A preliminary study of factors that influence children's sense of competence to manage their asthma

Information-enhancement and goal setting techniques for increasing adaptive motivation and decreasing urges to drink alcohol

OBJECTIVE

The aim of the study was to determine whether experimental manipulation of sense of control would change moderate drinkers' (N=106) task-specific motivational structure and explicit and implicit determinants of their urge to drink alcohol.

METHOD

The effects of various levels of information-enhancement and goal-setting on participants' performance on experimental tasks were assessed. Participants were randomly assigned to a high-sense-of-control, low-sense-of-control, or no-intervention group. Dependent measures were indices derived from a task-specific version of the Personal Concerns Inventory and the Shapiro Control Inventory, Alcohol Urge Questionnaire, and alcohol Stroop test.

RESULTS

At baseline, there were no differences among the groups on any of the measures; however, post-experimentally, induced sense of control had led to increases in adaptive motivation and decreases in explicit and implicit measures of the urge to drink.

CONCLUSIONS

The results show that sense of control can be experimentally induced. This finding has important clinical implications.

Effect of relaxation-breathing training on anxiety and asthma signs/symptoms of children with moderate-to-severe asthma: a randomized controlled trial

BACKGROUND

Emotional stress triggers and exacerbates asthma in children. Reducing anxiety in adults by relaxation-breathing techniques has been shown in clinical trials to produce good asthma outcomes. However, more evidence is needed on using this intervention with asthmatic children.

OBJECTIVE

To evaluate the effectiveness of combined self-management and relaxation-breathing training for children with moderate-to-severe asthma compared to self-management-only training.

DESIGN

Two-group experimental design.

SETTING AND PARTICIPANTS

Pediatric outpatient clinic of a medical center in central Taiwan. Participants were 48 children, ages 6-14 years, with moderate-to-severe asthma and their parents.

METHODS

Participants were randomly assigned to an experimental or comparison group and matched by gender, age, and asthma severity. Both groups participated in an asthma self-management program. Children in the experimental group were also given 30 min of training in a relaxation-breathing technique and a CD for home practice. Data on anxiety levels, self-perceived health status, asthma signs/symptoms, peak expiratory flow rate, and medication use were collected at baseline and at the end of the 12-week intervention. Effects of group, time, and group-time interaction were analyzed using the Mixed Model in SPSS (12.0).

RESULTS

Anxiety (especially state anxiety) was significantly lower for children in the experimental group than in the comparison group. Differences in the other four physiological variables were also noted between pre- and post-intervention, but these changes did not differ significantly between groups.

CONCLUSIONS

A combination of self-management and relaxation-breathing training can reduce anxiety, thus improving asthmatic children's health. These results can serve as an evidence base for psychological nursing practice with asthmatic children.

Screening children with asthma for psychosocial adjustment problems: a tool for health care professionals

OBJECTIVE

To develop a brief questionnaire for health care professionals to use in screening children with asthma for psychosocial adjustment problems.

METHOD

The initial version of the Childhood Asthma Resiliency Questionnaire (CARQ) listed 85 items focusing on self-esteem, medical fears, peer relationships, family relations, stress, and depression. The number of items was reduced after focus groups and pilot testing. In pilot tests, 100 children with asthma completed the CARQ. Parents completed the Child Behavior Checklist (CBCL). Another sample of 73 children with mild asthma was also obtained.

RESULTS

The total CARQ score was significantly correlated (p < 0.001) with Total Problems, Internalizing, and Externalizing Problems on the CBCL. Children with more hospitalizations and more days of school missed from asthma had significantly higher scores on the CARQ compared to children with less functional morbidity.

CONCLUSION

The CARQ appears to be a useful brief measure to help clinicians identify children at risk for problems adjusting to asthma.

Associations among risk factors, individual resources, and indices of school-related asthma morbidity in urban, school-aged children: a pilot study

This paper presents a conceptual model including examples of risk and resource factors associated with indices of school-related asthma morbidity (eg, missed sleep, participation in activities, school absences) in a group of urban, school-aged children with asthma from ethnic minority backgrounds. Specifically, the current longitudinal study examines relations between a contextual risk factor (ie, family life stressors), an asthma-related risk factor (ie, asthma symptoms), individual resources (ie, attention, children's problem-solving beliefs, and self-esteem), and aspects of asthma morbidity that have been shown to have an impact on children's academic performance. Participants of the study included 31 mother-child dyads from low-income, inner-city neighborhoods. Results of hierarchical regression analyses revealed that after controlling for risk factors (ie, asthma symptoms and family life stressors) at baseline, children's individual characteristics (ie, children's problem-solving beliefs and self-esteem) functioned as resource factors for some indices of asthma-related functioning (school absences, participation in activities, and missed sleep) at follow-up (1 year later). Results suggest that contextual and individual risk and resource factors should be further explored in studies including larger samples of urban children with asthma in order to help guide the development of preventive interventions in school-based and health care settings.

Relationships of asthma knowledge, self-management, and social support in African American adolescents with asthma

Despite nationwide efforts to manage asthma, the adverse outcomes of asthma continue to increase, especially in African American adolescents. The purpose of this study was to examine the relationships among asthma knowledge, self-management, and social support in African American adolescents with asthma. A correlational descriptive study was conducted using a convenience sample of 53 identified asthmatic adolescents from the Southern metropolitan school system in Alabama. Asthma knowledge was measured by the Parcel Knowledge about Asthma Questionnaire, social support by the Norbeck Social Support Questionnaire, and asthma self-management behaviors by the Asthma Behavioral Assessment Questionnaire. Both asthma knowledge and social support had significant positive relationships (r=0.31, r=0.30, respectively) with asthma self-management behaviors and accounted for 14% of self-management behaviors variability. Further studies are needed to understand how to better manage asthma in adolescents.

Implementing a pediatric asthma program: enabling self-care management through education

This article provides an overview of asthma prevalence among children, presents a summary of asthma triggers based on past research, outlines the essential components of a pediatric asthma home care model implemented by a large urban home health agency, and details the types of clinical documentation needed for care plan development and monitoring of asthma in the home.

Evaluating the needs of children with asthma in home care: the vital role of nurses as caregivers and educators

To date, few evaluations have examined issues specific to children's asthma management in their homes. This study examined the characteristics, risk factors, and needs of children with asthma, and the impact of home health nurses on improving parents'/family caregivers' knowledge about asthma triggers and management. The medical records of children, </=19 years, residing in New York City, who were admitted to home care with asthma in 1999 (n = 1,007) were reviewed retrospectively to collect a wide range of data. The majority of children with asthma in home care were </=5 years, male, racial/ethnic minorities, and hospital referred. Approximately one in four children with asthma suffered from additional comorbidities. Home environmental triggers included dust/dust mites, animal dander, mold, perfumes/detergents, and cigarette smoke. Notable psychosocial triggers were family tensions, physical activity, anxiety/stress, and friends/peer pressure. Most parents/family caregivers had inadequate knowledge about recognition of asthma attacks and its triggers and management. Discharge assessments suggested that home health nurses can help improve caregivers' knowledge about asthma management. Children with asthma in home care have diverse needs, receive few nurse home visits, and have parents/family caregivers in need of more intensive education on asthma symptom recognition and management.

Adolescents' coping with surgery for scoliosis: effects on recovery outcomes over time

Surgery for adolescent idiopathic scoliosis is painful and stressful and has a long and demanding recovery. The purpose of this study was to examine pre- and postoperative avoidant/vigilant coping and long-term activity outcomes through 9 months postsurgery for adolescents (11-18 years, N = 113) undergoing scoliosis surgery. Generally, more vigilant copers (preoperatively and 1 month postoperatively) participated in more activities (usual, new, and social) and had higher academic performance during recovery. Several moderation effects indicated these relationships were stronger for older adolescents and those more internal in locus of control. Adolescents were more vigilant in the hospital, became more avoidant 1 month after surgery, and remained at these levels 6 months postsurgery. Understanding coping processes and individual factors is necessary to develop interventions to help adolescents cope successfully with recovery demands.

Eine Skala zur Erfassung von elterlichen Selbstwirksamkeitserwartungen im Umgang mit dem Asthma ihres Kindes

Zusammenfassung. Theoretischer Hintergrund: Die wahrgenommene Selbstwirksamkeit wird als wichtige Erklärungs- und Vorhersagevariable zur Umsetzung von Behandlungsmaßnahmen erachtet. Messinstrumente zur Erhebung der Selbstwirksamkeit bei Eltern asthmakranker Kinder fehlen. Fragestellung: Entwicklung und Validierung einer Selbstwirksamkeitsskala, die die Erwartungen der Eltern bzw. Bezugspersonen im Umgang mit asthmaspezifischen Anforderungssituationen erfassen soll. Methode: 188 Eltern asthmakranker Kinder beantworteten diese Skala. Zur Konstrukt- und Kriteriumsvalidierung wurden die “allgemeine Kompetenzerwartung“, der “Paediatric-Asthma-Caregivers-Quality-of-Life-Questionnaire“, die gesundheitsbezogene Lebensqualität (SF-12) ebenso wie Krankheitsparameter und -indikatoren erfasst. Ergebnisse: Die psychometrischen Itemkennwerte liegen im annehmbaren Bereich; die interne Konsistenz ist zufriedenstellend; Veränderungen der Selbstwirksamkeit ergeben sich im Verlauf von Interventionen. Schlussfolgerung: Die Korrelationen mit konstruktfernen und -nahen Fragebögen unterstützen deren Validität. Die Skala kann in klinischen Studien die Veränderung des Selbstwirksamkeitserlebens abbilden.

Perceptions and attitudes of adolescents with asthma

BACKGROUND

Psychosocial factors can limit one's ability to effectively manage asthma. This can result in asthma morbidity that limits quality of life. While self-perceptions of asthmatic children and parents have been studied, less is known about self-perceptions of inner-city adolescents with asthma.

OBJECTIVE

To examine perceptions and attitudes to treatment among inner-city adolescents with asthma.

DESIGN/METHODS

We conducted a multistaged stratified sample survey at a high school located in the Bronx, NY. First, an asthma-screening survey was administered to 3800 registered students. Then, we identified a subset of 200 children with the most positive screening results for asthma. Next, a 32-item self-completion questionnaire was administered to this cohort. Students were surveyed regarding severity of asthma, perceptions and attitudes, and demographic information. Differences in proportions were tested by Chi-square analyses. Pearson rank-order correlation and multiple logistic regression were used to assess the relationship between perceptions and attitudes to self-treatment.

RESULTS

A total of 160 (80%) students participated. Mean age was 15.7 years. Of the respondents, 63% were female. 68% were Hispanic, 26% were African American. 33% had weekly symptoms, and 14% had daily symptoms. Additionally, 41% did not know the name of their asthma medicine. Only 38% reported bringing an "asthma pump" when leaving the house. While 70% reported feeling in control over their asthma symptoms, 63% reported feelings of anxiety and 39% could remember a time when they felt like they were going to die from asthma. Subjects who reported feeling in control over their asthma were more likely to take an asthma pump with them when leaving the house (r = 72, p = 0.004). Only 39% had disclosed their asthma to their friends, and 29% felt embarrassed about having an asthma attack in front of their friends. Subjects who felt embarrassed about their asthma were significantly less likely to take their asthma pumps with them (r = 0.98, p < 0.001) and less likely to use their medications in front of their friends (r = .87, p < 0.001).

CONCLUSIONS

Adolescents in this study reported feelings of anxiety, fear, and embarrassment about their asthma. Feelings of control over asthma symptoms were associated with positive attitudes toward self-treatment, while embarrassment was correlated with negative attitudes. These findings have implications for counseling adolescents with asthma about self-management strategies.

What determines knowledge of asthma among young people and their families?

In this analysis, we sought to determine factors that predicted the level of asthma knowledge in a sample of adolescents with asthma and their parents. Eighty-five young people aged 10-24 years attending tertiary care asthma clinics and 46 of their parents answered validated respiratory and asthma knowledge questionnaires. Older adolescents were more knowledgeable about asthma than were younger adolescents (r=0.36, p=0.001). Young people with severe asthma (p=0.015) scored higher on the asthma knowledge questionnaire than those with mild/moderate asthma. Asthma knowledge among young people was related to that of their mothers (r=0.47, p=0.014), however, only age and the asthma knowledge of fathers significantly predicted adolescent asthma knowledge. Adolescents develop increasing autonomy for asthma self-management as they mature, but parents remain an important source of information about asthma for young people.

Decision-making in children with asthma and their parents

PURPOSE

To learn how children with asthma and their parents make treatment-related decisions.

DATA SOURCES

Verbatim transcripts of focus group interviews of 28 school age children with asthma and their parents. Children had attended an educationally based asthma camp program. Questions related to choices parents and children made regarding implementation of their asthma treatment plans both, at home and at school.

CONCLUSIONS

Parents and children made many non-adherence decisions especially with respect to preventive aspects of the treatment plan. Symptoms were the driving force for children's decisions. Parents and children had concerns about implementing the management plan at school. Parents and children may not perceive asthma treatment options as true choices, thus affecting motivation for adherence.

IMPLICATIONS

Practitioners need to form partnerships with parents and children in developing treatment goals. Goals should focus on achievement of normal daily activities. Asthma education needs to be concrete and include school personnel. Practitioners need to give families positive, informational feedback.

Coping styles and locus of control as predictors for psychological adjustment of adolescents with a chronic illness

This study examines the way coping styles and locus of control contribute to the prediction of psychosocial adjustment in adolescents with a chronic illness. Psychosocial adjustment of 84 adolescents aged 13-16 years with a chronic illness was assessed with measures of social adjustment, global self-esteem and behavior problems. Linear regressions were performed with demographic factors (age and gender) and stress-processing factors (coping style and locus of control) as predictor variables. Results indicated that coping styles were related to most aspects of social adjustment. The coping styles 'seeking social support' and 'confrontation' were important predictors for positive social adjustment; the coping style 'depression' was a predictor for poor adjustment, viz, low social self-esteem and high social anxiety. Avoidance and locus of control were not strongly associated with psychosocial adjustment. Clinical implications of these findings were discussed in terms of preventive interventions for adolescents with a chronic illness.

Development and preliminary validation of a children's arthritis self-efficacy scale

OBJECTIVE

To develop a valid and reliable measure of arthritis self-efficacy for use with school-age children with juvenile idiopathic arthritis (JIA).

METHODS

Construction of the 11-item Children's Arthritis Self-Efficacy Scale (CASE) was based on an existing body of knowledge and the results of focus groups with children, their parents, and health professionals. Data for validation of the CASE were collected by self-administered questionnaires completed by 89 children and 151 caregivers.

RESULTS

Analyses revealed a 3-factor structure relating to self-efficacy for managing symptoms, emotional consequences, and activities, explaining 76.5% of the total variance. The CASE demonstrated high internal consistency, concurrent validity, and construct validity.

CONCLUSION

Preliminary findings suggest that the CASE is worthy of further psychometric testing and may have the potential to help delineate variations in adjustment among children with JIA.

Reviewing asthma and anxiety

The main characteristic of asthma is sudden and unexpected attacks of impaired breathing. Both the attacks themselves and the prospect of attacks generate much anxiety amongst patients. Several different forms of anxiety can be identified which vary in intensity and the situations in which they appear. Anxiety disorders are more common in asthmatics and have a considerable influence on asthma management because they influence symptom perception. Excessive anxiety about asthma symptoms can affect the patient's response to an asthma attack; anxiety related to asthma triggers can reduce the patient's quality of life and anxiety related to medical treatment can influence compliance. The extent of this influence depends upon an individual's ability to cope. Behavioural therapeutic programmes for patient education offer an opportunity to reduce anxiety and to improve asthma self-management. Physicians should look carefully for anxiety when taking the patient's history, and should support the patient's participation in asthma education programs.