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Flick U, Röhnsch G. Young adults living with chronic illness: disclosure strategies and peers' understanding. Disabil Rehabil 2024:1-12. [PMID: 39258793 DOI: 10.1080/09638288.2024.2400598] [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: 09/20/2023] [Revised: 08/30/2024] [Accepted: 08/31/2024] [Indexed: 09/12/2024]
Abstract
PURPOSE Many young adults living with chronic illness fear being perceived as different by their peers and excluded from social activities. This forces them to consider whether to disclose or conceal their illness. This article analyses young adults' disclosure strategies and links them to peers' understanding of illness. MATERIALS AND METHODS The explorative study is based on episodic interviews with sixty young adults living with chronic illnesses (type 1 diabetes, cancer, chronic inflammatory bowel disease or a rare disease) and thirty peers. The interviews were thematically coded. The young adults' statements were compared to the peer perspectives on a case-by-case basis. RESULTS We identified three groups of young adults: 1) those who are generally open with peers about their illness and its subjective meaning; 2) those who share selected health-related information's with selected peers; 3) those who refrain from active disclosure and are unsure how they might talk about their illness when it becomes apparent. Our findings also indicate that peers differ in the sophistication of their illness perceptions and the meaning they ascribe to living with a chronic illness. CONCLUSION Trainings should target both young adults and peers, and should assist both sides in talking about (serious) chronic illness.
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Affiliation(s)
- Uwe Flick
- Department of Education and Psychology, Qualitative Social and Education Research, Freie Universität Berlin, Berlin, Germany
| | - Gundula Röhnsch
- Department of Education and Psychology, Qualitative Social and Education Research, Freie Universität Berlin, Berlin, Germany
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Graziano F, Calandri E, Borghi M, Giacoppo I, Verdiglione J, Bonino S. Multiple sclerosis and identity: a mixed-methods systematic review. Disabil Rehabil 2024:1-18. [PMID: 39155841 DOI: 10.1080/09638288.2024.2392039] [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: 04/25/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE This systematic review addressed the following topics: (1) psychometric measures used to evaluate the identity/self in MS patients; (2) impact of MS on the identity/self of patients; (3) relationships between the identity/self and the adjustment to MS. METHOD Five electronic databases were searched for all peer-reviewed empirical studies published up to April 2024 (PROSPERO CRD42023485972). Studies were eligible if they included MS patients and examined identity/self through quantitative, qualitative, or mixed-method study design. MMAT (Mixed Method Appraisal Tool) checklist was used to assess the quality of included studies. After conducting narrative synthesis (quantitative studies) and thematic synthesis (qualitative studies), an integration was undertaken following a convergent segregated approach. RESULTS Forty-three studies were included (13 quantitative, 26 qualitative, and four mixed methods). Studies used measures of "self" to refer to specific domains, and of "identity" to highlight the individual's uniqueness and continuity of experience over time. MS causes a loss of various aspects of self (physical, working, family, and social self) and identity discontinuity. Maintaining a positive self-concept and integrating MS into one's identity are associated with better adjustment to MS. CONCLUSION Clinicians should consider the centrality of identity redefinition for the promotion of MS patients' adjustment to the illness.
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Affiliation(s)
- Federica Graziano
- Department of Psychology, University of Torino, Turin, Italy
- Cosso Foundation, Turin, Italy
| | | | - Martina Borghi
- Cosso Foundation, Turin, Italy
- CRESM (Regional Referral Centre for Multiple Sclerosis), AOU San Luigi Gonzaga Hospital, Turin, Italy
| | - Ilenia Giacoppo
- Department of Psychology, University of Torino, Turin, Italy
| | | | - Silvia Bonino
- Department of Psychology, University of Torino, Turin, Italy
- Cosso Foundation, Turin, Italy
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Sivaramakrishnan H, Davis E, Obadimeji L, Valentine J, Wood F, Shetty V, Finlay-Jones A. Behavior Change Techniques Involved in Physical Activity Interventions for Children With Chronic Conditions: A Systematic Review. Ann Behav Med 2024; 58:527-538. [PMID: 38917474 DOI: 10.1093/abm/kaae033] [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: 06/27/2024] Open
Abstract
BACKGROUND Behavior change techniques (BCTs) have been extensively used in physical activity interventions for children, however, no systematic reviews have synthesized their effects. PURPOSE The present review aimed to identify the most promising BCTs used in physical activity interventions associated with (i) increased physical activity behavior and (ii) positive psychosocial outcomes in children with chronic conditions. METHODS A systematic search of 6 databases identified 61 articles as eligible for inclusion. Data, including BCTs, were extracted from these studies and analyzed descriptively. Due to the heterogeneity of interventions, chronic conditions, and outcome measures, a meta-analysis was not conducted. RESULTS Social support (unspecified), graded tasks, generalization of target behavior, and credible source were the most commonly reported and most promising (i.e., present in 2+ studies evidencing significant effects) BCTs across all studies. These BCTs were found to be especially relevant to improving psychosocial outcomes in the short- and long-term and improving physical activity behaviors in the long-term. Meanwhile, to improve short-term physical activity behaviors, in addition to social support (unspecified), action planning, goal setting (behavior), and problem solving were found to be promising BCTs. CONCLUSIONS The BCTs identified in this review may be relevant to incorporate when planning future interventions to support physical activity and psychosocial outcomes for children with chronic conditions.
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Affiliation(s)
- Hamsini Sivaramakrishnan
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Crawley, Australia
| | - Elizabeth Davis
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Crawley, Australia
- Perth Children's Hospital, Nedlands, Australia
| | | | - Jane Valentine
- Telethon Kids Institute, Nedlands, Australia
- Perth Children's Hospital, Nedlands, Australia
| | - Fiona Wood
- School of Biomedical Sciences, University of Western Australia, Crawley, Australia
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth Children's Hospital, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
| | - Vinutha Shetty
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Crawley, Australia
- Perth Children's Hospital, Nedlands, Australia
| | - Amy Finlay-Jones
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Crawley, Australia
- School of Population Health, Curtin University, Bentley, Australia
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Lee SL, Wu LM, Lin SY, Chen TH, Lin WT. Cross-cultural translation and validation of the Chinese version Distress Tolerance Scale for adolescents with chronic physical disease. Child Care Health Dev 2024; 50:e13270. [PMID: 38706405 DOI: 10.1111/cch.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/18/2024] [Accepted: 03/31/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Chronic physical disease (CPD) makes life filled with many negative events in adolescents, but not all adolescents experiencing negative life events proceed to develop emotional distress, only those with low emotional distress tolerance (EDT). A valid and reliable scale to measure EDT in CPD adolescents is important for caring for their emotional distress. Therefore, the purpose of this study is to translate the 15-item English version Distress Tolerance Scale (DTS) into a Chinese version and then validate the scale for measuring EDT of adolescents with CPD. METHODS The 15-item English version DTS was translated into a Chinese version using the translation guidelines for cross-cultural research. Two cohorts of adolescents with CPD were recruited from four hospitals in southern Taiwan, with the first cohort including 124 adolescents with CPD employed to conduct exploratory factor analysis, corrected item-total correlation and reliability testing, while the second cohort, consisting of 238 adolescents with CPD, was utilized to examine confirmatory factor analysis and concurrent validity. RESULTS The two-factor nine-item Chinese version DTS for Adolescents with CPD (C-DTS-A) was developed. Lower scores of the C-DTS-A were significantly associated with higher diabetes distress, poorer self-management, and worse glycaemic control; their correlation coefficients sequentially were -.40, .17 and -.23. Cronbach's α and the test-retest reliability of the two-factor C-DTS-A ranged from .81 to .87 and from .79 to .89, respectively. CONCLUSION The two-factor nine-item C-DTS-A with good cross-cultural translation quality was a reliable and valid scale to assess EDT for adolescents with CPD.
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Affiliation(s)
- Shu-Li Lee
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shu-Yuan Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Han Chen
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neonatal Intensive Care Unit, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Ting Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Koivusilta LK, Acacio-Claro PJ, Mattila VM, Rimpelä AH. Health and health behaviours in adolescence as predictors of education and socioeconomic status in adulthood - a longitudinal study. BMC Public Health 2024; 24:1178. [PMID: 38671433 PMCID: PMC11055384 DOI: 10.1186/s12889-024-18668-7] [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: 11/24/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The positive association of health with education level and socioeconomic status (SES) is well-established. Two theoretical frameworks have been delineated to understand main mechanisms leading to socioeconomic health inequalities: social causation and health selection but how these work in adolescence is poorly known. We studied if adolescent health and health behaviours predict higher education and higher SES in adulthood and if family background and school performance in adolescence explain these associations. METHODS Surveys on health and health behaviours were sent to representative samples of 12-18-year-old Finns in 1981-1997 every second year (response rate 77.8%, N = 55,682). The survey data were linked with the respondents' and their parents' socioeconomic data from the Finnish national registries. Both latent variables, namely, health (perceived health, health complaints, chronic disease), health-compromising behaviours (smoking status, drunkenness frequency), and family background (parents' occupation-based SES, education, family type) and variables directly measuring health-enhancing behaviours (toothbrushing, physical activity) and school performance were used to predict higher education and higher occupation-based SES at age 34. Logistic regression analysis and structural equation models (SEM) were used. RESULTS In logistic regression analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours were related to higher education and SES, also after controlling for family background and school performance. In the SEM analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours directly predicted higher SES and higher education, although the standardised coefficients were low (from 0.034 to 0.12). In all models, health, lack of health-compromising behaviours, and health-enhancing behaviours predicted school performance, which in turn, predicted the outcomes, suggesting indirect routes to these. Good socioeconomic prospects in terms of family background predicted good health, healthy behaviours, and good school performance in adolescence and higher SES and higher education in adulthood. CONCLUSION Health and health behaviours in adolescence predicted education and SES in adulthood. Even though the relationships were modest, they support the health selection hypotheses and emphasise the importance of adolescence for health inequalities during the life-course. Health and health behaviours were strongly associated with school performance and family background which together modified the paths from health and health behaviours to the outcomes.
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Affiliation(s)
- Leena K Koivusilta
- Department of Social Research, Faculty of Social Sciences, University of Turku, 20014, Turku, Finland.
| | - Paulyn Jean Acacio-Claro
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, and Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
| | - Arja H Rimpelä
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, 33014, Tampere, Finland
- Department of Adolescent Psychiatry, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland
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Pugh A, Ritholz MD, Beverly EA. Similarities and Differences in Diabetes Diagnosis Stories Among Adults With Type 1 or Type 2 Diabetes in Appalachian Ohio. Clin Diabetes 2024; 42:408-418. [PMID: 39015170 PMCID: PMC11247034 DOI: 10.2337/cd23-0081] [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] [Indexed: 07/18/2024]
Abstract
This qualitative study examined adults' recollections of their reactions to their diabetes diagnosis and explored the similarities and differences among those diagnosed with type 1 versus type 2 diabetes. Based on semistructured interviews, the authors identified three themes: 1) shared emotional reactions of fear, sadness, confusion, and worry; 2) perceived differences in expressing concerns for diabetes complications; and 3) differences in perceiving the diagnosis as a surprise versus an inevitability. How health care professionals (HCPs) deliver diabetes diagnoses may be crucial to individuals' acceptance of the condition and coping strategies. HCPs should consider assessing people's emotional reactions to their diagnosis.
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Affiliation(s)
- Andrew Pugh
- Ohio University, Athens, OH
- Ohio University Diabetes Institute, Athens, OH
| | - Marilyn D. Ritholz
- Behavioral Health, Joslin Diabetes Center, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Elizabeth A. Beverly
- Ohio University Diabetes Institute, Athens, OH
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
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Igler EC, Austin JE, Sejkora EKD, Davies WH. Friends' Perspective: Young Adults' Reaction to Disclosure of Chronic Illness. J Clin Psychol Med Settings 2024; 31:197-207. [PMID: 37195582 PMCID: PMC10189708 DOI: 10.1007/s10880-023-09956-2] [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] [Accepted: 03/03/2023] [Indexed: 05/18/2023]
Abstract
Chronic illness can negatively impact adolescents' and young adults' social support. Social support can buffer the negative impact of living with chronic illness. The purpose of this study was to test the acceptability of a hypothetical message to promote social support after a recent diagnosis of a chronic illness. Young adults (18-24; m = 21.30; N = 370), the majority of which were Caucasian, college-students, and female, were asked to read one of four vignettes and to imagine this situation happened while they were in high school. Each vignette contained a hypothetical message from a friend diagnosed with a chronic illness (cancer, traumatic brain injury, depression, or eating disorder). Participants answered forced-choice and free-response questions asking about the likelihood they would contact or visit the friend, and feelings about receiving the message. A general linear model was used to assess quantitative results, and qualitative responses were coded using the Delphi coding method. Participants responded positively, reporting a high likelihood to contact the friend, and feeling glad to receive the message regardless of vignette viewed; however, those who read the eating disorder vignette were significantly more likely to express discomfort. In qualitative responses, participants described positive emotions associated with the message and desire to support the friend. However, participants reported significantly greater discomfort with the eating disorder vignette. The results provide evidence for the potential of a short, standardized disclosure message to promote social support following chronic illness diagnosis with some additional considerations for those recently diagnosed with an eating disorder.
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Affiliation(s)
- Eva C Igler
- Psychology Department, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
- Department of Psychology, Minnesota Epilepsy Group PA, 2427 Fairview Ave N, Suite 100, Roseville, MN, USA.
| | - Jillian E Austin
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ellen K D Sejkora
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - W Hobart Davies
- Psychology Department, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Finlay-Jones AL, Parkinson A, Sirois F, Perry Y, Boyes M, Rees CS. Web-Based Self-Compassion Training to Improve the Well-Being of Youth With Chronic Medical Conditions: Randomized Controlled Trial. J Med Internet Res 2023; 25:e44016. [PMID: 37703081 PMCID: PMC10534292 DOI: 10.2196/44016] [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: 11/03/2022] [Revised: 06/04/2023] [Accepted: 06/26/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Up to one-third of young people live with chronic physical conditions (eg, diabetes, asthma, and autoimmune disease) that frequently involve recurrent pain, fatigue, activity limitations, stigma, and isolation. These issues may be exacerbated as young people transition through adolescence. Accordingly, young people with chronic illness are at a high risk of psychological distress. Accessible, evidence-based interventions for young people with chronic illnesses are urgently needed to improve well-being, support adaptation, and enhance daily functioning. Self-compassion, which is an adaptive means of relating to oneself during times of difficulty, is a promising intervention target for this population. OBJECTIVE This study aims to test the efficacy of a 4-week, self-guided, web-based self-compassion training program for improving well-being among young Australians (aged 16-25 years) living with a chronic medical condition. The primary outcomes were self-compassion, emotion regulation difficulties, and coping; the secondary outcomes were well-being, distress, and quality of life. We also sought to test whether changes in primary outcomes mediated changes in secondary outcomes and gather feedback about the strengths and limitations of the program. METHODS We conducted a single-blind, parallel-group, randomized controlled trial comparing a 4-week, fully automated, web-based self-compassion training program with a waitlist control. Participants were recruited via the internet, and outcomes were self-assessed at 4 (T1) and 12 weeks (T2) after the baseline time point via a web-based survey. A mixed methods approach was used to evaluate the program feedback. RESULTS Overall, 151 patients (age: mean 21.15, SD 2.77 years; female patients: n=132, 87.4%) were randomized to the intervention (n=76, 50.3%) and control (n=75, 49.7%) groups. The loss-to-follow-up rate was 47.4%, and program use statistics indicated that only 29% (22/76) of young people in the experimental group completed 100% of the program. The main reported barrier to completion was a lack of time. As anticipated, treatment effects were observed for self-compassion (P=.01; partial η2=0.05; small effect); well-being (P≤.001; partial η2=0.07; medium effect); and distress (P=.003; partial η2=0.054; small-medium effect) at the posttest time point and maintained at follow-up. Contrary to our hypotheses, no intervention effects were observed for emotion regulation difficulties or maladaptive coping strategies. Improvements in adaptive coping were observed at the posttest time point but were not maintained at follow-up. Self-compassion, but not emotion regulation difficulties or coping, mediated the improvements in well-being. CONCLUSIONS Minimal-contact, web-based self-compassion training can confer mental health benefits on young people with chronic conditions. This group experiences substantial challenges to participation in mental health supports, and program engagement and retention in this trial were suboptimal. Future work should focus on refining the program content, engagement, and delivery to optimize engagement and treatment outcomes for the target group. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry 12619000572167; https://tinyurl.com/5n6hevt. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-020-8226-7.
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Affiliation(s)
- Amy Louise Finlay-Jones
- Youth Mental Health Team, Telethon Kids Institute, Nedlands, Australia
- School of Population Health, Curtin University, Bentley, Australia
- School of Medicine, University of Western Australia, Crawley, Australia
| | - Asha Parkinson
- Youth Mental Health Team, Telethon Kids Institute, Nedlands, Australia
- School of Population Health, Curtin University, Bentley, Australia
| | - Fuschia Sirois
- Department of Psychology, Durham University, Durham, United Kingdom
| | - Yael Perry
- Youth Mental Health Team, Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Crawley, Australia
| | - Mark Boyes
- School of Population Health, Curtin University, Bentley, Australia
| | - Clare S Rees
- School of Population Health, Curtin University, Bentley, Australia
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Maynard E, Bennett M. Changing bodies: A scoping review and thematic analysis of family experience during serious childhood illness. J Child Health Care 2023:13674935231168683. [PMID: 37028372 DOI: 10.1177/13674935231168683] [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] [Indexed: 04/09/2023]
Abstract
This scoping review has investigated experiences of children and parents encountering in-patient treatment for serious childhood illness, including current or potential use of technology as a support mechanism. The research questions were 1. What do children experience during illness and treatment? 2. What do parents experience when their child is seriously ill in hospital? 3. What tech and non-tech interventions support children's experience of in-patient care? The research team identified n = 22 relevant studies for review through JSTOR, Web of Science, SCOPUS and Science Direct. A thematic analysis of reviewed studies identified three key themes reflecting our research questions: Children in hospital, Parents and their children, and Information and technology. Our findings reflect that information giving, kindness and play are central in hospital experiences. Parent and child needs in hospital are interwoven and under researched. Children reveal themselves as active producers of pseudo-safe spaces who continue to prioritise normal child and adolescent experiences during in-patient care.
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Affiliation(s)
- Emma Maynard
- Dept of Child & Family Health & Methodologies Division, 4616King's College London, London, UK
| | - Megan Bennett
- School of Education & Sociology,171171University of Portsmouth Faculty of Humanities and Social Science, Portsmouth, UK
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Umgang mit subjektiv erlebten Coronarisiken: Sichtweisen junger chronisch kranker Erwachsener. PRA¨VENTION UND GESUNDHEITSFO¨RDERUNG 2023. [PMCID: PMC10022562 DOI: 10.1007/s11553-023-01020-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Hintergrund Junge Erwachsene mit chronischen Erkrankungen gelten als Gruppe, die durch Corona gefährdet ist. Ob und wie die Betroffenen sich zu schützen versuchen, welche Risikowahrnehmungen sie verdeutlichen und wie der Lockdown erlebt wird, dazu mangelt es an Erkenntnissen primär im deutschen Sprachraum. Ziele und Fragestellung Im Beitrag wird analysiert, welches Coronaschutzverhalten junge chronisch kranke Erwachsene berichten, welche Risikowahrnehmungen sie aufweisen und wie sie den Lockdown erleben. Material und Methoden Mit n = 59 jungen Erwachsenen (häufig Studierende oder Auszubildende), die von Typ‑1-Diabetes (n = 16), Krebs (n = 18), chronisch-entzündlichen Darmerkrankungen (n = 21) oder von bestimmten seltenen, komplexen Erkrankungen (n = 4) betroffen sind, wurden episodische Interviews geführt. Die Datenauswertung erfolgt mittels thematischen Kodierens. Ergebnisse Wenige Befragte meinen, durch Corona kaum persönlich gefährdet zu sein, so dass auch Schutzmaßnahmen wie Impfungen sekundär sind. Die meisten Interviewten jedoch berücksichtigen Schutzmaßnahmen penibel. Sie können sich hierzu entweder verpflichtet fühlen, um z. B. andere vulnerable Personen zu schützen, oder sie erleben sich als sehr anfällig für schwere Coronainfektionen. Ungeachtet von erlebten Einschränkungen im Lockdown ist dieser für viele Interviewte auch mit neuen Möglichkeiten verbunden. Online-Formate erleichtern ihnen, Studium/Ausbildung trotz chronischer Erkrankung fortzusetzen und Kontakte mit Freund*innen zu halten. Schlussfolgerung Coronarisikowahrnehmungen und Schutzverhalten junger chronisch kranker Erwachsener sollten in ihrem subjektiven Sinn verstärkt in der Versorgung und Begleitung dieser Zielgruppen berücksichtigt werden. Hybride Lehre sollte über den Lockdown hinaus beibehalten werden, damit die jungen Erwachsenen trotz ihrer chronischen Erkrankung sozial teilhaben können und zugleich vor Corona- und weiteren Infektionen geschützt sind.
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O’Mahony J, Marrie RA, Laporte A, Brown A. Addressing Health-Related Quality of Life Among Children With Multiple Sclerosis. Int J MS Care 2023; 25:35-42. [PMID: 36711221 PMCID: PMC9881424 DOI: 10.7224/1537-2073.2022-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Children with the chronic disease multiple sclerosis (MS) report lower health-related quality of life (HRQOL) compared with children who experience transient illness. The relationship between an MS diagnosis and the HRQOL of affected children is mediated by parental HRQOL. Interventions to improve the HRQOL of children with MS should, therefore, include parents of affected children. METHODS We performed a configurative review for improvements in the HRQOL of children facing diseases similar to MS and their parents. We used the generated concepts to form theories. Next, we performed qualitative interviews with clinicians who care for children with MS to characterize overlap between the proposed theories and usual care. Finally, we generated recommendations for improving the HRQOL of children with MS and their parents. RESULTS We theorize that the HRQOL of children with MS and their parents may be improved by strengthening self-concept, hope, and knowledge. Qualitative interviews with 7 clinicians who care for children with MS revealed no common psychosocial care protocol. The interviews did, however, reveal sources of psychosocial care that overlap with the proposed theories and barriers to optimizing such care. CONCLUSIONS Grounded in theory and clinically oriented practice, recommendations to improve the HRQOL of children with MS and their parents are to implement standardized screening, pool provider counseling strategies, create computer applications with psychosocial interventions, promote age-appropriate education resources, and secure positions for MS specialists.
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Affiliation(s)
- Julia O’Mahony
- From the Department of Internal Medicine (JO'M), University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- From the Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences (RAM), University of Manitoba, Winnipeg, MB, Canada
| | - Audrey Laporte
- From the Institute of Health Policy, Management, and Evaluation (AL), University of Toronto, Toronto, ON, Canada
| | - Adalsteinn Brown
- From the Dalla Lana School of Public Health (AB), University of Toronto, Toronto, ON, Canada
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Greene N, Araujo L, Campos C, Dalglish H, Gibbs S, Yermilov I. The Economic and Humanistic Burden of Pediatric-Onset Multiple Sclerosis. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:103-114. [PMID: 36348724 PMCID: PMC9584745 DOI: 10.36469/001c.37992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
Background: Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system. Pediatric-onset MS (POMS), defined as onset of MS before 18 years of age, is estimated to account for 2% to 5% of the MS population worldwide. Objectives: To conduct a literature review focused on the healthcare resource utilization and cost as well as quality-of-life (QOL) outcomes among patients with POMS. Methods: We conducted a systematic literature review of English-language studies published after September 2010 in MEDLINE and Embase to describe the global economic healthcare resource utilization and costs and humanistic (QOL) burden in patients with POMS. Results: We found 11 studies that reported on healthcare resource utilization, cost, or insurance coverage and 36 studies that reported on QOL outcomes in patients with POMS. Patients with POMS had higher rates of primary care visits (1.41 [1.29-1.54]), hospital visits (10.74 [8.95-12.90]), and admissions (rate ratio, 4.27 [2.92-6.25];OR, 15.2 [12.0-19.1]) compared with healthy controls. Mean per-patient costs in the United States were $5907 across all settings per year of follow-up between 2002 and 2012; mean costs per hospital stay were $38 543 (in 2015 USD) between 2004 and 2013. Three studies reported psychosocial scores between 71.59 and 79.7, and 8 studies reported physical health scores between 74.62 to 82.75 using the Pediatric Quality of Life Measurement Model (PedsQLTM). Twelve studies used the PedsQL™ Multidimensional Fatigue Scale. Mean scores on the self-reported general fatigue scale ranged from 63.15 to 78.5. Quality-of-life scores were lower than those of healthy controls. Discussion: Our review presents a uniquely broad and recent overview of the global economic and humanistic burden of patients with POMS. Additional research on healthcare resource utilization and cost would provide a more robust understanding of the economic burden in this population. Conclusions: Healthcare resource utilization and costs are high in this population, and patients report reduced QOL and significant fatigue compared with healthy children and adolescents.
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Affiliation(s)
- Nupur Greene
- Health Economics & Value Assessment, Sanofi, Cambridge, Massachusetts
| | - Lita Araujo
- Health Economics & Value Assessment, Sanofi, Cambridge, Massachusetts
| | - Cynthia Campos
- PHAR (Partnership for Health Analytic Research), LLC, Beverly Hills, California
| | - Hannah Dalglish
- PHAR (Partnership for Health Analytic Research), LLC, Beverly Hills, California
| | - Sarah Gibbs
- PHAR (Partnership for Health Analytic Research), LLC, Beverly Hills, California
| | - Irina Yermilov
- PHAR (Partnership for Health Analytic Research), LLC, Beverly Hills, California
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13
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McCabe EM, Jameson BE, Strauss SM. School Nurses Matter: Relationship Between School Nurse Employment Policies and Chronic Health Condition Policies in U.S. School Districts. J Sch Nurs 2022; 38:467-477. [DOI: 10.1177/1059840520973413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The increasing prevalence of chronic health conditions (CHCs) in school-aged children highlights the need to better understand school health services’ role regarding CHCs. Using U.S. nationally representative district-level data from the 2016 School Health Policies and Practices Study, we examined whether having policies on school nurses’ employment was associated with having policies on CHCs and whether having such policies varied by geographic location. Compared to districts without such employment policies, districts with such policies (52.3%) were significantly more likely to have CHC management policies. For each CHC policy examined, more than 20% of school districts did not have the CHC policy, with Northeast districts having the greatest proportion of such policies and West districts having the least. Thus, many students’ CHC needs may not be met at school. It is important for school nurses to play a key role in advocating for the development of school-based policies on CHCs.
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Affiliation(s)
- Ellen M. McCabe
- Hunter-Bellevue School of Nursing, Hunter College, New York, NY, USA
| | - Beth E. Jameson
- College of Nursing, Seton Hall University, South Orange, NJ, USA
| | - Shiela M. Strauss
- Hunter-Bellevue School of Nursing, Hunter College, New York, NY, USA
- Rory Meyers College of Nursing, New York University, NY, USA
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14
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Peck B, Terry D, Martin B, Matthews B, Green A. Group‐urotherapy for children with complex elimination disorder: An Australian study. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2022. [DOI: 10.1111/ijun.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Blake Peck
- Institute of Health and Wellbeing Federation University Ballarat Australia
| | - Daniel Terry
- Institute of Health and Wellbeing Federation University Ballarat Australia
| | - Benita Martin
- Ballarat Health Services Queen Elizabeth Centre, Grampians Regional Continence Service Ballarat Australia
| | - Belinda Matthews
- Ballarat Health Services Queen Elizabeth Centre, Grampians Regional Continence Service Ballarat Australia
| | - Andrea Green
- Ballarat Health Services Queen Elizabeth Centre, Grampians Regional Continence Service Ballarat Australia
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15
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Denison JA, Packer C, Nyambe N, Hershow RB, Caldas S, Miti S, Sudarsan S, Chen M, Bernholc A, Mwansa JK, McCarraher DR. Family Connections randomized controlled trial: assessing the feasibility and acceptability of an intervention with adolescents living with HIV and their caregivers in Ndola, Zambia. AIDS Care 2022; 34:459-468. [PMID: 33764845 DOI: 10.1080/09540121.2021.1902935] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Achieving the 95-95-95 UNAIDS targets requires meeting the needs of adolescents, however we lack evidenced-based approaches to improving adolescent adherence to antiretroviral therapy (ART), increasing viral suppression, and supporting general wellbeing. We developed Family Connections as a group intervention for adolescents and their adult caregivers and conducted a randomized controlled trial in Ndola, Zambia to test feasibility and acceptability. Fifty pairs (n = 100) of adolescents (15-19 years and on ART ≥ 6 months) and their caregivers were randomly assigned either to the intervention consisting of 10 group sessions over 6 months, or to a comparison group, which received the usual care. Each pair completed baseline and endline surveys, with adolescents also undergoing viral load testing. Of the 24-intervention adolescent/caregiver pairs, 88% attended at least eight group sessions. Most adolescents (96%) and all caregivers would recommend Family Connections to peers. Adolescent viral failure decreased but did not significantly differ by study group. Adolescents in the intervention group showed a greater reduction in HIV-related feelings of worthlessness and shame than the comparison group. The feasibility, acceptability, and the positive trend toward significantly reducing internalized stigma, generated by this Family Connections pilot study, contributes valuable data to support adolescent/caregiver approaches that use peer groups.
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Affiliation(s)
- Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine Packer
- Reproductive, Maternal, Newborn, and Child Health, FHI 360, Durham, NC, USA
| | | | - Rebecca B Hershow
- Reproductive, Maternal, Newborn, and Child Health, FHI 360, Durham, NC, USA
| | - Stephanie Caldas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sam Miti
- Arthur Davison Children's Hospital, Ndola, Zambia
| | - Swati Sudarsan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Donna R McCarraher
- Reproductive, Maternal, Newborn, and Child Health, FHI 360, Durham, NC, USA
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16
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Emery H, Padgett C, Ownsworth T, Honan CA. A systematic review of self-concept change in multiple sclerosis. Neuropsychol Rehabil 2022; 32:1774-1813. [PMID: 35168496 DOI: 10.1080/09602011.2022.2030367] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Self-concept or sense of self is often altered in the context of neurological illness. Yet, these core aspects of subjective experience are poorly understood for people with multiple sclerosis (MS). This systematic review aimed to synthesize the findings of quantitative and qualitative studies investigating self-concept in MS. PsycINFO, MEDLINE (PubMed), CINAHL, Scopus, and Web of Science were last systematically searched in May 2021, with the Mixed Methods Appraisal Tool and Consolidated Criteria for Reporting Qualiatative Research used to appraise the quality of the eligible articles. Articles were included if they measured or explored self-concept in MS populations, were published in English and peer-reviewed. A total of 30 studies (11 quantitative, 19 qualitative) were identified. Quantitative studies were synthesized using a narrative approach, with results suggesting that MS is associated with some degree of self-concept change. Qualitative studies were synthesized using thematic synthesis, with results illustrating a complex process of self-concept change that is catalyzed by MS-related events and characterized by varying degrees of resistance to, or acknowledgement of, such changes. Future prospective longitudinal studies are needed to characterize the nature of self-concept change in MS using validated tools that measure relevant aspects of self-concept for the MS population.
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Affiliation(s)
- Holly Emery
- School of Psychological Sciences, University of Tasmania, Launceston, Australia
| | - Christine Padgett
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Cynthia A Honan
- School of Psychological Sciences, University of Tasmania, Launceston, Australia
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17
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Suryaputri IY, Mubasyiroh R, Idaiani S, Indrawati L. Determinants of Depression in Indonesian Youth: Findings From a Community-based Survey. J Prev Med Public Health 2022; 55:88-97. [PMID: 35135052 PMCID: PMC8841193 DOI: 10.3961/jpmph.21.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/16/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives This study investigated the determinants of depression in adolescents and young adults. Methods The present study analyzed data from the 2018 Indonesia Basic Health Survey (Riset Kesehatan Dasar; RISKESDAS). The study subjects were adolescents (15-17 years old) and young adults (18-24 years old). In total, 64 179 subjects were included. Univariable, bivariable, and multivariable logistic regression analyses were performed to determine associations between youths’ characteristics, risky behavior, chronic disease, parents’ health, and youths’ depression. Results The prevalence of depression was 5.1% in adolescents and 5.6% in young adults. The risk factors for depression in adolescents were being women (adjusted odds ratio [aOR], 3.53; 95% confidence interval [CI], 2.89 to 4.30; p<0.001), an ex-smoker (aOR, 2.99; 95% CI, 2.10 to 4.25; p<0.001), or a current smoker (aOR, 2.60; 95% CI, 1.97 to 3.44; p<0.001); consuming alcohol (aOR, 2.00; 95% CI, 1.33 to 3.01; p=0.001), having a chronic disease (aOR, 2.64; 95% CI, 1.41 to 4.96; p=0.002); maternal depression (aOR, 2.47; 95% CI, 1.97 to 3.09; p<0.001); and paternal depression (aOR, 2.63; 95% CI, 1.98 to 3.50; p<0.001). In young adults, the risk factors were being women (aOR, 2.23; 95% CI, 1.82 to 2.75; p<0.001) or an ex-smoker (aOR, 2.47; 95% CI, 1.67 to 3.67; p<0.001), consuming alcohol (aOR, 2.42; 95% CI, 1.89 to 3.09; p<0.001), maternal depression (aOR, 3.12; 95% CI, 2.54 to 3.84; p<0.001), and paternal depression (aOR, 2.80; 95% CI, 2.17 to 3.63; p<0.001). Conclusions Being women, smoking, drinking alcohol, having a chronic disease, and having a parent with depression were crucial factors associated with youth depression. Mental health screening, prevention, and treatment should involve collaboration among primary healthcare, schools, universities, professionals, and families.
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Affiliation(s)
- Indri Yunita Suryaputri
- Center for Research and Development of Public Health Efforts, National Institute of Health Research and Development (NIHRD), Jakarta, Indonesia
- Corresponding author: Indri Yunita Suryaputri Center for Research and Development of Public Health Efforts, National Institute of Health Research and Development (NIHRD), Jakarta 10560, Indonesia E-mail:
| | - Rofingatul Mubasyiroh
- Center for Research and Development of Public Health Efforts, National Institute of Health Research and Development (NIHRD), Jakarta, Indonesia
| | - Sri Idaiani
- Center for Research and Development of Health Resources and Services, National Institute of Health Research and Development, Ministry of Health, Republic Indonesia, Jakarta, Indonesia
| | - Lely Indrawati
- Center for Research and Development of Public Health Efforts, National Institute of Health Research and Development (NIHRD), Jakarta, Indonesia
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18
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Callen G, Chory A, Sang F, Munyoro D, Aluoch J, Scanlon M, Enane L, McHenry M, Wools-Kaloustian K, Apondi E, Vreeman R. A Qualitative Examination of Perceived Stigma and its Sources Among Adolescents Living With HIV in Western Kenya. Glob Pediatr Health 2022; 9:2333794X211065335. [PMID: 35024383 PMCID: PMC8744199 DOI: 10.1177/2333794x211065335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction. Adolescents (10-19 years) living with HIV (ALWH) face unique challenges in controlling HIV long-term, including stigma and perception of stigma within their communities. Methods. We conducted a qualitative investigation of the sources of perceived HIV-related stigma with ALWH in western Kenya. Forty-six ALWH on ART, aware of their status, and engaged in care were enrolled. Interviews explored perceived stigma by probing the individuals and experiences that adolescents identify as causing or perpetuating their ongoing fears. Results. Participants (54% male, mean age 17.4) reported ongoing fears of stigmatization related to friends and peers not living with HIV. They described previous enacted and first-hand observations of stigma, most often occurring in pre-adolescence, by age mates or peers at school as the most common cause for their ongoing fears. Conclusions. Perceived stigma is prevalent among ALWH and develops from experiences in pre-adolescence. Anti-HIV stigma interventions addressing educators and children in school settings to combat perceived stigma at its source should be investigated.
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Affiliation(s)
- Grant Callen
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Ashley Chory
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
- Arnhold Institute for Global Health,
Department of Health Systems Design and Global Health, Icahn School of Medicine at
Mt. Sinai, New York City, NY, USA
| | - Festus Sang
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | | | - Michael Scanlon
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Leslie Enane
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Megan McHenry
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Edith Apondi
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
- Moi Teaching and Referral Hospital,
Eldoret, Kenya
| | - Rachel Vreeman
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
- Arnhold Institute for Global Health,
Department of Health Systems Design and Global Health, Icahn School of Medicine at
Mt. Sinai, New York City, NY, USA
- Moi University, Eldoret, Kenya
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19
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Barned C, Fabricius A, Stintzi A, Mack DR, O'Doherty KC. "The Rest of my Childhood was Lost": Canadian Children and Adolescents' Experiences Navigating Inflammatory Bowel Disease. QUALITATIVE HEALTH RESEARCH 2022; 32:95-107. [PMID: 34818940 DOI: 10.1177/10497323211046577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Children and adolescents with Inflammatory Bowel Disease (IBD) face significant and unique challenges related to their condition. The aim of this study was to better understand some of these challenges, and to explore how Canadian youth respond to them. We interviewed 25 pediatric patients with IBD, ranging in age from 10-17, to find out about their illness experiences. Using a thematic analysis, we discerned three themes: challenges related to diagnosis, making sense of change, and navigating sociability. Taken together, they paint a picture of young people facing great uncertainty prior to diagnosis, pronounced changes to selfhood as they make lifestyle adjustments, and facing difficulties with the implications of reduced sociability because of their disease. We conclude by providing recommendations for the development of resources aimed at helping newly diagnosed pediatric patients navigate these issues.
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Affiliation(s)
- Claudia Barned
- UHN Bioethics Program, 7989University Health Network, Toronto, Canada
- Pragmatic Health Ethics Research Unit, 5598Institut de recherches Cliniques de Montreal, Montreal, Canada
| | - Alexis Fabricius
- Department of Psychology, 3653University of Guelph, Guelph, Canada
| | - Alain Stintzi
- Ottawa Institute of Systems Biology and Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, 6363University of Ottawa, Ottawa, Canada
| | - David R Mack
- Children's Hospital of Eastern Ontario (CHEO) IBD Centre and Department of Pediatrics, 27338University of Ottawa, Ottawa, Canada
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20
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Wilson B, Weeks L, Morris P, Innocente S, Rothfus M. Coping experiences of young adults diagnosed with a chronic illness: a qualitative systematic review protocol. JBI Evid Synth 2021; 19:3315-3323. [PMID: 34410231 DOI: 10.11124/jbies-21-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review is to gain insight about the experience of emerging adults who are coping with a chronic illness diagnosis. INTRODUCTION Receiving a chronic illness diagnosis is filled with challenges and changes to a person's life. Coping is not an easy or linear process, and is particularly complex for emerging adults. The emerging adult stage is important to consider, as this is a stage characterized by identity exploration, transition to adulthood, and future planning. A chronic illness diagnosis interrupts these processes and affects the coping process in emerging adults. INCLUSION CRITERIA The population included will be persons between 18 and 25 years of age living in the community. Sources will focus on the experience of being diagnosed with a chronic illness, including its impacts on the individual's life. METHODS This qualitative review will be conducted following JBI qualitative review methodology. An initial search was conducted in order to identify relevant articles on the topic. Databases to be searched include CINAHL, PubMed, PsycINFO, and Nursing and Allied Health Database. A gray literature search will also be conducted. There will be no date or language limits on the search. The titles and abstracts will be screened by two independent reviewers, followed by an assessment of the full-text articles. Any disagreements will be resolved through discussion or in consultation with a third reviewer. Critical appraisal of included articles and data extraction will be conducted independently by two reviewers. Meta-aggregation of the articles will be completed and textually pooled in tabular format. Where that is not possible, results will be presented in a narrative format. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021224772.
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Affiliation(s)
- Beth Wilson
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Lori Weeks
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Patricia Morris
- Faculty of Nursing, University of New Brunswick, Saint John, NB, Canada
| | - Sarah Innocente
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Melissa Rothfus
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,WK Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada
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21
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Blamires J, Dickinson A, Tautolo ES, Byrnes CA. A "pretty normal" life: a qualitative study exploring young people's experience of life with bronchiectasis. Int J Qual Stud Health Well-being 2021; 16:2003520. [PMID: 34793292 PMCID: PMC8604450 DOI: 10.1080/17482631.2021.2003520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Bronchiectasis is a chronic respiratory disease that impacts significantly on quality of life for those who have it. There is a paucity of literature exploring the perspectives of children and young people. The aim of this study was to examine the day-to-day life experience of a group of young people with bronchiectasis. METHOD A qualitative study using semi-structured interviews explored fifteen young people's perspectives of life with bronchiectasis. Key themes were identified using an inductive iterative approach through constant comparative analysis guided by Thorne's interpretive description. RESULTS Life with bronchiectasis was conceptualized by participants as "Pretty Normal". This consisted of two co-existing life views which represented how young people balanced the ups and downs of adolescence while learning to accommodate the demands of living with bronchiectasis. Three key thematic elements "sore and tired", 'life interrupted and "looking after self", influenced and challenged these two views of life. CONCLUSIONS Young people with bronchiectasis portray life as being the same as their peers. Despite this, they recognized that the symptoms, interruptions, and self-management responsibilities led them to find ways of coping and integrating their experience into a new and modified view of normal.
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Affiliation(s)
- Julie Blamires
- School of Clinical Sciences Auckland University of Technology, Northcote, Auckland
| | - Annette Dickinson
- School of Clinical Sciences Auckland University of Technology, Northcote, Auckland
| | - El Shadan Tautolo
- School of Public Health & Interdisciplinary Studies Director-AUT Pacific Health Research Centre, Auckland University of Technology, NZ
| | - Catherine A Byrnes
- Department of Paediatrics; Child and Youth Health, Faculty of Health & Medical Sciences, University of Auckland, Auckland, NZ
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22
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Leite ACAB, García-Vivar C, DeMontigny F, Nascimento LC. Waves of family hope: narratives of families in the context of pediatric chronic illness. Rev Lat Am Enfermagem 2021; 29:e3504. [PMID: 34816873 PMCID: PMC8616230 DOI: 10.1590/1518-8345.5515.3504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/06/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze narratives about the experience of hope of families in the context of pediatric chronic illness. METHOD a narrative research using Family Systems Nursing as a conceptual framework. Three families of children and adolescents diagnosed with complex chronic illness participated in this study, totaling 10 participants. Data collection was developed using family photo-elicitation interviews. Family narratives were constructed and analyzed according to inductive thematic analysis with theoretical data triangulation. RESULTS the analytical theme - Waves of Family Hope in the Context of Pediatric Chronic Illness - is composed of four different types of hope: uncertain hope, caring hope, latent hope, and expectant hope. Movement through these hopes generates a driving energy and depends on a number of factors: support, information, searching for normality, and thoughts and comparisons. CONCLUSION the results highlight the interaction and reciprocities of the members of the family unit, and the dynamics of hope, and illustrate the different types of hope and the factors that influence them. This study highlights the experience of hope as a family resource rather than just an individual resource, and supports health professionals in the planning of family care considering hope as an essential and dynamic family resource.
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Affiliation(s)
- Ana Carolina Andrade Biaggi Leite
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal
de Nível Superior (CAPES), Brazil
| | - Cristina García-Vivar
- Universidad Pública de Navarra, Departamento de Ciencias de la
Salud, Pamplona, Navarra, Spain
| | - Francine DeMontigny
- Université du Québec en Outaouais, Department of Nursing, Gatineau,
Quebec, Canada
| | - Lucila Castanheira Nascimento
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Conselho Nacional de Desenvolvimento
Científico e Tecnológico (CNPq), Brazil
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23
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Kever A, Leavitt VM. Assessing diagnosis disclosure and concealment in multiple sclerosis: Development and initial validation of the DISCO-MS survey. Mult Scler 2021; 28:247-256. [PMID: 34498517 DOI: 10.1177/13524585211037581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with multiple sclerosis (MS) regularly report making strategic decisions about whether to share their diagnosis or keep it a secret; for many, this represents a key stressor. Surprisingly, the impact of disclosure and concealment are understudied in MS and a formal measurement instrument is lacking. We developed the Diagnosis Disclosure and Concealment in MS (DISCO-MS) survey, a self-assessment tool evaluating (1) frequency of concealment behaviors and (2) expected consequences of diagnosis disclosure in persons with MS. METHODS A systematic mixed-methods process was used for the design and initial validation of the DISCO-MS. Associations of DISCO-MS responses to demographics, clinical variables, and mood were examined in 204 participants with MS. RESULTS The 39-item DISCO-MS shows good psychometric characteristics. Approximately 25% of respondents conceal their diagnosis, particularly in professional settings. Higher concealment behaviors were associated with younger age, shorter disease duration, and lower physical disability. Nearly 50% of respondents believed that talking openly about their diagnosis might have undesirable professional and interpersonal consequences. Younger age, higher depression, and higher anxiety were associated with greater expectations of negative consequences. CONCLUSION Development and validation of the DISCO-MS presents the first step toward systematic study of the impact of DISCO on people with MS.
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Affiliation(s)
- Anne Kever
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Victoria M Leavitt
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA/Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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24
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Mrosková S, Klímová E, Majerníková Ľ, Tkáčová Ľ. Quality of Life of Children and Adolescents with Multiple Sclerosis-A Literature Review of the Quantitative Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168645. [PMID: 34444393 PMCID: PMC8392317 DOI: 10.3390/ijerph18168645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
Background: Multiple sclerosis (MS) is a chronic disease of the central nervous system that also develops in patients under 18 years of age. The disease negatively affects the quality of life (QoL) of children and adolescents. We conducted a literature review. The aim of the review was to identify the QoL of pediatric patients with MS and assess the factors determining their QoL. Methods: We analyzed studies published between 2000 and 2020 in PubMed, Scopus, Science Direct, Web of Science, and EBSCO databases. Results: In all, 17 studies were included in the review. The most common tool in assessing QoL was the generic module PedsQL. The range of mean/median global score of QoL was 53.8–81.7. The worst QoL was dominantly reported in the school and emotional spheres, on the contrary, the disease’s least determined area of QoL was the social and physical dimension. In particular, disability and fatigue were important predictors of QoL. Conclusions: MS negatively affects the school and emotional spheres in particular, so it is important to pay greater attention to these spheres of life of MS patients. As the review studies pay insufficient attention to the analysis of positive factors and their impact on the QoL of MS patients, research should integrate these phenomena. The use of MS-targeted tools in future research in the pediatric MS population is also appropriate.
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Affiliation(s)
- Slávka Mrosková
- Department of Nursing, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia; (Ľ.M.); (Ľ.T.)
- Correspondence: ; Tel.: +421-51-75-62-462
| | - Eleonóra Klímová
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia;
| | - Ľudmila Majerníková
- Department of Nursing, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia; (Ľ.M.); (Ľ.T.)
| | - Ľubomíra Tkáčová
- Department of Nursing, Faculty of Health Care, University of Prešov, Partizánska 1, 08001 Prešov, Slovakia; (Ľ.M.); (Ľ.T.)
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A Swiss Health Care Professionals' Perspective on the Meaning of Interprofessional Collaboration in Health Care of People with MS-A Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126537. [PMID: 34204475 PMCID: PMC8297392 DOI: 10.3390/ijerph18126537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022]
Abstract
Multiple sclerosis (MS) is a chronic, inflammatory autoimmune disease of the central nervous system mainly of adults ranging from 20 to 45 years of age. The risk of developing MS is 50% higher in women than in men. Most people with MS (PwMS) experience a spectrum of symptoms such as spasticity, continence dysfunctions, fatigue, or neurobehavioral manifestations. Due to the complexity of MS and the variety of patient-centered needs, a comprehensive approach of interprofessional collaboration (IPC) of multiple health care professionals (HCP) is necessary. The aim of this qualitative study was to explore the meaning of IPC in the comprehensive care of PwMS from a HCP perspective. Focus groups (FG) with HCP were conducted, recorded, and transcribed verbatim. The sample contained HCP from three MS clinics in different phases of care and rehabilitation. Four main categories emerged: (a) experience with IPC, (b) relevant aspects for IPC in patients’ treatment, (c) differences in in- and outpatient settings, and (d) influence of patient perspective. IPC plays a crucial role in HCP perspective when treating PwMS, which can benefit from an IPC therapeutic approach because HCP work together in a patient-centered way. The inpatient setting of HCP strongly supports the implementation of IPC. This prerequisite does not exist in outpatient settings.
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Celius EG, Thompson H, Pontaga M, Langdon D, Laroni A, Potra S, Bharadia T, Yeandle D, Shanahan J, van Galen P, Alexandri N, Kesselring J. Disease Progression in Multiple Sclerosis: A Literature Review Exploring Patient Perspectives. Patient Prefer Adherence 2021; 15:15-27. [PMID: 33447018 PMCID: PMC7802794 DOI: 10.2147/ppa.s268829] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/20/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Multiple sclerosis (MS) prognosis is often uncertain. This literature review considers patients' understanding of, and perspectives on, MS progression to better comprehend the unmet needs of people with MS (PwMS), in order to improve treatment adherence and quality of life (QoL). METHODS Literature searches for peer-reviewed papers concerning patient perspectives on the progression of MS and comparable conditions, published between January 2000 and January 2020, were conducted. RESULTS Little qualitative evidence exists that examines PwMS' perspectives on MS progression. The understanding and meaning ascribed to terms such as "disease progression" vary. Some PwMS find disease labels stigmatizing, confusing, and disconnected from reality. The lack of a clear definition of progression and discrepancies between PwMS and healthcare professional (HCP) perspectives may contribute to misunderstanding and poor communication. Patient descriptions of progression and relapses include symptoms in addition to those evaluated by standard severity and disability measures. Compared with HCPs, PwMS are still focused on relapse prevention but place higher priority on QoL and ascribe different relative importance to the causes of poor adherence to treatment plans. PwMS want to discuss progression and likely prognosis. Such communication needs to be personalized and delivered with sensitivity, at an appropriate time. Poor treatment adherence may arise from a lack of understanding and poor communication, particularly around treatment goals. The few studies that directly considered patient perspectives on the progression of comparable conditions supported and extended the perspectives of PwMS. Lack of adequate communication by HCPs was the most common theme. CONCLUSION Patient perspectives on disease progression in MS and other chronic progressive conditions are under-investigated and under-reported. The limited evidence available highlights the importance of providing adequate information and effective HCP communication. While further studies are needed, the current evidence base offers information and insights that may help HCPs to enhance patient care, well-being, and treatment adherence.
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Affiliation(s)
- Elisabeth G Celius
- Deparment of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Correspondence: Elisabeth G Celius Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, Oslo0424, NorwayTel +47 91 50 27 70 Email
| | - Heidi Thompson
- The Neurology Centre, Craigavon Area Hospital, Portadown, UK
| | | | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stanca Potra
- Patient Member of the MS in the 21st Century Steering Group, Bucharest, Romania
| | - Trishna Bharadia
- Patient Member of the MS in the 21st Century Steering Group, Buckinghamshire, UK
| | - David Yeandle
- Patient Member of the MS in the 21st Century Steering Group, Southampton, UK
| | - Jane Shanahan
- Patient Member of the MS in the 21st Century Steering Group, Ascot, UK
| | - Pieter van Galen
- Patient Member of the MS in the 21st Century Steering Group, Overijse, Belgium
| | - Nektaria Alexandri
- Global Medical Affairs, Neurology and Immunology, Merck KGaA, Darmstadt, Germany
| | - Jürg Kesselring
- Department of Neurology & Neurorehabilitation, Kliniken Valens, Valens, Switzerland
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Woodgate RL, Tennent P, Barriage S, Legras N. The centrality of disclosure decisions to the illness experience for youth with chronic conditions: A qualitative study. J Health Psychol 2020; 27:521-533. [PMID: 32985894 PMCID: PMC8832564 DOI: 10.1177/1359105320962242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper is to illuminate findings of disclosure experiences for youth living with chronic illness using a non-categorical approach. The findings were derived from a larger qualitative study framed by social constructivist grounded theory that sought to understand youth’s involvement in healthcare decision-making in the context of chronic illness. Fifty-four youth participated in the study, ranging from 9 to 24 years. Three main themes representing the youth’s perspectives and experiences of disclosing chronic illness were identified: (1) disclosure is central to the illness experience; (2) spectrum of disclosure; and (3) navigating others’ reactions to disclosure. The findings reinforce that more emphasis on decisions related to disclosing illness in research and clinical care for youth with chronic conditions is warranted.
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Sustaining, Forming, and Letting Go of Friendships for Young People with Inflammatory Bowel Disease (IBD): A Qualitative Interview-Based Study. Int J Chronic Dis 2020; 2020:7254972. [PMID: 32953877 PMCID: PMC7487095 DOI: 10.1155/2020/7254972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 01/09/2023] Open
Abstract
Inflammatory bowel disease (IBD) is an incurable, chronic, gastrointestinal condition that can constrain young people's social relationships. Few studies have specifically explored friendships of people with IBD. This qualitative, participatory study used interviews, photographs, and friendship maps to explore friendships and friendship networks of young people with IBD. An online Young Person's Advisory Group was actively engaged throughout the study. Thirty-one young people participated (n = 16 males, n = 15 female; n = 24 Crohn's disease, n = 6 ulcerative colitis, n = 1 IBD-unclassified; the mean age at study was 18.7 years; range 14-25 years). Findings present a metatheme “The importance and meaning of friendships” and three interwoven subthemes of “Sustaining friendships,” “Forming new friendships,” and “Letting go of friendships.” Friendship was important to the young people with IBD, providing support, but associated with challenges such as disclosure. Such challenges could be mitigated by clearer conversations with clinicians about friendships and more extensive conversations about friendships and long-term conditions in education settings.
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Trettin B, Hansen J, Bygum A. The impact of adolescents' everyday life experiences on their primary hyperhidrosis treatment - a qualitative study. J DERMATOL TREAT 2020; 33:928-934. [PMID: 32628056 DOI: 10.1080/09546634.2020.1789541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Hyperhidrosis is a disease affecting around 5% of the western population. The qualitative field within hyperhidrosis among adolescents has been sparsely investigated. The aim of this study was to investigate the impact of adolescent hyperhidrosis patients' everyday life experiences on their hyperhidrosis treatment. METHODS Qualitative, semi-structured interviews were carried out. In total, 10 adolescents, aged 12-18 years, participated in the study. Data were analyzed using a set of inseparable activities as described by Van Manen. RESULTS Three main themes were identified to represent common shared experiences across participants. The first theme was related to the impact of hyperhidrosis on the physical and psychological dimensions of life as it negatively affected both physical abilities and one's self-concept. Having hyperhidrosis was experienced as living a life in secrecy, characterized by individual routines for concealment and isolation in order to protect social identity. CONCLUSION The large negative impact of hyperhidrosis on adolescents is a strong justification for treatment of the disease. The substantial emotional distress suggests that treatment may need to include psychological support.
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Affiliation(s)
- Bettina Trettin
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern, Odense, Denmark
| | - Julie Hansen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Anette Bygum
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern, Odense, Denmark
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"I Don't Like to Make a Big Thing out of It": A Qualitative Interview-Based Study Exploring Factors Affecting Whether Young People Tell or Do Not Tell Their Friends about Their IBD. Int J Chronic Dis 2020; 2020:1059025. [PMID: 32577420 PMCID: PMC7305549 DOI: 10.1155/2020/1059025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/04/2020] [Indexed: 12/23/2022] Open
Abstract
Inflammatory Bowel Disease (IBD) describes a group of conditions that includes Crohn's disease and ulcerative colitis. Unlike some chronic conditions, to a greater or lesser extent, IBD is hidden from or invisible to others which enables concealment of the condition, especially when stigma is associated with the condition. Concealment or nondisclosure allows a means of identity management. Disclosure of a chronic condition is not a single event, and it is dependent on many factors. There is little literature that specifically addresses stigma and/or disclosure in relation to children and young people with IBD. An in-depth qualitative study was undertaken, framed by Interpretive Description and using interviews, friendship maps, and photographs within a participatory framework. Public and patient involvement and engagement (PPIE) was undertaken throughout (inception to dissemination) the study. Young people aged 14-25 years with IBD who had participated in the survey phase of the larger study self-selected to participate in interviews that focused broadly on friendship and feelings of social connectedness. Data were analysed using an iterative, interpretive approach. Preliminary themes were developed and these were explored further, and then tentative theoretical connections about friendship were developed. One superordinate theme focused on disclosure. Thirty-one young people (16 males, 15 females, mean age 18.7 years; 24 Crohn's, 7 colitis) participated in the interviews (of these, five created friendship maps and six utilised photographs). Three discrete, but interlinked, themes were generated, revealing young people's experiences of disclosure: to tell or not to tell; controlling the flow: the who, when, what, and how of telling; and reactions and responses to telling: anticipated and actual. Decisions about telling friends about having IBD are challenging for many young people. Having control over disclosure is not always possible, and the potential consequences can feel risky. However, most young people had positive experiences of disclosure and gained support from friends and romantic partners. Most young people downplayed the seriousness of their IBD, revealing some facets of their condition, aiming to sustain their self-identity. Only one young person had been given professional support to disclose. Provision of support and opportunities to discuss whether, when, who, and how to tell friends and what the risks and benefits may be is something that could be woven into an ongoing and wider person-centred dialogue between young people and health professionals within routine clinic visits.
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Denison JA, Burke VM, Miti S, Nonyane BAS, Frimpong C, Merrill KG, Abrams EA, Mwansa JK. Project YES! Youth Engaging for Success: A randomized controlled trial assessing the impact of a clinic-based peer mentoring program on viral suppression, adherence and internalized stigma among HIV-positive youth (15-24 years) in Ndola, Zambia. PLoS One 2020; 15:e0230703. [PMID: 32240186 PMCID: PMC7117673 DOI: 10.1371/journal.pone.0230703] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/21/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Youth-led strategies remain untested in clinic-based programs to improve viral suppression (VS) and reduce stigma among HIV-positive adolescents and young adults (AYA) in sub-Saharan Africa. In response, Project YES! placed paid HIV-positive youth peer mentors (YPM) in four HIV clinics in Ndola, Zambia including a Children's Hospital (pediatric setting), an adult Hospital and two primary care facilities (adult settings). METHODS A randomized controlled trial was conducted from December 2017 to February 2019. Consecutively recruited 15 to 24-year-olds were randomly assigned to an intervention arm with monthly YPM one-on-one and group sessions and optional caregiver support groups, or a usual care comparison arm. Survey data and blood samples were collected at baseline and at the six-month midline. Generalized estimating equation models evaluated the effect of study arm over time on VS, antiretroviral treatment (ART) adherence gap, and internalized stigma. RESULTS Out of 276 randomized youth, 273 were included in the analysis (Intervention n = 137, Comparison n = 136). VS significantly improved in both arms (I:63.5% to 73.0%; C:63.7% to 71.3.0%) [OR:1.49, 95% CI:1.08, 2.07]. In a stratified analysis intervention (I:37.5% to 70.5%) versus the comparison (C:60.3% to 59.4%) participants from the pediatric clinic experienced a relative increase in the odds of VS by a factor of 4.7 [interaction term OR:4.66, 95% CI:1.84, 11.78]. There was no evidence of a study arm difference in VS among AYA in adult clinics, or in ART adherence gaps across clinics. Internalized stigma significantly reduced by a factor of 0.39 [interaction term OR:0.39, 95% CI:0.21,0.73] in the intervention (50.4% to 25.4%) relative to the comparison arm (45.2% to 39.7%). CONCLUSIONS Project YES! engaged AYA, improving VS in the pediatric clinic and internalized stigma in the pediatric and adult clinics. Further research is needed to understand the intersection of VS and internalized stigma among AYA attending adult HIV clinics. TRIAL REGISTRATION ClinicalTrials.gov NCT04115813.
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Affiliation(s)
- Julie A. Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Virginia M. Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sam Miti
- Arthur Davison Children’s Hospital, Ndola, Zambia
| | - Bareng A. S. Nonyane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Katherine G. Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth A. Abrams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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