Hardiness in families of young children with asthma

Psychological Well-Being of Children with Asthma and Their Parents

Background/Objectives: The literature reports that emotional disorders in asthmatic children and their parents may affect asthma control. This research explores the baseline psychological well-being of asthmatic children and their mothers' and fathers' psychological functioning, focusing on the influence of the parents' anxiety and separation anxiety on children's asthma. Methods: In this cross-sectional study, we enrolled children with non-severe asthma and their parents, and a group of healthy children and their parents. The asthmatic children underwent anamnestic investigation, including asthma control and spirometry. Then, both the asthmatic and control triads filled a survey assessing their psychological functioning. Results: Among the 40 asthmatic children enrolled (8-18 years old), most had good clinical control maintained with GINA (Global Initiative for Asthma) therapy step 1-2 (14 patients, 35%) or step 3-4 (26 patients, 65%); 12 patients (30%) had at least one steroid course in the year before enrollment. They exhibited normal psychological adjustment but elevated levels of general (U = 179,500; p < 0.001) and state anxiety (U = 170,000; p < 0.001) compared to healthy peers. Additionally, the asthmatic children's mothers displayed higher levels of separation anxiety compared to the fathers (t = -2.865, p = 0.006). Increased separation anxiety in the mothers corresponded to a history of at least one exacerbation in the previous year. Conclusions: The asthmatic children exhibited normal psychological adjustment with higher general and state anxiety. Also, their mothers showed greater levels of separation anxiety compared to their fathers. Lastly, higher mothers' separation anxiety corresponded to a history of at least one exacerbation in the previous year. The influence of the parents' psychological well-being on the children's asthma control was previously unexplored.

Understanding and Measuring Help-Seeking Barriers among Intimate Partner Violence Survivors: Mixed-Methods Validation Study of the Icelandic Barriers to Help-Seeking for Trauma (BHS-TR) Scale

Intimate partner violence (IPV) against women is a global human rights violation of vast proportions and a severe public health problem. Despite high rates of adverse outcomes related to IPV, help-seeking and service utilization among survivors is low. This exploratory sequential mixed-methods study using a combined etic-emic approach describes the validation of the Icelandic Barriers to Help-Seeking for Trauma (BHS-TR) scale. The qualitative phase involved developing new items based on the experiences of 17 Icelandic IPV survivors, identifying barriers including beliefs that help-seeking is a sign of weakness, and the desire to safeguard oneself from re-traumatization. The quantitative phase examined the psychometrics of the BHS-TR in a sample of 137 IPV survivors in Iceland. Results supported an eight-factor structure (Financial Concerns; Unavailable/Not Helpful; External Constraints; Inconvenience; Weakness/Vulnerability; Problem Management Beliefs; Frozen/Confused; and Shame), which when grouped comprised two indices of Structural and Internal Barriers. The scale's internal consistency was high (α  =  0.87), and the results provided evidence of convergent, discriminant, and known-group validity. This study adds to the growing literature supporting the advantages of applying mixed methods for instrument development and validation, and its results highlight the significance of giving rise to the voices of survivors. The BHS-TR is the first trauma-specific and survivor-centered measure of help-seeking barriers available in Iceland. It can be used to provide valuable information that may guide the development of evidence-based interventions to break down barriers and help survivors find ways to trauma recovery.

Effect of Family Empowerment Education on Pulmonary Function and Quality of Life of Children With Asthma and Their Parents in Tunisia: A Randomized Controlled Trial

PURPOSE

Patient education is fundamental in asthma management, especially at pediatric age. It is increasingly recognized as effective in reducing the burden of the disease, but is less clear in improving the quality of life of children with asthma and their parents. This study assessed the effect of an asthma therapeutic education program on pulmonary function and quality of life in children with asthma and their parents.

DESIGN AND METHODS

A monocentric randomized controlled trial conducted in Farhat Hached University Hospital of Sousse (Tunisia) from May 2018 to September 2019. Thirty-seven families in the experimental group and 39 families in the control group received allocated intervention at baseline. Thirty-four families in each group completed the study at the 12-month follow-up.

RESULTS

The intervention significantly improved quality of life scores of children and their parents (all p < 0.05). Children in the experimental group had significantly better forced expiratory maneuver than children in the control group. Nonetheless, the FEV1/FVC ratio did not show any significant difference in the experimental and control group (p = 0.9; p = 0.14, respectively).

CONCLUSIONS

This study demonstrated that a long-term family-based asthma education program resulted in better pulmonary function and QOL of children and parents enrolled in the intervention group, particularly children with non-allergic asthma.

PRACTICE IMPLICATIONS

Family-based asthma education can reduce the burden of allergic and non-allergic asthma on children and their parents through improving their quality of life. Also, the pulmonary function of children with non-allergic asthma was improved due to My Asthma Therapeutic Education intervention.

[Parental evaluation of behavioral problems in children with developmental language disorder]

Parental evaluation of behavioral problems in children with developmental language disorder Abstract. Objective: Children with developmental language disorder (DLD) often suffer from problems in everyday communication and react with social withdrawal or oppositional behavior. In light of the lack of studies in preschool children regarding this topic, the present study analyzes the occurrence of behavioral problems in children with DLD aged 4;0 to 5;11 years. Furthermore, we assessed differences in parental perception regarding their child's behavior. Methods: This monolingual, Caucasian study sample consisted of 30 children with DLD and 40 healthy controls. The groups were matched for nonverbal IQ and socioeconomic status. All children were examined for their language proficiency level. The Child Behavior Checklist was used to detect behavioral problems. Results: The study revealed significant differences between children with DLD and the control group on several syndrome scales including the total problem scale. Children with DLD always showed more severe symptoms and also reached T-scores in clinical range (≥64) significantly more often. The parental perception did not differ. Conclusions: The results indicate the presence of behavioral problems in children with DLD already in preschool age. In particular, we found social problems, attention problems, and internalizing disorders.

Quality of Life Determinants in Children and Adolescents with Mild to Moderate Asthma in Tunisia

Chronic childhood asthma is a leading cause of poor quality of life. Factors associated with this major asthma outcome were controversial. The aim of this study is to assess the quality of life of children and adolescents with mild to moderate asthma and to determine the factors associated with quality of life impairment in this population. This was a descriptive study carried out in the pediatric outpatient clinic of a University Hospital in the center of Tunisia over a period of 3 months (April-June 2018). Participants were children with mild to moderate asthma aged 7 to 17 years. The Pediatric Asthma Quality of Life Questionnaire was used to assess quality of life. Binary logistic regression was performed to identify predictors of asthma-related quality of life. A total of 90 children participated in the study. Almost 68% of children were aged 7 to 11, and nearly 32% were adolescents. The mean of PAQLQ total score was 4.7 ± 1.2. The final logistic regression model demonstrated that asthma symptoms control had the greatest impact on quality of life, followed by acute health care use in the past 12 months (p = .007; p = .01, respectively). The child gender and the parent's quality of life were also associated with the child's quality of life (p = .02; p = .008, respectively). This study revealed that children and adolescents with mild to moderate asthma had a moderate quality of life score. Asthma symptoms control, acute health care use, gender, and parent's quality of life determined the quality of life of children with asthma. Family-based asthma training programs that target family functioning and asthma outcomes are required.

Evaluating the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma: A randomized control trial

BACKGROUND

Empowerment can be an effective strategy for changing an individual's health behaviours. However, how to empower whole families to manage their children's asthma is a challenge that requires innovative nursing intervention based on family-centred care.

AIMS

To evaluate the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma compared to those receiving traditional self-management only.

DESIGN

A randomized control trial.

METHODS

Sixty-five families were recruited from one asthma clinic in a medical centre in Taiwan. After random assignment, 34 families in the experimental group received the family empowerment program consisting of four counselling dialogues with the child and its family. We empowered the family caregiver's ability to manage their child's asthma problems through finding the problems in the family, discovery and discussion about the way to solve problems, and enabling the family's cooperation and asthma management. The other 31 families received the traditional care in asthma clinics. The Parental Stress Index and Family Environment Scale of family caregivers, and pulmonary function, and asthma signs of children with asthma were collected at pre-test, 3-month post-test, and one-year follow-up. We utilized the linear mixed model in SPSS (18.0) to analyze the effects between groups, across time, and the interaction between group and time.

RESULTS

The family empowerment program decreased parental stress (F=13.993, p<.0001) and increased family function (cohesion, expression, conflict solving, and independence) (F=19.848, p<.0001). Children in the experimental group had better pulmonary expiratory flow (PEF) (F=26.483, p<.0001) and forced expiratory volume in first second (FEV1) (F=7.381, p=.001) than children in the comparison group; however, no significant change in forced expiratory volume in first second (FEV1)/forced vital capacity (FVC) was found between the two groups. Sleep problems did not show significant changes but cough, wheezing, and dyspnoea were significantly reduced by family caregiver's observations.

CONCLUSION

We empowered families by listening, dialogues, reflection, and taking action based on Freire's empowerment theory. Nurses could initiate the families' life changes and assist children to solve the problems by themselves, which could yield positive health outcomes.

Assessing family resources: validation of the Swedish version of the Family Hardiness Index

All families face normative transitions. Some are perceived as stressful and calls for family resources to maintain or restore family well-being. In times of illness, families also need to develop strengths and capabilities to enhance family well-being. The way these are developed is related to family hardiness. Family hardiness is thus seen as a family resource, and the Family Hardiness Index (FHI) was developed to measure family stress resistance and adaptation resources. The index was not available in Swedish and no extensive international psychometric evaluation was found. Therefore, the aim was to translate and validate the Swedish version of the FHI. The study was approved by a Regional Ethical Review Board. Data from 174 Swedish participants, family members to persons with cognitive dysfunctions (n = 95) and nursing students (n = 79) were included. Family members were enrolled in outpatient clinics in primary care and rehabilitation, and nursing students at a nursing school. Psychometric properties were evaluated through calculations of missing data, distributions of item and scale scores, item correlations, Cronbach's alpha, confirmatory factor analyses and correlations with theoretically related constructs. Sample scores had acceptable data quality, internal consistency for the FHI total scale was satisfactory (α = 0.86), and construct validity was supported. Our findings cast some doubt on the intended interpretation since confirmatory factor analyses showed that a modified four-subscale version, excluding one subscale, showed best fit. The Control subscale lacked important psychometric properties in terms of homogeneity, internal consistency and construct validity. The sample size was probably sufficiently large for the factor analyses, but the subgroup analyses should be treated with caution. The conclusion is that the Swedish version of the FHI is a promising scale for assessing family hardiness, but more solid evidence for the factor structure in various Swedish and international samples is needed.

"I wouldn't look at it as stress": conceptualizations of caregiver stress among low-income families of children with asthma

Low-income caregivers of children with asthma experience multiple stressors, likely worsening family health. As part of Community Action Against Asthma's community-based participatory research partnership, researchers conducted 40 qualitative semi-structured interviews and quantitative surveys with low-income caregivers of children with asthma in Detroit, Michigan. Participants described daily childhood asthma experiences and completed scales including the Peds Quality of Life Family Impact Module and Zarit Burden Caregiver Scale. Quantitative scale findings suggested participants are moderately stressed or affected by their child's illness. While there was some accordance between qualitative and quantitative findings, qualitative findings additionally captured many relevant life stressors, seemingly overlooked or conflated in scale responses. Many participants described asthma as part of childrearing, rather than as a stressor or burden. Findings encourage improvement of clinical, psychometric assessments used to measure and address stressors that shape health for many families with children with asthma.

Continued development of the family management style framework

Based on a review of 64 published reports, this article addresses the implications of current research for the further development of the Family Management Style Framework (FMSF). Articles are published in 46 different journals, including 13 in nursing and 12 in interdisciplinary outlets. Most studies are based on samples of less than 50 individuals. The review provides continuing support for the 8 dimensions of the framework, with between 8 and 16 reports supporting the relevance of each. Changes to the sociocultural component of the framework are proposed as well as wording changes to reflect the broader applicability of the framework. The family's social network, health care and education professionals, and resources predominate as key influences on family management.

Medication use in children with asthma: not a child size problem

OBJECTIVE

The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma--in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children.

METHODS

A literature search using electronic search engines (i.e., Medline, International Pharmaceutical Abstracts (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms "asthma," "children," and "medicines" (and derivatives of these keywords) was conducted.

RESULTS

The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child's self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, "off-label" prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications.

CONCLUSION

These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.

Family resources and parental health in families of children with Duchenne muscular dystrophy

BACKGROUND

This study was based on two models, namely, the resiliency model of family stress, adjustment, and adaptation and the model for family stressors, resources, and function. Family resources, such as family hardiness and support, have previously been shown to improve family adaptation. There is little evidence for the potential buffering effects of family resources on parental health in families of children with Duchenne muscular dystrophy (DMD).

PURPOSE

This article reports on relationships among family support, family hardiness, severity of child disability, and parental perceptions of child health status variables and their influence on parental health in families of children with DMD in Taiwan.

METHODS

A total of 126 parents, all with children suffering from DMD, were recruited for this study. Associations between child health status, age at diagnosis, demographics, and family resource variables were examined using Pearson linear correlation, linear regression, and causal modeling.

RESULTS

Parental employment and education, perceived child health, family hardiness, and family support were found to correlate with parental health. Age at diagnosis correlated with family hardiness but not directly with parental health.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Nursing intervention to promote family hardiness and support can help maintain parental health and promote family adaptation in the face of a child's chronic disease. Caregiving programs should also promote parental health by enhancing family hardiness and support. Family members' support through health promotion, psychological and spiritual care, financial support, and convenient community services can lead to better parental health and contribute to overall family health and adaptation.

Use of complementary and alternative medicine and the anxiety levels of mothers of children with chronic diseases

AIMS

This study aimed to determine the use of complementary and alternative medicine (CAM) by mothers with a chronically ill child and their anxiety levels.

METHODS

This study used a descriptive design. The study was conducted with 135 mothers of a chronically ill child at a general pediatric and oncology unit in Uludağ University Hospital, Bursa, Turkey. A questionnaire, including sociodemographic items and the State-Trait Anxiety Inventory, were given to the mothers.

RESULTS

In the study, 42.29% of the mothers reported using one or more CAM therapies for their child with a chronic disease, including herbal medicine, taking the child to hodja (prayers), a special diet, and a special massage. The mothers experienced anxiety and the presence of a disease within the close family circle increased the anxiety level of the mothers.

CONCLUSION

Herbs and other alternative supplements were used by some children with a chronic disease in Turkey. The most commonly used CAM therapies included oral herbal medicine, taking the child to hodja, massage, and diets. Therefore, it is important to consider the implications of the popularity of complementary therapies. Most of the mothers used more than one of these therapies for their child and the anxiety level of the mothers was found to be moderate.

Impact of peanut allergy on quality of life, stress and anxiety in the family

BACKGROUND

Peanut allergy (PA) is known to impact on quality of life (QoL) of the sufferer, but little research has focused on all family members. We therefore sought to establish the impact of PA on QoL and reported anxiety of children with clinically confirmed PA, their parents and older siblings.

METHODS

Forty-six families, who had a child with PA, completed QoL (PedsQL or WHOQOL-BREF), anxiety (SCAS or STAI) and perceived stress (PSS) scales. PA children completed a PA specific QoL questionnaire (Pediatr Allergy Immunol 2003;14:378). Parents and sibling also completed QoL proxy questionnaires for the PA child (PedsQL, Pediatr Allergy Immunol 2003;14:378).

RESULTS

Mothers rated their own psychological (P < 0.01) and physical (P < 0.05) QoL significantly worse than fathers rated theirs, and had higher scores than fathers for anxiety (P < 0.05) and stress (P < 0.001). Children with PA had significantly poorer physical health-related QoL (P < 0.05), QoL within school (P < 0.01) and general QoL (P < 0.05) than their siblings did, and greater separation anxiety (P < 0.05). The majority of differences were between girls with PA and female siblings. Mothers felt that there was a greater impact on QoL for their PA child, compared with that reported by siblings, fathers or the PA children themselves (P < 0.01).

CONCLUSIONS

Mothers report that they have significantly poorer QoL and suffer more anxiety and stress than fathers do; this inter-parental difference may be an important feature of family stress caused by PA. Siblings have a similar view of how QoL affects the PA child as the PA child does, while mothers may possibly overestimate this impact.

Parent-reported medication use in a head start population

This study investigates the prevalence of medication use within a Head Start population. Parent-reported data (N = 1,397) from initial enrollment information indicated 6.8% of children were taking 34 different types of medication. More than two thirds (69%) of those on medication were prescribed more than one medication, and more than one third (37%) were taking three or more medications. The majority of children were reported to be taking medications that were asthma (88%) or allergy (17%) related. Psychotropic medications accounted for 4% of the medications, indicating a prevalence of less than 0.3%. African American and Hispanic children were overrepresented in those taking medicines. School nurses can work with parents and caregivers of Head Start children by raising awareness of (1) the benefits and side effects of medications commonly taken within this population, (2) the significant role that asthma medications play in low-income areas, and (3) the issues and challenges associated with polypharmacy practices.

The lived experience of fathers who have children with asthma: a phenomenological study

Asthma is a common chronic illness of childhood and a major cause of school absenteeism and hospitalization. When a child is diagnosed with asthma, parents become responsible for the long-term management of a chronic condition that is characterized by unpredictable and irregular episodes. Much of the research concerning parenting children who have asthma had focused on mothers. Paternal experiences in caring for a child with asthma have received little attention. In this phenomenological study, van Manen's (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy. The Althouse Press: London, ON) method of inquiry was used to explore the lived experience of fathers who have children with asthma. Eight fathers with children aged between 7 and 11 years who had been diagnosed with asthma were interviewed. Five themes were identified: feeling relief in knowing the diagnosis, learning the ropes, being vigilant, living with concern, and being comfortable with asthma management. Understanding the experience of fathers who have children with asthma and gaining insight into their needs and concerns are essential first steps to providing supportive nursing care.

Family function in families of children with Duchenne muscular dystrophy

This article investigates the relationships of child- and family-related variables with family function in families with children who have Duchenne muscular dystrophy. Child-related variables included level of disability (indicator: Barthel Index) and age at diagnosis. Family-related variables included caregiver health status (indicator: Duke Health Profile), family income and employment, family support (indicator: Family APGAR), family hardiness (indicator: Family Hardiness Index), and family functioning (indicator: Family Assessment Device). Family function displayed a significant correlation with age at diagnosis, but not with disability level. It was also significantly correlated with family hardiness, caregiver health status, and levels of family support, but not with income or employment variables. These findings highlight the need to assist families to cope with the presence of serious illness in their children.

The experience of long-term diagnosis with human immunodeficiency virus: a stimulus to clinical eupraxia and person-centred medicine

The biopsychosocial challenges of living with human immunodeficiency virus (HIV) have changed over time and they dictate the need for relevant medical services. The meaning of an HIV diagnosis has moved from a terminal to a manageable condition with the development of antiretrovirals, bringing profound changes to the experience of living with HIV and the meaning and use of diagnostic labels. Six biological stage-related categories in the literature of psychological medicine of HIV are critiqued. Long-term HIV highlights the inadequacy of physician-centred, acute-care medicine in chronic illness and its exclusion of preventive, psychological and rehabilitative modalities. 'Eupraxia' is presented as a conceptual framework for chronic care medicine, referring to best practice, wellbeing, best interests, and (public) welfare, through facilitated but collaborative approaches. A public-centred service model is proposed, using idiographic assessment and treatment by clinicians as patient delegates (proxies), monitoring joined-up care, providing group-based biopsychosocial treatment, facilitating autonomous and self-managing behaviour by the public, removing professional and practice hierarchies, and implementing real-time clinical and managerial accountability with public ownership and involvement. This model is superior in its health-and cost-effectiveness but can only work within a nationalized system that focuses equally on standardized outcomes and evidential and personalized health outcomes.

Listening to the family's voice: Nordic nurses' movement toward family centered care

Clinical nurses, teachers, and researchers in the Nordic countries are faced with increasing expectations in identifying their contribution to knowledge development in family nursing at national and international levels. In this paper, I provide an insight into the contribution of Nordic nurses to family centred care (family system nursing), present findings from an integrative review on family nursing in the Nordic countries, share with you examples of family level interventions, and offer some ideas regarding where we might want to direct our focus in family system nursing in the future.