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Metzner G, von der Warth R, Glattacker M. The concept of treatment beliefs in children and adolescents with chronic health conditions: a scoping review. Health Psychol Rev 2024; 18:421-455. [PMID: 37675876 DOI: 10.1080/17437199.2023.2253300] [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: 07/14/2022] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
Children and adolescents with chronic health conditions are faced with ongoing challenges, making self-regulation crucial. As children grow up, they gradually develop differentiated beliefs about illness and treatment. While research indicates treatment beliefs as relevant factor on outcomes like adherence, the specific contents and dimensions of children's and adolescents' treatment beliefs remained unclear. This scoping review therefore aimed at the identification of treatment beliefs dimensions in children and adolescents with chronic health conditions, the underlying theoretical frameworks, and methodological operationalisation. Published literature was examined by applying systematic searches in electronic databases (Medline, PsycINFO, CINAHL) and comprehensive selection criteria, resulting in 49 included studies. The predominant treatment beliefs dimensions were necessity, concerns, perceived benefits and costs/barriers, and expectations. The latter can be differentiated into outcome, social, process, and structural expectations, and expectations of one's own role in the treatment process. In addition, dimensions that cover emotions and reasons for treatment were identified. The results are related to the methods and theoretical models applied, which were often adapted from adult research. However, additional and possibly more child-specific dimensions such as social expectations and emotions were found. This scoping review indicates several research gaps and discusses practical implications.
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Affiliation(s)
- Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Pera MC, Coratti G, Casiraghi J, Bravetti C, Fedeli A, Strika M, Albamonte E, Antonaci L, Rossi D, Pane M, Sansone VA, Mercuri E. Caregivers' Expectations on Possible Functional Changes following Disease-Modifying Treatment in Type II and III Spinal Muscular Atrophy: A Comparative Study. J Clin Med 2023; 12:4183. [PMID: 37445216 DOI: 10.3390/jcm12134183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Background: The primary aim of this study was to explore current caregivers' expectations on possible functional changes following treatment in comparison to data obtained in the pre-pharmacological era. Methods: A questionnaire, previously used in 2016, was administered to caregivers of type II and III SMA patients of age between 3 and 71 years, and to patients over the age of 13 years. The questionnaire focuses on (1) caregivers and patients expectations, (2) meaningfulness of the changes observed on the functional motor scales, and (3) their willingness to be enrolled in a clinical trial. A comparative study was performed with data obtained using the same questionnaire soon before the advent of disease-modifying therapies. Results: We administered the questionnaire to 150 caregivers. When comparing current caregiver data to those obtained in 2016, the most obvious differences were related to disease perception over the last year (stability: 16.5% in 2016 vs. 43.6% in 2022; deterioration 70.5% vs. 12.8%, and improvement: 12.9% vs. 43.6%) and expectations from clinical trials with higher expectations in 2022 compared to 2016 (p < 0.001). Forty-five of the 150 in the current study were caregivers of patients above the age of 13. In these 45 the questionnaire was also administered to the patient. No difference was found in responses between patients and their caregivers. Conclusions: Both carers and patients reported that even small changes on functional scales, similar to those reported by clinical studies and real-world data, are perceived as meaningful. Comparing the recent responses to those obtained in 2016, before pharmacological treatment was available, we found significant changes in caregivers' perception with increased expectations. These findings will provide a better understanding of the patients' expectations and facilitate discussion with regulators.
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Affiliation(s)
- Maria Carmela Pera
- Department of Life Science and Public Health, Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- The NEMO Center in Rome, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giorgia Coratti
- Department of Life Science and Public Health, Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- The NEMO Center in Rome, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Jacopo Casiraghi
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, 20162 Milan, Italy
| | - Chiara Bravetti
- Department of Life Science and Public Health, Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- The NEMO Center in Rome, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alessandro Fedeli
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, 20162 Milan, Italy
| | - Milija Strika
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, 20162 Milan, Italy
| | - Emilio Albamonte
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, 20162 Milan, Italy
| | - Laura Antonaci
- The NEMO Center in Rome, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Diletta Rossi
- The NEMO Center in Rome, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Marika Pane
- Department of Life Science and Public Health, Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- The NEMO Center in Rome, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Valeria Ada Sansone
- Department of Life Science and Public Health, Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- The NEMO Center in Rome, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Eugenio Mercuri
- Department of Life Science and Public Health, Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- The NEMO Center in Rome, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Clarke R, Heath G, Nagakumar P, Farrow C. Influence of parental anxiety and beliefs about medicines on feeding and exercise in children living with asthma. J Child Health Care 2023:13674935231171453. [PMID: 37122084 DOI: 10.1177/13674935231171453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This study's primary objective was to establish differences in beliefs about medicines, levels of asthma-related anxiety and diet and exercise behaviours between parents of children with well controlled and poorly controlled asthma. Secondary objectives were to explore how asthma control might shape relationships between parental cognitions and parenting practices concerning paediatric asthma. Parents of children with asthma aged 10-16 years (N = 310) completed standardised questionnaires measuring beliefs about medicines, parental asthma-related anxiety, parenting attitudes towards child activity, parental feeding and asthma control. Parents of children with poorly controlled asthma reported significantly greater asthma medication necessity and concern, asthma-related anxiety, control of child activity, pressure to exercise and unhealthy feeding practices. Moderation analyses indicated that the relationship between parental concern about asthma medicine and parental control of child activity was strongest in children with poorly controlled asthma. Also, the relationship between parental asthma-related anxiety and use of food to regulate child emotion was only significant when asthma was poorly controlled. Parental beliefs about asthma medicines and asthma-related anxiety may indirectly influence asthma outcomes through unhealthy parenting practices around exercise and diet. Eliciting and understanding parents' perceptions of asthma medications and anxiety may facilitate personalised interventions to improve asthma control.
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Affiliation(s)
- Rebecca Clarke
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Gemma Heath
- School of Psychology, Aston University, Birmingham, UK
| | - Prasad Nagakumar
- Department of Paediatric Respiratory Medicine and Cystic Fibrosis, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Claire Farrow
- School of Psychology, Aston University, Birmingham, UK
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Valero-Moreno S, Montoya-Castilla I, Pérez-Marín M. Quality of life in patients with asthma: Medical indicators and psychological variables. J Pediatr Nurs 2023; 69:e136-e144. [PMID: 36609027 DOI: 10.1016/j.pedn.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Quality of life (QoL) is a widely studied term concerning asthma because it allows the impact of the disease on the patient's life to be assessed through the patient's perception. The study aims to analyze which asthma-related, psychological, and family variables affect the QoL of adolescents with asthma. DESIGN AND METHODS This cross-sectional design involves 150 patients diagnosed with asthma aged between 12 and 16 years. The patients' emotional symptomatology, the threat of illness, self-esteem, bonds, quality of life, family, and disease variables were assessed. Statistical analyses were performed using QCA models. RESULTS The results indicate that girls have a poorer QoL, and age is negatively associated. QCA models found that the variables that best explained the quality of life of these patients, in the case of the medical indicators, were control, good compliance, shorter diagnosis times, and improvement. Regarding psychological variables: a lower threat of illness, less emotional distress, and better parental mood explained the high QoL. CONCLUSIONS AND PRACTICAL IMPLICATIONS Adolescent QoL is affected by variables related to their asthma that are beyond their control and other psychological and family variables that may increase the perception of their QoL.
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Affiliation(s)
- Selene Valero-Moreno
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain
| | - Inmaculada Montoya-Castilla
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain
| | - Marián Pérez-Marín
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain.
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Valero-Moreno S, Montoya-Castilla I, Pérez-Marín M. Family styles and quality of life in adolescents with bronchial asthma: The important role of self-esteem and perceived threat of the disease. Pediatr Pulmonol 2023; 58:178-186. [PMID: 36193795 PMCID: PMC10091749 DOI: 10.1002/ppul.26178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/30/2022] [Accepted: 09/28/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Analyze the relationship between family styles and quality of life (QoL) in adolescents with bronchial asthma and study the influence of self-esteem as a protective factor and threat perception as a risk factor. METHODS Family styles, QoL, perceived threat of the disease, and self-esteem were assessed in a total of 150 adolescents diagnosed with bronchial asthma with ages ranging from 12 to 16 years (M = 13.28; SD = 1.29), 60.7% being male. Descriptive statistics and mean comparisons were conducted according to the level of self-esteem. Relationships between variables were also studied using Pearson's correlations, and finally, the mediating role of self-esteem and the perceived threat of the disease was assessed using PROCESS. RESULTS Adolescents shown healthy family characteristics (high scores on affect and parental mood and low scores on psychological control) and high scores on QoL. Thirty-five percent of adolescents showed low self-esteem and a tendency to underestimate the disease. There are existing relationships between family styles and QoL; thus, healthy family characteristics (affection, parental mood, autonomy promotion) were positively associated with QoL, while psychological control was negatively associated with QoL. Disease threat and self-esteem mediated the relationship between family styles and adolescent QoL. Disease threat was negatively, and self-esteem was positively associated with QoL. CONCLUSIONS Self-esteem and family support are protective factors for the well-being of adolescents with bronchial asthma; however, the high perceived threat of the disease can have negative consequences for the adolescent's health and negatively impact their QoL.
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Affiliation(s)
- Selene Valero-Moreno
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain
| | - Inmaculada Montoya-Castilla
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain
| | - Marián Pérez-Marín
- Personality, Assessment and Psychological Treatments Department, Faculty of Psychology, Universitat de Valencia, Valencia, Spain
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Dowell JA, Arcoleo KA. Child's Illness Representation Instrument: Testing Reliability & Factor Structure Study. J Nurs Meas 2022; 31:JNM-2021-0052.R1. [PMID: 35882531 DOI: 10.1891/jnm-2021-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Researchers have determined that illness representation, including identifying the illness, understanding the cause, and knowing the risk, may influence asthma symptom management. PURPOSE The purpose of study was to determine reliability and factor structure for child's version of illness representation. METHODS A Maximum Likelihood factor analysis was used to examine reliability and factor structure of the child version of illness representation (CIR) scale. The sample included teens ages 12 to 18 from United States (N=331) with asthma. RESULTS The reliability was 0.79. Eight factors loaded with the most percentage of variance. CONCLUSIONS The perceptions of teens on the health care provider's prescribing practices may shed light on medication adherence. More research is needed to examine CIRS function in a study on medication adherence.
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Ge P, Liu ST, Xu SX, Zhang JZ, Lai YJ, Fu RC, Ke XY, Zhao J, Bian Y, Wu YB. The Influence of Parents on Medication Adherence of Their Children in China: A Cross-Sectional Online Investigation Based on Health Belief Model. Front Public Health 2022; 10:845032. [PMID: 35493366 PMCID: PMC9046660 DOI: 10.3389/fpubh.2022.845032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To explore the influence of parents on the medication adherence of their children. Study Design A cross-sectional online investigation. Methods A questionnaire with 41 questions was designed based on the health belief model (HBM) distributed and collected online in 28 cities around China through multi-stage stratified sampling. The reliability of the questionnaire was assessed with Cronbach's α coefficient and split-half reliability, and its validity was evaluated with exploratory factor analysis and content validity index. The structural equation model (SEM) was constructed to explore the relationship between the parents' health beliefs and their children's medication adherence. Subgroup analysis was conducted to study the differences between parents with different demographic characteristics (male and female, rural and urban). Results 573 questionnaires were included for analysis, with an effective rate of 62.97%. The Cronbach'α coefficient of the questionnaire was 0.821 > 0.6, the split-half reliability was 0.651 > 0.6, the I-CVI of each dimension were >0.78, and the S-CVI/AVE (I-CVI average) was 0.95 > 0.9. The result of the questionnaire exploratory factor analysis met the standard. According to the SEM, self-efficacy (λ = 0.177), perceived susceptibility (λ = −0.244), and perceived severity (λ = 0.243) were direct influencing factors of children's medication adherence. In the subgroup analysis, the model established by each subgroup was consistent with the model established by the overall sample. The absolute values of females' perceived susceptibility, severity, and self-efficacy for their children's medication adherence path coefficients were higher than males'. Conclusion Parents' perceived severity and self-efficacy may positively impact on their children's medication adherence, while parents' susceptibility to children's medication non-adherence may negatively impact on children's medication adherence. Objective constraints, perceived barriers, and benefits may in directly impact on children's medication adherence. Women's health beliefs appear to have a more significant impact on their children's medication adherence than men's. It may be an effective strategy to increase their children's medication adherence by improving parents' health beliefs. Medical staff should explain medication adherence knowledge to the parents of children, and inform the children of the possible consequences of non-adherence with medication, to improve the subjective perception of parents on the severity of children's non-adherence with medication, and improve parents' self-efficacy in rational medication for children. In addition, attention should be paid to the mental health of the parents, and more social and psychological support.
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Affiliation(s)
- Pu Ge
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Si-tong Liu
- School of Pharmacy, Peking University, Beijing, China
| | - Shu-xian Xu
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Jin-zi Zhang
- College of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Yong-jie Lai
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Run-chen Fu
- School of Pharmacy, Shandong First Medical University, Taian, China
| | - Xin-yu Ke
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Juan Zhao
- The Fourth Hospital of Harbin, Harbin, China
| | - Ying Bian
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
- *Correspondence: Ying Bian
| | - Yi-bo Wu
- School of Public Health, Peking University, Beijing, China
- Yi-bo Wu
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Sonney J, Cho EE, Zheng Q, Kientz JA. Refinement of a Parent-Child Shared Asthma Management Mobile Health App: Human-Centered Design Study. JMIR Pediatr Parent 2022; 5:e34117. [PMID: 35175214 PMCID: PMC8895285 DOI: 10.2196/34117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The school-age years, approximately ages 7 through 11, represent a natural transition when children begin assuming some responsibility for their asthma management. Previously, we designed a theoretically derived, tailored parent-child shared asthma management mobile health app prototype, Improving Asthma Care Together (IMPACT). OBJECTIVE The purpose of this study was to use human-centered design (HCD) to iteratively refine IMPACT to optimize user experience and incorporate evidence-based longitudinal engagement strategies. METHODS This study used a mixed methods design from December 2019 to April 2021. Our app refinement used the HCD process of research, ideation, design, evaluation, and implementation, including 6 cycles of design and evaluation. The design and evaluation cycles focused on core app functionality, child engagement, and overall refinement. Evaluation with parent-child dyads entailed in-person and remote concept testing and usability testing sessions, after which rapid cycle thematic analyses identified key insights that informed future design refinement. RESULTS Twelve parent-child dyads enrolled in at least one round of this study. Eight of the 12 child participants were male with a mean age of 9.9 (SD 1.6) years and all parent participants were female. Throughout evaluation cycles, dyads selected preferred app layouts, gamification concepts, and overall features with a final design prototype emerging for full-scale development and implementation. CONCLUSIONS A theoretically derived, evidence-based shared asthma management app was co-designed with end users to address real-world pain points and priorities. An 8-week pilot study testing app feasibility, acceptability, and preliminary efficacy is forthcoming.
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Affiliation(s)
- Jennifer Sonney
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States.,Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Emily E Cho
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Qiming Zheng
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Julie A Kientz
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
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Sonney J, Ward T, Thompson HJ, Kientz JA, Segrin C. Improving Asthma Care Together (IMPACT) mobile health intervention for school-age children with asthma and their parents: a pilot randomised controlled trial study protocol. BMJ Open 2022; 12:e059791. [PMID: 35144958 PMCID: PMC8845324 DOI: 10.1136/bmjopen-2021-059791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Asthma is an incurable, lifelong condition that places children at increased risk for exacerbation, hospitalisation and school absences. Most paediatric asthma interventions target parents alone and are overly prescriptive. Improving Asthma Care Together (IMPACT) is a novel shared management system comprised of a mobile health (mHealth) application, symptom watch and tailored health intervention that pairs parent and child together as an asthma management team. IMPACT helps families monitor asthma status, tailor asthma management strategies and facilitate intentional transition of asthma management to the child. The purpose of this study is to determine the feasibility, acceptability and preliminary efficacy of the IMPACT intervention. METHODS AND ANALYSIS This pilot randomised controlled trial will recruit 60 children with asthma (7-11 years) and one parent. All parent-child dyads will complete data collection sessions at baseline, postintervention and follow-up. Dyads randomised to the intervention group (IMPACT) will complete the 8-week intervention comprised of weekly activities including symptom monitoring, goal setting and progress monitoring. Dyads randomised to the control group will receive usual care but then be provided access to IMPACT at the end of the study. Feasibility will be measured by the proportion of eligible dyads enrolled and retained. Acceptability of IMPACT will be assessed using the Acceptability of Intervention Measure, the System Usability Scale and a semistructured interview. Preliminary efficacy is determined based on change in primary outcomes, parent-reported and child-reported asthma responsibility and asthma self-efficacy scores, from baseline. ETHICS AND DISSEMINATION This study has been approved by the University of Washington Institutional Review Board; study ID: STUDY00010461. Participants gave informed consent to participate in the study before taking part. Study results will be disseminated in peer-reviewed journals and scientific conferences. A lay summary will be provided to study participants. TRIAL REGISTRATION NUMBER NCT04908384 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jennifer Sonney
- Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
| | - Teresa Ward
- Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
| | - Hilaire J Thompson
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington, USA
| | - Julie A Kientz
- Human Centered Design & Engineering, University of Washington Seattle Campus, Seattle, Washington, USA
| | - Chris Segrin
- Department of Communication, The University of Arizona, Tucson, Arizona, USA
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Sonney JT, Thompson HJ, Landis CA, Pike KC, Chen ML, Garrison MM, Ward TM. Sleep intervention for children with asthma and their parents (SKIP Study): a novel web-based shared management pilot study. J Clin Sleep Med 2021; 16:925-936. [PMID: 32056537 DOI: 10.5664/jcsm.8374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVES The objective of this study was to describe the feasibility, acceptability, and preliminary efficacy of a novel Sleep Intervention for Kids and Parents (SKIP). Parent and child primary sleep outcomes were total sleep time, wake after sleep onset (WASO), sleep efficiency (SE), and bedtime range. METHODS Children 6-11 years of age with asthma and 1 parent, both with behavioral sleep disturbance, enrolled in this single-group pilot. The 8-week shared management intervention included weekly online educational modules, goal setting, and progress reporting. Feasibility was measured by the number of dyads who were eligible, enrolled, and retained. Acceptability was measured by survey and semistructured interview. Total sleep time, WASO, SE, and bedtime range were measured by actigraphy at baseline, after the intervention, and 12-week follow-up. Mixed-effects regression models were used to determine change in sleep outcomes from baseline. RESULTS Thirty-three of 39 eligible dyads enrolled; of 29 dyads that started the intervention, 25 (86%) completed all study visits. SKIP was acceptable for 61% of children and 92% of parents. Compared with baseline, at follow-up, children had significantly improved WASO (-37 minutes; 95% confidence interval [CI], -44.5 to -29.7; P < .001), SE (5.4%; 95% CI, 4.2-6.5; P < .001), and bedtime range (-35.2 minutes; 95% CI, -42.9 to -27.5; P < .001). Parents also had significantly improved WASO (-13.9 minutes; 95% CI, -19.5 to -8.2; P < .001), SE (2.7%; 95% CI, 1.7-.7; P < .001), and bedtime range (-35.3 minutes; 95% CI, -51.0 to -19.7; P < .001). CONCLUSIONS SKIP was feasible, acceptable, and we observed improved child and parent sleep outcomes except total sleep time. Following refinements, further testing of SKIP in a controlled clinical trial is warranted. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Sleep Intervention for Kids and Parents: A Self-Management Pilot Study; URL: https://www.clinicaltrials.gov/ct2/show/study/NCT03144531; Identifier: NCT03144531.
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Affiliation(s)
- Jennifer T Sonney
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington
| | - Hilaire J Thompson
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington
| | - Carol A Landis
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington
| | - Kenneth C Pike
- Office of Nursing Research, University of Washington School of Nursing, Seattle, Washington
| | - Maida L Chen
- Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Michelle M Garrison
- Department of Health Services, University of Washington School of Public Health, Division of Child and Adolescent Psychiatry, University of Washington School of Medicine, Seattle, Washington.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Teresa M Ward
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington
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Clark H, Carpenter D, Walsh K, Davis SA, Garcia N, Sleath B. Medication Errors in Adolescents Using Asthma Controller Medications. Glob Pediatr Health 2020; 7:2333794X20981341. [PMID: 33403224 PMCID: PMC7739079 DOI: 10.1177/2333794x20981341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to describe the number and types of errors that adolescents and caregivers report making when using asthma controller medications. A total of 319 adolescents ages 11 to 17 with persistent asthma and their caregivers participated in this cross-sectional study. Adolescent and caregiver reports of asthma medication use were compared to the prescribed directions in the medical record. An error was defined as discrepancies between reported use and the prescribed directions. About 38% of adolescents reported 1 error in using asthma controller medications, 16% reported 2 errors, and 5% reported 3 or more errors. About 42% of caregivers reported 1 error in adolescents using asthma controller medications, 14% reported 2 errors, while 6% reported 3 or more errors. The type of error most frequently reported by both was not taking the medication at all. Providers should ask open-ended questions of adolescents with asthma during visits so they can detect and educate families on how to overcome errors in taking controller medication use.
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Affiliation(s)
- Henry Clark
- University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | - Betsy Sleath
- University of North Carolina, Chapel Hill, NC, USA
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Rehman N, Morais-Almeida M, Wu AC. Asthma Across Childhood: Improving Adherence to Asthma Management from Early Childhood to Adolescence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:1802-1807.e1. [PMID: 32112922 PMCID: PMC7275896 DOI: 10.1016/j.jaip.2020.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/24/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
Asthma affects nearly 6 million US children. Throughout childhood, children undergo a series of biological, developmental, and psychosocial changes. Thus, factors influencing a child's asthma management differ across 3 essential stages-early childhood (0-5 years), school-aged years (5-12 years), and adolescence (12-18 years)-and require varied intervention by parents, school personnel, clinicians, and the children themselves. Because asthma care in children is characterized by fluctuations in severity and coordination among many stakeholders, optimal asthma control is difficult to achieve in this young population. Challenges in childhood asthma management are reflected in the low rates of children's adherence to medication regimes. Although pharmacological and biological factors addressing age in physicians' treatment choices are well outlined, age-specific approaches to patient-provider communication and asthma-related interventions are also important in improving quality of life for patients with pediatric asthma.
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Affiliation(s)
- Narmeen Rehman
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital, CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Ann Chen Wu
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass.
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Arcoleo K, Marsiglia F, Serebrisky D, Rodriguez J, Mcgovern C, Feldman J. Explanatory Model for Asthma Disparities in Latino Children: Results from the Latino Childhood Asthma Project. Ann Behav Med 2020; 54:223-236. [PMID: 31586174 PMCID: PMC7093263 DOI: 10.1093/abm/kaz041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Little research has been conducted that integrates, in one explanatory model, the multitude of factors potentially leading to disparities among Latino children. PURPOSE A longitudinal, observational study tested an explanatory model for disparities in asthma control between Mexican and Puerto Rican children with persistent asthma requiring daily controller medication use. METHODS Mexican and Puerto Rican children aged 5-12 years (n = 267) and their caregivers (n = 267) were enrolled and completed interviews and child spirometry at baseline and 3, 6, 9, and 12 months postenrollment. A 12 month retrospective children's medical record review was completed. Participants were recruited from two school-based health clinics and the Breathmobile in Phoenix, AZ, and two inner-city hospital asthma clinics in the Bronx, NY. RESULTS Statistically significant differences in the social/contextual predictors of asthma illness representations (IRs) were noted between Mexican and Puerto Rican caregivers. The structural equation model results revealed differences in asthma control over time by ethnicity. This model accounted for 40%-48% of the variance in asthma control test scores over 12 months. Caregivers' IRs aligned with the professional model of asthma management were associated with better children's asthma control across 1 year. These results also supported the theoretical notion that IRs change over time impacting caregivers' treatment decisions and children's asthma control. CONCLUSIONS These findings extend a previous cross-sectional model test using a more comprehensive model and longitudinal data and highlight the importance of considering within-group differences for diagnosis and treatment of children coming from the vastly heterogeneous Latino umbrella group. TRIAL REGISTRATION Trial number NCT01099800.
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Affiliation(s)
- Kimberly Arcoleo
- Center for Innovation in Pediatric Practice, Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Flavio Marsiglia
- School of Social Work, Arizona State University, University Center, Phoenix, AZ, USA
| | - Denise Serebrisky
- Department of Pediatrics, Albert Einstein College of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Pelham Parkway South, Bronx, NY, USA
| | - Juliana Rodriguez
- Department of Pediatrics, Albert Einstein College of Medicine, Pelham Parkway South, Bronx, NY, USA
| | - Colleen Mcgovern
- College of Nursing, University of North Carolina, Carrington Hall, Chapel Hill, NC, USA
| | - Jonathan Feldman
- Department of Pediatrics, Albert Einstein College of Medicine, Pelham Parkway South, Bronx, NY, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Children’s Hospital at Montefiore, Bronx, NY, USA
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De Keyser HH, Ramsey R, Federico MJ. They just don't take their medicines: Reframing medication adherence in asthma from frustration to opportunity. Pediatr Pulmonol 2020; 55:818-825. [PMID: 31944593 PMCID: PMC10187561 DOI: 10.1002/ppul.24643] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/03/2020] [Indexed: 12/19/2022]
Abstract
Assessing and addressing suboptimal adherence to asthma medications is a key component in the treatment of all children with asthma, particularly those with difficult-to-treat asthma. However, parents often overreport adherence to asthma medications. Increased medication adherence could lead to improved outcomes in the form of better asthma control and decreased asthma exacerbations, as well as decreased healthcare utilization costs. Yet there are many complex factors that affect medication adherence, and barriers are often different in each family. Social determinants of health, complex healthcare relationships, and patient-related factors may all affect medication adherence. Multicomponent patient-centered strategies, as well as strategies that utilize technology and habit formation strategies may be helpful in improving medication adherence. Further study is needed to reliably and sustainably improve medication adherence in children with asthma across the broader population; in some populations, alternate diagnoses, adjusting therapy, and other intervention may be required to improve asthma control and health.
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Affiliation(s)
- Heather Hoch De Keyser
- Breathing Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Rachelle Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Monica J Federico
- Breathing Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
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Sonney J, Duffy M, Hoogerheyde LX, Langhauser E, Teska D. Applying Human-Centered Design to the Development of an Asthma Essentials Kit for School-Aged Children and Their Parents. J Pediatr Health Care 2019; 33:169-177. [PMID: 30228032 PMCID: PMC10648398 DOI: 10.1016/j.pedhc.2018.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
This study aimed to design and test an asthma essentials kit to support parent-child shared asthma management. Fourteen children (age range = 7-11 years) with asthma and their parents participated in this study. Development of the asthma essentials kit involved a generative phase, focused on understanding and designing to meet user needs, and an evaluative phase, which entailed narrowing, evaluating, and refining the asthma essentials kit. As is typical in human-centered design, analysis was iterative throughout the design process such that findings informed each subsequent phase. The final asthma essentials kit concepts collectively addressed the three user-identified priorities: roles and responsibilities, desire for normalcy, and shared asthma management. Concept prototypes included a to-go bag, cue card, wearable device, and mobile health application. Usability and acceptability testing showed that the asthma essentials kit prototypes were highly useful, acceptable, and easy to navigate. Human-centered design holds promise in developing interventions to meet user needs.
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Affiliation(s)
- Jennifer Sonney
- Jennifer Sonney, Assistant Professor, Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA..
| | - Morgan Duffy
- Morgan Duffy, Graduate Student, Human Centered Design and Engineering, University of Washington, Seattle, WA.; Morgan Duffy, Graduate Student, Human Centered Design and Engineering, University of Washington, Seattle, WA
| | - Lulu Xiao Hoogerheyde
- Lulu Xiao Hoogerheyde, Graduate Student, Human Centered Design and Engineering, University of Washington, Seattle, WA
| | - Erika Langhauser
- Erika Langhauser, Graduate Student, Human Centered Design and Engineering, University of Washington, Seattle, WA
| | - Danielle Teska
- Danielle Teska, Graduate Student, Human Centered Design and Engineering, University of Washington, Seattle, WA
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Abstract
As the number of persons with dementia grows, an increasing number of families, professionals, and laypersons will come into contact with persons with cognitive deterioration. Assessing dementia illness representations (IRs) among these groups may have great importance for understanding their responses to dementia. The purpose of this study was to summarize and critically review the literature on dementia IRs. A total of 25 articles that satisfied the inclusion criteria were identified. The review revealed that conceptually, research attention on dementia IRs has increased over the past several years as a result of changes in the notion of IRs and in the dementia discourse. Regardless of the population examined, dementia was mostly described as a chronic condition, presenting more cognitive than behavioral symptoms, and as being caused mainly by age, heredity, and abnormal brain changes. Methodologically, the area of dementia IRs is characterized by design, sample, and data collection weaknesses. Findings suggest that although the literature in the area of dementia and IRs is increasing, several conceptual and methodological limitations still have to be resolved in order to advance knowledge in the area. The research and clinical implications of these findings stress the importance of IRs in the area of dementia.
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Affiliation(s)
- Shiri Shinan-Altman
- The Louis and Gabi Weisfeld School of Social Work, Faculty of Social Sciences, Bar Ilan University, Ramat Gan, Israel,
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Sleath B, Gratie D, Carpenter D, Davis SA, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Reported Problems and Adherence in Using Asthma Medications Among Adolescents and Their Caregivers. Ann Pharmacother 2018; 52:855-861. [PMID: 29592540 DOI: 10.1177/1060028018766603] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many factors affect youth adherence to asthma medications. Better understanding of the relationship between problems reported by youth in using asthma medications, self-efficacy, outcome expectations, and adherence is needed. OBJECTIVE The study examined the relationship between youth and caregiver problems in using asthma medications, asthma management self-efficacy, outcome expectations, and youth- and caregiver-reported adherence to asthma controller medications. METHODS Adolescents with persistent asthma and their caregivers were recruited at 4 pediatric practices. Youth were interviewed after their medical visit while caregivers completed a questionnaire. Multivariable linear regression was used to analyze the data. RESULTS Of 359 participating youth, 319 were on controller medications. Youth reported 60% average adherence, whereas caregivers reported 69%. Youth who reported difficulty using their inhaler correctly and youth who reported difficulty remembering to take their medications were significantly less likely to be adherent. Caregivers who reported that it was hard to remember when to give the asthma medications were significantly less likely to report their child being adherent. Both youth and caregivers with higher outcome expectations were significantly more likely to self-report being adherent. CONCLUSIONS Pharmacists and other health care providers should consider asking youth and caregivers about problems in using asthma medications, self-efficacy in managing asthma, and outcome expectations for following treatment regimens, so that they can help youth overcome difficulties they might have in managing their asthma.
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Affiliation(s)
- Betsy Sleath
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel Gratie
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Scott A Davis
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles Lee
- 2 Polyglot Systems, Inc, Morrisville, NC, USA
| | - Ceila E Loughlin
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nacire Garcia
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sonney J, Insel KC. Exploring the intersection of executive function and medication adherence in school-age children with asthma. J Asthma 2018. [PMID: 29513610 DOI: 10.1080/02770903.2018.1441870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is one of the most common chronic diseases of childhood. For children with persistent asthma, asthma control is largely related to controller medication adherence. With increasing calls for children to be involved in their own asthma management, there is a gap in our knowledge about the executive functioning of children with asthma. OBJECTIVE The purpose of this study was to explore the relationship between executive function, asthma, and medication adherence among school-age children with asthma. METHODS Thirty-one children ages 7 to 11 years (M = 8.9 ± 1.51) and one of their parents were enrolled in this study. Parents reported on asthma control while children reported on asthma control, medication beliefs, medication adherence, and completed an executive function battery that assessed inhibition, updating, shifting and planning. RESULTS Compared to the reference sample, children in this study had significantly lower composite scores in inhibition, t (31) = -3.84, p =. 001, and shifting, t (30) = -3.73, p =. 001. Controlling for age and asthma control, hierarchical regression analyses revealed that shifting accounted for 16% of the variance in child-reported medication adherence. CONCLUSIONS This study revealed lowered executive functioning scores among school-age children with persistent asthma. Furthermore, it appears executive functioning and controller medication adherence are intertwined and warrant future exploration.
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Affiliation(s)
- Jennifer Sonney
- a Department of Family and Child Nursing , School of Nursing, University of Washington , Seattle , WA
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