Parents' Perception of Self-Management Behaviors for Their Children With Spina Bifida in South Korea: A Qualitative Study

A qualitative study on the experiences of Turkish caregivers of learning clean intermittent catheterization

PURPOSE

The process of caregivers learning to implement clean intermittent catheterization (CIC) affects both children and caregivers negatively. The aim of this study was to examine the experiences of caregivers performing CIC on their children with spina bifida (SB).

DESIGN AND METHODS

This study was conducted with a qualitative design between June 5 and September 25, 2022, with the caregivers of 17 children. The data were collected using a semi-structured questionnaire and analyzed using a thematic analysis technique. The COREQ guidelines were followed in the study.

RESULTS

The data were grouped under fourteen sub-themes: "not knowing CIC, having knowledge about CIC, positive and supportive, negative and compelling, family support, health personnel support, loneliness, sharing responsibility, taking on the role of caregiver, satisfaction, sadness, indecisiveness, limitation of social life, change in social life routine". Caregivers had both positive and negative experiences in this period.

CONCLUSION

Caregivers face various challenges during the implementation of CIC for children with SB. The results reveal the importance of identifying the performance of caregivers. Nurses who are aware of the difficulties faced by caregivers in this period can be actively involved in personalized care-oriented health education, counseling, and support for caregivers.

IMPLICATIONS FOR CLINICAL PRACTICE

Failure to provide adequate support to caregivers during the CIC application process causes both children and caregivers to be negatively affected in this process. For this reason, protocols or guidelines should be created by nurses in order to reduce the negative experiences of caregivers who apply CIC to their children.

Clinical profile of Korean children with spina bifida: a single-center prospective cohort study

BACKGROUND

Spina bifida (SB) is a chronic condition requiring lifelong self-management, underscoring the need to establish a dedicated cohort for longitudinal monitoring of health outcomes. The purpose of this study was to describe the development and initial implementation of a single-center prospective cohort study of children with SB and their parents living in South Korea and to describe demographics, clinical outcomes, psychosocial characteristics, and family data for this cohort.

METHODS

This cohort was established through expert panel formation, identification of health indicators based on the Life Course Model for Spina Bifida, creation of a cohort database system, and quality control planning. Participants, children aged 4-12 years with SB and their parents, were recruited from a large SB clinic at a tertiary hospital in South Korea. Two approaches were used to collect data: (1) diagnosis and clinical outcomes (e.g., lesion level, surgical history, laboratory results) were collected from the electronic medical record by pediatric nurse practitioners and (2) demographics, psychosocial characteristics and family data were collected from online self-reported questionnaires completed by children with SB and their parents if the child with SB was aged 7-12 years and by only the parents if the child with SB was aged 4-6 years.

RESULTS

Between September 2022 and September 2023, 162 children (mean age 7.6 ± 2.6 years) and their parents participated, with 35.8% (4-6 years), 29% (7-9 years), and 35.2% (10-12 years). Diagnoses included lipomyelomeningocele (51.2%), myelomeningocele (27.2%), and tethered cord syndrome (20.4%). Clean intermittent catheterization was used by 38.3% and enemas by 22.2%. Moreover, 30.9% experienced urinary incontinence and 26.5% experienced fecal incontinence. Ambulation assistive devices were used by 14.8%, and ventriculoperitoneal shunts by only 4.3%.

CONCLUSIONS

This cohort provides a comprehensive understanding of demographics, and clinical and psychosocial outcomes for children with SB in South Korea. The dataset offers opportunities for data-driven, life-course tailored interventions to meet the specific needs of this population and their families.

Cross-cultural adaptation and validation of the Korean version of the quality of life assessment in spina bifida for children (QUALAS-C-K)

PURPOSE

This study aimed to translate and cross-culturally adapt the QUAlity of Life Assessment in Spina bifida for Children (QUALAS-C) and validate the Korean version of the QUALAS-C (QUALAS-C-K).

MATERIALS AND METHODS

Three urologists translated the QUALAS-C into Korean. Facial and content validity were assessed in the pilot study. Back-translation into English was performed. In the main study, the QUALAS-C-K and Korean version of KIDSCREEN-27 were administered simultaneously. Test-retest reliability was confirmed by re-administering the QUALAS-C-K. Internal consistency was verified using Cronbach's alpha. Factor analysis was performed, and convergent and divergent validity were demonstrated using the Korean version of KIDSCREEN-27.

RESULTS

A total of 53 children with spina bifida participated in the main study. Cronbach's alpha for the overall instrument determined good internal consistency (0.72-0.85), the intraclass correlation coefficient showed good stability (0.74-0.77), and the factor analysis converged to the same two-factor structure as in the original version. Construct validity revealed weak-to-moderate associations (r ≤ 0.57) between QUALAS-C-K and K-KIDSCREEN-27, indicating that QUALAS-C-K measures different aspects of the HRQOL than K-KIDSCEEN-27.

CONCLUSIONS

The QUALAS-C-K is a reliable and valid instrument for assessing the health-related quality of life of children with SB in Korea.

Changes in Correlates of Health-Related Quality of Life Between Children with Spina Bifida and Their Parents as Influenced by Their Level of Independence in Toileting Self-Management: A Cross-Sectional Study

Background Spina bifida (SB) leads to various complications, such as bladder and bowel disorders, which can significantly impact quality of life (QOL). Parents of children with SB are often heavily involved in bladder and bowel management, which can affect their own QOL. Therefore, transitioning to independent bladder and bowel management is pivotal because it influences the QOL of both children with SB and their parents. In this study, we investigated changes in health-related quality of life (HRQOL) among children with SB and their parents in the process of attaining independence in bladder and bowel self-management. Methods Children with SB aged 8-17 years and their parents completed the Japanese version of the QOL assessment in SB for children/teenagers (QUALAS-C/T-J) and the Short Form-8 (SF-8). Independence in bladder and bowel management was assessed using a visual analogue scale (VAS). We calculated the correlation between children's or parents' HRQOL and the children's level of independence in bladder and bowel management. Additionally, we conducted a Mann-Whitney U test on the scores of the higher and lower independence groups. The correlation between parent and child HRQOL was analyzed by dividing children's independence into two groups. Results This study consisted of 83 parent-child pairs. Parents' and children's HRQOL and levels of self-management independence were not significantly correlated, either overall or by level of independence. The parent-child group with less independence, especially in bowel management, showed moderate to strong HRQOL correlations, whereas the group with more independence showed weaker correlations. Conclusions The strength of the correlation for parent-child HRQOL was found to change based on the level of independence in bladder and bowel self-management. These results suggest that the strength of parent-child cohesion tends to be pronounced in regard to the children's degree of independence in bowel management.

Parent-youth interactions: Transitioning to toileting self-management in spina bifida patients

Purpose

Spina bifida (SB) involves neurogenic bladder and bowel deficits. While parents manage the bladder and bowel disorders of their youth in the early years, the youth themselves must eventually take responsibility for their own management. However, the experience of shifting responsibility for complex toilet management from the parents to the youth has not been thoroughly investigated. Therefore, as exploratory research, the present study aimed to reveal the interactions between parents and youths with SB during the time of increasing responsibility for bladder and bowel management (i.e., the transition phase).

Methods

Twelve parent-youth pairs (youths with SB aged 11-18 years) participated in dyadic interviews, and a parent-youth transition experience was categorized by the context of parent-youth interactions and analyzed using the grounded theory approach.

Results

The results indicated that parents provide professional, complete bladder and bowel management until their youth reach physical and mental maturity. During the transitional phase, they work together to master youth self-management in interactions described as "share, try, and decide through parent-youth interactions". Finally, the youth are able to master control of their own bladder and bowel management without requiring assistance from their parents.

Conclusions

Although parent-youth interactions are not always present during the pre- and post-transition phases, the parent-youth relationship acts to facilitate the independence of the youth by taking advantage of the parent-youth subsystem during the transitional phase. Interventions during these challenging periods could help facilitate the transition to bladder and bowel self-management among the youth.

Factors affecting the transition to adulthood of Korean young adults with spina bifida: a qualitative study

BACKGROUND

Transition to adulthood to live independently while self-managing health and daily life without parental help is crucial for young adults with chronic conditions. Despite its importance as a precursor to effectively managing lifelong conditions, little is known about the experiences of young adults with spina bifida (SB) in transition to adulthood in Asian countries. This study aimed to explore the experiences of Korean young adults with SB to identify the facilitators or barriers to the transition from adolescence to adulthood from their perspectives.

METHODS

This study used a qualitative descriptive design. The data were collected in South Korea through three focus group interviews with 16 young adults with SB, aged 19-26, from August to November 2020. We conducted a qualitative content analysis using a conventional approach to identify the factors that facilitated and hindered the participants' transition to adulthood.

RESULTS

Two themes emerged as facilitators and barriers to the transition to adulthood. a) Facilitators: understanding and acceptance of SB, acquiring self-management skills, parenting styles encouraging autonomy, parents' emotional support, school teachers' thoughtful consideration, and participation in self-help groups. b) Barriers: overprotective parenting style, experience of being bullied by peers, damaged self-concept, concealing one's chronic condition from others, and the lack of privacy in school restrooms.

CONCLUSIONS

Korean young adults with SB shared their experiences of struggling to properly manage their chronic conditions on their own, particularly concerning regular bladder emptying, during the transition from adolescence to adulthood. To facilitate the transition to adulthood, education on the SB and self-management for adolescents with SB and on parenting styles for their parents are important. To eliminate barriers to the transition to adulthood, improving negative perceptions of disability among students and teachers and making school restrooms CIC-friendly are needed.

Unexpected challenges faced by caregivers of children with neurogenic bladder: A qualitative study

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.

Self-management and independence guidelines for the care of people with spina bifida

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.