Family management of a chronic health condition: perspectives of adolescents

"I have a Ph.D. in my daughter": Mother and Child Experiences of Living with Childhood Chronic Illness

Children in the United States are increasingly living with chronic illnesses. Existing literature has focused on adolescent children's experiences. The current study involved interviews with 10 families: children (ages 6-11) diagnosed with chronic illnesses and their mothers to better understand the experience of living with chronic illness. Using grounded theory, participants' responses fell into several themes: impact on family dynamics, parental advocacy, initial difficulty followed by resilience, unique stressors, and areas of social support. Overall, both mothers and children reported unique challenges related to living with childhood chronic illness, especially in terms of family dynamics, sibling relationships, and the mother-child relationship. However, almost all families also emphasized their ability to be resilient. The results have implications for medical practitioners and teachers who work with school-age children with chronic illnesses. Mothers need to feel supported and understood by professionals. Families need support to cope with stressors and strengthen couple, sibling, and parent-child relationships.

Cochlear implant-specific risks should be considered, when assessing the quality of life of children and adolescents with hearing loss and cochlear implants–not just cochlear implant-specific benefits–Perspective

Cochlear implants (CIs) are electronic medical devices that enable hearing in cases where traditional hearing aids are of minimal or no use. Quality of life (QoL) studies of children and adolescents with a CI have so far focused on the CI-specific benefits. However, the CI-specific risks listed by the U.S. Food and Drug Administration have not yet been considered. From this list, medical and device-related complications, lifelong dependency on the implanted device, and neurosecurity risks (CI technology is an interface technology) may be particularly relevant for young CI users. Medical and device-related complications can cause physical discomfort (e.g., fever, pain), as well as functioning problems (e.g., in speech discrimination, social behavior, and mood). In the worst case, reimplantation is required. Clinical experience shows that these complications are perceived as a burden for young CI users. Furthermore, many young patients are worried about possible complications. Additionally, CIs can be at least a temporary burden when children, typically at the age of 8–9 years, realize that they need the CI for life, or when they become peer victims because of their CI. Concerning neurosecurity risks, it is still unknown how young CI recipients perceive them. In summary, CI-specific risks can be perceived as a burden by young CI users that impairs their QoL. Therefore, they should not be ignored. There is an urgent need for studies on this topic, which would not only be important for professionals and parents, but also for the design of CI-specific QoL instruments.

Improving knowledge on safe medication management of inpatient children and adolescents: a pre-post study

OBJECTIVE

The primary aim of this study was to assess the impact of an education intervention on knowledge regarding medication use in hospitalized children and adolescents.

METHODS

A pre-post multicentre study was conducted in pediatric wards of the hospitals in Lazio Region between July 2019-March 2021. An in-person education intervention was provided to hospitalized patients aged 6-15 years, able to understand spoken and written Italian language. Topics included: correct intake and management of medications at home. Prior and after the education intervention, we evaluated patient knowledge with a self-administered test.

RESULTS

One-hundred-and-four (n = 104) patients participated in the study. In the pre-education period, 79.8% of the patients answered correctly to at least 60% of the questions of the test; the lowest number of correct answers concerned medication intake (36.5%; 33.6%), food-drug interactions (44.2%), appropriate indication to use of antibiotics (36.5%) and antibiotic resistance (55.8%). After the education intervention, 100% of the patients completed the test correctly.

CONCLUSION

The education intervention increased knowledge on several areas of interest, in children of different age-groups and including patients with chronic diseases.

PRACTICE IMPLICATIONS

Children's education is essential to encourage gradual transfer of responsibility for medication use, in ways that respect parental responsibilities and the health status and capabilities of the child.

Family Management of Severe Obesity in Adolescents

PURPOSE

Severe obesity, defined as a body mass index (BMI) ≥120th percent of the 95th BMI percentile for age and sex, is the fastest growing subcategory of obesity among youth, yet little is known about how this group understands and incorporates weight management strategies. The aims of this study were to explore how parents and adolescents understand severe obesity and incorporate management into their daily lives and evaluate the applicability of the Family Management Styles Framework (FMSF) to better understand the impact of severe obesity for adolescents.

DESIGN AND METHODS

Directed content analysis grounded in a modified version of the FMSF was used to analyze one-time in-home face-to-face interviews with adolescents aged 12-17 years (N = 14) who received pediatric weight management care and a parent (N = 17).

RESULTS

Both adolescents and parents described the day-to-day management as challenging and impactful to parent-child and sibling relationships. They described the need for sustained support and coaching in meeting daily physical activity requirements and related stories of weight stigma experienced. Further, parents' and adolescents' views were mostly congruent, except in their view of effectiveness of daily routines and how family attitudes and actions did or did not support the adolescent.

CONCLUSIONS

The FMSF was successfully applied to understand family management of adolescents with severe obesity. These adolescents have complex physical and psychological needs impacting effective weight management and family life.

PRACTICE IMPLICATIONS

Technology interventions should be considered to improve physiological and psychological outcomes for youth with severe obesity.

Tracing the Use of the Family Management Framework and Measure: A Scoping Review

This article reports the results of a scoping review of research applications of the Family Management Style Framework (FMSF) and the Family Management Measure (FaMM). We identified 32 studies based on the FMSF and 41 studies in which the FaMM was used, 17 of which were based on the FMSF. Both the framework and measure have been used by investigators in multiple countries, with most applications of the FaMM outside the United States. Although the FMSF and FaMM were originally developed for use with families in which there was a child with a chronic physical condition, both have been applied to a broader range of health conditions and to studies focusing on families with an adult member facing a health challenge. Based on our findings, we make recommendations for how researchers can more fully address all aspects of the FMSF.

South African adolescents living with spina bifida: contributors and hindrances to well-being

BACKGROUND

Spina bifida myelomeningocele is a major cause of disability among adolescents. However, little research is available in low-income nations such as South Africa. Investigating the contributors and hindrances to well-being in adolescents with spina bifida myelomeningocele may yield novel insights. In this study we included both adolescents and their primary caregivers to examine their perspectives on caring for and facilitating improvements in the life of the adolescents living with spina bifida myelomeningocele.

OBJECTIVES

To identify and document the perceptions of adolescents with spina bifida myelomeningocele and their primary caregivers on the factors that contribute to and hinder the well-being of adolescents living with spina bifida myelomeningocele in South Africa.

METHOD

An explorative qualitative research design was utilized, guided by a positive psychology theoretical framework. Fourteen participants, consisting of seven adolescent-primary caregiver dyads, were interviewed. Data were analyzed using thematic analysis and coded inductively using ATLAS.ti software.

RESULTS

We identified eight themes describing participants' perceptions on contributors and hindrances to the well-being of adolescents with spina bifida myelomeningocele. Contributing factors included: family support, social groups, special needs education, sport participation, striving for independence, and finding meaning in life. Hindrances included: structural (lack of resources, medical care and mobility challenges) and social (bullying and harmful friendships, secrecy about the condition, social isolation and unhappiness) hindrances to well-being.

CONCLUSION

Acknowledging the contributors and hindrances to the well-being of adolescents with spina bifida myelomeningocele is crucial for guiding informed positive interventions and preventing blind spots. Given the limited number of positive contexts, concentrated effort is required to facilitate opportunities for growth in a range of environments. Primary caregivers lack insight into the positive and negative aspects of the adolescents' lives. We suggest families prioritize bonding time and open communication.Implications for rehabilitationExploring the perspectives of adolescents living with spina bifida and their parents regarding well-being is important to develop appropriate interventions.Adolescents living with spina bifida value social support and social interaction as ways to maintain well-being.Special needs education institutions with curriculums tailored to adolescents with spina bifida promote comfort, acceptance, and personal excellence.Sport contributes to the mental, social and physical well-being of adolescents with spina bifida. Sport inspires and offers opportunities for success, it improves school attendance, increases positive affect, and provides opportunities for close relationships with friends and family.Finding ways to mitigate the stigma around spina bifida is necessary to improve adolescents' well-being within South Africa.

Adapting the Family Management Styles Framework to Include Children

EMPIRICAL STUDY PURPOSE

Propose an adapted Family Management Style Framework that includes the perspectives of children with chronic health conditions.

DESIGN AND METHODS

Building on the current Family Management Style Framework, the authors used recent empirical studies with children to further develop the framework. Definitions of each dimension and component of the framework were reviewed and revised to reflect the perspectives of the child, based on the child data and prior work.

RESULTS

The Family Management Style Framework was adapted to reflect children's perspectives of themselves and their family. Based upon our understanding of the components of the framework, we expanded the components and revised the definitions of the dimensions to reflect the child perspectives.

CONCLUSIONS

Incorporating the perspectives of children allows us to consider the transactions that occur during condition management between parents, children and families. Additional research is needed to explore this interaction and the implications it has on the outcomes.

PRACTICE IMPLICATIONS

Children experience the way their family manages their chronic health condition and incorporate those experiences as part of their developing understanding of themselves and their condition. Practitioners should encourage children to express their understanding of their condition and its management to model and encourage them to dialogue about management with their families.

Determinants of Quality of Care for Adolescents and Young Adults With Chronic Illnesses: A Mixed Methods Study

Measuring the quality of service and user experience is an acknowledged priority for healthcare services; however it seems that healthcare systems have to work very hard to achieve this goal as evidenced by reports of gaps and disparities in the quality of care provided to clients, especially within pediatric and adolescent populations.

OBJECTIVES

To identify quality determinants for healthcare services for adolescents and young adults with chronic conditions based on the perceptions and the experiences of adolescents and young adults themselves.

METHODOLOGY

A sequential exploratory mixed method design guided this study. The initial qualitative phase employed semi-structured in-depth interviews to elicit the elements and determinants of quality of care as identified by adolescents and young adults living with chronic conditions. The second phase employed a questionnaire developed from the data gathered during the qualitative phase to survey the target population. This was distributed to a larger sample of adolescents and young adults with chronic conditions to determine and confirm the relevance of the identified care elements and quality determinants.

RESULTS

The study revealed 4 main determinants: the provision of adolescent friendly information relating to all aspects of living with chronic conditions, services that facilitate and encourage independence, services characterized by structure with the capacity to be both dynamic and responsive, and finally health care professionals knowledgeable and skilled in relation to adolescent specific issues.

Experiences among children and adolescents of living with spina bifida and their visions of the future

Purpose Transitioning to independence may be problematic for persons with spina bifida (SB). Experiences of young persons with SB may provide insights into this group's needs for support. Therefore, the aim of this study was to investigate children's and adolescents' experiences of living with SB, their social and emotional adjustment, and their thoughts about becoming independent adults. Method Semi-structured interviews were conducted with young persons with SB (N = 8, age range 10-17 years). Social and emotional problems were assessed using Beck Youth Inventories. The interview transcripts were analyzed using qualitative content analysis. Results Three main themes were found: being a person with SB; everyday living as a person with SB; and preparing for life as an adult with SB. Indications of emotional and social problems were most prominent among participants with milder physical disability. Conclusions The findings indicate that young persons with SB may overestimate their independence. Other potentially problematic areas were lack of motivation, planning and preparedness for becoming independent. Research on transition to independence in this group should consider assistance at an early age in planning and executing strategies for independence. In addition, the potentially difficult situation for young persons with mild SB should be investigated further. Implications for rehabilitation Children and adolescents with spina bifida might lack the motivation and skills for planning their future and health care programmes should therefore include preparations for life as an adult. Clinical assessment of the level of independence should specifically distinguish between the activities they know how to do and what tasks they actually execute independently. Routine follow-ups should include screening for problems with social and emotional adjustment. Be aware of a potential condition-severity paradox whereby those with less severe impairment might have an increased risk of developing symptoms of social and emotional problems.

Children with chronic conditions: perspectives on condition management

This qualitative study described children's (8-13 years old) perspectives of their chronic health conditions (e.g., asthma, diabetes, cystic fibrosis): how they perceived their condition, its management, and its implications for their future. The study used the family management style framework (FMSF) to examine child perspectives on the joint venture of condition management between the child and family. Children within this age group viewed condition management in ways similar to their parents and have developed their own routines around condition management. Future studies of this phenomenon comparing child and parent perspectives would further our understanding of the influence of family management.

Identifying factors related to family management during the coping process of families with childhood chronic conditions: a multi-site study

This study was designed to determine the key predictors for each aspect of family management of families with children who have chronic conditions in China. The participants included 399 caregivers whose children have chronic illnesses. We used the following instruments: Child Behavior Checklist; Feetham Family Functioning Survey; and Family Management Measures. The final modes of the hierarchical regression explained 29-48% of the variance in aspects of family management. More family support should be provided for those with low family income, children with renal and genetic disorders and rheumatic diseases and those living in rural areas. Child and family functioning affects family management.

A qualitative synthesis of adolescents' experiences of living with spina bifida

In this article, I explore the experiences and perspectives of youth living with spina bifida, the second most common congenital condition in North America, to inform the development of health programs. I undertook a thematic metasynthesis to integrate qualitative evidence across studies examining the experiences of youth with spina bifida. I used 10 electronic databases to search for and review 4,051 abstracts, and identified 12 articles meeting the inclusion criteria. I examined those articles using a constant comparative approach, drawing on concepts of normalcy and biographical disruption to inform understanding of three emergent themes: (a) the medical management of spina bifida; (b) the importance of peer and family relationships (i.e., social support, belonging, and challenges in peer connections); and (c) identity and self-concept (i.e., normalization). This metasynthesis provides insight for youth, parents, and clinicians on areas of life in which youth could use further support.

Doença crônica da criança: necessidades familiares e a relação com a Estratégia Saúde da Família

Este estudo objetivou conhecer a percepção da família sobre a relação com a Unidade Saúde da Família (USF) na vivência com a doença crônica da criança. Em um desenho qualitativo utilizou-se o Interacionismo Simbólico como sustentáculo teórico, a Pesquisa de Narrativa como método e entrevistas com as famílias como instrumento para a coleta de dados. Os dados foram coletados por entrevista semiestruturada, com 7 famílias de crianças com doença crônica, cadastradas em USFs de uma região com alto índice de vulnerabilidade social, de um município do interior paulista. Os resultados mostraram como a relação da família com a USF é influenciada por elementos da experiência e trajetória familiar e como a vivência da doença crônica da criança é fortemente marcada pela relação com os serviços de saúde. Tal situação tem grande influência sobre as respostas da família, o que exige um engajamento sistemático e comprometido do sistema de saúde no alívio do sofrimento familiar, para além do tratamento pontual da patologia.

Testing the Applicability of the Family Management Style Framework to Chinese Families

Family management is an important concept in caring for chronically ill children. The purpose of this study is to determine the applicability of the Family Management Style Framework for Chinese families with a child who has a chronic condition. The children ranged in age from 6 to 16 years. The structural equation modeling approach was utilized to examine the relationships among the contextual variables, the family management, the child, and the family functioning. A total of 538 caregivers from seven hospitals in China were included in this study. The final model adequately fitted the data. The predictor variables accounted for 23%, 26%, 7.8%, and 12% of the variance in the easy and the challenging parts of family management and the child and family unit, respectively. These findings indicated that the framework is applicable to Chinese families. This result reinforces the importance of interventions designed to enable caregivers to improve family management.

Health care autonomy in children with chronic conditions: implications for self-care and family management

Health care autonomy typically occurs during late adolescence but health care providers and families often expect children with chronic health conditions to master self-care earlier. Few studies have examined the development of health care autonomy as it pertains to self-care and family management. This review links the 3 concepts and discusses the implications for families and health care providers. Case studies are provided as exemplars to highlight areas where intervention and research is needed.