What do parents need to enhance participation of their school-aged child with a physical disability? A cross-sectional study in the Netherlands

A Reliable and Valid Parent Self-Report Tool to Assess Children's Global Health Needs

PURPOSE

This study aimed to develop and validate a parent self-report questionnaire to explore global health needs in 2- to 6-year-old children.

DESIGN AND METHODS

The development of the tool started with a conceptualization phase, followed by the design, pilot testing and psychometric validation of the questionnaire. The construct validity was assessed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were carried out to explore the construct validity of the questionnaire. The normed fit index (NFI), root mean square error of approximation (RMSEA), chi square test and comparative fit index (CFI) were used to test the goodness-of-fit. Reliability was explored through Cronbach's alpha for internal consistency.

RESULTS

A total of 973 parents completed the 119 items of the Necesidades de salud de la Población Infantil (NPI) questionnaire for the psychometric validation stage. The EFA identified seven factors: Lifestyles, Promotion of healthy lifestyles and influence of significant persons, Children's socioemotional aspects, Parents' socioemotional aspects, Parental self-efficacy, Situational influences, Professional advice. All the factors showed good internal consistency (Cronbach's alpha >0.7). The CFA showed good adjustment to the model (RMSEA = 0.048). The values of NFI and CFI were 0.741 and 0.779 respectively.

CONCLUSIONS

The NPI questionnaire is a reliable and valid instrument.

PRACTICE IMPLICATIONS

The seven-factor questionnaire will be useful for analyzing children's global health needs, designing health promotion programs according to identified needs and assessing related interventions.

Validity and Reliability of the Life Transition Scale in Parents of Disabled Children Across the Life Transition Process

Purpose

The Life Transition Scale (LTS) consists of 24 items that assess the life transition process of parents of autistic children. This study aimed to examine the validity and reliability of the LTS in parents of children with a wide spectrum of disabilities.

Methods

Data were collected from 260 parents of children with disabilities through self-report questionnaires. Validity was examined using exploratory and confirmative factor analysis to determine the factor structures of the LTS; socio-demographic differences in LTS scores were examined using the t-test or ANOVA. Reliability was examined using Cronbach's ⍺ coefficient.

Results

A four-factor structure was validated (x²=640.0, p<.001, GFI=.81, RMSEA=.07, NNFI=.89, CFI=.89, PNFI=.74, Q [x²/df]=2.60). The validity of the LTS was verified by exploratory factor analysis, with factor loading ranging from .30 to .80. There were significant differences in the accepting phase according to children's and parents' age and the type of disability, and in the wandering phase according to parental gender, educational level, job, and socioeconomic status. The Cronbach's ⍺s for the reliability of each of the four structures were acceptable, within a range of .80~.90.

Conclusion

The LTS is a valid and reliable measurement to assess the life transition process of parents with disabled children.

The meaning of leisure to children and young people with significant physical disabilities: Implications for optimising participation

Introduction

The facilitation of meaningful leisure participation for children and young people requires an understanding of what leisure means to them. This study aimed to understand meaningful leisure from the perspective of children and young people with complex physical and communication disabilities.

Method

A hermeneutic phenomenological research design was used. Data was gathered through multiple interviews with six young people supported by photo elicitation, Talking Mats and direct observation. Individual case studies were analysed, together with six autobiographies of people with similar disabilities. Data analysis was iterative and multi-directional, alternating between segments and the whole throughout interpretation.

Results

Leisure experience meanings were uniquely constructed for each person, based on preferences, personality and circumstances. The tree of leisure emerged as a useful metaphor for three essential features (control, engrossing, enjoyment) and four key meanings (escape, exploration, exchange and expression) of leisure. Children and young people experienced five meaningful outcomes that lasted beyond the leisure activity (restoration, protection, construction, reflection and connection).

Conclusion

For children and young people with disabilities, a balanced array of diverse leisure experiences provides a powerful and accessible route to wellbeing. Implications for practice include understanding the individual, focusing on the social environment, supporting self-advocacy and promoting opportunities for free movement.

Treatment and re/habilitation of children with cerebral palsy in India: a scoping review

AIM

To describe the nature and extent of the literature addressing the medical and its re/habilitative management of cerebral palsy (CP) in India.

METHOD

Online worldwide scholarly databases, research hosting directories, Indian publishing houses, and grey literature were used to identify papers published between 2005 and 2016. We retrieved 144 English language papers that described the medical and rehabilitative management of Indian children with CP.

RESULTS

Quantitative, qualitative, and mixed research designs are published by a variety of health care professionals in India. Intervention (45%) and observational studies (30%) predominate. Outcomes were categorized using the World Health Organization's International Classification of Functioning, Disability and Health framework, with body structure and function most reported and activity/participation least reported; 57% described its re/habilitation interventions and 43% were medical interventions.

INTERPRETATION

There is a substantial body of CP research in India that focuses on interventions to reduce impairments, with minimal attention given to activities and participation, environmental, and personal factors. Twenty-six per cent of studies are published in what appear to be 'predatory journals'. This paper serves as an alert about the presence of 'predatory journals' in medicine that may introduce publication bias, which can distort results reported in those studies individually, or from conclusions drawn in reviews that contain those studies.

WHAT THIS PAPER ADDS

Cerebral palsy research in India focuses on interventions to reduce impairment. Activities, participation, and environmental factors are minimally addressed. Quantitative studies are more common than qualitative studies. Many Indian studies are published in journals that are not indexed in worldwide databases of scholarly journals.

Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy?

This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system.

WHAT THIS PAPER ADDS

The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.

Daily actions, challenges, and needs among Dutch parents while supporting the participation of their child with a physical disability at home, at school, and in the community: a qualitative diary study

BACKGROUND

Parents have a vital influence on the participation of their child with a physical disability. The aim of this study is to gain insight into parents' own daily actions, challenges, and needs while supporting their child with a physical disability at home, at school, and in the community. An additional objective of this study is to refine the preliminary thematic framework previously identified in a scoping review.

METHODS

A qualitative research inquiry was performed based on using a diary over a 7-day period to gather data. To systematically organise data into a structured format, content analysis has been applied using both inductive and deductive reasoning guided by the existing preliminary thematic framework.

RESULTS

Analysis of the eligible diaries shows that the actions mentioned by the 47 parents describe several efforts to enhance participation of their children with a physical disability by using, enabling, or changing the social and physical environment, or by supporting their child to perform or engage in meaningful activities. Those parents' actions are primarily a result of challenges caused by restrictions in social and physical environments. Parental responses highlighted, above all, the need for environments designed for all people. Based on the findings a redefined thematic framework is presented.

CONCLUSIONS

Parents' actions, challenges, and needs are mainly directed towards the social or/and physical environment. The presented thematic framework can offer practitioners knowledge to support parents. More work is necessary to provide tailored approaches. Paediatric rehabilitation may need to address the importance of the environment on the participation of a child with a physical disability.

Information seeking by parents of children with physical disabilities: An exploratory qualitative study

BACKGROUND

Evidence suggests that parents of children with disabilities feel that not all their information needs are being met, but it remains unclear how parents try to fill these information gaps.

AIMS

The aim of this study is to describe how parents of children with physical disabilities search for and evaluate information.

METHODS

Qualitative semi-structured interviews were conducted with 15 parents of children with a disability, aged 1.5-21 years. Data were analysed using thematic analysis.

RESULTS

There was much variation in information needs between parents. Parents used different sources, depending on the type of information needed, the most important being healthcare professionals, peers, and websites. Peers played an important role in information provision and were the preferred source of experience-based knowledge and support. The Internet is a widely used medium to search for information and to access various sources. There was a general preference for closed Internet communities for peer contact. Information was commonly evaluated by comparing sources.

CONCLUSIONS AND IMPLICATIONS

Parents use different sources for different information needs, and evaluate information by comparing them. Healthcare professionals and parents can support each other in locating and evaluating information including experience-based knowledge. Healthcare professionals should guide parents in their search for information and experience-based knowledge from peers.

Co-creation of a digital tool for the empowerment of parents of children with physical disabilities

PLAIN ENGLISH SUMMARY

Parents of children with physical disabilities do a lot to support their child in daily life. In doing this they are faced with many challenges. These parents have a wide range of unmet needs, especially for information, on different topics. It is sometimes hard for them to get the right information at the right moment, and to ask the right questions to physicians and other healthcare professionals. In order to develop a digital tool to help parents formulate questions and find information, we thought it would be crucial to work together in a process of co-creation with parents, researchers, IT-specialists and healthcare professionals. In close collaboration with them we developed a tool that aims to help parents ask questions, find information and take a more leading role in consultations with healthcare professionals, called the WWW-roadmap (WWW-wijzer in Dutch).In two groups of parents (one group with and one group without experience of using the tool), we will study the effects of using this tool, on consultations with physicians. We expect that using the tool will result in better empowerment, satisfaction and family-centred care.

BACKGROUND

Parents of children with physical disabilities do much to support their child in daily life. In doing so, they are faced with many challenges. These parents have a wide range of unmet needs, especially for information, on various topics. Getting timely and reliable information is very difficult for parents, whereas being informed is a major requirement for the process of empowerment and shared decision-making. This paper describes the development of a digital tool to support parents in this process. During its development, working together with parents was crucial to address relevant topics and design a user-centred intervention.

METHODS

In co-creation with parents, healthcare professionals, IT-professionals and researchers, a digital tool was developed, the 'WWW-roadmap' ['WWW-wijzer' in Dutch]. This digital tool aims to enable parents to explore their questions (What do I want to know?), help in their search for information (Where can I find the information I need), and refer to appropriate professionals (Who can assist me further?).During the process, we got extensive feedback from a parent panel consisting of parents of children with physical disabilities, enabling us to create the tool 'with' rather than 'for' them. This led to a user-friendly and problem-driven tool.

DISCUSSION

The WWW-roadmap can function as a tool to help parents formulate their questions, search for information and thus prepare for consultations with healthcare professionals, and to facilitate parental empowerment and shared-decision making by parent and professional. Effects of using the WWW-roadmap on consultations with professionals will be studied in the future.

Factors contributing to defaulting scheduled therapy sessions by caregivers of children with congenital disabilities

BACKGROUND

Defaulting scheduled rehabilitation therapy may result in increased adverse outcomes such as permanent disability and increased healthcare costs. Concomitantly, there is evidence to suggest that early and continued rehabilitation of children with congenital disabilities can improve outcomes significantly. This study was conducted to determine factors contributing to caregivers' defaulting scheduled rehabilitation therapy sessions.

METHODS

A descriptive cross sectional study was carried out at Chitungwiza Central Hospital, a tertiary facility offering in and outpatient rehabilitation services in Zimbabwe. Caregivers of children who had congenital disabilities (N=40) and who had a history of defaulting treatment but were available during the data collection period responded to an interviewer administered questionnaire. Data were analysed for means and frequencies using STATA 13.

RESULTS

Factors that contributed to caregivers defaulting scheduled therapy included economic constraints (52%), child related factors (43%), caregiver related factors (42%), service centred factors (30%) and psychosocial factors(58%). Majority of the caregivers (98%) were motivated to attend therapy by observable improvements in their children. Other motivators were incentives given in the rehabilitation department (45%), availability of rehabilitation personnel to provide the required services (48%) and psychosocial support from fellow caregivers, families and the rehabilitation staff (68%). Although all the caregivers could not distinguish occupational therapy from physiotherapy services they all reported that therapy was important.

CONCLUSIONS

A combination of psychosocial, economic, child centred and service centred factors contributed to caregivers defaulting scheduled therapy. Interventions that may potentially improve caregiver attendance to scheduled therapy include community outreach services, efficient rehabilitation service provision at the hospitals, and facilitation of income generating programmes for caregivers.