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Gowda NC, Chatterjee R, Balakrishnan A, Lawrence A, Aggarwal A. Caregiver burden in families of children with juvenile idiopathic arthritis in India. Clin Rheumatol 2024; 43:2009-2019. [PMID: 38662098 DOI: 10.1007/s10067-024-06975-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024]
Abstract
Juvenile Idiopathic Arthritis (JIA) causes caregiver burden on families with children affected with it. Our study aimed to explore this multifaceted burden in the Indian context. In this cross-sectional study, we administered the Hindi translated CAREGIVER questionnaire to adult caregivers in the families of JIA patients ≤ 18 years. The responses to the 28 items were used to calculate the burden scores in various dimensions. The relationship of the global burden scores with demographic and socioeconomic factors were analysed. Non parametric tests were used. Two hundred twenty-one caregivers participated with a median age of 39 years (IQR 32-45). This included 116 fathers, 50 mothers, 32 brothers, 18 uncles, three grandfathers, one sister, and one grandmother. The JIA patients had a median age of 15 (12-17) years, and the male-to-female ratio was 3.2:1. Enthesitis-related arthritis was the predominant subtype (72.4%). Most caregivers (70.6%) expressed sadness at diagnosis, and 29.9% continued to express sadness. Nearly two-thirds (65.6%) had to borrow money from others. More than half (59.3%) of the caregivers neglected their health, and 9.0% became sick. Male gender of the child, systemic JIA subtype, low socioeconomic status, high disease activity, extra-articular damage, high parent-reported disease activity and poor quality of life were associated with higher global caregiver burden. JIA has a significant emotional, social, economic, and labour impact on caregivers. Economic and psychosocial support needs to be given to family caregivers caring for children with JIA.
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Affiliation(s)
- Nikhil C Gowda
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Rudrarpan Chatterjee
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Anu Balakrishnan
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Able Lawrence
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014.
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Chausset A, Lambert C, Belot A, Merlin E, Cannizzaro E, Kone-Paut I, Ballot C, Devauchelle V, Poignant S, Carlomagno R, Lohse A, Barbier C, Despert V, Carbasse A, Sparsa L, Adank E, Vanoni F, Reumaux H, Pillet P, Kaiser D, Hofer M, Freychet C, Schott AM. Individual and environmental determinants associated with longer times to access pediatric rheumatology centers for patients with juvenile idiopathic arthritis, a JIR cohort study. Pediatr Rheumatol Online J 2023; 21:24. [PMID: 36918902 PMCID: PMC10015663 DOI: 10.1186/s12969-023-00809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Despite guidelines, poor access to appropriate care for juvenile idiopathic arthritis (JIA) patients remains a global issue. Prompt referral to a pediatric rheumatology (PR) center and effective care is known to be critical for changing the natural history of the disease and improving long-term prognosis. This project assesses socio-economic factors of delayed referral to a pediatric rheumatologist (PRst) for JIA patients in France and Switzerland within the Juvenile Inflammatory Rheumatism (JIR) Cohort. METHODS All patients diagnosed with JIA, presenting at one center of the JIRcohort in France or Switzerland with additional data on referral pathway were included. Patient characteristics at first visit to the PR center, dates of visits to healthcare providers during referral, and parent characteristics were extracted from the JIRcohort database. RESULTS Two hundred fifty children were included. The overall median time to first PR assessment was 2.4 months [1.3; 6.9] and ranged widely across the JIA subtypes, from 1.4 months [0.6; 3.8] for children with systemic juvenile idiopathic arthritis (sJIA) to 5.3 months [2.0; 19.1] for children with enthesitis-related arthritis (ERA). A diagnosis of ERA and an appointment with an orthopedist during the referral pathway were significantly associated with a longer time before the first PR visit (hazard ratio HR 0.50 [95% CI: 0.29; 0.84]) and HR 0.68 [95% CI: 0.49; 0.93], respectively) in multivariable analysis. Having a mother with a post-graduate educational attainment level was tendentially associated with a shorter time before the first PR visit, (HR 1.32 [95% CI: 0.99; 1.78]). CONCLUSIONS Time to first PRst visit was most often short compared to other studies and close to the British recommendations. However, this time remained too long for many patients. We observed no social inequities in access to a PRst, but we show the need to improve effective pathway and access to a PR center for JIA patients.
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Affiliation(s)
- Aurélie Chausset
- CRECHE Unit, INSERM CIC 1405, Department of Pediatrics, CHU Clermont-Ferrand, Clermont-Ferrand, France.
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard University Lyon 1, Lyon, France.
- Pédiatrie, CHU Estaing, 1 Place Lucie & Raymond Aubrac, Clermont-Fd cedex1, 63003, France.
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology, HFME, Hospices Civils de Lyon, National Referee Centre RAISE & INSERM U1111, Lyon University, Lyon, France
| | - Etienne Merlin
- CRECHE Unit, INSERM CIC 1405, Department of Pediatrics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Elvira Cannizzaro
- Department of Rheumatology, University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - Isabelle Kone-Paut
- Department of Pediatrics & Pediatric Rheumatology, Centre de référence maladies auto-inflammatoires rares et amylose inflammatoire (CEREMAIA), Bicêtre University, Paris Sud Hospital, Le Kremlin-Bicêtre, France
| | - Claire Ballot
- Pediatric Hematology, Jean-Minjoz Hospital, Besançon, France
| | - Valérie Devauchelle
- Rheumatology Department, CHU Brest and Brest University, INSERM UMR 1227, Brest, France
| | | | - Raffaella Carlomagno
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- University Hospital, Geneva, Switzerland
| | - Anne Lohse
- Department of Rheumatology, Nord Franche-Comté Hospital, Belfort, France
| | | | | | - Aurélia Carbasse
- Department of Pediatrics, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | | | - Eva Adank
- Department of Pediatrics, Kantonsspital Graubünden, Chur, Switzerland
| | - Federica Vanoni
- Institute of Pediatrics of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Héloise Reumaux
- Pediatric Rheumatology, Lille University Hospital, Lille, France
| | - Pascal Pillet
- Department of Pediatrics, Hôpital des Enfants, CHRU Bordeaux, Bordeaux, France
| | - Daniela Kaiser
- Department of Pediatrics, Centre Hospitalier Cantonal Luzern, Lucerne, Switzerland
| | - Michael Hofer
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- University Hospital, Geneva, Switzerland
| | - Caroline Freychet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard University Lyon 1, Lyon, France
- Pediatric Nephrology, Rheumatology, Dermatology, HFME, Hospices Civils de Lyon, National Referee Centre RAISE & INSERM U1111, Lyon University, Lyon, France
- Pediatrics, CHU Saint-Etienne, Saint-Etienne, France
| | - Anne-Marie Schott
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard University Lyon 1, Lyon, France
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Chausset A, Pereira B, Echaubard S, Merlin E, Freychet C. Access to paediatric rheumatology care in juvenile idiopathic arthritis: what do we know? A systematic review. Rheumatology (Oxford) 2021; 59:3633-3644. [PMID: 32940701 DOI: 10.1093/rheumatology/keaa438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/28/2020] [Accepted: 06/21/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE This review examines time to access appropriate care for JIA patients and analyses the referral pathway before the first paediatric rheumatology (PR) visit. We also describe factors associated with a longer referral. METHODS We performed a systematic literature review, screening electronic databases (PubMed, Web of Science, EMBASE, Cochrane library and Open Grey database) up to February 2020. Articles written before 1994 (i.e. before the introduction of the unifying term JIA) were excluded. RESULTS From 595 nonduplicate citations found, 15 articles were finally included in the review. Most of the studies took place in Europe. The median time to first PR visit ranged from 3 to 10 months, with some disparities between referral pathway and patient characteristics. Patients with systemic-onset JIA had the shortest time to referral. Some clinical and biological factors such as swelling, fever, and elevated CRP and/or ESR were associated with a shorter time to first PR visit. Conversely, enthesitis, older age at symptom onset or pain were associated with a longer time. Whatever the country or world region, and despite disparities in healthcare system organization and healthcare practitioner availabilities, times to access PR were not wide-ranging. CONCLUSION This is the first systematic review to summarize research on access to PR for JIA patients. The pathway of care for JIA patients remains complex, and reasons for delayed referral depend on several factors. Standardized clinical guidelines and fast-track pathways to facilitate prompt referral to specialized teams have to allow for worldwide disparities in healthcare provision.
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Affiliation(s)
- Aurélie Chausset
- Department of Pediatrics, Clermont Ferrand University Hospital, Clermont-Ferrand.,CRECHE Unit, INSERM, CIC 1405, Clermont Auvergne University, Clermont-Ferrand
| | - Bruno Pereira
- Department of Biostatistics, Clermont Ferrand University Hospital, Clermont-Ferrand
| | - Stéphane Echaubard
- Department of Pediatrics, Clermont Ferrand University Hospital, Clermont-Ferrand
| | - Etienne Merlin
- Department of Pediatrics, Clermont Ferrand University Hospital, Clermont-Ferrand.,CRECHE Unit, INSERM, CIC 1405, Clermont Auvergne University, Clermont-Ferrand
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Waite-Jones JM, Swallow V, Madill A. From 'neurotic' to 'managing' mother: The 'medical career' experienced by mothers of a child diagnosed with Juvenile Idiopathic Arthritis. Br J Health Psychol 2020; 25:324-338. [PMID: 32150659 DOI: 10.1111/bjhp.12409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/13/2020] [Indexed: 11/27/2022]
Abstract
Objective Despite increased research into how caring for a child diagnosed with juvenile idiopathic arthritis (JIA) affects mothers, more needs to be known about ways in which such experiences transform their lives. Insight into the experiences of such mothers was sought through analysis of interviews with eight mothers and one father caring for a child with JIA. Design The study is situated within a larger project involving families with a child with JIA. A social constructionist approach was adopted and grounded theory including a 'negative case,' guided gathering and analysing data. Individual, semi-structured interviews were conducted based on the research question: 'What is it like to be the mother of a child with juvenile idiopathic arthritis?' Results Findings suggest that mothers find difficulty living up to the 'ideal mother' expected within Western society when forced to provide competing demands of age-related, yet illness-relevant care. The unpredictable nature of JIA means mothers face a lack of understanding from professionals so become hyper-vigilant, 'battling' on behalf of their ill child. A self-perpetuating loop develops if this is misperceived as being overprotective, leaving mothers vulnerable to being judged 'neurotic'. However, with experience, often at an emotional cost, such mothers' confidence in managing the competing demands of caring for their ill child increases such they can navigate a positive journey from 'neurotic' to 'managing' mother. Conclusions Understanding this process could help health care professionals reduce stressful experiences faced by mothers when caring for a chronically ill child. Statement of contribution What is already known on this subject? Mothers of chronically ill children are often diagnosed with anxiety and depression. Such mothers will have taken over managing their child's condition, and this can include negative experiences within the health care system. Qualitative methods enable deeper understanding of the experiences of mothers of chronically ill children. What does the study add? Potentially gendered position of mothers of children with chronic conditions. Taken for granted assumptions implicitly underpin interactions between mothers and some professionals. Greater partnership between mothers and professionals ultimately improves the care of the ill child.
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Affiliation(s)
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, UK
| | - Anna Madill
- School of Psychology, University of Leeds, UK
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Torres-Made MD, Peláez-Ballestas I, García-Rodríguez F, Villarreal-Treviño AV, Fortuna-Reyna BDJ, de la O-Cavazos ME, Rubio-Pérez NE. Development and validation of the CAREGIVERS questionnaire: multi-assessing the impact of juvenile idiopathic arthritis on caregivers. Pediatr Rheumatol Online J 2020; 18:3. [PMID: 31937332 PMCID: PMC6961380 DOI: 10.1186/s12969-020-0400-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/06/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The primary caregiver is an important person in the life of patients with JIA. Their reactions depend on social, emotional and economic factors that affect the therapeutic alliance. Some generic instruments have been used to evaluate burden, anxiety, or quality of life of caregivers. This study aims to develop a specific instrument to measure the psychosocial and economic impacts on primary caregivers of patients with JIA. METHODOLOGY This is a mixed methods research, that includes qualitative and quantitative data, and was carried out in two phases. First phase: a pragmatic qualitative study (questionnaire construction) was conducted in two parts, a non-systematic literature review followed by interviews with primary caregivers. Second phase: a cross-sectional study (questionnaire validation) to complete validation and estimate Cronbach's alphas based on tetrachoric correlation coefficients, correlation matrix and Cohen's kappa coefficient test. RESULTS There were 38 articles found related to the experience of caregivers. 15 primary caregivers were interviewed (female 93%, median age 45 years). Thematic analysis identified 9 important topics from the perspective of participants (economic impact, coping, family roles, impact of diagnosis, mental health, couple/mate relationships, impact at work, religion, and knowledge of the disease). These topics were combined to create the interview questionnaire (56 items). Later, it was modified to 62 items that were divided into five dimensions: impact of the disease (psychosocial, economic, family, and relationships), knowledge of the disease, alternative medicine, future, and religion. The interview questionnaire was applied to 32 primary caregivers (female 93%, median age 37 years), results identify depression on 29 (90%), 18 (56%) feel sadness at diagnosis, 20 (63%) mentioned that JIA has influenced in their financial situation, 23 (72%) feel anxiety about the future, and 11 (37%) considered that their family relationships have changed. Statistical analysis identified inconsistencies during convergent and divergent validity of the construct. Consequently, 11 items were eliminated, 3 relocated, 6 modified, and 39 compacted obtaining the "Impact of Pediatric Rheumatic Diseases on Caregivers Multi-assessment Questionnaire" (CAREGIVERS questionnaire). This final version resulted on an eight-dimension (28 items) instrument. CONCLUSIONS The CAREGIVERS questionnaire captures perspectives of both the participants and clinicians. It will be helpful to measure the impact of the disease and thus, to improve the quality of care of children with JIA and their families.
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Affiliation(s)
- Marcia Daniela Torres-Made
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Ingris Peláez-Ballestas
- 0000 0001 2221 3638grid.414716.1Rheumatology Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Fernando García-Rodríguez
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Ana Victoria Villarreal-Treviño
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Brenda de Jesús Fortuna-Reyna
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Manuel Enrique de la O-Cavazos
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Nadina Eugenia Rubio-Pérez
- Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José E. González", Monterrey, Mexico.
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Ma J, Yu Q, Zhang T, Zhang Y. Chinese family care patterns of childhood rheumatic diseases: A cluster analysis. Int J Nurs Sci 2019; 7:41-48. [PMID: 32099858 PMCID: PMC7031127 DOI: 10.1016/j.ijnss.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/14/2019] [Accepted: 11/27/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives The purpose is to distinguish family care (FC) patterns of childhood rheumatic diseases in Chinese families and to determine the predictors of FC patterns. Methods This secondary analysis contained two cross-section surveys with a convenient sample of totally 398 caregivers who have a child with rheumatic diseases from four pediatric hospitals. Caregivers were required to completed Family Management Measure questionnaire. Cluster analysis was used to distinguish patterns and multinomial logistic regression analysis was used to find predictors. Results Four patterns were identified: the normal-perspective and collaborative (28.4%), the effortless and contradictory (24.6%), the chaotic and strenuous (18.3%), and the confident and concerning (28.7%). Disease category (χ2 = 21.23, P = 0.002), geographic location (χ2 = 8.41, P = 0.038), maternal educational level (χ2 = 12.69, P = 0.048) and family monthly income (χ2 = 33.21, P < 0.001) predicted different patterns. Conclusions FC patterns were different among families. Disease-related and family-related factors were vital predictors to distinguish patterns consistent with the Family Management Style Framework. The result assisted that clinicians recognize FC patterns and predictors effectively to provide tailored advice in time.
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Affiliation(s)
- Jiali Ma
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Qinglin Yu
- Department of Nephrology and Rheumatology, Children's Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Taomei Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
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Freychet C, Lambert C, Pereira B, Stephan JL, Echaubard S, Merlin E, Chausset A. Medical pathways of children with juvenile idiopathic arthritis before referral to pediatric rheumatology centers. Joint Bone Spine 2019; 86:739-745. [PMID: 31121314 DOI: 10.1016/j.jbspin.2019.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A better understanding about the referral pathway of patients suffering from juvenile idiopathic arthritis (JIA) is required The aim of this study was to describe and analyze time from onset of symptoms to first pediatric rheumatology (PR) visit and the referral pathway of children with incident JIA in two French competence centers. METHODS From October 2009 to October 2017, new JIA patients were registered in the "Auvergne-Loire cohort on JIA". We collected referral pathway, symptom onset, biological and clinical data at first assessment in PR department. RESULTS In all, 111 children were included. Median time to first PR visit was 3.3 months [interquartile range (IQR) 1.3, 10.7] with a significant difference between JIA subtypes. After exclusion of systemic JIA, older age at onset of symptoms, and presence of enthesitis or joint pain were significantly associated with a longer time to first PR visit, while joint swelling or limping, abnormal ESR or CRP were associated with a shorter time. The median number of health care practitioners met was 3 [IQR 3, 4]. Orthopedists referred children to a PR center in 64% of cases, pediatricians in 50%, emergency care practitioners in 27% and general practitioners in 25%. Although non-systemic JIAs are not an emergency, 45% were referred to the emergency room. CONCLUSION Time to first PR visit is rather short compared to other countries but remains too long. Pediatric rheumatologists should offer primary care providers basic training on JIA and fast direct access to PR departments if JIA is suspected.
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Affiliation(s)
- Caroline Freychet
- Health services and performance research (HESPER) laboratory, Claude-Bernard university, 8, avenue Rockefeller, 69003 Lyon, France; Service de pédiatrie, CHU de St-Étienne, 42000 St-Étienne, France.
| | - Céline Lambert
- Délégation de la recherche clinique et de l'innovation, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation de la recherche clinique et de l'innovation, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Jean L Stephan
- Service de pédiatrie, CHU de St-Étienne, 42000 St-Étienne, France
| | - Stéphane Echaubard
- Inserm CIC 1405, service de pédiatrie, CHU Estaing, 63003 Clermont-Ferrand, France
| | - Etienne Merlin
- Inserm CIC 1405, service de pédiatrie, CHU Estaing, 63003 Clermont-Ferrand, France
| | - Aurélie Chausset
- Inserm CIC 1405, service de pédiatrie, CHU Estaing, 63003 Clermont-Ferrand, France
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Yuwen W, Lewis FM, Walker AJ, Ward TM. Struggling in the Dark to Help My Child: Parents' Experience in Caring for a Young Child with Juvenile Idiopathic Arthritis. J Pediatr Nurs 2017; 37:e23-e29. [PMID: 28778610 PMCID: PMC5681389 DOI: 10.1016/j.pedn.2017.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/28/2017] [Accepted: 07/18/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of this study is to describe parents' experiences in caring for 2-5-year-old children with juvenile idiopathic arthritis (JIA). DESIGN AND METHODS A qualitative study using single-occasion in-depth interviews was conducted. Nine parents (eight mothers and one father) were interviewed in-person or via telephone. Data were analyzed using inductive content analysis. Methods used to protect the trustworthiness of study results included maintenance of an audit trail, peer debriefing, and member checks. RESULTS The core construct Struggling in the Dark to Help My Child explained parents' experience in six domains: not knowing, trying to reach out in the dark, feeling my child's pain, working out the kinks to stay on top to manage, feeling drained by the whole process, and being hard on the entire household. Parents struggled with the unknown, searched for resources, witnessed their child's suffering without knowing how to help, and tried every possible way to stay on top of the child's illness and treatment, even when they felt drained physically and emotionally. JIA not only consumed their lives, but also affected the entire family, including the siblings and spouse, and the relationships among family members. CONCLUSION AND IMPLICATIONS Findings highlight the day-to-day lived challenges parents face when caring for a young child with JIA. Healthcare providers including nurses need to assess the particular needs of an ill child and parents as well as the impact of the illness on the physical and psychosocial health of the entire family so that proper resources can be provided.
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Affiliation(s)
- Weichao Yuwen
- Nursing and Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, United States.
| | - Frances M Lewis
- Family and Child Nursing, University of Washington, Seattle, WA, United States
| | - Amy J Walker
- Family and Child Nursing, University of Washington, Seattle, WA, United States
| | - Teresa M Ward
- Family and Child Nursing, University of Washington, Seattle, WA, United States
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