those caring for children with neurogenic bladders, with a focus on unexpected burdens and challenges. METHODS In light of limited existing research, a qualitative research methodology was selected to explore the caregiver experience. Semi-structured phone interviews were conducted with primary caregivers of children with neurogenic bladder, all of whom were patients in the pediatric urology department of a single tertiary pediatric referral center. Purposive sampling was used to ensure diverse representation. Interviews were recorded, transcribed, and professionally translated if needed. Transcripts were analyzed using a team-based inductive grounded-theory approach, facilitated by ATLAS. ti software. Member-checking focus groups were held to validate the results. RESULTS Twenty-five caregivers were interviewed (20 in English, 5 in Spanish), at which point thematic saturation was reached. Three primary themes emerged surrounding the topic of unexpected challenges: 1. High caregiver burden, 2. Challenges with catheterization and supplies, 3. Urinary tract infections. Member-checking focus groups validated the thematic analysis and provided additional insights into mitigating factors for these challenges. A child's independence with his or her health care regimen was cited as particularly important for decreasing caregiver burden. DISCUSSION Caregivers of children with neurogenic bladder report their role is more difficult than they anticipated it would be. Catheterization represents a particularly burdensome task, and recurrent infections are an unexpected and persistent medical challenge. Understanding unexpected challenges that caregivers face will help pediatric urologists target modifiable factors to decrease caregiver burden, address current gaps in counseling and expectation-setting, and set the stage for more complete shared decision-making. CONCLUSIONS This study represents an initial qualitative characterization of the experience caring for a child with neurogenic bladder. This is a key first step in understanding how caregivers make decisions for their children and their families. This initial study is foundational to a larger project to create a decision aid for caregivers of children with neurogenic bladder.
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Affiliation(s)
- Kassie D Flewelling
- Department of Behavioral Health, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Derek M Wengryn
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Cindy L Buchanan
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Gemma P Beltran
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Vijaya M Vemulakonda
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah L Hecht
- Department of Pediatric Urology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA.
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Preoperative occupational therapy in children with neurogenic bladder: improving independence with bladder management and self-catheterization. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-021-00643-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Stiles-Shields C, Kritikos TK, Starnes M, Smith ZR, Holmbeck GN. The Transition from Pediatric to Adult Health Care in Young Adults with Spina Bifida: Demographic and Physician-Related Correlates. J Dev Behav Pediatr 2022; 43:e179-e187. [PMID: 34570065 PMCID: PMC8942874 DOI: 10.1097/dbp.0000000000001001] [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: 12/18/2020] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined the transition to adult health care for individuals with spina bifida (SB) and explored demographic and relational associations with transition status. METHOD Young adults with SB (18-30; n = 326) were recruited to complete an anonymous, online survey. Frequencies of reported experiences, behaviors, and satisfaction with the transition to adult health care were examined. Nonparametric tests and exploratory hierarchical regressions were used to examine demographic and relational factors with physicians between those (1) who had and had not yet transitioned and (2) who did and did not return to pediatric care. RESULTS Most of the sample reported having transitioned to adult health care, with three-quarters reporting that their primary physician is an adult primary care doctor. Individuals who had transitioned were more likely to be younger (p = 0.01) and to not have a shunt (p = 0.003). Beyond the effect of age and shunt status, relational factors with pediatric providers were not associated with transition (p > 0.1). After transition, over one-third reported returning to a pediatric provider. Those who did not return to pediatric care were more likely to have myelomeningocele, be a full-time student, and to not have a shunt (p < 0.001). Beyond the effect of age and shunt status, lower ratings of communication with adult providers were associated with a return to pediatric care (p = 0.04). CONCLUSION The results highlight the need for additional research about barriers and facilitators to the transition to adult health care to target interventions that support this critical milestone in young adults with SB.
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Affiliation(s)
- Colleen Stiles-Shields
- Rush University Medical Center, Department of Psychiatry and Behavioral Sciences, Section of Community Behavioral Health, 1645 W. Jackson Blvd., Chicago, IL 60612
| | - Tessa K. Kritikos
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Meredith Starnes
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Zoe R. Smith
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Grayson N. Holmbeck
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
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Longitudinal Trajectories of Clean Intermittent Catheterization Responsibility in Youths with Spina Bifida. J Urol 2022; 207:192-200. [PMID: 34448629 PMCID: PMC8783611 DOI: 10.1097/ju.0000000000002204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Clean intermittent catheterization (CIC) responsibility among youths with spina bifida is not well studied. We sought to determine longitudinal trajectories of CIC responsibility to examine the transition of CIC responsibility from caregiver-CIC to self-CIC. MATERIALS AND METHODS We performed a secondary analysis of a prospective cohort study of youths with spina bifida. Participants aged 8-15 years originally recruited from 4 hospitals and a statewide spina bifida association were followed every 2 years. Participants who required CIC were included. Group-based trajectory modeling was used to isolate distinct trajectories of CIC responsibility, which was the primary outcome and was graded from caregiver-CIC to shared-CIC to self-CIC. Predictors of trajectory group membership were entered into multivariate logistic regression models and included various demographic, clinical and psychosocial characteristics such as CIC adherence and CIC mastery. RESULTS Of 140 youths in the original cohort study, 89 met eligibility criteria for this study. Mean age was 11 years at enrollment and 93% of patients had myelomeningocele. Two distinct trajectory groups emerged: 17% of patients had a low-flat trajectory and 83% had a high-increasing trajectory of CIC responsibility, with shared-CIC by age 8-9 years and increasing self-CIC responsibility thereafter. Significant predictors of group membership in the high-increasing trajectory group included less severe spinal lesion levels, higher CIC mastery and lower CIC adherence. CONCLUSIONS Nearly 1 in 5 youths with spina bifida in our cohort persistently required caregiver-CIC over time, while the remainder achieved shared-CIC responsibility by age 8-9 years, with increasing self-CIC responsibility thereafter.
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Stern AR, Winning AM, Rausch JR, Holmbeck GN. Medical responsibility growth in youth with spina bifida: Neuropsychological and parenting predictors. Health Psychol 2021; 40:692-701. [PMID: 34881937 DOI: 10.1037/hea0001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE For youth with spina bifida (SB) there is a growing need to understand how responsibilities for health care are transferred from family- to self-management over time. The current study examined trajectories of responsibility for medical tasks in youth with SB across adolescence, as well as executive functioning/attention and parenting behaviors as predictors of growth. METHOD As part of a larger, longitudinal study, 140 youth with SB (ages 8-15 at time 1; Mage = 11.43) reported on their responsibility for relevant medical tasks across five time points. Attention and executive functioning were assessed via performance-based and parent/teacher-report methods. Parenting behaviors consisted of acceptance, behavioral control, and psychological control and were assessed via observational and parent-report. RESULTS Growth curve analyses revealed significant increases in youth medical responsibility across all SB tasks over time. Attention, executive functioning, maternal behavioral control, and paternal psychological control emerged as predictors of growth parameters in responsibility for communicating about SB and managing health care appointments. CONCLUSION Results indicated that youth with SB obtain increasing responsibility for their health care over time. The transfer of responsibility for SB management may differ based on individual (i.e., the child's neuropsychological abilities) and family level (i.e., parenting behaviors) factors. Further research is needed to understand how growth in medical responsibility relates to changes in other aspects of SB self-management across development, such as medical adherence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Joseph R Rausch
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health
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Logan LR, Sawin KJ, Bellin MH, Brei T, Woodward J. Self-management and independence guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2021; 13:583-600. [PMID: 33252094 PMCID: PMC7838981 DOI: 10.3233/prm-200734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Self-management and independence behaviors are associated with improved health conditions common to spina bifida such as skin integrity and bowel and bladder management. While most children with spina bifida ultimately achieve basic self-care behaviors, (e.g., dressing appropriately, planning activities with peers, or cooking pre-planned meals), they often lag 2-5 years behind their typically-developing peers in these activities [1]. Valid and reliable condition-specific assessments of self-management and independence are critical to optimizing outcomes for this population. Partnerships among parents, clinicians, and youths with spina bifida are essential to implementing tailored interventions based on these assessments. The guidelines delineated in this article are informed by current self-management research for people with spina bifida and offer recommendations to promote self-management and independence across the lifespan.
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Affiliation(s)
- Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, Syracuse, NY, USA
| | - Kathleen J. Sawin
- Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Timothy Brei
- Division of Developmental Medicine, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA
| | - Jason Woodward
- University of Cincinnati College of Medicine, Division of Developmental and Behavioral Pediatrics Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Smith ZR, Holmbeck GN. Cross-Lag Model of Medical Responsibility and Skills in Youth With Spina Bifida. J Pediatr Psychol 2021; 46:1119-1129. [PMID: 34313781 DOI: 10.1093/jpepsy/jsab055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/22/2021] [Accepted: 04/29/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study examined bidirectional associations between mother- and father-reported medical responsibility and medical skill mastery in youth with spina bifida (SB). METHODS Participants were 140 youth with SB and their parents who participated in three waves of a longitudinal study across four years (ages 8-15 years at Time 1). Mother- and father-report of both medical responsibility and medical skill mastery were used, and age and estimated intelligence quotient were included as covariates, in cross-lagged models. RESULTS The cross-lagged model provided evidence for significant bidirectional associations between mother-reported medical responsibility and skill mastery across time (root mean square error of approximation=0.09, comparative fix index=0.97). These paths showed that higher levels of child responsibility predicted an increase in skill mastery and that higher levels of mastery predicted an increase in child responsibility across time. Moreover, based on mother-report, sharing of responsibility had stronger effects on increases in skill mastery (Time 1 to Time 2 β=.25, Time 2 to Time 3 β=.27) than skill mastery had on increases in child responsibility (Time 1 to Time 2 β=.08, Time 2 to Time 3 β=.07). The only significant cross-lagged path for father-report was from Time 1 skill mastery to Time 2 responsibility (β=.34). CONCLUSIONS Mothers perceive a bidirectional relationship between responsibility and skill mastery across time, whereas fathers appear to mainly consider how skills might affect a subsequent increase in responsibility sharing. Thus, it is important to consider both parents' perspectives when working to increase medical autonomy in youth with SB.
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Affiliation(s)
- Zoe R Smith
- Department of Psychology, Loyola University Chicago
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Parents' Perception of Self-Management Behaviors for Their Children With Spina Bifida in South Korea: A Qualitative Study. Rehabil Nurs 2021; 46:73-82. [PMID: 32251027 DOI: 10.1097/rnj.0000000000000261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to explore parents' perceptions of self-management behaviors for their children with spina bifida (SB). DESIGN Qualitative method. METHODS In-depth interviews were conducted with nine Korean parents of children with SB. The data were analyzed using the content analysis method. FINDINGS Parental perceptions of the experiences of self-management behaviors in children with SB were classified into risk factors that hinder self-management behaviors and protective factors that accelerate them. Each category of factors was then further classified into child-, parent-, and school-related factors. CONCLUSIONS To promote self-management behaviors in children with SB, reducing risk factors and promoting protective factors considering child, family, and school dimensions based on cultural differences are necessary. CLINICAL RELEVANCE Rehabilitation nurses should be considered essential healthcare providers who can offer stepwise guidance to achieve self-management behaviors in children with SB according to their stage of development.
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Betz CL, Mannino JE, Disabato JA. Survey of US pediatric nurses' role in health care transition planning: Focus on assessment of self-management abilities of youth and young adults with long-term conditions. J Child Health Care 2021; 25:468-480. [PMID: 32870717 DOI: 10.1177/1367493520953649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The survival rates of youth and young adults (YYAs) diagnosed with long-term conditions have improved considerably as 90% now enter adulthood; health care transition planning (HCTP) has emerged as a nursing practice priority. The aim of this national online survey was to investigate the extent to which nurses, recruited from two major United States pediatric nursing organizations are involved with HCTP including assessing YYA self-management abilities (SMA). Findings of a 9-item assessment of self-management abilities subscale of the nurses' role in HTCP tool are reported. The nurse respondents (n = 1269), identified the most frequently assessed SMA was the YYAs' ability to understand and speak about their condition and its treatment (M = 2.3, SD = .89). The least frequently assessed was the YYAs' ability to identify community advocates to help them become more independent (M =1.5, SD = .90). Regression analysis identified significant predictors of the frequency nurses assess YYA for SMA included nurses' level of knowledge, perceived level of importance, HCTP and skills identified in job description, and caring for YYA. Findings indicate HCTP care advancements will necessitate HCTP training and development of nurse-led service efforts to facilitate optimal outcomes for YYA.
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Affiliation(s)
- Cecily L Betz
- Department of Pediatrics, Keck School of Medicine, University of Southern California, CA, USA
| | - Jennifer E Mannino
- Barbara H. Hagan School of Nursing, and Health Sciences 6957Molloy College, NY, USA
| | - Jennifer A Disabato
- College of Nursing and School of Medicine, 296427University of Colorado Anschutz Medical Campus, CO, USA
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Smith ZR, Holmbeck GN. Factor Structure of Medical Autonomy Scales in Young People with Spina Bifida. J Pediatr Psychol 2021; 46:698-709. [PMID: 33684932 DOI: 10.1093/jpepsy/jsab013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The primary goal of this study was to examine the factor structure of a spina bifida (SB) medical responsibilities measure and a medical regimen skills scale across time in families of youth with SB. METHOD One-hundred and forty youth with SB and their parents were assessed in both childhood/adolescence and adolescence/young adulthood. The Sharing of SB Medical Responsibilities Scale (SOSBMR) includes 34 items for which participants indicate who is responsible for each task. The SB Independence Survey (SBIS) is composed of 50 SB-specific medical skills items in yes-no format. Confirmatory factor analyses (CFA) were conducted to examine the factor structure of the SOSBMR and SBIS in childhood and adolescence (ages 8-15) and in adolescence/young adulthood (AYA; ages 16-25). RESULTS One- and seven-factor CFAs were compared for both measures. For the SBIS, both mother- and father-report were used in childhood; self-report was employed for AYA. For the SOSBMR, only self-report was used for both age groups. Across each rater and time point, the seven-factor models of the SBIS and SOSBMR had adequate to excellent fit and reliability, indicating the ability to use each subscale. In addition, each of the corresponding subscales on the SOSBMR and SBIS were associated with each other across raters and time, showing good concurrent and predictive validity. CONCLUSIONS From childhood to young adulthood, the subscales of the SOSBMR can be used to examine responsibility across multiple medical tasks and the SBIS can be used to assess medical regimen skills and mastery in young people with SB.
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Stiles-Shields C, Shirkey KC, Winning AM, Smith ZR, Wartman E, Holmbeck GN. Social Skills and Medical Responsibility Across Development in Youth With Spina Bifida. J Pediatr Psychol 2021; 46:341-350. [PMID: 33236095 PMCID: PMC7977436 DOI: 10.1093/jpepsy/jsaa113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine the predictive role of social skills in youth with spina bifida (SB) on growth in medical responsibility across development. METHODS As part of a larger, longitudinal study, 140 youth with SB were assessed across four time points (ages 8-22 across time points). Mixed-effects models were investigated for change with: (a) no predictors (i.e., change in medical responsibility across age; time was examined using the participant's age, centered at 11.5 years); (b) social variables (i.e., observed social behaviors, parent- and teacher-reported social skills) as predictors; and (c) social variables as predictors with intelligence quotient, lesion level, and sex as covariates. RESULTS Significant growth with age was identified for medical responsibility (p < .0001). Observed, parent-reported, and teacher-reported social skills did not significantly predict this growth; however, all three predicted the intercept for medical responsibility at 11.5 years of age (ps ≤ .047). Parent-reported social skills remained a significant predictor of the intercept at 11.5 years of age when including the covariates (p = .008). CONCLUSIONS Children with SB who exhibited more positive social skills were more likely to a have higher level of medical responsibility in late childhood, but higher levels of social skills were not associated with a more rapid increase in responsibility over time. Identifying existing social strengths and promoting the practice of prosocial skills may have additional benefits to children with SB, including their acquisition of medical responsibility.
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Affiliation(s)
- Colleen Stiles-Shields
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center
| | | | | | - Zoe R Smith
- Psychology Department, Loyola University Chicago
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Holmbeck GN, Kritikos TK, Stern A, Ridosh M, Friedman CV. The Transition to Adult Health Care in Youth With Spina Bifida: Theory, Measurement, and Interventions. J Nurs Scholarsh 2021; 53:198-207. [PMID: 33482054 DOI: 10.1111/jnu.12626] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE This article focuses on the transition to adult health care in youth with spina bifida (SB) from the perspective of theory, measurement, and interventions. METHODS The purpose of this article is to discuss (a) a theory of linkages between the transfer of medical responsibility from parent to child and the transition from pediatric to adult health care, as mediated by transition readiness; (b) measurement issues in the study of self-management and the transition to adult health care; and (c) U.S.-based and international interventions focused on the transition to adult health care in young adults with SB. FINDINGS Individuals with SB must adhere to a complex multicomponent treatment regimen while at the same time managing a unique array of cognitive and psychosocial challenges and comorbidities that hinder self-management, medical adherence, and the transition to adult health care. Moreover, such youth endure multiple transitions to adult health care (e.g., in the areas of urology, orthopedics, neurosurgery, and primary care) that may unfold across different time frames. Finally, three transition-related constructs need to be assessed, namely, transition readiness, transition completion, and transition success. CONCLUSIONS SB provides an important exemplar that highlights the complexities of conducting research on the transition to adult health care in youth with chronic health conditions. Many transition trajectories are possible, depending on the functioning level of the child and a host of other factors. Also, no single transition pathway is optimal for all patients with SB. CLINICAL RELEVANCE The success of the process by which a child with SB transitions from pediatric to adult health care can have life-sustaining implications for the patient.
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Affiliation(s)
- Grayson N Holmbeck
- Professor, Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Tessa K Kritikos
- Postdoctoral Research Fellow, Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Alexa Stern
- Graduate Student, Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Monique Ridosh
- Assistant Professor, Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Catherine V Friedman
- Research Assistant, Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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19
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Ridosh MM, Stiles-Shields C, Stern A, Winning AM, Anderson L, Sawin KJ, Holmbeck GN. The Adolescent/Young Adult Self-Management and Independence Scale (AMIS-II): Expanding evidence for validity and reliability. J Pediatr Rehabil Med 2021; 14:583-596. [PMID: 33935116 PMCID: PMC8788943 DOI: 10.3233/prm-200679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this longitudinal study was to evaluate the internal consistency reliability and construct validity of the Adolescent/Young Adult Self-Management and Independence Scale-II (AMIS-II), an interview-based measure of self-management for youth with chronic health conditions. METHODS A diverse sample of adolescents and young adults (AYA) with spina bifida (SB) (n = 64 AYA; mean 20.88; age range 18-25 years) completed an AMIS-II interview. Six years earlier, parents from 55 families completed questionnaires that assessed children's responsibility for SB-related care (Sharing of Spina Bifida Management Responsibilities) and their ability to perform skills across condition-related tasks (The Spina Bifida Independence Survey). Parents also reported on child's communication skills, adaptive behaviors, and independent management of finances (Adaptive Behavior Assessment System-Second Edition; Scales of Independent Behavior-Revised). Descriptive and correlational analyses were conducted to assess the construct validity and the internal consistency reliability of the AMIS-II. RESULTS The AMIS-II demonstrated excellent internal consistency reliability (AMIS-II total scale α= 0.95; subscales α= 0.90 -0.91). Evidence in support of construct validity was found in associations between the AMIS-II and measures of child responsibility for SB-related care, ability to perform condition-related skills, and adaptive behaviors (r's = 0.378 -0.777; p's < 0.05). CONCLUSION This study provides further evidence of strong reliability and validity for the AMIS-II. Additional research with this measure will facilitate a better understanding of factors related to self-management behaviors in adolescents and young adults with spina bifida.
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Affiliation(s)
- Monique M Ridosh
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Alexa Stern
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Adrien M Winning
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Lara Anderson
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Kathleen J Sawin
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA.,Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Sawin KJ, Margolis RHF, Ridosh MM, Bellin MH, Woodward J, Brei TJ, Logan LR. Self-management and spina bifida: A systematic review of the literature. Disabil Health J 2021; 14:100940. [PMID: 32980287 DOI: 10.1016/j.dhjo.2020.100940] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Self-management is critical to optimizing the health of individuals with a chronic condition or disability and is, therefore, a central concept in individual and family-centered healthcare delivery. The purpose of this review is to report the state of the science of self-management for individuals with spina bifida (SB) from a lifespan perspective. OBJECTIVE This review will summarize the (a) development and use of self-management skills and behaviors across the life span, (b) factors related to self-management behaviors, (c) development of generic or condition-specific measures of self-management used with a spina bifida population, and (d) development and/or outcomes of interventions to improve self-management in SB. METHODS The search strategy was limited to primary research articles published between 2003 and 2019 and followed PRISMA guidelines. The databases searched included: PubMed, CINAHL, PsycINFO, Web of Science, Cochrane, and Google Scholar. Studies that addressed self-management concepts in individuals throughout the life span and published in English were included. RESULTS The search yielded 108 citations and 56 articles met inclusion/exclusion criteria. A systematic narrative synthesis was reported. The level of evidence identified was primarily Level III articles of good quality. Multiple demographic, environmental, condition and process factors were related to self-management behaviors. SB self-management instruments and intervention development and testing studies were identified. CONCLUSIONS This review provides a synthesis of the state of the science of self-management including factors related to self-management behaviors, preliminary evidence of instruments for use in SB, factors important to consider in the development and testing of future interventions, and gaps in the literature.
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Affiliation(s)
- Kathleen J Sawin
- Nurse Scientist, Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Corporate Center, Suite 140, 999 N 92nd St, Wauwatosa, WI, 53226, USA; Center Scientist, Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, USA.
| | - Rachel H F Margolis
- School of Social Work, University of Maryland, 525 W. Redwood Street, Baltimore, MD, 21201, USA.
| | - Monique M Ridosh
- Marcella Niehoff School of Nursing, Loyola University Chicago, 2160 S. First Avenue, Building 115, Room 345, Maywood, PhD, RN, IL, 60153, USA.
| | - Melissa H Bellin
- School of Social Work, University of Maryland, 525 W. Redwood Street, Baltimore, MD, 21201, USA.
| | - Jason Woodward
- Assistant Professor of Internal Medicine and Pediatrics, University of Cincinnati College of Medicine, Division Developmental and Behavioral Peds, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 4002, Cincinnati, OH, 45229, USA.
| | - Timothy J Brei
- Department of Pediatrics, Division of Developmental Pediatrics, Seattle Children's Hospital and University of Washington School of Medicine, 4800 Sand Point Way NE O.C.840, Seattle, WA, 98105, USA.
| | - Lynne Romeiser Logan
- Department of PM&R, Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA.
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21
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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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22
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Kayle M, Chu DI, Stern A, Pan W, Holmbeck GN. Predictors of Distinct Trajectories of Medical Responsibility in Youth with Spina Bifida. J Pediatr Psychol 2020; 45:1153-1165. [PMID: 32895710 PMCID: PMC7588101 DOI: 10.1093/jpepsy/jsaa065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine if there are distinct developmental trajectories of medical responsibility in youth with spina bifida (SB) across ages 8-17 years and to identify condition-related, parental, and family systems predictors of membership in these trajectory groups. METHODS Participants were 140 youth with SB and their parents who participated in four waves of a longitudinal study across 6 years (ages 8-15 years at Time 1). Multi-method (questionnaires and observed family interactions) and multi-respondent assessments were conducted during home visits. RESULTS Findings revealed that there were two distinct developmental trajectories that characterized this sample, with one being labeled "high increasing" (two thirds of the sample) and one labeled "low increasing" (one third of the sample). Most predictor variables were significantly associated with trajectory group membership, with the exception of ethnicity, SES, and measures of conflict. When all significant univariate predictors were included in the same model, only intelligence quotient (IQ), family stress, and gender were retained as significant. CONCLUSIONS Most youth exhibited relatively rapid increases in responsibility over the course of late childhood and adolescence, but there was a smaller portion of the sample that did not exhibit this type of developmental trajectory. The magnitude of the IQ effect on group differentiation appeared to attenuate the effects of most other predictors. It will be important for clinicians working with youth with SB to recognize that the transfer of medical responsibility from parent to child cannot be expected to unfold in the same manner for all families of youth with SB.
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Affiliation(s)
| | - David I Chu
- Division of Pediatric Urology at Ann & Robert H. Lurie Children's Hospital of Chicago
| | | | - Wei Pan
- School of Nursing, Duke University
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Driscoll CFB, Ohanian DM, Ridosh MM, Stern A, Wartman EC, Starnes M, Holmbeck GN. Pathways by which Maternal Factors are Associated With Youth Spina Bifida-Related Responsibility. J Pediatr Psychol 2020; 45:610-621. [PMID: 32337548 DOI: 10.1093/jpepsy/jsaa020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Achieving condition-related autonomy is an important developmental milestone for youth with spina bifida (SB). However, the transfer of condition-related responsibility to these youth can be delayed due to parent factors. This study aimed to investigate two potential pathways by which maternal factors may be associated with condition-related responsibility among youth with SB: (a) Maternal adjustment → perception of child vulnerability (PPCV) → youth condition-related responsibility; and (b) Maternal PPCV → overprotection → youth condition-related responsibility. METHODS Participating youth with SB (N = 140; Mage=11.4 years, range = 8-15 years) were recruited as part of a longitudinal study; data from three time points (each spaced 2 years apart) from the larger study were used. Mothers reported on personal adjustment factors, PPCV, and overprotection. An observational measure of overprotection was also included. Mothers, fathers, and youth with SB reported on youths' degree of responsibility for condition-related tasks. Analyses included age, lesion level, IQ, and the dependent variables at the prior wave as covariates. RESULTS Bootstrapped mediation analyses revealed that PPCV significantly mediated the relationship between maternal distress and youth responsibility for medical tasks such that higher levels of distress at Time 1 predicted higher levels of PPCV at Time 2 and lower youth medical responsibility at Time 3. Furthermore, self-reported maternal overprotection significantly mediated the relationship between maternal PPCV and youth responsibility for medical tasks. CONCLUSIONS Maternal personal distress, PPCV, and self-reported overprotection are interrelated and affect youth's condition-related responsibility. Interventions for mothers of youth with SB that target these factors may improve both maternal and youth outcomes.
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Affiliation(s)
| | | | | | - Alexa Stern
- Psychology Department, Loyola University Chicago
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Holbein CE, Smith AW, Peugh J, Modi AC. Allocation of Treatment Responsibility in Adolescents With Epilepsy: Associations With Cognitive Skills and Medication Adherence. J Pediatr Psychol 2020; 44:72-83. [PMID: 29447360 DOI: 10.1093/jpepsy/jsy006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/20/2018] [Indexed: 01/09/2023] Open
Abstract
Objectives To describe allocation of treatment responsibility (ATR) in adolescents with epilepsy, investigate associations between cognitive skills and ATR, and examine whether ATR for antiepileptic drugs (AEDs) predicted electronically monitored adherence. Method Sixty adolescents with epilepsy and their caregivers completed the Allocation of Treatment Responsibility Scale and a battery of self-report measures. Medical chart review data and electronically monitored AED adherence were collected for 1 year. Descriptive data assessed ATR for caregivers and adolescents; multivariate hierarchical regressions tested associations between variables. Results ATR for labs and clinic appointments was greatest for caregivers, while ATR for AEDs was more likely to be shared between caregiver and adolescent. Poorer attention was associated with greater caregiver responsibility for AEDs. Greater caregiver responsibility for AEDs was associated with higher electronically monitored adherence over 12 months. Conclusions In adolescents with epilepsy, caregivers are responsible for most treatment tasks, although responsibility for taking medication was shared with the adolescent. Greater caregiver responsibility for medication results in better long-term AED adherence. ATR is an important construct that warrants further attention in research and clinical practice, especially in the context of transition and health outcomes in pediatric epilepsy.
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Affiliation(s)
| | - Aimee W Smith
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - James Peugh
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Avani C Modi
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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25
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Stiles-Shields C, Crowe AN, Driscoll CFB, Ohanian DM, Stern A, Wartman E, Winning AM, Wafford QE, Lattie EG, Holmbeck GN. A Systematic Review of Behavioral Intervention Technologies for Youth With Chronic Health Conditions and Physical and Intellectual Disabilities: Implications for Adolescents and Young Adults With Spina Bifida. J Pediatr Psychol 2020; 44:349-362. [PMID: 30561676 DOI: 10.1093/jpepsy/jsy097] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Behavioral intervention technologies (BITs) stand as a promising delivery mechanism that overcomes multiple condition-specific and access barriers for self-management interventions for adolescents and young adults with spina bifida (AYA-SB). The purpose of the current review was to synthesize the behavioral and self-management intervention literature in conditions that have overlapping symptoms with youth with SB and to develop a model of likely user needs for AYA-SB that promotes self-management. METHOD The search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) databases. The review was based on a systematic narrative synthesis framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092342). RESULTS In total, 18 articles were included in the current BIT review. The majority of included studies (1) targeted the management of chronic health conditions, (2) were informed by evidence-based approaches, (3) relied on content delivery, (4) were Web-based, (5) used linear or user-driven workflows, (6) included professional human support, and (7) included a control condition. CONCLUSIONS Many of the evaluated BITs resulted in acceptable usage and maintained or improved targeted symptoms. A user needs model for AYA-SB is proposed with the intention that future research will promote further refinement and ultimate deployment of a BIT for AYA-SB to promote self-management.
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Affiliation(s)
| | | | | | | | - Alexa Stern
- Psychology Department, Loyola University Chicago
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Peycelon M, Szymanski KM, Francesca Monn M, Salama AK, Risk H, Cain MP, Misseri R. Adherence with bladder irrigation following augmentation. J Pediatr Urol 2020; 16:33.e1-33.e8. [PMID: 31796294 DOI: 10.1016/j.jpurol.2019.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with bladder augmentation (BA) are routinely counseled to irrigate their bladders daily. However, reports of adherence with this regimen are lacking. OBJECTIVE To evaluate adherence to a bladder irrigation protocol and identify risk factors associated with adherence among adults with spina bifida (SB) and BA. STUDY DESIGN Adults with SB after BA followed in a multidisciplinary clinic were identified (2017-2019). All patients or caregivers were taught the importance of and the technique for the bladder irrigation protocol prior to and after BA. Patient demographics (age, gender, ambulatory status, and presence of a caregiver in clinics) and surgical details (type of BA, age at surgery, length of follow-up, presence of a catheterizable channel, position of stoma, bladder neck surgery, presence of Malone antegrade colonic enema or ventriculo-peritoneal shunt, and number of stone surgeries) were obtained from the medical record. Patients reported other variables in a standardized clinic questionnaire. Answers were confirmed by health care providers. The variables included who performs clean intermittent catheterization (CIC), size of catheter, frequency of CIC, use of overnight catheterization, difficulties with CIC, number of UTIs, and continence per urethra and per catheterizable channel. Adherence to bladder irrigation was also assessed in the questionnaire. ‛Strict adherence' was defined as bladder irrigation performed ≥6 times/week with ≥120 mL of saline. For statistical analysis, a more lenient definition of ‛higher adherence' was used: bladder irrigation ≥2 times/week with at least 60 mL. ‛Lower adherence' was defined as ≤1 time/week or with less than 60 mL. Factors associated with ‛higher adherence' were assessed with non-parametric tests (Bonferroni-corrected p-value: 0.002). RESULTS Adherence was assessed in 87 eligible patients (60.9% females; mean age of 28.8 ± 8.2 years). No patient (0.0%) reported ‛strict adherence', and 62 and 25 patients (71.3% and 28.7%) reported ‛higher' and ‛lower' adherence' to bladder irrigation, respectively. Nine patients (10.3%) in the ‛lower adherence' group did not irrigate at all. No variables were statistically significant on univariate analysis, including previous bladder stone surgery or having a channel (p ≥ 0.01). On exploratory analysis, higher adherence was only associated with self-catheterizations versus those performed by caregivers (76.7% vs 33.3%, p = 0.01). CONCLUSIONS Adherence to a bladder irrigation protocol in adults with SB and BA is poor. A history of bladder stones requiring surgery and the presence of a catheterizable channel do not appear to affect adherence. It remains unclear why some patients are more likely than others to irrigate their bladders. Future work will focus on methods to improve adherence.
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Affiliation(s)
- Matthieu Peycelon
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA; Reference Center for Rare Diseases (CRMR), Malformations Rares des Voies Urinaires (MARVU), Université de Paris, Sorbonne Paris Cité. 48, Boulevard Sérurier, Paris, France
| | - Konrad M Szymanski
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA
| | - M Francesca Monn
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA
| | - Amr K Salama
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA
| | - Hillary Risk
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA
| | - Mark P Cain
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA
| | - Rosalie Misseri
- Department of Pediatric Urology of Riley Children Hospital, Indiana University, School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, USA.
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Abstract
Research supports a resilience-disruption model of family functioning in families with a child with spina bifida. Guidelines are warranted to both minimize disruption to the family system and maximize family resilience and adaptation to multiple spina bifida-related and normative stressors. This article discusses the spina bifida family functioning guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida, and reviews evidence-based directions with the intention of helping individuals with spina bifida achieve optimal mental health throughout their lifespan. Guidelines address clinical questions pertaining to the impact of having a child with spina bifida on family functioning, resilience and vulnerability factors, parenting behaviors that may facilitate adaptive child outcomes, and appropriate interventions or approaches to promote family functioning. Gaps in the research and future directions are discussed.
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Affiliation(s)
- Tessa K. Kritikos
- Corresponding author: Tessa K. Kritikos, Loyola University Chicago, 1000 W Sheridan Rd, Chicago, IL 60626, USA. Tel.: +1 610 764 0711; E-mail:
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Driscoll CFB, Murray CB, Holbein CE, Stiles-Shields C, Cuevas G, Holmbeck GN. Camp-based psychosocial intervention dosage and changes in independence in young people with spina bifida. Dev Med Child Neurol 2019; 61:1392-1399. [PMID: 30980543 PMCID: PMC7590995 DOI: 10.1111/dmcn.14250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
Abstract
AIM To examine associations between camp-based intervention dosage and changes in independence-related skills for young people with spina bifida. METHOD Participants were 110 individuals (mean age [SD] 14y 7mo [6y 1mo], range 6-32y; 66 females, 54 males) who attended a summer camp for individuals with spina bifida between 2 to 6 times (mean 2.40; operationalized as 'dosage'). Parents of young campers (e.g. those <18y) also participated in data collection. Campers and/or parents completed preintervention measures assessing campers' level of medical responsibility, mastery over medical tasks, and social skills. Outcomes included change in preintervention scores from dose 1 to final dose. RESULTS Hierarchical regression analyses with and without covariates (age, IQ, and lesion level at dose 1) revealed that increased dosage was significantly associated with greater parent-reported improvements in campers' medical responsibility and mastery over medical tasks. Increased dosage was also significantly associated with camper-report of increased medical responsibility, but this relationship was no longer significant when including covariates. Intervention dosage was not associated with changes in campers' social skills. INTERPRETATION Repeated participation in a camp-based intervention was associated with improvements in condition-related independence. Future work may focus on the development of interventions to promote improvements in social skills for young people with spina bifida. WHAT THIS PAPER ADDS Participating in an intervention over multiple summers is associated with increases in campers' responsibility for spina bifida-related tasks. Repeated summer camp intervention participation is associated with improved mastery over condition-related tasks for campers with spina bifida. Repeated camp intervention participation is not associated with changes in social skills for campers with spina bifida.
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Affiliation(s)
| | - Caitlin B Murray
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | - Gina Cuevas
- Psychology Department, Loyola University Chicago, Chicago, IL, USA
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Stern A, Driscoll CFB, Ohanian D, Holmbeck GN. A Longitudinal Study of Depressive Symptoms, Neuropsychological Functioning, and Medical Responsibility in Youth With Spina Bifida: Examining Direct and Mediating Pathways. J Pediatr Psychol 2019; 43:895-905. [PMID: 29444296 DOI: 10.1093/jpepsy/jsy007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/23/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Given the increased risk for cognitive deficits and development of depressive symptoms in youth with spina bifida (SB), this study aimed to examine two pathways through which depressive symptoms and neuropsychological dysfunction may be associated with medical autonomy in this population: (1) depressive symptoms as predictors of medical autonomy as mediated by attention/executive functioning (the cognitive scarring model), and (2) attention/executive functioning as predictors of medical autonomy as mediated by depressive symptoms (the cognitive vulnerability model). Methods Participants were recruited as part of a larger, longitudinal study, and included 114 youth with SB (M age = 10.96 at Time 1), their parents, and teachers. Neuropsychological constructs included attention, working memory, and planning/organizing abilities, which were measured with questionnaire and performance-based data. Depressive symptoms and medical responsibility were assessed via questionnaires from multiple respondents. Results Bootstrapped mediation analyses revealed that teacher-reported depressive symptoms significantly mediated the relations between neuropsychological functioning (i.e., attention and working memory) and medical responsibility (all p's < .05); neuropsychological dysfunction did not mediate the relationship between depressive symptoms and medical responsibility. Conclusions One way in which neurocognitive dysfunction may hinder the development of medical autonomy in youth with SB is through an increased risk for depressive symptoms.
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Affiliation(s)
- Alexa Stern
- Psychology Department, Loyola University Chicago
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Choi EK, Jung E, Ji Y, Bae E. A 2-Step Integrative Education Program and mHealth for Self-Management in Korean Children with Spina Bifida: Feasibility Study. J Pediatr Nurs 2019; 49:e54-e62. [PMID: 31519400 DOI: 10.1016/j.pedn.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/02/2019] [Accepted: 09/02/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to develop and test the feasibility of a 2-step self-management program, including onsite integrative education and a mobile health (mHealth) intervention, for children with spina bifida (SB). DESIGN AND METHODS This feasibility study used a quasi-experimental single group pre-and post-test design. The onsite integrative education and the mHealth program, "Glowing Stars™," were developed and then tested for content validity by a panel of experts. The feasibility and user satisfaction were evaluated using factors such as school adjustment, self-management knowledge, self-efficacy, self-management behavior, and quality of life measurement by children aged 10 to 12 years with SB and their parents, from March 2018 to April 2018. RESULTS A total of five children with SB completed this intervention. All children perceived that this program was usable and feasible to maintain self-management behavior. A statistically significant difference was observed in the children's self-management behavior domain between the first and second post-test (p = .043). CONCLUSION This innovative 2-step self-management intervention program complements existing single interventions and confirms the possibility of mHealth technology as an intervention for children with SB. PRACTICE IMPLICATIONS In pediatric nursing, this innovative intervention could be adapted for children with chronic conditions, with a positive effect on self-management.
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Affiliation(s)
- Eun Kyoung Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea.
| | - Eunyoung Jung
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea.
| | - Yoonhye Ji
- Bladder-Urethra Rehabilitation Clinic, Department of Pediatric Urology, Severance Children's Hospital, Yonsei University Healthcare System, Seoul, South Korea.
| | - Eunjeong Bae
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea.
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Parental Distress and Stress in Association with Health-Related Quality of Life in Youth with Spina Bifida: A Longitudinal Study. J Dev Behav Pediatr 2018; 39:744-753. [PMID: 30204623 PMCID: PMC6263838 DOI: 10.1097/dbp.0000000000000603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined associations between 3 distinct parent factors (parent personal distress, parenting stress, and spina bifida (SB)-specific parenting stress) and youth and parent proxy reports of youth health-related quality of life (HRQOL) over time. METHOD Participants were recruited as part of a longitudinal study, and data were collected at 3 time points, spaced 2 years apart. Parents and youth completed questionnaires, and youth completed neuropsychological assessment tasks to determine youth intelligence quotient during home visits. RESULTS Analyses revealed that higher levels of maternal SB-specific parenting stress were related to lower levels of youth-reported HRQOL at time 1. Other parent factors were not associated with youth report of HRQOL at the earlier time points, although higher levels of maternal SB-specific parenting stress and paternal parenting stress were associated with lower levels of youth HRQOL at time 3. For mothers and fathers, increased parent personal distress, parenting stress, and SB-specific parenting stress were associated with decreased proxy report of youth HRQOL. Of these three parent factors, SB-specific parenting stress was consistently the most strongly associated with parent proxy-report of youth HRQOL. CONCLUSION Parenting stress and distress are important targets for interventions, and these interventions may improve youth outcomes, especially as youth age. Future research is needed to identify other factors influencing youth HRQOL over time.
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Ohanian DM, Stiles-Shields C, Afzal KI, Bechtel Driscoll CF, Lennon Papadakis J, Stern A, Starnes M, Holmbeck GN. Cultural Considerations for Autonomy and Medical Adherence in a Young Palestinian American Muslim Female With Spina Bifida: A Longitudinal Case Study in a Research Context. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2018; 6:386-397. [PMID: 31231602 DOI: 10.1037/cpp0000250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This case study examines the unique presentation of a young Palestinian-American Muslim female, who is a part of an ongoing longitudinal study examining family and peer relationships, psychological adjustment, and neuropsychological functioning in youth with spina bifida. Throughout ten years of data collection, Palestinian-Arab culture and Islamic faith have consistently emerged as important factors that can be considered when interpreting this participant's general level of autonomy, medical autonomy, medical adherence, and psychological adjustment. This case study examines important aspects of adaptive and independent functioning for youth with spina bifida and how this family's culture interacts with these different domains of functioning. Moreover, it explores potential conflicts between an Arab collectivist family structure and Western biomedical ethics and suggests how clinicians might navigate these conflicts and bolster culturally-rooted strengths of families and patients from non-Western backgrounds.
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Affiliation(s)
- Diana M Ohanian
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Colleen Stiles-Shields
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Khalid I Afzal
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, 5841 S Maryland Ave, MC 3077, Chicago, IL 60637
| | | | | | - Alexa Stern
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Meredith Starnes
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Grayson N Holmbeck
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
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Jordan A, Wood F, Edwards A, Shepherd V, Joseph-Williams N. What adolescents living with long-term conditions say about being involved in decision-making about their healthcare: A systematic review and narrative synthesis of preferences and experiences. PATIENT EDUCATION AND COUNSELING 2018; 101:1725-1735. [PMID: 29937112 DOI: 10.1016/j.pec.2018.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To understand the preferences and experiences of adolescents (age 10-19) with long-term conditions (LTCs) towards involvement in discussions and decisions regarding management of their condition. METHODS A systematic review and narrative synthesis of mixed-methods, quantitative and qualitative and research was performed. Six databases were searched from inception to March 2017. The quality of the articles was assessed, and relevant data were extracted and coded thematically. RESULTS The search yielded 27 articles which met the inclusion criteria. Decision-making involvement preferences and experiences were reported from the adolescents' perspectives. Adolescents often report that they do not have any choice of treatment options. Variability in preferences and experiences were found within and between individuals. Mismatches between preferences and experiences are common, and often with negative emotional consequences. DISCUSSION Adolescent preferences for involvement in the decision-making process are situational and individualistic. Healthcare professionals can encourage involvement by ensuring that adolescents are informed of treatment options, and aware of the value of their contribution. Future research should explore adolescent perceived barriers and facilitators to SDM. PRACTICAL IMPLICATIONS Interventions are needed to effectively train HCPs in the delivery of shared decision-making, and to support the participation of adolescents with LTCs in shared decision-making.
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Affiliation(s)
- Amber Jordan
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom.
| | - Fiona Wood
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Adrian Edwards
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Victoria Shepherd
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
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Psihogios AM, Murray C, Zebracki K, Acevedo L, Holmbeck GN. Testing the Utility of a Bio-Neuropsychosocial Model for Predicting Medical Adherence and Responsibility During Early Adolescence in Youth With Spina Bifida. J Pediatr Psychol 2018; 42:910-921. [PMID: 27831479 DOI: 10.1093/jpepsy/jsw092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/05/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives The present longitudinal, multi-method, and multi-informant study examined biological, neuropsychological, and social predictors of medical adherence and responsibility among early adolescents with spina bifida (SB). Methods Youth with SB (M age = 11.40 at Time 1) and their parents and teachers completed surveys, and families and peers completed observational assessments, at two biennial data collection time points (n = 112 for both time points). Multinomial logistic regressions tested predictors of group membership (adherent vs. nonadherent and child responsible vs. not responsible with SB medical tasks). Results Consistent with the bio-neuropsychosocial model, several risk factors emerged for SB management. Impaired gross motor classification and low IQ were barriers to obtaining medical responsibility, and high family stress and executive dysfunction were barriers to adherence and responsibility. Conclusions This study offered intervention targets to promote self-management and adherence for youth with SB and their families, including parent stress-management and family problem-solving.
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Affiliation(s)
| | | | - Kathy Zebracki
- Shriners Hospitals for Children.,Northwestern University Feinberg School of Medicine
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Moayed MS, Ebadi A, Khodaveisi M, Nassiri Toosi M, Soltanian AR, Khatiban M. Factors influencing health self-management in adherence to care and treatment among the recipients of liver transplantation. Patient Prefer Adherence 2018; 12:2425-2436. [PMID: 30510406 PMCID: PMC6248226 DOI: 10.2147/ppa.s180341] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Liver transplantation is the global treatment of end-stage liver diseases. Since the patients' survival rate has been improved, the patient may experience reductions in physical, cognitive, and psychosocial functions after liver transplantation influencing their adherence to care and treatment. The transplant survival is complex and patients' adherence to care and treatment should be considered when health care providers make decisions regarding treatment. This qualitative study aimed to explore factors influencing health self-management in adherence to care and treatment among the recipients of care and treatment. METHODS In this study, 23 interview sessions were carried out with a total 18 patients, 2 family members and 3 transplantation team members from May to November 2017. The patients were selected using the purposive method from both genders, with a various age range and initial diseases leading to liver transplantation, and time passed from liver transplantation. A semi-structured interview guide was developed based on literature review and pilot interviews. The participants were asked to describe their experiences of self-management behaviors in adherence to treatment and care. The data were analyzed using a conventional content analysis method and managing via the MAXQDA-10 software. RESULTS Two themes were developed during data analysis as "self-regulation" and "self-care". "Self-regulation" consisted of "intentionally changing", "positively thinking", "information seeking", "problem-solving", "past knowledge transferring", and "self-controlling". "Self-care" had three sub-themes "shift to independence", "vigilance", and "self-care support". CONCLUSION The participants perceived the health self-management in adherence to care as a set of factors related to "self-regulation" and "self-care" behaviors. "Self-regulation" is required to create a balance in life. Also, "self-care" efforts can help with maintaining and improving patients' health.
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Affiliation(s)
- Malihe Sadat Moayed
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Ebadi
- Nursing Education, Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Masoud Khodaveisi
- Chronic Diseases (Home Care) Research Center, Community Health Nursing Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohssen Nassiri Toosi
- Internal Medicine, Hepatologist, Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Soltanian
- Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahnaz Khatiban
- Mother and Child Care Research Center, Medical-Surgical Nursing Department, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran,
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Wu YP, Stenehjem DD, Linder LA, Yu B, Parsons BG, Mooney R, Fluchel MN. Adherence to Oral Medications During Maintenance Therapy Among Children and Adolescents With Acute Lymphoblastic Leukemia: A Medication Refill Analysis. J Pediatr Oncol Nurs 2017; 35:86-93. [PMID: 29188741 DOI: 10.1177/1043454217741877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Adherence to oral medications during maintenance therapy is essential for pediatric patients with acute lymphoblastic leukemia. Self-reported or electronic monitoring of adherence indicate suboptimal adherence, particularly among particular sociodemographic groups. This study used medication refill records to examine adherence among a national sample of pediatric patients with acute lymphoblastic leukemia. Patients in a national claims database, aged 0 to 21 years with a diagnosis of acute lymphoblastic leukemia and in the maintenance phase of treatment, were included. Medication possession ratios were used as measures of adherence. Overall adherence and adherence by sociodemographic groups were examined. Adherence rates were 85% for 6-mercaptopurine and 81% for methotrexate. Adherence was poorer among patients 12 years and older. Oral medication adherence rates were suboptimal and similar to or lower than previously documented rates using other methods of assessing adherence. Refill records offer a promising avenue for monitoring adherence. Additional work to identify groups most at-risk for poor adherence is needed. Nurses are well positioned to routinely monitor for medication adherence and to collaborate with the multidisciplinary team to address barriers to adherence.
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Affiliation(s)
- Yelena P Wu
- 1 University of Utah, Salt Lake City, UT, USA
| | - David D Stenehjem
- 1 University of Utah, Salt Lake City, UT, USA.,3 Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth, MN, USA
| | - Lauri A Linder
- 1 University of Utah, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Bin Yu
- 1 University of Utah, Salt Lake City, UT, USA
| | | | - Ryan Mooney
- 1 University of Utah, Salt Lake City, UT, USA
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Gutiérrez-Colina AM, Eaton CK, Lee JL, Reed-Knight B, Loiselle K, Mee LL, LaMotte J, Liverman R, Blount RL. Executive Functioning, Barriers to Adherence, and Nonadherence in Adolescent and Young Adult Transplant Recipients. J Pediatr Psychol 2015; 41:759-67. [PMID: 26567316 DOI: 10.1093/jpepsy/jsv107] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/14/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE : To evaluate levels of executive functioning in a sample of adolescent and young adult (AYA) transplant recipients, and to examine executive functioning in association with barriers to adherence and medication nonadherence. METHOD : In all, 41 caregivers and 39 AYAs were administered self- and proxy-report measures. RESULTS : AYA transplant recipients have significant impairments in executive functioning abilities. Greater dysfunction in specific domains of executive functioning was significantly associated with more barriers to adherence and greater medication nonadherence. CONCLUSION : AYA transplant recipients are at increased risk for executive dysfunction. The assessment of executive functioning abilities may guide intervention efforts designed to decrease barriers to adherence and promote developmentally appropriate levels of treatment responsibility.
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Affiliation(s)
| | - Cyd K Eaton
- Department of Psychology, University of Georgia
| | - Jennifer L Lee
- Department of Pediatrics, Emory University School of Medicine
| | | | | | - Laura L Mee
- Department of Psychiatry and Behavioral Science, Emory School of Medicine, and
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