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Levy S, Wynd AHD, Motee A. "Crafting a 'TransitionOmeter': A Proposed Framework for Developing and Honing Capabilities of Young People Transitioning to Adult Healthcare Services.". Compr Child Adolesc Nurs 2024:1-12. [PMID: 38713540 DOI: 10.1080/24694193.2024.2348830] [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: 01/05/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024]
Abstract
This paper focuses on an innovative approach to preparing children and young people, with Spina Bifida, to move from child-centered to adult-oriented healthcare systems. Reflecting on our role in delivering a national nurse led service, we set to identify and critique international transition tools in use for this population. Specifically, we aimed to identify the core capabilities and indicators of progression to successful transition, so that holistic interventions could be planned to match the needs of individuals and their carers. There were two phases to the study, initially focusing on a systematic literature review on transition tools and the specific items that these tools captured, including skills, abilities and behaviors. Phase two culminated in the articulation of a segmented and incremental "road map", aligned with facets deemed essential for a successful healthcare transition. The reporting of the literature review (phase one) followed the PRISMA guidelines and shaped the qualitative element of the study (phase two) through the use of semi-structured interviews and thematic analysis. The search strategy yielded 11 studies, which were then manually searched for other relevant literature, adding a further 14 articles. The review analyzed 7 specific tools for spina bifida and 8 generic tools, which were deemed appropriate for this group of patients. A comprehensive list of core capabilities was then articulated and framed to fit a progression timeline. Specific interventions were formulated to explore ways to co-produce resources that could enhance and support a planned transition to adult-focused services. Our proposed mapping of capabilities and progression could shape other transition programs, where nurses work collaboratively with young people, carers and other members of a team. More work is needed to further explore and embed the framework that, as we did, could be digitized and shared with all stakeholders involved in the transition process.
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Affiliation(s)
- Sharon Levy
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Hwang CK, Harris KT, Wood D. Barriers to Transitional Care in Spina Bifida. Urol Clin North Am 2024; 51:187-196. [PMID: 38609191 DOI: 10.1016/j.ucl.2024.01.006] [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] [Indexed: 04/14/2024]
Abstract
The health care needs children with spina bifida evolve over their lifetime; continued, regular contact with appropraitely trained, multidisciplinary providers is crucial to a patient's health and quality of life. Substantial research has been conducted to improve the transition process starting at an early age; however, there continue to be strong barriers to successful transition. This article reviews key aspects of the care of patients with spina bifida, the impact of inadequate transition to adult care, barriers to transition, and offers a potential vision for the future.
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Affiliation(s)
- Catalina K Hwang
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA
| | - Kelly T Harris
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA
| | - Dan Wood
- Division of Urology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO 80045, USA.
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Roth JD, Miller MA, O'Neil JO, Wiener JS, Wood HM. Transitioning young adults with spina bifida: Challenges and paths to success. J Pediatr Urol 2024; 20:200-210. [PMID: 37788943 DOI: 10.1016/j.jpurol.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION AND BACKGROUND Recent medical advances, including closure of myelomeningocele defects, shunting of hydrocephalus, and focusing on renal preservation have led to many individuals with spina bifida (SB) living into adulthood. This has led to more individuals with SB transitioning their care from pediatric-based to adult-based care models. OBJECTIVE We seek to explore the process of transition, with a focus on difficulties in transitioning individuals with SB. Additionally, we explore new problems that arise during the period of transition related to sexual function and dysfunction. We also discuss some of the difficulties managing neurogenic bladder and the sequalae of their prior urologic surgeries. STUDY DESIGN Each of the authors was asked to provide a summary, based on current literature, to highlight the challenges faced in their area of expertise. CONCLUSIONS Transitioning care for individuals with SB is especially challenging due to associated neurocognitive deficits and neuropsychological functioning issues. Sexual function is an important component of transition that must be addressed in young adults with SB. Management of neurogenic bladder in adults with SB can be challenging due to the heterogeneity of the population and the sequelae of their prior urologic surgeries. The aim is to ensure that all individuals with SB receive appropriate, evidence-based care throughout their lifetime.
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Affiliation(s)
- Joshua D Roth
- Department of Urology, Riley Hospital for Children, Indiana University School of Medicine, United States.
| | - Matthew A Miller
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, United States
| | - Joseph O O'Neil
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, United States
| | - John S Wiener
- Division of Urology, Duke University School of Medicine, United States
| | - Hadley M Wood
- Department of Urology, Cleveland Clinic, United States
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Choi EK, Park J, Kim K, Bae E, Ji Y, Yang SH, Chinbayar A, Yun H. Factors affecting the transition to adulthood of Korean young adults with spina bifida: a qualitative study. BMC Nurs 2023; 22:46. [PMID: 36803401 PMCID: PMC9940440 DOI: 10.1186/s12912-023-01194-z] [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: 06/13/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Transition to adulthood to live independently while self-managing health and daily life without parental help is crucial for young adults with chronic conditions. Despite its importance as a precursor to effectively managing lifelong conditions, little is known about the experiences of young adults with spina bifida (SB) in transition to adulthood in Asian countries. This study aimed to explore the experiences of Korean young adults with SB to identify the facilitators or barriers to the transition from adolescence to adulthood from their perspectives. METHODS This study used a qualitative descriptive design. The data were collected in South Korea through three focus group interviews with 16 young adults with SB, aged 19-26, from August to November 2020. We conducted a qualitative content analysis using a conventional approach to identify the factors that facilitated and hindered the participants' transition to adulthood. RESULTS Two themes emerged as facilitators and barriers to the transition to adulthood. a) Facilitators: understanding and acceptance of SB, acquiring self-management skills, parenting styles encouraging autonomy, parents' emotional support, school teachers' thoughtful consideration, and participation in self-help groups. b) Barriers: overprotective parenting style, experience of being bullied by peers, damaged self-concept, concealing one's chronic condition from others, and the lack of privacy in school restrooms. CONCLUSIONS Korean young adults with SB shared their experiences of struggling to properly manage their chronic conditions on their own, particularly concerning regular bladder emptying, during the transition from adolescence to adulthood. To facilitate the transition to adulthood, education on the SB and self-management for adolescents with SB and on parenting styles for their parents are important. To eliminate barriers to the transition to adulthood, improving negative perceptions of disability among students and teachers and making school restrooms CIC-friendly are needed.
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Affiliation(s)
- Eun Kyoung Choi
- grid.15444.300000 0004 0470 5454College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Jisu Park
- grid.15444.300000 0004 0470 5454Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Kyua Kim
- grid.15444.300000 0004 0470 5454Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Eunjeong Bae
- grid.15444.300000 0004 0470 5454College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722 Seoul, Republic of Korea
| | - Yoonhye Ji
- grid.15444.300000 0004 0470 5454Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Seung Hyeon Yang
- grid.15444.300000 0004 0470 5454College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722 Seoul, Republic of Korea
| | - Altantuya Chinbayar
- grid.15444.300000 0004 0470 5454Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Hyeseon Yun
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
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Bauer WS, Schiffman RF. A Center Experience with Common Data Elements in Chronic Illness Self-Management Research. West J Nurs Res 2023; 45:478-485. [PMID: 36691709 DOI: 10.1177/01939459221144851] [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: 01/25/2023]
Abstract
In recent decades, the use of common data elements has expanded across the health disciplines. This has included growth within programs of research focused on self-management and family nursing. Family nursing and self-management science may be expanded with the increased use of common concepts, measures, and theoretical frameworks. This article describes the experience of exploring the use of common data elements and identifying shared concepts from the perspective of one National Institute of Nursing Research funded Exploratory Center in Self-Management. Guidance offered by the Individual and Family Self-Management Theory is discussed, and implications for family research are presented.
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Affiliation(s)
- Wendy S Bauer
- College of Nursing, University of Wisconsin Oshkosh, WI, USA
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Fremion E, Kaufman M, Mukherjee S, Murphy P, Smith K. 2023 updates to the spina bifida transition to adult care guidelines. J Pediatr Rehabil Med 2023; 16:583-593. [PMID: 38160373 PMCID: PMC10789338 DOI: 10.3233/prm-230052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE This article provides an update to the 2018 Spina Bifida Association's Transition to Adult Care Guidelines. METHODS A workgroup of topic experts was convened including authors from the initial guideline workgroup. The workgroup reviewed and updated the primary, secondary, and tertiary outcome goals, clinical questions, and guideline recommendations based on a literature review. RESULTS Twenty-two additional articles were identified from the literature search. Updated references included observational studies describing transition to adult care outcomes, transition care model initiatives, and a validated self-management assessment tool. CONCLUSION Structured transition initiatives increase the likelihood of establishing with adult care, decrease acute care use for young adults with spina bifida, and have the potential to improve quality of life and optimize chronic condition management. However, there is still a need to implement structure transition practices more broadly for this population using these recommended guidelines.
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Affiliation(s)
- Ellen Fremion
- Departments of Internal Medicine and Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Melissa Kaufman
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shubhra Mukherjee
- Department of Physical Medicine and Rehabilitation, Shriners Children’s Chicago, Chicago, IL, USA
| | - Pamela Murphy
- District Medical Group Children’s Rehabilitative Services, Phoenix, AZ, USA
| | - Katherine Smith
- Department of Clinical Pediatrics, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
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Choi EK, Bae E, Yun H. Nurse-led eHealth transition care program for adolescents with spina bifida: A feasibility and acceptability study. J Pediatr Nurs 2022; 67:44-51. [PMID: 35939952 DOI: 10.1016/j.pedn.2022.07.004] [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: 03/31/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to evaluate the feasibility and acceptability of a nurse-led eHealth transition care program for adolescents with spina bifida. DESIGN AND METHODS This study used a single-arm, pretest-posttest intervention study. Adolescents with spina bifida, aged 12-15 years, and their parents participated in the program. A 6-week program was delivered through an online platform in real-time by nurses. We evaluated feasibility and acceptability using criteria such as the completion rate, program satisfaction, changes in transition readiness, social support, career preparation behavior, sexual knowledge, and sexual worries at three time points from July to September 2021. RESULTS Thirteen adolescents completed all sessions and surveys (13/14, 92.9%). All adolescents expressed high satisfaction with both the content and delivery methods of the program. Significant benefits in transition readiness, career preparation behavior, and sexual knowledge were identified over the study period. However, the evaluation of social support and sexual worries did not demonstrate any significant improvements. Additionally, through family counseling, adolescents benefited from experiences such as reflecting on their current transition readiness, setting and achieving individualized goals and plans using a self-checklist with their parents and nursing professionals. CONCLUSION This nurse-led eHealth intervention was feasible and acceptable for adolescents with spina bifida. Furthermore, our results highlight the practicability and the potential for strategic dissemination of using this eHealth program in transitional care during the COVID-19 pandemic. PRACTICE IMPLICATIONS The eHealth transition care program contributes to broadening existing nursing interventions not only in medical areas but also in daily life areas.
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Affiliation(s)
- Eun Kyoung Choi
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Eunjeong Bae
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Hyeseon Yun
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea.
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Murray CB, Murphy LK, Jordan A, Owens MT, McLeod D, Palermo TM. Healthcare Transition Among Young Adults With Childhood-Onset Chronic Pain: A Mixed Methods Study and Proposed Framework. THE JOURNAL OF PAIN 2022; 23:1358-1370. [PMID: 35301116 DOI: 10.1016/j.jpain.2022.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
Chronic pain extends from childhood to adulthood for many young people. The transition from pediatric to adult care is a critical, yet understudied, healthcare task facing young adults with chronic pain. The aims of this observational, sequential mixed methods study were to 1) document the healthcare transition status of young adults with chronic pain (Stage 1, quantitative aim), 2) examine young adults' perspectives of barriers and facilitators of healthcare transition (Stage 2, qualitative aim), and 3) integrate findings to construct a theoretical framework of healthcare transition. A cohort was identified with childhood chronic pain and prior care in one of 15 multidisciplinary pediatric pain clinics across the United States and Canada. Approximately 6 years later, 189 young adults (M age = 21.0; age range = 18-24; 81.5% female) from this cohort with continuing chronic pain completed surveys for Stage 1, and a subsample (n = 17) completed qualitative interviews for Stage 2. Quantitative findings demonstrated that young adults may experience lapses in care, with 41.8% indicating they had not transitioned to adult pain services. Qualitative analysis revealed young adults experienced significant barriers (eg, abrupt departure from pediatric care) as well as facilitators (eg, acceptance of pain prognosis) of healthcare transition. Quantitative and qualitative findings were integrated to construct a healthcare transition framework for chronic pain, which highlights transition as a complex process involving multiple pathways, outcomes, and stakeholders. Advancements in research and practice are needed to develop transition services to bridge gaps in care and optimize health outcomes for young people with chronic pain. PERSPECTIVE: This mixed-methods study demonstrated that 41.8% of young adults with chronic pain experience lapses in adult-centered pain care and identified key barriers and facilitators to successful healthcare transition. Findings were integrated to construct the first healthcare transition framework for youth with chronic pain.
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Affiliation(s)
- Caitlin B Murray
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington.
| | - Lexa K Murphy
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Abbie Jordan
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, UK
| | - Michele Tsai Owens
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dorothy McLeod
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Tonya M Palermo
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
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Bray EA, Everett B, George A, Salamonson Y, Ramjan LM. Developing a Health Care Transition Intervention With Young People With Spinal Cord Injuries: Co-design Approach. JMIR Form Res 2022; 6:e38616. [PMID: 35900814 PMCID: PMC9377469 DOI: 10.2196/38616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/17/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Successful transition from pediatric to adult health care settings supports long-term health management and better overall outcomes in all domains. However, young people with spinal cord injuries (SCIs) continue to report challenges and unmet needs during the transition process. Including end users in health care research and intervention design is paramount as interventions designed in this way better meet their specific needs and are often more innovative. Although studies have reported involving young people with chronic conditions in the development of health care transition (HCT) interventions, few details have been provided as to how this was achieved. Objective This study outlined the co-design and development of an HCT intervention to support young people with SCIs. It contextualized the co-design process, methods, materials used, and steps implemented from defining the problem to conceiving and designing the solution. This was accomplished by understanding and listening to end users’ needs and recommendations for HCT. Methods Using participatory methods, this qualitative study reports the co-design of an HCT intervention to support young people with SCIs and parents or caregivers. Two co-design workshops were conducted: one with young people with SCIs and one with parents and caregivers. Categories were defined through a hybrid deductive and inductive qualitative content analysis process that was informed by the Care Transitions Framework and guided the development of the HCT intervention. Following the creation of a prototype intervention, young people with SCIs, parents and caregivers, and key pediatric SCI stakeholders provided feedback on the intervention content and design in focus groups. Similar to the workshops, the focus groups were analyzed using a hybrid deductive and inductive qualitative content analysis process informed by the Care Transitions Framework. The Enhancing the Quality and Transparency of Health Research guidelines for qualitative research (Consolidated Criteria for Reporting Qualitative Research) were applied. Results Overall, 4 young people and 4 parents or caregivers participated in the co-design workshops. Key recommendations for the HCT intervention were that participants wanted a “one-stop shop” for all their transition information needs and an editable portable medical summary to take with them to appointments. On the basis of the analysis of participants’ recommendations from the workshops, it was determined that a website would be an appropriate hosting platform for the interventions. The focus group feedback on the design and content of the prototype website was extremely positive, with minor recommendations for improvement. Conclusions This is the first study to co-design and develop an HCT intervention in partnership with young people with SCIs and parents and caregivers. Although the study sample was small, it has shown that it is possible to meaningfully engage and empower young people with SCIs and parents and caregivers in the co-design of an HCT intervention. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2021-053212
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Affiliation(s)
- Emily Alice Bray
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Bronwyn Everett
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
- Ingham Institute Applied Medical Research, Liverpool, Australia
| | - Ajesh George
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
- Ingham Institute Applied Medical Research, Liverpool, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Yenna Salamonson
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
- Ingham Institute Applied Medical Research, Liverpool, Australia
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Lucie M Ramjan
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
- Ingham Institute Applied Medical Research, Liverpool, Australia
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Stiles-Shields C, Kritikos TK, Starnes M, Smith ZR, Holmbeck GN. The Transition from Pediatric to Adult Health Care in Young Adults with Spina Bifida: Demographic and Physician-Related Correlates. J Dev Behav Pediatr 2022; 43:e179-e187. [PMID: 34570065 PMCID: PMC8942874 DOI: 10.1097/dbp.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined the transition to adult health care for individuals with spina bifida (SB) and explored demographic and relational associations with transition status. METHOD Young adults with SB (18-30; n = 326) were recruited to complete an anonymous, online survey. Frequencies of reported experiences, behaviors, and satisfaction with the transition to adult health care were examined. Nonparametric tests and exploratory hierarchical regressions were used to examine demographic and relational factors with physicians between those (1) who had and had not yet transitioned and (2) who did and did not return to pediatric care. RESULTS Most of the sample reported having transitioned to adult health care, with three-quarters reporting that their primary physician is an adult primary care doctor. Individuals who had transitioned were more likely to be younger (p = 0.01) and to not have a shunt (p = 0.003). Beyond the effect of age and shunt status, relational factors with pediatric providers were not associated with transition (p > 0.1). After transition, over one-third reported returning to a pediatric provider. Those who did not return to pediatric care were more likely to have myelomeningocele, be a full-time student, and to not have a shunt (p < 0.001). Beyond the effect of age and shunt status, lower ratings of communication with adult providers were associated with a return to pediatric care (p = 0.04). CONCLUSION The results highlight the need for additional research about barriers and facilitators to the transition to adult health care to target interventions that support this critical milestone in young adults with SB.
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Affiliation(s)
- Colleen Stiles-Shields
- Rush University Medical Center, Department of Psychiatry and Behavioral Sciences, Section of Community Behavioral Health, 1645 W. Jackson Blvd., Chicago, IL 60612
| | - Tessa K. Kritikos
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Meredith Starnes
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Zoe R. Smith
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Grayson N. Holmbeck
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
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Choi EK, Yun H, Bae E. An Online-Based Transition Care Program for Adolescents with Spina Bifida Using Intervention Mapping: A Protocol for Program Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031056. [PMID: 35162083 PMCID: PMC8834098 DOI: 10.3390/ijerph19031056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Abstract
Adolescents with spina bifida (SB) face challenges in their transition to adulthood due to intensive medical regimens and delayed development of independence. Despite an increasing interest in the transition of adolescents with SB to adulthood, the clinical evidence of transition care remains limited, and existing studies have focused on the effects of intervention programs. This study aims to describe the process of systematically developing an online-based transition care program for adolescents with SB using the intervention mapping (IM) protocol. IM consists of six steps: (1) logic model of the problem; (2) program objectives; (3) program design; (4) program production; (5) plan to implement the program; (6) plan for evaluation. At first, five problems faced during the transition were identified, based on which four program objectives and six program strategies were established. The online transition care program for adolescents with SB was developed as a six-week program. The main strength of this program is that it reflects the diverse perspectives of adults with SB and health care professionals and is easy to apply because it is online. We aim to further validate the feasibility of this transitional care program to evaluate its effect based on our evaluation plan.
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Affiliation(s)
- Eun Kyoung Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul 03722, Korea;
| | - Hyeseon Yun
- Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul 03722, Korea;
| | - Eunjeong Bae
- Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul 03722, Korea;
- Correspondence: ; Tel.: +82-2-2228-3340
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Longitudinal Trajectories of Clean Intermittent Catheterization Responsibility in Youths with Spina Bifida. J Urol 2022; 207:192-200. [PMID: 34448629 PMCID: PMC8783611 DOI: 10.1097/ju.0000000000002204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Clean intermittent catheterization (CIC) responsibility among youths with spina bifida is not well studied. We sought to determine longitudinal trajectories of CIC responsibility to examine the transition of CIC responsibility from caregiver-CIC to self-CIC. MATERIALS AND METHODS We performed a secondary analysis of a prospective cohort study of youths with spina bifida. Participants aged 8-15 years originally recruited from 4 hospitals and a statewide spina bifida association were followed every 2 years. Participants who required CIC were included. Group-based trajectory modeling was used to isolate distinct trajectories of CIC responsibility, which was the primary outcome and was graded from caregiver-CIC to shared-CIC to self-CIC. Predictors of trajectory group membership were entered into multivariate logistic regression models and included various demographic, clinical and psychosocial characteristics such as CIC adherence and CIC mastery. RESULTS Of 140 youths in the original cohort study, 89 met eligibility criteria for this study. Mean age was 11 years at enrollment and 93% of patients had myelomeningocele. Two distinct trajectory groups emerged: 17% of patients had a low-flat trajectory and 83% had a high-increasing trajectory of CIC responsibility, with shared-CIC by age 8-9 years and increasing self-CIC responsibility thereafter. Significant predictors of group membership in the high-increasing trajectory group included less severe spinal lesion levels, higher CIC mastery and lower CIC adherence. CONCLUSIONS Nearly 1 in 5 youths with spina bifida in our cohort persistently required caregiver-CIC over time, while the remainder achieved shared-CIC responsibility by age 8-9 years, with increasing self-CIC responsibility thereafter.
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Starowicz J, Cassidy C, Brunton L. Health Concerns of Adolescents and Adults With Spina Bifida. Front Neurol 2021; 12:745814. [PMID: 34867728 PMCID: PMC8633437 DOI: 10.3389/fneur.2021.745814] [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: 07/22/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Due to advancements in medical care, people with spina bifida (SB) are surviving well into adulthood, resulting in a growing number of patients transitioning to an adult sector unequipped to care for people with chronic rehabilitative and medical needs. The Transitional and Lifelong Care (TLC) program is a multidisciplinary clinical service that compensates for this gap, providing comprehensive, coordinated care to adolescents, and adults with SB. As a relatively new clinical service, objective data about the patients using the service and their needs is scant. This study sought to identify the most common health concerns among TLC patients with SB at initial clinical consultation. A retrospective chart review of 94 patient charts was performed. Following data extraction, descriptive analyses were completed. The mean age of the sample was 29.04 ± 13.8 years. One hundred individual concerns and 18 concern categories were identified. On average, patients or care providers identified nine health concerns across various spheres of care, with care coordination being the most prevalent concern identified (86%). Patients also commonly had concerns regarding neurogenic bladder (70%), medications (66%), assistive devices (48%), and neurogenic bowel (42%). The numerous and wide-ranging health concerns identified support the need for individualised, coordinated care and a "medical home" for all adolescents and adults with SB during and following the transition to adult care. Health care providers caring for this population should continue to address well-documented health concerns and also consider raising discussion around topics such as sexual health, mental health, and bone health. Further research is required to understand how best to address the complex medical issues faced by adults with SB to maximise health and quality of life and improve access to healthcare.
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Affiliation(s)
- Jessica Starowicz
- Faculty of Health Sciences, Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Caitlin Cassidy
- Schulich School of Medicine and Dentistry, Physical Medicine and Rehabilitation and Paediatrics, Western University, London, ON, Canada
| | - Laura Brunton
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, ON, Canada
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Fremion E, Madey R, Staggers KA, Morrison-Jacobus M, Laufman L, Castillo H, Castillo J. Factors associated with self-management independence and quality of life for adolescents and young adults with spina bifida engaged in a guideline-based transition clinic. J Pediatr Rehabil Med 2021; 14:631-641. [PMID: 34657852 DOI: 10.3233/prm-200758] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To determine characteristics associated with self-management independence and quality of life (QOL) among adolescents and young adults with spina bifida (AYASB) engaged in a spina bifida (SB) health care transition clinic. METHODS During SB transition visits, Eighty-eight AYASB ages 14-20 completed the Adolescent/Young Adult Self-management and Independence Scale II Self-Report/SB (AMIS II-SR/SB), scores ranging from 1-7 with 7 indicating full independence in activities, and the QUAlity of Life Assessment in Spina bifida for Teens (QUALAS-T), which has two subscales, family/independence (QFI) and bowel/bladder (QBB), with scores ranging from 0-100 with 100 indicating maximal QOL score. Demographic and clinical variables were collected from the electronic medical record. RESULTS The baseline AMIS II-SR/SB score was 3.3 (SD 1.0). Baseline scores for QUALAS-T QFI and QBB subscales were 73.8 (SD 19.9) and 63.8 (SD 25.8). Older age was associated with a higher baseline AMIS II-SR/SB score (p = 0.017). Over time, AMIS II-SR/SB total significantly improved (p < 0.001), but QFI and QBB did not. AYASB not on chronic intermittent catheterization (CIC) and those using urethral CIC significantly improved in AMIS II-SR/SB total scores (p = 0.001), but those using abdominal channel CIC did not. CONCLUSION Baseline bladder management method was associated with self-management improvement for AYASB engaged in a SB-specific transition clinic.
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Affiliation(s)
- Ellen Fremion
- Transition Medicine, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA.,Spina Bifida Transition Clinic, Texas Children's Hospital, Houston, TX, USA
| | | | - Kristen A Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | | | - Larry Laufman
- Transition Medicine, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Heidi Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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