Factors associated with self-concept in children with asthma

Applying theoretical models of positive emotion to improve pediatric asthma: A positive psychology approach

Positive emotion, encompassing feelings such as joy and happiness, has been shown to predict a multitude of health outcomes. However, the role of positive emotion in pediatric asthma is not understood. No work to date has examined how positive emotion may offer benefits to children and adolescents with asthma. Based on theory and models of positive emotion and health, we hypothesize that positive emotion may improve asthma outcomes through mediators such as health behaviors and health-relevant physiological functioning. Moreover, boosting positive emotion during times of stress may be particularly relevant in mitigating asthma symptoms. In the present commentary, we elaborate on the hypothesized mechanisms behind such associations grounded within positive emotion theoretical frameworks. Additionally, we summarize the methodologically rigorous work of positive emotion interventions in other clinical settings to propose that positive emotion could be a useful tool in the management of pediatric asthma.

Assessment of Self-Stigma, Self-Esteem, and Asthma Control: A Preliminary Cross-Sectional Study Among Adult Asthmatic Patients in Selangor, Malaysia

Purpose: The elusive goal of asthma management guidelines is to achieve and maintain good asthma control in asthmatic patients. Against a background of long-term respiratory limitations when living with asthma, stigma and low self-esteem have also been identified as the social phenomenon among adult asthmatics. This study aimed to assess the levels of self-stigma, self-esteem, and asthma control, and to investigate the impact of self-stigma and self-esteem as psychosocial factors on asthma control in Malaysian adults living with asthma.

Materials and Methods: In this multicenter cross-sectional study, post-ethics approval and patients' consents, 152 stable asthmatic patients (aged > 18 years old; nil cognitive disability; not diagnosed with other respiratory diseases) were recruited from four respiratory clinics in Selangor, Malaysia. The patients' socio-demographic, medical, and psychosocial (self-stigma and self-esteem) data were recorded in a pre-validated, self-designed questionnaire. All data were analyzed descriptively and inferentially (independent t-test/one-way ANOVA, and multiple linear regression) using the Statistical Package for Social Sciences (SPSS®).

Results: The enrolled patients showed moderate levels of self-stigma (62.12 ± 6.44) and self-esteem (29.31 ± 3.29), and not well-controlled asthma (17.58 ± 3.99). The number of patients' visits to emergency rooms because of asthma [CI (−1.199, 0.317), p < 0.001] was the significant predictor to asthma control among all selected study variables from socio-demographic and medical data. Moreover, from psychosocial factors both self-stigma [CI (−0.367, 0.190), p < 0.001], and self-esteem [CI (−0.007, 0.033), p = 0.041] found to be the significant predictors of asthma control.

Conclusion: The preliminary evidences presented in this study found that frequent emergency room visits, high self-stigma and low self-esteem in asthma patients becomes more apparent with poor asthma control. Educational interventions to reduce patients' self-stigma and improve self-esteem are needed to achieve optimal control of asthma.

Self-concept in children and adolescents with epilepsy: The role of family functioning, mothers' emotional symptoms and ADHD

PURPOSE

This study aimed to identify the associated factors of poor self-concept in children and adolescents with epilepsy.

METHODS

Fifty-three patients with uncomplicated epilepsy (aged 7-18years) and 28 healthy controls were included. Study measures included the Piers-Harris 2 Self-Concept Scale, Family Assessment Device (FAD), Turgay DSM-IV based ADHD rating Scale (T-DSM-IV-S), Conners' Teacher Rating Scale (CTRS-R), Beck Depression Inventory and State-Trait Anxiety Inventory (STAI). Neurology clinic charts were reviewed for the epilepsy-related variables.

RESULTS

While the Piers-Harris 2 total score was not significantly different between the groups, patients with epilepsy had lower (poorer) scores on freedom from anxiety and popularity subscales. Linear regression analysis revealed that the problem solving, affective responsiveness, general functioning and communication scores of FAD; total and inattentiveness scores of T-DSM-IV-S and mothers' Beck scores were associated with the total score of Piers-Harris 2. Epilepsy-related factors were not found to be associated with self-concept scores.

CONCLUSION

Poor self-concept in children with epilepsy is associated with negative family functioning, mothers' emotional symptoms and ADHD, especially the symptoms of inattentiveness.

Psychometric properties of the Family Resilience Assessment Scale: A Singaporean perspective

Families of young people with chronic illnesses are more likely to experience higher levels of stress. In turn, their ability to cope with multiple demands is likely to affect young people's adaptation. The purpose of this study was to examine psychometric properties of the Family Resilience Assessment Scale (FRAS), an assessment tool that measures the construct of family resilience. A total of 152 young people with epilepsy, aged 13 to 16years old, from KK Women's and Children's Hospital, Singapore, completed the FRAS along with the Rosenberg Self-Esteem Scale. Factor structure of the FRAS was examined. Exploratory factor analysis resulted in a 7-factor solution - meaning-making and positive outlook, transcendence and spirituality, flexibility and connectedness, social and economic resources (community), social and economic resources (neighbors), clarity and open emotional expression, and collaborative problem-solving - accounting for 83.0% of the variance. Internal consistency of the scale was high (α=0.92). Family resilience was significantly correlated with higher levels of self-esteem. Our study provides preliminary findings that suggest that FRAS is a reliable and valid scale for assessing the construct of family resilience among young people with epilepsy in Singapore.

Factors related to emotional responses in school-aged children who have asthma

A systematic review of the literature was performed to answer the following questions (a) What factors contribute to the emotional responses of school-age children who have asthma? (b) What are the potential gaps in the literature regarding the emotional responses of school-age children (ages 6-12) who have asthma? (c) Are children with a lower socioeconomic status (SES) and those who are minorities represented in the literature proportionate to their prevalence? Two main focus areas regarding emotional responses were identified: (a) factors related to children who have asthma and (b) factors related to caregivers of children who have asthma. Internalizing disorders were reported consistently for children and caregivers of children who have asthma. Negative consequences of asthma for children included panic and asthma attacks, missed school days, and behavioral problems. Issues for caregivers included higher levels of anxiety and depressive symptoms, asthma management deficits, and lower caregiver warmth and involvement. Gaps in the literature included separated studies for children ages 6-12, a lack of a standardized method to define SES, studies that were of a more experimental nature, and a disparate number of studies of minority children and caregivers relative to their asthma prevalence.

Can schools promote the health of children with asthma?

This report describes the evaluation of a whole-school intervention to improve morbidity and psychosocial well-being in pupils with asthma. In all, 193 children with asthma (7-9 years) from 23 primary/junior schools in the south of England participated. Schools (n = 12) randomly assigned to the intervention group (IV) received a staff asthma training session, advice on asthma policy and practice and an emergency beta(2)-agonist inhaler with spacer. Pupils participated in an asthma lesson. Staff and pupils in non-intervention (NI) schools (n = 11) received no asthma-oriented input. While wheeze reports improved for all children with asthma, only the IV group showed lower requirement for medication (P = 0.01), clinically significant improvement (P < 0.05) in activity related quality of life (QOL) and increased self-esteem (SE: social P = 0.01; athletic P = 0.05; behaviour P = 0.001) in girls. SE decreased for NI girls but there was no change for non-asthmatic peers in NI or IV schools which had similar baseline levels of SE and QOL. There was a marginal improvement in the establishment of asthma policies/practices and no change in school absence or staff knowledge. The significantly increased peer group understanding of asthma seen in the intervention schools may have mediated increased well-being in the IV group. Primary schools are a potentially important context for improving asthma morbidity and psychosocial well-being of children with asthma.

Comparative study of children's self-concepts and parenting stress between families of children with epilepsy and asthma

The purpose of the present study was to conduct a comparative study on families of children with epilepsy and asthma with regard to the variables of children's self-concepts and parenting stress. While past research has indicated higher rates of behavioral problems in children with epilepsy, behavioral problems were associated primarily with children's self-concept. How an individual assesses his or herself impacts significantly upon self conceptualization and the attainment of a stable concept about oneself as an individual is a critical development factor during an individual's cognitive development stage. Nevertheless, specific factors related to such have not previously been well delineated. Forty-eight children, 8 to 13 years of age with epilepsy, and 54 children in the same age range with asthma were investigated for this study. Parents of subjects were also involved in this study. The self-concepts of subject children were assessed using the Harter's Self-Perception Profile for Children (SPPC). Parenting stress was measured using Abidin's Parenting Stress Index (PSI)/long form. Children's demographic variables and illness severity were also measured as potential risk factors. Results showed significant differences between the two groups in terms of self-concept and parenting stress, with epileptic children returning significantly lower self-concept scores in 3 SPPC subscales. Demographic variables and illness conditions were not found to be effective predictors of parenting stress. Level of parenting stress was revealed to be significantly associated with children's self-concept in the epilepsy group. Results suggest that parents of children with epilepsy will benefit from coping strategies that may help lower parenting stress levels and influence positively upon children's self-concept. In addition to providing regular drug therapy, providing further support is needed.

Relationships of family functioning, self-esteem, and resourceful coping of Thai adolescents with asthma

Within the context of Rosenbaum's theory of learned resourcefulness, this correlational study examined the relationships among family functioning, self-esteem, and resourceful coping in Thai adolescents with asthma. A convenience sample of 132 Thai adolescents (aged 12-17 years) with asthma was recruited from the outpatient asthma clinics of four hospitals in Bangkok. Self-administered questionnaires included an assessment of demographic information and asthma status, the revised Family APGAR, the Rosenberg Self-Esteem Scale, and the Children's Self-Control Scale. Hierarchical multiple regression analysis was used to examine the relationships among variables. Effective family functioning had a significant positive effect on self-esteem (beta = .27, p < .01) and resourceful coping (beta = .30, p < .01), controlling for gender and age. However, self-esteem was not significantly correlated with resourceful coping (beta = .15, p = .08). The findings suggest that nursing interventions should take into account the role of family functioning in promoting self-esteem and resourceful coping in Thai adolescents with asthma. Recommendations for future research include replication of the study with a larger sample of adolescents with asthma and with adolescents with other chronic illnesses.

Children's asthma, internalizing problems, and social functioning: an urban perspective

PROBLEM

Asthma may serve as a risk factor for higher levels of psychosocial problems in urban school-aged children.

METHOD

Interview data were collected from 48 children (27 with asthma and 21 without asthma) and their mothers.

FINDINGS

Asthma did not function as a risk factor for psychosocial problems in this sample. Children with more symptoms of depression and anxiety experienced poorer social functioning, regardless of their health status.

CONCLUSION

These results highlight the importance of examining co-occurring difficulties in psychosocial development among urban children in order to design interventions that minimize the impact of such challenges.

Self-concept: comparison between school-aged children with congenital heart disease and normal school-aged children

AIMS AND OBJECTIVES

The aim of this study was to evaluate and compare the self-concept of school-aged children with congenital heart disease to those of normal school-aged children. The primary objective was to analyse results of the Self-Concept Scale questionnaire administered to children with congenital heart disease aged 9-12 years. Sixty-four children with congenital heart disease (study group), and 71 without congenital heart disease (control group), completed the questionnaire.

BACKGROUND

Little attention has focused on school-aged children with congenital heart disease who are in the important stages of developing self-concept.

RESULTS

The mean score on the Physical self-concept of the Self-Concept Scale was significantly lower for the study group than the control group (P < 0.05). No significant differences were observed between children with congenital heart disease and normal children in terms of family self-concept, school self-concept, appearance self-concept, emotional self-concept and general self-concept for the Self-Concept Scale.

CONCLUSIONS

Nurses should use the study findings to encourage positive self-concept development and improve their patient education about physical activity before the child is discharged. Thus, children with congenital heart disease could leave the hospital with a clear understanding of their body and condition, and how it affects daily life.

RELEVANCE TO CLINICAL PRACTICE

The results of this study may provide more holistic views on self-concept for clinical nurses working with children who have congenital heart disease and their families and for school nurses working with elementary school children.

Prevalence of asthma in a Portuguese countryside town: repercussions on absenteeism and self-concept

BACKGROUND

Childhood asthma represents an increasing health problem and is the leading cause of hospital admission and absenteeism in children with chronic disease. It also compromises quality of life, eventually contributing to disturbances in self-concept. Self-concept is a recent and global perspective of "the self" and relates to skills, self-image and self-esteem. Little information is available on this topic and there are no data from Portuguese countryside towns.

OBJECTIVE

The aim of this study was to determine the prevalence of asthma among all school children in the 5th and 6th grades in a Portuguese countryside town and to establish its possible correlation with absenteeism and self-concept.

METHODS

In April 2002, two questionnaires were administered in the presence of the researcher to a group of 950 children attending different schools. The children completed the internationally renowned questionnaires: ISAAC and the Self-Concept Scale by Susan Harter.

RESULTS

Our sample (n = 818) had a mean age of 11 years (10-15 years) and a male-to-female ratio of 1/1. The cumulative prevalence of asthma was 11.9 % and that of active asthma was 8.8 %; 63.9 % of asthmatics were male and 36.1 % were female. The mean age of asthmatics was 11.34 years and 74 % had active symptoms. Comparison of this group of 97 asthmatic children with the remaining children revealed a statistically significant correlation between the presence of asthma and school absenteeism (global: p = 0.04; gymnastics: 0.05). Regarding the Self-Concept Scale a statistically significant association was found between the presence of asthma and school achievement (p = 0.027), physical appearance (p = 0.015), behavior (p < 0.000) and self-esteem (p < 0.000). No statistically significant correlations were found in social acceptance (p = 0.289) or athletic competence (p = 0.085). Asthmatic boys had higher self-concept scores than girls, except in the domain of behavior.

CONCLUSIONS

Twelve percent of the population studied was asthmatic. In asthmatic children, absenteeism was higher and self-concept was lower for almost all domains, except social acceptance and athletic achievement, probably due to overprotection.

Comparative Optimism About Health and Nonhealth Events in 8- and 9-Year-Old Children

Comparative optimism has been studied extensively in adults and is a significant component of social- cognitive models about health. In contrast, little is known about comparative optimism in children or about the wider social- cognitive processes that underpin their health-related behavior. This study investigated comparative optimism for health- and nonhealth-related topics in 101 children 8 or 9 years of age, the youngest ages that have been investigated so far. Children were shown to be unrealistically optimistic for health and nonhealth events. The implications of these findings for understanding comparative optimism in children are discussed.

Coping as a mediator of psychosocial impediments to optimal management and control of asthma

Adherence to asthma medication regimens by asthma patients is often poor and contributes to the continued and substantial burden of asthma in the community. There is evidence of increased rates of behavioural problems, anxiety and depression in people with moderate-to-severe asthma and these factors may interfere with adherence and contribute to poor asthma control. An alternative explanation is that the relationship between feelings of anxiety and depression, and adherence to the treatment regimen may be more accurately predicted from the coping styles used, rather than the experience of asthma itself. The objective of this paper was to review evidence for associations between coping strategies used by asthma patients, asthma management and health outcomes. The Medline and PsychInfo databases were searched for articles containing the terms "asthma" and "coping". Patients with asthma tended to use different strategies for coping with stress and illness compared to healthy participants and individuals with other chronic illnesses. Emotion-focussed coping strategies such as denial were commonly used by patients with poor medication adherence, those who attended emergency departments for asthma, were admitted to hospital for asthma, or suffered near-fatal asthma attacks. Interventions to improve coping strategies have been effective in reducing symptoms and psychological distress. The availability of coping resources to patients and/or their caregivers and the coping strategies that are used are likely to mediate the influence of psychosocial factors on the management of asthma. Further studies exploring the ways in which individuals cope with asthma will improve our understanding of the mechanisms linking psychological and social status to asthma morbidity and mortality.

Managing asthma within the context of the rural family

The purpose of this qualitative study was to describe the experiences of rural families caring for children with asthma. The chief caregivers from six rural families were interviewed about the family's daily experiences in living with asthma, their knowledge of asthma triggers, and strategies for managing asthma. Parental knowledge about asthma and asthma management strategies was quite good. The cost of asthma regimens and school policies about medications were major barriers to better control. Other management strategies were directed at maintaining normality of family life.