Parental perceptions of congenital cardiovascular malformations in their children

Barriers to healthcare access for children with congenital heart disease in eight Latin American countries

BACKGROUND

Mortality from congenital heart disease has decreased considerably in the last two decades due to improvements in overall health care. However, there are barriers to access to healthcare in Latin America for this population, which could be related to factors such as healthcare system, policies, resources, geographic, cultural, educational, and psychological factors. Understanding the barriers to access to care is of paramount importance for the design and implementation of policies and facilitate the provision of care.

AIM

The aim of the study was to investigate the perception of barriers to access to health care on parents/guardians of children with congenital heart disease in selected Latin American countries.

METHODS

A descriptive, cross-sectional study, in which parents/guardians or primary caregivers of children with congenital heart disease was recruited to participate and surveyed. Once the informed consent process had been completed, a set of paper-based scales was used to collect data, namely socioeconomic and demographic information, the Barriers to Care for Children with Special Health Care Needs Questionnaire, and the General Health Questionnaire.

RESULTS

In total, 286 participants completed the surveys, with an average age of 34.81 years and 73.4% being female. Mean score of overall barriers was 54.45 (minimum score 39, maximum score 195, higher scores show greater perception of barriers). In Mexico, the parents/guardians of children perceived fewer barriers to access (46.69), while Peru is the country where the most barriers were perceived (69.91). Nonpoor participants showed higher overall barrier perception scores (57.34) than poor participants (52.58). The regression analysis demonstrated the overall perception of barriers was positively associated with individual and social factors, such as educational level, contract status, household monthly income, and psychological well-being and with the country of the participants.

CONCLUSIONS

Multiple factors are associated with the perception of barriers to accessing health care for children with congenital heart disease, including socioeconomic status, expectations, psychological well-being, and structural factors.

Perioperative stress and anxiety in parents of children operated on for congenital heart disease

INTRODUCTION

Levels of stress and anxiety suffered by parents of children with congenital heart disease (PCUCS) during their children's admission for cardiac surgery may be higher than those suffered by other parents who go through the same experience.

OBJECTIVE

General objective of this study was to measure the stress and anxiety suffered by PCUCS and parents of children undergoing renal surgery (PCURS) in relation to the intervention of their children. The specific objective of the quantitative study was to compare global stress and anxiety according to sex, time of the perioperative period, and cohort. The general objective of the qualitative section is to explore the experience that PCUCS and PCURS have during their hospital stay and to identify the specific factors that influence the genesis of stress and anxiety.

METHOD

A cohort study was carried out in which PCURS and PCUCS were included. The quantitative part was performed by comparing the scores of three questionnaires that measure stress levels (PSS-14), state anxiety (STAIE) and trait anxiety (STAIR) throughout three perioperative moments. At the same time, a qualitative study was carried out with semi-structured interviews and collection of diaries on which a descriptive phenomenological analysis was carried out, according to Munhall. The analysis of the text was carried out according to Colaizzi.

RESULTS

Stress and anxiety levels were significantly higher in PCUCS compared to PCURS. Mothers in the cardiac cohort were those with the highest scores on all scales. In the qualitative study, four themes emerged: "stress and anxiety from the moment of diagnosis", "surgical intervention as a critical moment", "harshness of the postoperative period in the Intensive Care Unit" and "joy and gratitude versus dependence and fear for the future".

CONCLUSIONS

PCUCS suffer higher levels of stress and anxiety than PCURS, being the mothers of the cardiac cohort those who suffer these disorders with greater intensity. This study can constitute a starting point to develop strategies that cover these parental needs.

ORAL HISTORY OF MOTHERS OF CHILDREN WITH CONGENITAL ZIKA VIRUS SYNDROME

ABSTRACT Objective: qualitative, exploratory study, based on the Oral History theoretical methodological framework, conducted in a Health Regional of Goiana, Pernambuco, Brazil. Data collection occurred from October 2017 to May 2018, with 13 mothers through individual interviews. Method: qualitative, exploratory study, based on the Oral History theoretical methodological framework, conducted in a Health Regional of Goiana, Pernambuco, Brazil. Data collection occurred from October 2017 to May 2018, with 13 mothers through individual interviews. The data were processed in a software using the similitude analysis method, which identified the most frequent terms and resulted in the interpretation of the corpus through the words in the light of the reference. Results: the interpretation of the corpus highlights the maternal experiences regarding the discovery of the Congenital Zika Virus Syndrome, of the forced paths implying changes in lifestyle and of the coping strategies used to care for the child. Conclusion: the stories of mothers of children with the syndrome allowed reflection on the challenges related to disability and their children´s need for daily care. The context of the syndrome, associated with low socioeconomic conditions, revealed the magnitude and peculiarities of the problem that permeate the limits to dignity, compromising quality of life and showing the precariousness of the lives of women neglected by the State and society.