Rationale and design of a randomized controlled clinical trial of a resilience-building intervention in adults with congenital heart disease

BACKGROUND

Adults with congenital heart disease (ACHD) are at risk for lower quality of life (QOL) and psychological health. Behavioral interventions to meet their psychosocial needs are lacking. The aim of this study is to evaluate the feasibility of implementing the Promoting Resilience in Stress Management (PRISM) intervention in ACHD and its efficacy in increasing resilience in this population.

METHODS

We designed a phase II randomized controlled clinical trial of patients with moderate or complex ACHD, physiological stages C or D. Enrolled participants will be randomized to receive PRISM or usual care. PRISM is a manualized, skills-based behavioral intervention comprised of four one-on-one sessions targeting resilience resources (stress-management, goal-setting, cognitive reframing, meaning making), an optional session on advance care planning, and a facilitated family meeting. Participants in both groups will complete study questionnaires at enrollment and 3-months later. The primary aim is to describe feasibility, namely the proportions of patients who a) enroll in the study among those eligible, and b) complete the PRISM intervention among those randomized to that arm. We will also evaluate PRISM's efficacy by using linear regression models to compare changes in mean resilience scores between assigned groups. In exploratory analyses, we will evaluate effects on QOL, psychological distress, perceived competence for health care management, and comfort with advance care planning.

DISCUSSION

This study will provide rigorous evidence to determine the feasibility and efficacy of a brief intervention to promote resilience and psychosocial health in ACHD. Findings may guide the development of a future multi-site effectiveness study.

CLINICAL TRIAL REGISTRATION

NCT04738474.

Association of nurse-mother partnerships with parenting stress and family resilience among South Korean mothers of children with congenital heart disease

PURPOSE

Advances in the management of congenital heart disease (CHD) have significantly decreased mortality rates, indicating a need for continuous care as a chronic condition throughout the child's lifespan. This study examined the association of nurse-mother partnerships with parenting stress and family resilience among South Korean mothers of children with CHD.

DESIGN AND METHODS

This descriptive study involved 93 mothers of children aged six years or younger with CHD admitted to a hospital. Data were collected from September to November 2020 and analyzed using SPSS/WIN (version 29.0) for t-tests, analyses of variance, Pearson's correlation coefficient, and multiple regression analyses.

RESULTS

The means and standard deviations of the nurse-mother partnership, parenting stress, and family resilience were 4.13 ± 0.47, 76.98 ± 16.6, and 56.54 ± 7.86 points, respectively. Parenting stress increased as the number of hospitalizations and surgeries increased and with complex types of CHD. Nurse-mother partnerships were stronger with longer hospital stays. Family resilience was higher with younger children, fewer rehospitalizations, and shorter hospital stays. A positive correlation was found between nurse-mother partnerships and family resilience, and a negative correlation between parenting stress and family resilience. Factors influencing parenting stress included family resilience, rehospitalizations, and complex types of CHD, and those affecting family resilience were nurse-mother partnerships, parenting stress, and the child's age.

CONCLUSION

Nurse-mother partnerships significantly affect family resilience.

PRACTICAL IMPLICATIONS

Enhancing nurse-mother partnerships can improve family resilience, which in turn can reduce parenting stress, thus offering guidance for future nursing interventions.

Developing the WE BEAT Well-Being Education Programme to foster resilience and build connection in paediatric heart disease

BACKGROUND

The study of psychological well-being and related resilient outcomes is of increasing focus in cardiovascular research. Despite the critical importance of psychological well-being and related resilient outcomes in promoting optimal cardiac health, there have been very few psychological interventions directed towards children with heart disease. This paper describes the development and theoretical framework of the WE BEAT Wellbeing Education Program, a group-based psychoeducation and coping skills training intervention designed to improve psychological well-being and resilience in adolescents with paediatric heart disease.

METHODS

Program development was informed by patient and family needs and input gathered via large, international survey methods as well as qualitative investigation, a theoretical framework, and related resilience intervention research.

RESULTS

An overview of the WE BEAT intervention components and structure of the programme is provided.

CONCLUSIONS

The WE BEAT Wellbeing Education Program was developed as one of the first resiliency-focused interventions in paediatric heart disease with an overall objective to foster positive psychological well-being and resilient outcomes through a health promotion and prevention lens in an accessible format while providing access to safe, peer-to-peer community building. Feasibility pilot results are forthcoming. Future directions include mobile app-based delivery and larger-scale efficacy and implementation trials.

Effects of an Online Health Management Program for South Korean Adolescents with Complex Congenital Heart Disease during Their Transition to Adulthood: A Randomized Controlled Trial

Adolescents with complex congenital heart disease (CHD) are at risk of experiencing complications later in life. The purpose of this study was to develop an online health management program for adolescents with complex CHD and to evaluate its effects on self-efficacy, health behavior, and health-related quality of life. A randomized controlled trial design was used. A total of 29 adolescents with complex CHD were divided into an experimental group of 15 and a control group of 14. Participants in the intervention group took part in the 4-week online health management program (weekly online group sessions, 1:1 phone coaching, dietary diary feedback, and provision of health information) developed based on self-efficacy theory, while those in the control group received standard medical follow-up. Data were collected from August 2021 to March 2022 using a questionnaire-including the Korean Self-Rated Abilities for Health Practices: Health Self-Efficacy Measure (K-SRAHP) and Pediatric Cardiac Quality of Life Inventory (PCQLI)-and an ActiGraph accelerometer to track physical activity and sleep. The intervention group showed significant improvements in health self-efficacy (p = 0.003), psychosocial impact (p = 0.013), daily step counts (p = 0.011), and moderate to vigorous-intensity physical activity (p = 0.027). Additionally, a decrease in weekend leisure time sedentary behavior (p = 0.035) was observed. However, there were no significant differences in sleep behavior between two groups. The online health management program significantly enhanced self-efficacy, health behavior, and psychosocial impact in adolescents with complex CHD. These findings will inform the development of policies for transitional medical care tailored to adolescents with complex CHD.

Key Psychosocial Health Outcomes and Association With Resilience Among Patients With Adult Congenital Heart Disease

BACKGROUND

Adult congenital heart disease (ACHD) can negatively impact quality of life (QOL). Strengthening resilience may improve this and other psychosocial outcomes important for living a meaningful life.

OBJECTIVES

The purpose of this study was to describe resilience and key psychosocial health outcomes in ACHD and evaluate the associations between resilience and these outcomes.

METHODS

We conducted a prospective cohort study of outpatients with moderate or complex ACHD between May 2021 and June 2022. Participants completed surveys at baseline and 3 months, evaluating resilience (Connor-Davidson Resilience Scale-10), health-related QOL (EQ5D-3L, linear analog scale), health status (Euroqol visual analog scale), self-competence (Perceived Competence Scale), and psychological symptom burden (Hospital Anxiety and Depression Scale) and distress (Kessler-6).

RESULTS

The mean participant age (N = 138) was 41 ± 14 years, 51% were female, and 83% self-identified as non-Hispanic White. ACHD was moderate for 75%; 57% were physiologic class B. Mean baseline resilience score (Connor-Davidson Resilience Scale-10) was 29.20 ± 7.54. Participants had relatively good health-related QOL, health status, and self-competence, and low psychological symptom burden and distress. Higher baseline resilience was associated with better values of all outcomes at 3 months (eg, 1 point higher resilience was associated with 0.92 higher linear analog scale; 95% CI: 0.52-1.32) with or without adjustment for demographics. After further adjusting for the baseline psychosocial measure, only the association between resilience and QOL measures at 3 months remained statistically significant.

CONCLUSIONS

Resilience is positively associated with health-related QOL for outpatients with moderate or complex ACHD, though relationships are small in magnitude. Study findings can guide the application of resilience-building interventions to the ACHD population.

Effects of transition programmes to adulthood for adolescents and young adults with CHD: a systematic review with meta-analysis

BACKGROUND

The increased survival rate among individuals with CHD has sparked interest in their transition to adult healthcare. Although there is a general agreement on the importance of transition interventions, the empirical evidence supporting them is insufficient. Therefore, this study aimed to conduct a systematic review and meta-analysis of transition interventions for adult healthcare in adolescents and young adults.

METHODS AND RESULTS

A literature search was conducted for studies comparing the quantitative effects of transition interventions with control groups, published up to March 15, 2023, in major databases (CENTRAL, Embase, PubMed, Web of Science, CINAHL, KISS, and KMbase), major clinical trial registries, academic journal sites related to the topic, and grey literature databases. Ten studies involving a total of 1,297 participants were identified. Transition interventions proved effective in enhancing disease-related knowledge (Hedge's g = 0.89, 95% CI = 0.29-1.48) and self-management (Hedge's g = 0.67, 95% CI = 0.38-0.95), as well as reducing loss to follow-up (OR = 0.41, 95% CI = 0.22-0.77). The certainty of evidence for the estimated values of each major outcome was low or very low.

CONCLUSIONS

This study supports the implementation of transition interventions by demonstrating that they can improve patients' disease knowledge and self-management, while also promoting treatment continuity. However, since the available data on transition interventions for adolescents and young adults with CHD remain limited, the widespread adoption of structured transition interventions in the future may alter the conclusions of this study.

REGISTRATION

URL: https://www.crd.york.ac.uk/PROSPERO. Unique identifier: CRD42023399026.

Cardiac rehabilitation for children and young people (CardioActive): protocol for a single-blind randomised feasibility and acceptability study of a centre-based cardiac rehabilitation programme versus usual care in 11-16 years with heart conditions

BACKGROUND

Congenital heart conditions are among the most common non-communicable diseases in children and young people (CYP), affecting 13.9 million CYP globally. While survival rates are increasing, support for young people adjusting to life with a heart condition is lacking. Furthermore, one in three CYP with heart conditions also experiences anxiety, depression or adjustment disorder, for which little support is offered. While adults are offered cardiac rehabilitation (CR) to support their mental and physical health, this is not offered for CYP.One way to overcome this is to evaluate a CR programme comprising exercise with mental health support (CardioActive; CA) for CYP with heart conditions. The exercise and mental health components are informed by the metacognitive model, which has been shown to be effective in treating anxiety and depression in CYP and associated with improving psychological outcomes in adult CR.

METHOD AND ANALYSIS

The study is a single-blind parallel randomised feasibility trial comparing a CR programme (CA) plus usual care against usual care alone with 100 CYP (50 per arm) aged 11-16 diagnosed with a heart condition. CA will include six group exercise, lifestyle and mental health modules. Usual care consists of routine outpatient management. Participants will be assessed at three time points: baseline, 3-month (post-treatment) and 6-month follow-up. Primary outcomes are feasibility and acceptability (ie, referral rates, recruitment and retention rates, attendance at the intervention, rate of return and level of completion of follow-up data). Coprimary symptom outcomes (Strength and Difficulties Questionnaire and Paediatric Quality of Life) and a range of secondary outcomes will be administered at each time point. A nested qualitative study will investigate CYP, parents and healthcare staff views of CR and its components, and staff's experience of delivering CA. Preliminary health economic data will be collected to inform future cost-effectiveness analyses. Descriptive data on study processes and clinical outcomes will be reported. Data analysis will follow intention to treat. Qualitative data will be analysed using thematic analysis and the theoretical framework of acceptability.

ETHICS AND DISSEMINATION

Ethical approval was granted on 14 February 2023 by the Greater Manchester East Research Ethics Committee (22/NW/0367). The results will be disseminated through peer-reviewed journals, conference presentations and local dissemination.

TRIAL REGISTRATION NUMBER

ISRCTN50031147; NCT05968521.

Resilient Hearts: Measuring Resiliency in Young People With Congenital Heart Disease

Background Congenital heart disease (CHD) is a life-long disease with long-term consequences on physical and mental health. Patients with CHD face multifaceted physical and psychosocial challenges. Resilience is an important factor that can be protective and positively impact mental health. We studied resiliency and its associated factors in teenagers and young adults with and without CHD using a social media-delivered survey. Resilience was measured using the 25-item Connor-Davidson Resilience Scale, a validated metric with a historical mean of 80.4/100 in the general adult population. Methods and Results Individuals with and without CHD, aged 10 to 25 years, were prospectively recruited on social media to complete an online survey. The survey was completed from January to February 2022. Respondents provided information on their demographics and CHD details (where applicable) and completed the Connor-Davidson Resilience Scale. As a group, participants with CHD had higher resilience scores compared with same-aged healthy individuals (65.3±16.1 versus 55.4±13.8; P<0.001). For both cohorts, sex, race, and age were not associated with differences in resilience score. For individuals with CHD, lower resilience was associated with more hospital admissions, lack of exercise, presence of a mental health diagnosis, and no participation in support groups or disease-specific camps. Conclusions Young people with CHD had higher resilience than individuals without CHD in our sample. We identified several factors, both modifiable and nonmodifiable, that are associated with higher resilience. Awareness of resiliency and its contributors in the population with CHD may assist medical teams in improving patient physical and psychological well-being.

Resilience in children with congenital heart disease: a comparative study with health counterparts

OBJECTIVE

Resilience is a complex, yet rather unexplored topic in patients with congenital heart disease (CHD). The goal of this study was to assess and compare resilience in children with CHD with healthy controls during the COVID-19 pandemic.

DESIGN AND PATIENTS

From June 2020 to June 2021, 124 children with various CHDs (14.6±2.1 years, 49 girls) and 124 matched healthy controls (14.8±2.0 years, 49 girls) completed the Resilience Scale-11 short version.

RESULTS

Resilience was significantly reduced in children with CHD compared with healthy controls (CHD: 59.0±10.0 vs healthy controls: 64.4±6.5, p<0.001). That reduction was prominent in all CHD subgroups except those with left heart obstruction (aortic stenosis and coarctation of the aorta) and patients with transposition of the great arteries. Complex CHD had the lowest resilience of 57.6±8.4 (p<0.001) after adjusting for age and sex according to group differences. There was no difference between native CHD and CHD with open-heart surgery (native: 59.5±12.2 vs surgery: 58.8±9.3, p=0.758).

CONCLUSIONS

Resilience was reduced in children and adolescents with CHD compared with healthy peers during the COVID-19 pandemic. Children with complex severity appeared to be particularly affected. These findings emphasise continued efforts to provide a holistic and multidisciplinary approach in medical aftercare of these patients and their families.

Resilience mediates the effect of peer victimization on quality of life in Chongqing adolescents: from a perspective of positive childhood experiences

Background

Peer victimization is a harmful experience that contributed to one's psychological problems, physical health deterioration, and so on. Quality of life (QoL) is an important indicator of adolescent health assessment. To identify potential pathways of positive experiences in preventing peer victimization's detrimental effects and then provide intervention ideas for adolescent health, this study was conducted to examine the relationship between peer victimization and QoL in Chongqing adolescents and discover whether resilience plays a mediating role and positive childhood experiences (PCEs) act as a moderating role in the relationship.

Methods

Data were the first follow-up of a cohort study conducted in four complete middle schools in two districts of Chongqing, China. Self-designed peer victimization items, the Connor-Davidson Resilience Scale, the Adolescent Quality of Life Scale, and the Benevolent Childhood Experiences Scale were used. We investigated the differences and correlations in peer victimization, QoL, and resilience between the two PCEs groups. Mplus version 8.3 was used to analyze the mediating role of resilience and the moderating role of PCEs in peer victimization and QoL.

Results

Peer victimization, resilience, and QoL differed between the two PCEs groups (P < 0.001). Peer victimization negatively correlated with QoL and resilience, while resilience positively correlated with QoL (P < 0.001). In the models with total QOL as the dependent variable, the indirect effect was -0.431 (8.08% of the total effect) in the low-PCEs group vs. -2.077 (41.97% of the total effect) in the high-PCEs group. In the models with four dimensions of QOL as the dependent variable, the indirect effects ranged from -0.054 to -0.180 (6.07-12.95% of the total effects) in the low-PCEs group and from 0.295 to -0.823 in the high-PCEs group (35.89-68.76% of the total effects). Both total and indirect effects were significant (P < 0.05). In addition, the differences in indirect effects were significant between the two PCEs groups (P < 0.05), while differences in total and direct effects were almost not apparent.

Conclusion

Resilience partially mediated the effect of peer victimization on QoL in Chongqing adolescents, and PCEs moderated this mediation. Schools, families, and society should focus on resilience intervention and prioritize the enhancement of PCEs for improving adolescent QoL.

The RISE study protocol: resilience impacted by positive stressful events for people with cystic fibrosis

Introduction

For people with cystic fibrosis (CF), gaining access to elexacaftor/tezacaftor/ivacaftor (ETI) therapy, a new modulator drug combination, is perceived as a positive life event. ETI leads to a strong improvement of disease symptoms. However, some people with CF experience a deterioration in mental wellbeing after starting ETI therapy. The primary objective of this study is to investigate if and in which direction mental wellbeing of people with CF changes after starting ETI therapy. Our secondary objectives include, among others, investigation of underlying biological and psychosocial factors associated with a change in mental wellbeing of people with CF after starting ETI therapy.

Methods and analysis

The Resilience lmpacted by Positive Stressful Events (RISE) study is a single-arm, observational, prospective longitudinal cohort. It has a timeframe of 60 weeks: 12 weeks before, 12 weeks after, 24 weeks after and 48 weeks after the start of ETI therapy. The primary outcome is mental well-being, measured at each of these four time points. Patients aged ≥12 years at the University Medical Center Utrecht qualifying for ETI therapy based on their CF mutation are eligible. Data will be analysed using a covariance pattern model with a general variance covariance matrix.

Ethics

The RISE study was classified by the institutional review board as exempt from the Medical Research Involving Human Subjects Act. Informed consent was obtained by both the children (12-16 years) and their caregivers, or only provided by the participants themselves when aged ≥16 years.

Defining and Measuring Resilience in Children with a Chronic Disease: a Scoping Review

More than 25% of all children grow up with a chronic disease. They are at higher risk for developmental and psychosocial problems. However, children who function resiliently manage to adapt positively to these challenges. We aim to systematically review how resilience is defined and measured in children with a chronic disease. A search of PubMed, Cochrane, Embase, and PsycINFO was performed on December 9, 2022, using resilience, disease, and child/adolescent as search terms. Two reviewers independently screened articles for inclusion according to predefined criteria. Extraction domains included study characteristics, definition, and instruments assessing resilience outcomes, and resilience factors. Fifty-five out of 8766 articles were identified as relevant. In general, resilience was characterized as positive adaptation to adversity. The included studies assessed resilience by the outcomes of positive adaptation, or by resilience factors, or both. We categorized the assessed resilience outcomes into three groups: personal traits, psychosocial functioning, and disease-related outcomes. Moreover, myriad of resilience factors were measured, which were grouped into internal resilience factors (cognitive, social, and emotional competence factors), disease-related factors, and external factors (caregiver factors, social factors, and contextual factors). Our scoping review provides insight into the definitions and instruments used to measure resilience in children with a chronic disease. More knowledge is needed on which resilience factors are related to positive adaptation in specific illness-related challenges, which underlying mechanisms are responsible for this positive adaptation, and how these underlying mechanisms interact with one another.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42844-023-00092-2.

Effectiveness of physical and mental health interventions for young people with heart conditions: protocol for a systematic review and meta-analysis

INTRODUCTION

Cardiovascular disease is among the most common of non-communicable diseases, affecting 13.9 million children and young people (CYP) globally. Survival rates for CYP with heart conditions are rising, however, support for adjusting to life with a heart condition is lacking, as such it is unsurprising that one in three suffer from anxiety, depression or adjustment disorder. The proposed review aims to identify and assess the effectiveness of physical and mental health interventions across physical and mental health outcomes in young people with cardiac conditions using narrative synthesis and meta-analysis if appropriate.

METHODS AND ANALYSIS

Embase, Medline, PubMed, PsycINFO, Cochrane Databases, Web of Science and reference lists of relevant publications will be searched from 1980 to June 2022 for articles published in English or Italian. Screening, data extraction, intervention coding and risk of bias will be performed by two independent reviewers using an extraction checklist. Intervention content and features will be identified and reported using the Template for Intervention Description and Replication checklist. A narrative review of the included studies will be conducted. If possible and appropriate, a random-effects model meta-analysis will be conducted to calculate the pooled within-group and between-group effect sizes for the primary outcome measures. If sufficient data are available, a subgroup meta-analysis will investigate whether specific intervention types are associated with different levels of intervention effectiveness.

ETHICS AND DISSEMINATION

This systematic review does not directly involve the use of human beings, therefore, there is no requirement for ethical approval. Findings will be disseminated through peer-reviewed publication and in various media, such as conferences, congresses or symposia.

PROSPERO REGISTRATION NUMBER

CRD42022330582.

Advances in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: A Practical Approach to Transition Program Design: A Scientific Statement From the American Heart Association

It is now expected that most individuals with congenital heart disease will survive to adulthood, including those with complex heart conditions. Maintaining lifelong medical care requires those with congenital heart disease to eventually transfer from pediatric to adult-oriented health care systems. Developing health care transition skills and gaining independence in managing one's own health care is imperative to this process and to ongoing medical and psychosocial success. This scientific statement reviews the recent evidence regarding transition and provides resources, components, and suggestions for development of congenital heart disease transition programs with the goals of improving patient knowledge, self-management, and self-efficacy skills to the level they are capable to eventually integrate smoothly into adult-oriented health care. Specifically, the scientific statement updates 3 sections relevant to transition programming. First, there is a review of specific factors to consider, including social determinants of health, psychosocial well-being, and neurocognitive status. The second section reviews costs of inadequate transition including the public health burden and the impairment in individual quality of life. Finally, the last section discusses considerations and suggestions for transition program design including communication platforms, a family-centered approach, and individual models. Although this scientific statement reviews recent literature surrounding transitions of care for individuals with congenital heart disease there remain significant knowledge gaps. As a field, we have yet to determine ideal timing and methods of transition, and barriers to transition and transfer remain, particularly for the underserved populations. The consequences of poor health care transition are great and garnering outcomes and information through organized, multifaceted, collaborative approaches to transition is critical to improving the lifelong care of individuals with congenital heart disease.

Objective and Personalized Assessment of Disease-Related Knowledge Among Patients With Congenital Heart Disease - Development and Validation of the Japanese Version of the Leuven Knowledge Questionnaire for Congenital Heart Disease

Background: Disease understanding in patients with congenital heart disease is important in transitional and lifelong care. This study aimed to develop the Japanese version of the Leuven Knowledge Questionnaire for Congenital Heart Disease (LKQCHD) and identify factors associated with disease-related knowledge. Methods and Results: After confirming the content and face validity of the scale, a questionnaire including the LKQCHD was distributed to 59 eligible patients aged >16 years attending a university hospital. For the 58 participants who responded (30 males, 28 females; median age 22 years), the mean (±SD) LKQCHD total score was 53.7±15.4, with mean (±SD) scores for each domain as follows: Disease and Treatment, 68.3±19.7; Preventing Complications, 45.8±19.0; Physical Activity, 74.1±34.1; Sex and Heredity, 37.9±35.4; and Contraception and Pregnancy, 40.2±29.1. Regarding known-groups validity, we found a positive correlation between the LKQCHD score and age (ρ=0.268, P=0.042), and a significantly low LKQCHD score in the moderate/severe disease group (η²=0.131, P=0.021). Regarding convergent validity, the LKQCHD score was positively correlated with the total and subscale scores of the Resilience Assessment Tool (r=0.213 [P=0.109] and r=0.405 [P=0.002], respectively). Conclusions: We confirmed the validity of the Japanese version of the LKQCHD, concluding that patient education regarding long-term complications, prevention methods, heredity, pregnancy, and childbirth is needed.

Long-term effectiveness of an mHealth-tailored physical activity intervention in youth with congenital heart disease: A randomized controlled trial

AIMS

To evaluate the long-term effectiveness of the Care & Organize Our Lifestyle (COOL) programme, a self-regulation theory-based mHealth programme, on improving disease knowledge and physical activity in youth with congenital heart disease (CHD).

DESIGN

A three-arm parallel-group randomized controlled trial.

METHODS

A total 143 participants with simple and moderate CHD aged 15-24 years were recruited from June 2016 to February 2018. The 12-month programme compared two active intervention groups to a standard-care control group (n = 47). Participants in one active intervention group (n = 49) were provided with COOL Passport, a mobile healthcare application. Those in the other group (n = 47) were provided with access to the Health Promotion Cloud system and use of game-based interactive platforms along with COOL Passport. Outcomes were the Leuven Knowledge Questionnaire for Congenital Heart Disease and the International Physical Activity Questionnaire-Taiwan Show-Card Version.

RESULTS

After 12 months, 103 participants remained; the overall attrition rate was 28%. No significant differences were observed between the groups in any domain of disease knowledge after 6 months or 1 year. Neither active group exhibited significantly greater physical activity intensity than the standard-care control group in any month during the 1 year.

CONCLUSION

The mHealth-tailored intervention of the COOL programme did not improve disease knowledge or physical activity in young adults with CHD.

IMPACT

The application of the COOL Passport and Health Promotion Cloud system and use of game-based interactive platforms must be modified and verified in future studies and may have clinical potential.

TRIAL REGISTRATION

The registry of clinical trials was ClinicalTrials.gov: NCT04264650.

Mental Health Disorders in Children With Congenital Heart Disease

BACKGROUND

Data on anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) are lacking for youth with congenital heart disease (CHD), particularly those with simple CHD. This study aims to characterize these disorders in youth with CHD compared to those without CHD.

METHODS

A comparative cross-sectional study was conducted by using the electronic medical records of a large tertiary care hospital between 2011 and 2016. Inclusion criteria were youth aged 4 to 17 years with >1 hospitalization or emergency department visits. Exclusion criteria were patients with arrhythmias or treatment with clonidine and/or benzodiazepines. The primary predictor variable was CHD type: simple, complex nonsingle ventricle, and complex single ventricle. The primary outcome variable was a diagnosis and/or medication for anxiety and/or depression or ADHD. Data were analyzed by using logistic regression (Stata v15; Stata Corp, College Station, TX).

RESULTS

We identified 118 785 patients, 1164 with CHD. Overall, 18.2% (n = 212) of patients with CHD had a diagnosis or medication for anxiety or depression, compared with 5.2% (n = 6088) of those without CHD. All youth with CHD had significantly higher odds of anxiety and/or depression or ADHD. Children aged 4 to 9 years with simple CHD had ∼5 times higher odds (odds ratio: 5.23; 95% confidence interval: 3.87-7.07) and those with complex single ventricle CHD had ∼7 times higher odds (odds ratio: 7.46; 95% confidence interval: 3.70-15.07) of diagnosis or treatment for anxiety and/or depression. Minority and uninsured youth were significantly less likely to be diagnosed or treated for anxiety and/or depression or ADHD, regardless of disease severity.

CONCLUSIONS

Youth with CHD of all severities have significantly higher odds of anxiety and/or depression and ADHD compared to those without CHD. Screening for these conditions should be considered in all patients with CHD.

Comparison of resilience and quality of life between adolescent blood cancer survivors and those with congenital heart disease: a cross sectional study

BACKGROUND

The resilience and Quality of Life (QOL) of adolescent cancer survivors was compared with those of children with other diseases to identify the patterns and factors that affect resilience and QOL The purpose of the present study was to compare the resilience and QOL between adolescent blood cancer survivors and adolescents with Congenital Heart Disease (CHD).

METHODS

A cross-sectional study was conducted in two hospitals. Ninety-four adolescent blood cancer survivors and 81 adolescents with CHD completed a self-reported questionnaire regarding resilience, QOL, and general characteristics. Independent t-test and ANCOVA were used to compare the resilience and QOL between adolescent blood cancer survivors and adolescents with CHD.

RESULTS

The resilience of adolescent blood cancer survivors was significantly lower than that of adolescents with CHD, and the QOL of adolescent blood cancer survivors was not different from that of adolescents with CHD.

CONCLUSIONS

The experiences of adolescent blood cancer survivors were different from those of adolescents with CHD even though they are of the same ages. Adolescents with chronic disease have a different level of illness controllability and self-regulation according to their disease and situation. Therefore, health-providers need to develop the specific programs for improving resilience and QOL of adolescents with chronic illness with focusing their characteristics and situations.

Assessing resiliency in paediatric rehabilitation: A critical review of assessment tools and applications

BACKGROUNDS

Resiliency has attracted a growing interest in paediatric rehabilitation as a key capacity for disabled children and their families to thrive. This study aimed to identify measures used to assess resiliency of disabled children/youth and their families and critically appraise the current use of resiliency measures to inform future research and practice.

METHODS

A two-stage search strategy was employed. First, systematic reviews of resiliency measures published since 2000 were searched. Second, full names of measures identified in at least two systematic reviews were searched across four electronic databases. Included studies assessed resiliency among children/youth (0-18 years old) with chronic health conditions and/or disabilities and their families. Identified articles were then analysed to discern the study's definition of resiliency, authors' rationales for measurement selection, and types of perceived adversities facing the study participants.

RESULTS

From an initial yield of 25 measures identified in five systematic reviews, 11 were analysed in two or more reviews. The second stage yielded 41 empirical studies published between 2012 and 2018, which used 8 of the 11 resiliency measures searched by name. Of 41, 17 studies measured resiliency of disabled children/youth, 23 assessed resiliency within family members, and 1 studied both children/youth and their families. Our critical appraisal identified inconsistencies between the studies' definition of resiliency and chosen measures' operationalization, implicit assumption of disabilities as a developmental risk that automatically results in life adversities, and the tendency among family studies to reduce resiliency down to stress coping skills. Research that encompasses contextual factors and developmental influences is lacking.

CONCLUSIONS

There is a need for a situated measurement approach that captures multiple interacting factors shaping resiliency over one's life course. Resiliency measures would benefit from a greater focus on a person-environment transaction and an alternative definition of resiliency that accounts for multiple capacities to navigate through disabling environments.

Illness acceptance in adolescents: A concept analysis

AIM

To strengthen the theoretical understanding of illness acceptance in adolescents and to inform healthcare strategies geared toward supporting adolescents with chronic illness.

BACKGROUND

Illness acceptance is associated with positive health outcomes. Though well understood in adults with chronic illness, less is known about how this phenomenon ensues in adolescents. Adolescents may have a difficult time accepting an illness due to their unique developmental needs. Consequently, they are vulnerable to poor health outcomes.

DESIGN

Concept analysis.

DATA SOURCES

A literature search through 2 databases (PubMed and PsycINFO) and a hand-search through Google were conducted to identify uses of the concept.

REVIEW METHODS

The Walker and Avant method of concept analysis.

RESULTS

Four attributes of illness acceptance were identified: understanding of illness, overcoming limitations, normalization, and readiness for responsibility. Antecedents that predisposed illness acceptance included peer and family support, disease management education, and developmental readiness. Positive consequences of illness acceptance included high self-esteem, improved quality of life, resilience, identity formation, and better disease control.

CONCLUSIONS

Establishing a standardized conceptual understanding of how illness acceptance ensues in adolescents can enable nurses and other health professionals to tailor developmentally appropriate care strategies and optimize the overall quality of life for this unique patient population.

The Effects of Illness Cognition on Resilience and Quality of Life in Korean Adolescents and Young Adults with Leukemia

Purpose: The purpose of this study was to examine the effects of illness cognition on resilience and quality of life (QOL) in adolescents with leukemia. Methods: This study used a cross-sectional, descriptive design. The study was conducted at a hospital in Seoul, Korea. The target population of this study was 72 adolescents and young adults (AYA) who received follow-up visit for leukemia. Participants completed measures of their resilience, illness cognition (i.e., helplessness, acceptance, and perceived benefits), and QOL. The correlation between the study variables was analyzed using Pearson's correlation coefficient, while the impacts on resilience and QOL were analyzed using hierarchical multiple regression. Results: Acceptance, which is a subcategory of illness cognition, was associated with resilience and QOL of AYA leukemia survivors. After acceptance was included in model 2 using the hierarchical multiple regression analysis, the increased explanatory powers of resilience and QOL were 23% and 33%, respectively. Conclusion: The results suggest that acceptance, which is a subcategory of illness cognition, may be an important factor for resilience and QOL in AYA leukemia survivors.

Predictive model for quality of life in patients with recurrent coronary artery disease

Background:

The aims of this study were to construct and verify a model that explains the quality of life in patients with recurrent coronary artery disease.

Methods:

Participants were 212 patients with recurrent coronary artery disease undergoing percutaneous coronary intervention. Data were collected through structured questionnaires from 21 December 2016–30 April 2017, and were analyzed using SPSS 23.0 and AMOS 23.0.

Results:

The model’s fit indices were adequate. Type D personality, symptom experience, and resilience had a direct effect on quality of life, while type D personality, cardiac function status, social support, and resilience had an indirect effect on quality of life. Type D personality, cardiac function status, social support, symptom experience, and resilience explained 55% of the total variance in quality of life. Thus, type D personality, cardiac function status, social support, symptom experience, and resilience affected the quality of life in patients with recurrent coronary artery disease.

Conclusions:

Systematic and integrated intervention programs considering factors related to quality of life may be useful for improving quality of life for patients with recurrent coronary artery disease.

Resilience in children and their parents enduring pediatric medical traumatic stress

Due to the general lack of familiarity with the concept in the medical field, resilience is rarely considered in pediatric medical traumas. Resilience is an ability that enables recovery after adversities such as traumas, surgeries, serious health problems, or social issues. Stress from medical traumas encompasses both the psychological and physical responses of children and their families. Lack of resilience in children with medical traumatic stress may contribute to poor adjustment, slow recovery, disruptive behaviors, and psychiatric disorders. Furthermore, persistent parental distress increases the child's risk of low resilience. Consequently, these patients and their parents require early identification. This is achievable using a common stress measure such as the Perceived Stress Scale. Moreover, health care providers can screen patients' risks for low resilience, which include few social contacts, poor family functioning, and low cohesion among family members. Findings from the stress scale and screened risks could indicate the need for additional psychosocial support at the time of diagnosis of a serious illness, soon after injuries, and before and after operations. Such interventions can include decreasing distress, counseling children and their parents, and enabling strong connections to health care providers. Health care providers can help parents to minimize distress and adjust to their child's illness, thereby supporting the child's resilience, adjustment, and recovery.

The adaptation process of mothers raising a child with complex congenital heart disease

Mothers of children with congenital heart disease (CHD) tend to be concerned about their child's normal life. The majority of these mothers tend to experience negative psychological problems. In this study, the adaptation process of mothers raising a child with complex CHD was investigated based on the sociocultural context of Korea. The data collection was conducted by in-depth interviews and theoretical sampling was performed until the data were saturated. The collected data were analyzed using continuous theoretical comparisons. The results of the present study showed that the core category in the mothers' adaptation process was 'anxiety regarding the future', and the mothers' adaptation process consisted of the impact phase, standing against phase, and accepting phase. In the impact phase, the participants emotionally fluctuated between 'feelings of abandonment' and 'entertaining hope'. In the standing against phase, participants tended to dedicate everything to child-rearing while being affected by 'being encouraged by support' and 'being frustrated by tasks beyond their limits'. In the accepting phase, the subjects attempted to 'accept the child as is', 'resist hard feelings', and 'share hope'. Health-care providers need to develop programs that include information regarding CHD, how to care for a child with CHD, and effective child-rearing behaviors.

Health condition and familial factors associated with health-related quality of life in adolescents with congenital heart disease: a cross sectional study

Background

The focus of clinical care after the repair of congenital heart disease has shifted from saving life of the patient to the patient’s quality of life. The purpose of this study was to examine the health condition and familial factors associated with the health related quality of life of adolescents with congenital heart disease.

Methods

Ninety-eight adolescents aged 13–19 years were collected from a congenital heart clinic from July 22 to August 23, 2013. Perceptions of parental rearing behaviors, health related quality of life of adolescent with congenital heart disease, and general characteristics were measured. We used multiple linear regression analysis to explore factors that are associated with the health related quality of life of adolescents with congenital heart disease.

Results

New York heart association class (Adj R² = .186, p = .000), presence of siblings (Adj R² = .240, p = .010), and mother’s emotional warmth (Adj R² = .265, p = .043) were significantly associated with the health related quality of life of adolescents with congenital heart disease.

Conclusions

Emotionally warm parental rearing behaviors and the presence of siblings were important familial factors that were positively associated with HRQOL in adolescents with CHD. Therefore, it is important for healthcare providers to develop a greater sensitivity to, and awareness of, the familial influences that may be impacting a subject’s HRQOL, as well as the exigencies of the CHD, itself.

A positive perspective of knowledge, attitude, and practices for health-promoting behaviors of adolescents with congenital heart disease

Background:

Health-promoting behaviors could serve as a major strategy to optimize long-term outcomes for adolescents with congenital heart disease. The associations assessed from a positive perspective of knowledge, attitudes, and practice model would potentially cultivate health-promoting behaviors during adolescence.

Aim:

The purpose of this study was to examine the relationships between disease knowledge, resilience, family functioning, and health-promoting behaviors in adolescents with congenital heart disease.

Methods:

A total of 320 adolescents with congenital heart disease who were aged 12–18 years were recruited from pediatric cardiology outpatient departments, and participated in a cross-sectional survey. The participants completed the Leuven Knowledge Questionnaire for Congenital Heart Disease; Haase Adolescent Resilience in Illness Scale; Family Adaptability, Partnership, Growth, Affection, and Resolve; and Adolescent Health Promotion scales. The collected data were analyzed using descriptive statistics and three multiple regression models.

Results:

Greater knowledge of prevention of complications and higher resilience had a more powerful effect in enhancing health-promoting behaviors. Having symptoms and moderate or severe family dysfunction were significantly more negatively predictive of health-promoting behaviors than not having symptoms and positive family function. The third model explained 40% of the variance in engaging in health-promoting behaviors among adolescents with congenital heart disease.

Conclusion:

The findings of this study provide new insights into the role of disease knowledge, resilience, and family functioning in the health-promoting behavior of adolescents with congenital heart disease. Continued efforts are required to plan family care programs that promote the acquisition of sufficient disease knowledge and the development of resilience for adolescents with congenital heart disease.