Understanding Parents' Experiences When Caring for a Child With Functional Constipation: Interpretive Description Study

The psychosocial implication of childhood constipation on the children and family: A scoping review protocol

Background

Constipation is a common problem in childhood that can have psychological, emotional, social, and health-related quality-of-life (HRQOL) consequences on children and their families. Primary or functional constipation (FC) has no known underlying pathology but is associated with lifestyle, psychological, and behavioural factors. Misdiagnosis and inadequate management of constipation can result in chronicity that can continue to adulthood, reducing quality of life for the child and their parents/family. It also causes emotional, psychological and emotional distress and concern for children and their families. This scoping review aims to answer the research question, "What has been reported about the psychosocial implication of childhood constipation among children and their families?"

Methods

The methodology for this scoping review will draw on the six stages of Arksey and O'Malley Framework and the updated and refined version by Peters et al. (2022). The process and reporting will follow the PRISMA-ScR guidelines. The Population, Concept and Context (PCC) framework will guide the development of inclusion criteria and the search strategy for this scoping review. Systematic literature searches of PUBMED, CINAHL, ASSIA, PsycInfo and Cochrane Library will be conducted from inception to present. The critical appraisal will be performed on selected articles to promote trustworthiness and methodological rigour. Plans for consultation exercise and dissemination of findings will also be presented.

Conclusion

This scoping review aims to present a comprehensive synthesis of the characteristics and extent of available literature to develop an understanding of and identify gaps in current knowledge regarding the psychosocial implication of childhood constipation on children and their families.

Four year evaluation of a parent advisory group to support a research program for knowledge translation in child health

BACKGROUND

In 2016, we developed a pediatric parent advisory group to inform our research program which creates innovative knowledge translation (KT) tools for parents on priority topics related to acute childhood illness. We implemented a mixed methods strategy to evaluate the experiences of group members. The purpose of this paper is to present the findings from parent evaluations over four years and to discuss our experiences collaborating with the group over a multi-year period.

METHODS

We conducted year-end surveys and interviews of group members to understand parents' perceptions of their experiences, group management, researcher interaction, and other outcomes of advisory group participation from 2018 to 2021. We applied a mixed methods approach, collecting and analyzing both quantitative (survey) and qualitative (survey/interview) data. Survey data were analyzed by term using descriptive statistics (i.e., frequencies, percentages). Open-ended survey responses were analyzed by conventional content analysis. Interview data were analysed thematically.

RESULTS

Year-end survey response rates and interview participation varied over the years. Responses to evaluation questions were generally positive and most improved over time. Results prompted changes to improve P-PAG operations, such as changes to location of meetings, communications about the group's purpose, offering sufficient context for discussion items, and providing feedback about how members' input was used. Themes identified from the qualitative data related to the importance of certain aspects of group functioning, positive views of the group's current management, and potential areas for improvement. Parents regularly expressed a desire for more diversity in the group's membership and an interest in hearing more about how the research program's activities fit into the broader healthcare system and their impacts on health outcomes.

CONCLUSIONS

Our experience in establishing, managing, and evaluating a parent advisory group over many years has resulted in valuable insights regarding patient engagement in health research and sustaining an advisory group over time. We have learned that an intentional and iterative approach with regular evaluations and responsive changes has been essential for fostering meaningful engagement. Significant resources are required to maintain the group; in turn, the group has made substantial and diverse contributions to the research program and its outputs.

Development and survey of a questionnaire to measure parental perceptions of childhood defecation and constipation

BACKGROUND

There are insufficient data and measuring tools for parental perception of defecation and constipation in Thai children. The primary objective of this study was to develop a tool to measure parental perceptions towards defecation and constipation in children. The secondary objective was to identify parental understanding and misconceptions about these issues.

METHODS

The authors developed a questionnaire in three domains: knowledge, attitude, and practice. Content validity was evaluated using the item-objective congruence index (IOC) by five experts. The reliability of the measure was assessed based on both internal consistency and test-retest reliability. Then, a descriptive cross-sectional survey was conducted on Thai parents at pediatric outpatient clinics and wards in Bhumibol Adulyadej Hospital.

RESULTS

The authors developed a first draft questionnaire consisting of 31 items, which were categorized into three domains of knowledge, attitude, and practice. During expert validation, five items were disqualified. To assess the questionnaire's reliability, Cronbach's alpha value was calculated and found to be 0.229 for the original questionnaire. However, after removing irrelevant questions, Cronbach's alpha value increased to 0.511 for an 18-item questionnaire. The adjusted questionnaire demonstrated excellent test-retest reliability (Intraclass correlation coefficient, ICC = 0.91). The survey with 306 parents revealed parental misconceptions about the pathophysiology of stool withholding, stool soiling indicating constipation, toilet training after meals, and monitoring bowel movements.

CONCLUSION

The developed questionnaire helps to assess parental perception regarding defecation and constipation in Thai children. Based on the survey results, the authors suggest that parental education on these issues is still necessary.

What is needed by parents of constipated infants and toddlers: A cross-sectional study in China

Background

Childhood functional constipation is a worldwide problem that affects the intestinal function of children and the quality of life of their families. Treatment and management of the disease need to be carried out at home by parents. Assessment of caregiving needs is an important link in planning and implementing the intervention. This study aimed to assess the caregiving needs of parents of FC infants and toddlers.

Methods

The researchers recruited convenience samples of parents from an outpatient pediatric constipation clinic of a children's medical center. Totally 211 fathers/mothers were recruited. Nursing needs were measured by a questionnaire, and associations between nursing needs and potential factors were examined using multiple regression analysis.

Results

The vast majority of participants (88.7%) expressed the need of receiving support from professionals, and only 44 (20.85%) had obtained help from medical staff. The needs of parents mainly include information needs, health needs, psychological needs, and social needs. Of all the needs, the highest score was for information needs (3.87 ± 0.69), followed by the dimension of health needs (3.74 ± 0.82). Results showed statistically significant differences in parental education, place of residence, age of children, duration of FC, defecation frequency, difficulty of defecation, and stool traits in nursing needs (p < 0.05). The regression model explained 64.2% of the variance of nursing needs.

Conclusions

Information needs were the major concern for parents, and the unmet needs of parents should be addressed during treatment and care. When developing care plans and providing health education, it should be adjusted according to the specific conditions of the child and parents to improve the compliance of the parents with treatment and care.

Everyday life with childhood functional constipation: A qualitative phenomenological study of parents' experiences

Childhood functional constipation (FC) is a worldwide problem with treatment regiments affecting everyday life.

AIM

To explore parents´ experiences of living with a child with FC and its impact on everyday family life.

METHOD

A qualitative phenomenological interview study using a reflective lifeworld research approach. Interviews with 15 parents of otherwise healthy children aged 1-14 years affected by FC.

FINDINGS

Shame is the driving force making parents put everyday life on hold. The quest for control, self-imposed loneliness, guilt, inadequacy, and frustrating battles become essential parts of everyday life to protect it from FC-related shame.

CONCLUSION

FC has as great an impact on everyday life as any childhood illness. Every part of family life is affected by FC. Continuously family support and guidance are needed.

PRACTICE IMPLICATIONS

Healthcare professionals need to take FC more seriously, listen to the parents and try to understand their experiences of everyday life to enable custom made care plans with the family-unit in focus. Care with clinical sensitivity might help parents deal with the attendant shame and stigmatization that stem from illness beliefs about FC.

Burden of Pediatric Functional Gastrointestinal Disorder in an Emergency Department-A Single-Center Experience

OBJECTIVES

Functional gastrointestinal disorders (FGIDs) are recurrent or chronic gastrointestinal signs and symptoms in the absence of anatomical or biochemical alterations. They are commonly treated in outpatient setting but often present to emergency departments. We aimed to estimate the burden of pediatric FGID on a busy accident and emergency (A&E) department.

METHODS

Electronic patient records were used to retrospectively analyze the A&E attendances of 3866 patients presenting with either constipation or abdominal pain. Those found not to have a surgical/organic cause were assessed in terms of various parameters, that is, arrival times, wait times, and investigations performed.

RESULTS

A total of 91.31% of the attendances relating to constipation or nonsurgical, nonorganic causes of abdominal pain were self-referred with only 3.64% arriving via ambulance, an average wait time ranging between 138 and 156 minutes, and a total of 1008 investigations carried out on patients presenting with these symptoms. A total of 63.65% of the patients were discharged without follow-up.

CONCLUSIONS

Functional gastrointestinal disorders place considerable burden on the A&E, in terms of resource usage, time of clinicians, and financial strain. More education should be provided to families of those experiencing FGID in an outpatient setting to minimize A&E resource utilization. More research is needed to ascertain the true burden of FGIDs, both financially and in terms of time and resource.

Adapting child health knowledge translation tools for Somali parents: a qualitative study exploring process considerations and stakeholder engagement (Preprint)

Background

Objective

Methods

Results

Conclusions

A Scoping Review of Non-Pharmacological Health Education Provided to Families of Children With Idiopathic Childhood Constipation Within Primary Health Care

Objectives:

Idiopathic childhood constipation is a prevalent condition that initially brings the child under the care of the primary health care team. Although it is acknowledged that health education is crucial to reducing chronicity, the range of evidenced-based non-pharmacological health education provided to families has not previously been reviewed. For this scoping review, 4 research questions sought to identify papers that provide information on the utilization of guidelines, the range of health education, who provides it, and whether any gaps exist.

Methods:

Following a registered protocol and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, searches of 10 online databases, reference lists, Google Scholar, and book chapter references were made. Eligible papers were original research published in English between January 2000 and December 2022.

Results:

Twelve worldwide studies (2 qualitative and 10 quantitative) reported that: evidence-based guidelines are not consistently used by primary care providers; the range of non-pharmacological health education provided is inconsistent; the non-pharmacological health education is provided by doctors, nurses, and pharmacists; and that gaps exist in non-pharmacological health education provision.

Conclusion:

This review demonstrates that rather than a lack of guideline-awareness, decreased specific idiopathic childhood constipation knowledge (and possibly time) may be responsible for inconsistent non-pharmacological health education. Inappropriate treatment and management of some children escalates risk for chronicity. Improving health education provision however, may be achieved through: increased collaboration; better utilization of nurses; and through developing the child’s health literacy by involving both child and family in all aspects of health education and decision-making.