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Garcia Rodrigues M, Rodrigues JD, Pereira AT, Azevedo LF, Pereira Rodrigues P, Areias JC, Areias ME. Impact in the quality of life of parents of children with chronic diseases using psychoeducational interventions - A systematic review with meta-analysis. PATIENT EDUCATION AND COUNSELING 2022; 105:869-880. [PMID: 34389225 DOI: 10.1016/j.pec.2021.07.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 06/20/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to identify psychoeducational interventions applied to parents of children with chronic diseases and evaluate their impact on their quality of life (QoL). METHODS It was conducted in six databases, complemented by references from the included studies and other reviews, manual search, and contact with experts. We included primary studies on parents of children with chronic diseases that studied psychoeducational interventions versus standard care. RESULTS We screened 6604 titles and abstracts, reviewed the full text of 60 records, and included 37 primary studies. Half of the studies were on Asthma. We found three intervention formats: one-to-one (43%), groups (49%), and combined approach with individual and group settings (8%). More than 60% of the included studies found statistically significant differences between the intervention and the control group (p < 0.05). CONCLUSION Several interventions have shown efficacy in improving parental QoL. Despite that, there is insufficient evidence of interventions' implementation. PRACTICE IMPLICATIONS A holistic approach encompassing the patient and the family's biopsychosocial dimensions is fundamental in successfully managing chronic disease in children. It is vital to design and implement interventions accommodating the common issues experienced by children, parents, and families that deal with chronic childhood conditions. Systematic review registration number PROSPERO 2018 CRD42018092135.
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Affiliation(s)
- Marisa Garcia Rodrigues
- Department of Pediatric Cardiology, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - José Daniel Rodrigues
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Ana Teresa Pereira
- Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal.
| | - Luís Filipe Azevedo
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Pedro Pereira Rodrigues
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - José Carlos Areias
- Cardiovascular R&D Unit (UnIC), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Maria Emília Areias
- Cardiovascular R&D Unit (UnIC), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Instituto Universitário de Ciências da Saúde (IUCS), Portugal.
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Herth FJF, Sandhaus RA, Turner AM, Sucena M, Welte T, Greulich T. Alpha 1 Antitrypsin Therapy in Patients with Alpha 1 Antitrypsin Deficiency: Perspectives from a Registry Study and Practical Considerations for Self-Administration During the COVID-19 Pandemic. Int J Chron Obstruct Pulmon Dis 2021; 16:2983-2996. [PMID: 34754184 PMCID: PMC8570922 DOI: 10.2147/copd.s325211] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/27/2021] [Indexed: 01/06/2023] Open
Abstract
Alpha 1 Antitrypsin deficiency (AATD) is a hereditary condition characterized by low serum Alpha 1 Antitrypsin (AAT) levels and a predisposition towards early-onset emphysema. Infusion of AAT is the only disease-modifying therapy that can sufficiently raise plasma AAT levels above the putative protective threshold and reduce the decline in lung density loss. Several randomized controlled trials (RCTs) and registry studies support the clinical efficacy of AAT therapy in slowing the progression of AATD-related emphysema and improving survival outcomes. The COVID-19 pandemic has prompted physicians to develop additional strategies for delivering AAT therapy, which are not only more convenient for the patient, but are “COVID-19 friendly”, thereby reducing the risk of exposing these vulnerable patients. Intravenous (IV) self-administration of AAT therapy is likely to be beneficial in certain subgroups of patients with AATD and can remove the need for weekly hospital visits, thereby improving independence and well-being. Increasing the awareness of self-administration in AATD through the development of formal guidelines and training programs is required among both physicians and patients and will play an essential role, especially post-COVID-19, in encouraging physicians to consider self-administration for AATD in suitable patients. This review summarizes the benefits of AAT therapy on the clinical endpoints of mortality and quality of life (QoL) and discusses the benefits of self-administration therapy compared with conventional therapy administered by a healthcare professional. In addition, this review highlights the challenges of providing AAT therapy during the COVID-19 pandemic and the potential considerations for its implementation thereafter.
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Affiliation(s)
- Felix J F Herth
- Department of Pneumology and Critical Care Medicine, University of Heidelberg, Heidelberg, Germany
| | - Robert A Sandhaus
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Maria Sucena
- Pulmonology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Tobias Welte
- Department of Pulmonary and Infectious Diseases, Hannover Medical School, Hannover, Germany
| | - Timm Greulich
- Department of Internal Medicine and Pneumology, University Hospital Marburg, Marburg, Germany
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Niemitz M, Schrader M, Carlens J, Hengst M, Eismann C, Goldbeck L, Griese M, Schwerk N. Patient education for children with interstitial lung diseases and their caregivers: A pilot study. PATIENT EDUCATION AND COUNSELING 2019; 102:1131-1139. [PMID: 30709570 DOI: 10.1016/j.pec.2019.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Patient education in children with rare chronic diseases like children's interstitial lung disease (chILD) remains a challenge. AIMS To develop and evaluate a component-based educational program for individual counselling and to improve patients' and caregivers' self-efficacy and treatment satisfaction. Furthermore, to create chILD-specific educational material and assess physicians' satisfaction with the intervention as well as patients' health-related quality of life (HrQoL). METHODS The study was conducted in two German centers for pediatric pulmonology, as a single-group intervention with pre-post-follow-up design. RESULTS Participants (N = 107, age: M = 7.67, SD = 5.90) showed significant improvement of self-efficacy (self-report: t = 2.89, p < 0.01; proxy-report: t = 3.03, p < 0.01), and satisfaction (patients: t = 3.56, p = 0.001; parents t = 6.38, p < 0.001) with the medical consultations. There were no pre-post differences in HrQoL. Participants were highly satisfied with the material and the physicians with the program. CONCLUSIONS The chILD education-program is a promising strategy to improve patients' and their parents' self-efficacy and treatment-satisfaction. Specific effects of the intervention need to be determined in a randomized controlled trial. PRACTICE IMPLICATION Healthcare providers managing pediatric patients with chILD, may choose to use a patient education-program specifically tailored to the needs of chILD patients and their families, such as the program described here, which is the first of its kind.
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Affiliation(s)
- Mandy Niemitz
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm Medical Centre, Ulm, Germany.
| | - Miriam Schrader
- Department for Pediatric Pneumology, Allergologssy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Julia Carlens
- Department for Pediatric Pneumology, Allergologssy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Meike Hengst
- Dr. von Hauner Children´s Hospital, Department of Pediatric Pneumology, University Hospital Munich, German Center for Lung research (DZL), München, Germany
| | - Claudia Eismann
- Dr. von Hauner Children´s Hospital, Department of Pediatric Pneumology, University Hospital Munich, German Center for Lung research (DZL), München, Germany
| | - Lutz Goldbeck
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm Medical Centre, Ulm, Germany
| | - Matthias Griese
- Dr. von Hauner Children´s Hospital, Department of Pediatric Pneumology, University Hospital Munich, German Center for Lung research (DZL), München, Germany
| | - Nicolaus Schwerk
- Department for Pediatric Pneumology, Allergologssy and Neonatology, Hannover Medical School, Hannover, Germany
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Lonabaugh KP, O'Neal KS, McIntosh H, Condren M. Cystic fibrosis-related education: Are we meeting patient and caregiver expectations? PATIENT EDUCATION AND COUNSELING 2018; 101:1865-1870. [PMID: 29910140 DOI: 10.1016/j.pec.2018.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this study was to improve patient education in clinic by evaluating patient perceptions of education provided, as well as patient self-confidence related to topics within cystic fibrosis (CF). The study assessed whether self-confidence matched knowledge and defined patient-specific goals for education timing and information sources. METHODS Age specific questionnaires were distributed over four months to patients 11 years of age and older and caregivers of patients of all ages at a single CF Foundation accredited care center. RESULTS Participants reported frequent education on all topics except for reproductive effects of CF and mental health. A positive correlation was seen between overall confidence in CF-related knowledge and performance on a validated knowledge scale in adolescent caregivers only. Participants expected all educational milestones to be met by 13-14 years of age. CONCLUSIONS Gaps in CF education remain and educational models should deliver information by the early teens without overlooking reproductive effects and mental health. PRACTICE IMPLICATIONS The educational model for CF clinics should become more comprehensive by including education on topics such as mental health and reproductive effects. Providers are an important pathway for information and should not disregard the value of education provided during clinic visits.
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Affiliation(s)
- Kevin P Lonabaugh
- College of Pharmacy, University of Oklahoma-Tulsa, 4502 E 41(st) St, Tulsa, OK, 74135, USA.
| | - Katherine S O'Neal
- College of Pharmacy, University of Oklahoma-Tulsa, 4502 E 41(st) St, Tulsa, OK, 74135, USA
| | - Heather McIntosh
- School of Community Medicine, University of Oklahoma-Tulsa, 4502 E 41(st) St, Tulsa, OK, 74135, USA; Office for Research Development and Scholarly Activity, University of Oklahoma-Tulsa, 4502 E 41(st) St, Tulsa, OK, 74135, USA
| | - Michelle Condren
- School of Community Medicine, University of Oklahoma-Tulsa, 4502 E 41(st) St, Tulsa, OK, 74135, USA
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Nicolais CJ, Bernstein R, Riekert KA, Quittner AL. Parent knowledge of disease management in cystic fibrosis: Assessing behavioral treatment management. Pediatr Pulmonol 2018; 53:162-173. [PMID: 29193881 DOI: 10.1002/ppul.23916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 08/16/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-shortening, burdensome disease requiring complex knowledge to manage the disease. Significant gaps in knowledge have been documented for parents, which may lead to unintentionally poor adherence and insufficient transfer of treatment responsibility from parents to adolescents. There are no current, validated measures of parent knowledge for this population and there are no measures that assess the knowledge required for day-to-day behavioral management of CF. We assessed the psychometric properties of the parent version of the Knowledge of Disease Management-Cystic Fibrosis measure (KDM-CF-P) using data from iCARE (I Change Adherence and Raise Expectations), a randomized control adherence intervention trial. METHODS A total of 196 parents in the iCARE standard care/control arm completed 35 items assessing their knowledge of disease management at their 12-month study visit, prior to beginning the intervention. Items were eliminated from the measure if they met the threshold for ceiling effects, were deemed clinically irrelevant, or did not correlate well with their intended scale. Item-to-total correlations, confirmatory factor analysis, discriminant function, reliability, and convergent validity were calculated. RESULTS The KDM-CF-P (19 items) demonstrated internal consistency of KR20 = 0.60 on each scale and a two-scale structure. Convergent validity for knowledge scores was found with maternal education, family income, and type of medical insurance. Parents correctly answered approximately 85% of items on the KDM-CF-P. CONCLUSIONS The KDM-CF-P psychometrics support a two-scale measure with clinical utility. It is useful for assessing gaps in knowledge that can be remediated through individualized, tailored interventions.
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Affiliation(s)
| | - Ruth Bernstein
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alexandra L Quittner
- Miami Children's Research Institute, Nicklaus Children's Hospital, Miami, Florida
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Williams LK, McCarthy MC, Burke K, Anderson V, Rinehart N. Addressing behavioral impacts of childhood leukemia: A feasibility pilot randomized controlled trial of a group videoconferencing parenting intervention. Eur J Oncol Nurs 2016; 24:61-69. [PMID: 27697278 DOI: 10.1016/j.ejon.2016.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/23/2016] [Accepted: 08/18/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE Child emotional and behavioral problems constitute significant sequelae of acute lymphoblastic leukemia (ALL) treatment. The aims of this study were to a) examine the feasibility, acceptability and satisfaction of a parenting intervention amongst parents of children with ALL and b) explore whether participation in a parenting intervention shows promise for improvements in child behavior. METHODS 12 parents with a child aged between 2 and 8 years receiving maintenance phase treatment for ALL participated in a phase 2 randomized controlled trial comparing eight weeks of group online participation in Triple P: Positive Parenting Program with no intervention. RESULTS The number of eligible parents who completed the intervention was low (31.6%). Main reasons for non-consent or dropout were program time commitment too high or content not relevant. For parents who completed the intervention, satisfaction and acceptability was high. Parents reported the intervention as highly relevant and topical, feasible, helpful and a positive experience. Results indicated a non-significant trend towards improved total child behavioral and emotional difficulties following the intervention. Qualitative results indicated that intervention group parents reported improvements in parenting skills and competence, and decreased child behavioral problems. CONCLUSIONS These pilot data highlight the difficulties of engaging and retaining parents in an 8-week parenting intervention in this context. For parents who completed the intervention, results indicated high feasibility, acceptability and satisfaction. Suggestions for further research and intervention modifications are provided to enhance uptake and strengthen efforts to assist parents in addressing child behavioral and emotional challenges during ALL treatment.
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Affiliation(s)
- Lauren K Williams
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia; School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia.
| | - Maria C McCarthy
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia; Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Kylie Burke
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia; Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia; Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia; Department of Pediatrics, University of Melbourne, Flemington Road, Parkville, Victoria, 3052, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
| | - Nicole Rinehart
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
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Annunziato RA, Rubes M, Ambrose M, Caso N, Dillon M, Sicherer SH, Shemesh E. Allocation of food allergy responsibilities and its correlates for children and adolescents. J Health Psychol 2016; 20:693-701. [PMID: 26032786 DOI: 10.1177/1359105315579798] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
This study examined the degree to which children and adolescents with food allergy accept responsibility for their own care, and the extent to which greater self-management is associated with past history of a life-threatening allergic reaction or anxiety. For children (n = 190), caregiver and patient report of self-management was consistent, but agreement was poor for adolescent dyads (n = 59). History of a life-threatening allergic reaction was associated with greater self-management for children only, while among adolescents, it was associated with greater anxiety. Given that shifting to self-management may be challenging, discussion and preparation about this process is warranted.
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Kazmerski TM, Miller E, Abebe KZ, Matisko J, Schachner D, Spahr J. Patient Knowledge and Clinic Attendance in Adolescent Patients with Cystic Fibrosis. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015. [DOI: 10.1089/ped.2014.0475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Traci M. Kazmerski
- Children's Hospital of Pittsburgh of University of Pennsylvania Medical Center, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of University of Pennsylvania Medical Center, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kaleab Z. Abebe
- Center for Research on Health Care Data Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Janice Matisko
- Children's Hospital of Pittsburgh of University of Pennsylvania Medical Center, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Diane Schachner
- Children's Hospital of Pittsburgh of University of Pennsylvania Medical Center, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jonathan Spahr
- Children's Hospital of Pittsburgh of University of Pennsylvania Medical Center, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Savage E, Beirne PV, Ni Chroinin M, Duff A, Fitzgerald T, Farrell D. Self-management education for cystic fibrosis. Cochrane Database Syst Rev 2014; 2014:CD007641. [PMID: 25198249 PMCID: PMC6481678 DOI: 10.1002/14651858.cd007641.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Self-management education may help patients with cystic fibrosis and their families to choose, monitor and adjust treatment requirements for their illness, and also to manage the effects of illness on their lives. Although self-management education interventions have been developed for cystic fibrosis, no previous systematic review of the evidence of effectiveness of these interventions has been conducted. OBJECTIVES To assess the effects of self-management education interventions on improving health outcomes for patients with cystic fibrosis and their caregivers SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register (date of the last search: 22 August 2013).We also searched databases through EBSCO (CINAHL; Psychological and Behavioural Sciences Collection; PsychInfo; SocINDEX) and Elsevier (Embase) and handsearched relevant journals and conference proceedings (date of the last searches: 01 February 2014 ). SELECTION CRITERIA Randomised controlled trials, quasi-randomised controlled trials or controlled clinical trials comparing different types of self-management education for cystic fibrosis or comparing self-management education with standard care or no intervention. DATA COLLECTION AND ANALYSIS Two authors assessed trial eligibility and risk of bias. Three authors extracted data. MAIN RESULTS Four trials (involving a total of 269 participants) were included. The participants were children with cystic fibrosis and their parents or caregivers in three trials and adults with cystic fibrosis in one trial. The trials compared four different self-management education interventions versus standard treatment: (1) a training programme for managing cystic fibrosis in general; (2) education specific to aerosol and airway clearance treatments; (3) disease-specific nutrition education; and (4) general and disease-specific nutrition education. Training children to manage cystic fibrosis in general had no statistically significant effects on weight after six to eight weeks, mean difference -7.74 lb (i.e. 3.51 kg) (95% confidence interval -35.18 to 19.70). General and disease-specific nutrition education for adults had no statistically significant effects on: pulmonary function (forced expiratory volume at one second), mean difference -5.00 % (95% confidence interval -18.10 to 8.10) at six months and mean difference -5.50 % (95% confidence interval -18.46 to 7.46) at 12 months; or weight, mean difference - 0.70 kg (95% confidence interval -6.58 to 5.18) at six months and mean difference -0.70 kg (95% confidence interval -6.62 to 5.22) at 12 months; or dietary fat intake scores, mean difference 1.60 (85% confidence interval -2.90 to 6.10) at six months and mean difference 0.20 (95% confidence interval -4.08 to 4.48) at 12 months. There is some limited evidence to suggest that self-management education may improve knowledge in patients with cystic fibrosis but not in parents or caregivers. There is also some limited evidence to suggest that self-management education may result in positively changing a small number of behaviours in both patients and caregivers. AUTHORS' CONCLUSIONS The available evidence from this review is of insufficient quantity and quality to draw any firm conclusions about the effects of self-management education for cystic fibrosis. Further trials are needed to investigate the effects of self-management education on a range of clinical and behavioural outcomes in children, adolescents and adults with cystic fibrosis and their caregivers.
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Affiliation(s)
- Eileen Savage
- University College CorkSchool of Nursing and Midwifery, Brookfield Health Sciences ComplexCorkIreland
| | - Paul V Beirne
- University College CorkDepartment of Epidemiology and Public Health4th Floor, Western Gateway Building, Western RoadCorkIreland
| | | | - Alistair Duff
- Leeds Teaching Hospitals NHS TrustDepartment of Clinical & Health PsychologyBeckett StreetLeedsUKLS9 7TF
| | - Tony Fitzgerald
- University College CorkDepartment of Epidemiology and Public Health4th Floor, Western Gateway Building, Western RoadCorkIreland
| | - Dawn Farrell
- University College CorkSchool of Nursing and Midwifery, Brookfield Health Sciences ComplexCorkIreland
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Goldbeck L, Fidika A, Herle M, Quittner AL. Psychological interventions for individuals with cystic fibrosis and their families. Cochrane Database Syst Rev 2014; 2014:CD003148. [PMID: 24941199 PMCID: PMC7388585 DOI: 10.1002/14651858.cd003148.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND With increasing survival estimates for individuals with cystic fibrosis, long-term management has become an important focus. Psychological interventions are largely concerned with adherence to treatment, emotional and social adaptation and health-related quality of life. We are unaware of any relevant systematic reviews. OBJECTIVES To determine whether psychological interventions for people with cystic fibrosis provide significant psychosocial and physical benefits in addition to standard medical care. SEARCH METHODS Studies were identified from two Cochrane trials registers (Cystic Fibrosis and Genetic Disorders Group; Depression, Anxiety and Neurosis Group), Ovid MEDLINE and PsychINFO; unpublished trials were located through professional networks and Listserves. Most recent search of the Cystic Fibrosis and Genetic Disorders Group's register: 19 December 2013.Most recent search of the Depression, Anxiety and Neurosis Group's register: 12 November 2013. SELECTION CRITERIA Randomised controlled studies of a broad range of psychological interventions evaluating subjective and objective health outcomes, such as quality of life or pulmonary function, in individuals of all ages with cystic fibrosis and their immediate family. We were interested in psychological interventions, including psychological methods within the scope of psychotherapeutic or psychosomatic mechanism of action (e.g. cognitive behavioural, cognitive, family systems or systemic, psycho-dynamic, or other, e.g. supportive, relaxation, or biofeedback), which were aimed at improving psychological and psychosocial outcomes (e.g. quality of life, levels of stress or distress, psychopathology, etc.), adaptation to disease management and physiological outcomes. DATA COLLECTION AND ANALYSIS Three authors were involved in selecting the eligible studies and two of these authors assessed their risk of bias. MAIN RESULTS The review includes 16 studies (eight new studies included in this update) representing data from 556 participants. Studies are diverse in their design and their methods. They cover interventions with generic approaches, as well as interventions developed specifically to target disease-specific symptoms and problems in people with cystic fibrosis. These include cognitive behavioural interventions to improve adherence to nutrition or psychosocial adjustment, cognitive interventions to improve adherence or those associated with decision making in lung transplantation, a community-based support intervention and other interventions, such as self-hypnosis, respiratory muscle biofeedback, music therapy, dance and movement therapy, and a tele-medicine intervention to support patients awaiting transplantation.A substantial proportion of outcomes relate to adherence, changes in physical status or other specific treatment concerns during the chronic phase of the disease.There is some evidence that behavioural interventions targeting nutrition and growth in children (4 to 12 years) with cystic fibrosis are effective in the short term. Evidence was found that providing a structured decision-making tool for patients considering lung transplantation improves patients' knowledge of and expectations about the transplant, and reduces decisional conflict in the short term. One study about training in biofeedback-assisted breathing demonstrated some evidence that it improved some lung function measurements. Currently there is insufficient evidence for interventions aimed at other aspects of the disease process. AUTHORS' CONCLUSIONS Currently, insufficient evidence exists on psychological interventions or approaches to support people with cystic fibrosis and their caregivers, although some of the studies were promising. Due to the heterogeneity between studies, more of each type of intervention are needed to support preliminary evidence. Multicentre studies, with consequent funding implications, are needed to increase the sample size of these studies and enhance the statistical power and precision to detect important findings. In addition, multicentre studies could improve the generalisation of results by minimizing centre or therapist effects. Psychological interventions should be targeted to illness-specific symptoms or behaviours to demonstrate efficacy.
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Affiliation(s)
- Lutz Goldbeck
- Dptm. Child and Adolescent Psychiatry/Psychotherapy, University Clinic Ulm, Steinhoevelstr. 5, Ulm, Baden-Württemberg, Germany, D-89075
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Annunziato RA, Baisley MC, Arrato N, Barton C, Henderling F, Arnon R, Kerkar N. Strangers headed to a strange land? A pilot study of using a transition coordinator to improve transfer from pediatric to adult services. J Pediatr 2013; 163:1628-33. [PMID: 23993138 DOI: 10.1016/j.jpeds.2013.07.031] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/05/2013] [Accepted: 07/19/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the impact of a transition coordinator on outcomes for pediatric liver transplant recipients vs a historical comparison group. STUDY DESIGN To examine the utility of a transition coordinator, medication adherence, as measured by SDs of tacrolimus blood levels (Tacrolimus SD), was compared between the "transition coordinator group" (20 transplant recipients transferred between 2007 and 2012) and comparison group for 1 year before and after transfer. Measures of health care management, quality of life, and acceptability were administered to the transition coordinator group as well. RESULTS A repeated measures ANOVA was used to compare adherence values between the transition coordinator group and the comparison group. During the year before transfer, for the transition coordinator group, Tacrolimus SD was 1.98 (SD = 1.05) vs 3.25 (SD = 1.19) for comparison patients, F(1,25) = 4.77, P = .04. After transfer, levels remained stable for the transition coordinator group, Tacrolimus SD = 1.88 (SD = 1.57), but increased for comparison patients, Tacrolimus SD = 4.36 (SD = 0.99), F(1,25) = 6.99, P = .01. Psychosocial outcomes remained stable during the transfer period and acceptability was high. CONCLUSIONS Our findings, although limited by a small sample size, suggest that a transition coordinator is a promising method to improve this process.
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Affiliation(s)
- Rachel A Annunziato
- Department of Psychology, Fordham University, Bronx, NY; Division of Behavioral and Developmental Health, Department of Pediatrics and Kravis Children's Hospital at the Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY.
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Sysko R, Zandberg LJ, Devlin MJ, Annunziato RA, Zitsman JL, Walsh BT. Mental Health Evaluations for Adolescents Prior to Bariatric Surgery: A Review of Existing Practices and a Specific Example of Assessment Procedures. Clin Obes 2013; 3:62-72. [PMID: 24073019 PMCID: PMC3781169 DOI: 10.1111/cob.12019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Best practice guidelines for adolescents considering bariatric surgery recommend a pre-operative mental health evaluation. However, only general information about these assessments appears in the literature, which makes consistency of administration challenging. This review proposes a specific empirically-derived format for pre-surgical mental health evaluations and summarizes currently available data on the psychiatric functioning of adolescents seeking bariatric surgery. DESIGN Studies of mental health evaluations for adults preparing for bariatric surgery are reviewed, as is the limited literature relevant to adolescent evaluations. A specific and detailed example of an evaluation (clinical interview, self-report questionnaires, cognitive assessment) used for younger patients at a major metropolitan hospital center is presented, followed by data from an initial group of adolescents completing this evaluation. SUBJECTS 200 adolescents (n=139 female; age: 14-18 y, BMI: 35.4-83.3 kg/m2) presenting for bariatric surgery. RESULTS A notable subset of adolescents reported current Axis I conditions (31.5%) and current mental health treatment (29.5%), but reports of current illicit drug use (1.5%) and regular alcohol use (0.5%) were relatively rare. Procedures for using the completed evaluation and post-surgery monitoring of psychosocial issues are discussed. CONCLUSIONS Adolescents considering weight loss surgery should receive comprehensive pre-surgical mental health evaluations, but additional data are needed to develop specific recommendations the use of these evaluations in post-operative care.
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Affiliation(s)
- Robyn Sysko
- Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, NY
| | | | - Michael J. Devlin
- Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, NY
| | | | - Jeffrey L. Zitsman
- Center for Adolescent Bariatric Surgery, Department of Surgery, Division of Pediatric Surgery, Columbia University Medical Center, New York, NY
| | - B. Timothy Walsh
- Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, NY
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Mkwanazi NB, Rochat TJ, Imrie J, Bland RM. Disclosure of maternal HIV status to children: considerations for research and practice in sub-Saharan Africa. Future Virol 2012. [DOI: 10.2217/fvl.12.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An estimated 2.8 million children are born to HIV-infected mothers each year, 2.5 million of whom are likely to be HIV-exposed but uninfected. In sub-Saharan Africa up to 40% of pregnant women are HIV-infected, resulting in large numbers of HIV-uninfected children living with at least one HIV-infected parent. These parents face many challenges, including the dilemma of when and how to disclose their HIV status to their children, particularly those who are pre-adolescent. This article summarizes the current evidence on maternal HIV disclosure to their HIV-uninfected children, explores the reported benefits of disclosure to children and mothers, highlights the gaps in knowledge and areas for future research, and discusses possible future intervention models focusing on primary school-aged children in sub-Saharan Africa.
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Affiliation(s)
- Ntombizodumo B Mkwanazi
- Africa Centre for Health & Population Studies, University of KwaZulu–Natal, PO Box 198, Somkhele, 3935, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Tamsen J Rochat
- Africa Centre for Health & Population Studies, University of KwaZulu–Natal, PO Box 198, Somkhele, 3935, South Africa
- Department of Psychology, Stellenbosch University, South Africa
| | - John Imrie
- Africa Centre for Health & Population Studies, University of KwaZulu–Natal, PO Box 198, Somkhele, 3935, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Centre for Sexual Health & HIV Research, Faculty of Population Health Sciences, University College London, UK
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Savage E, Beirne PV, Ni Chroinin M, Duff A, Fitzgerald T, Farrell D. Self-management education for cystic fibrosis. Cochrane Database Syst Rev 2011:CD007641. [PMID: 21735415 DOI: 10.1002/14651858.cd007641.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Self-management education may help patients with cystic fibrosis and their families to choose, monitor and adjust treatment requirements for their illness, and also to manage the effects of illness on their lives. Although self-management education interventions have been developed for cystic fibrosis, no previous systematic review of the evidence of effectiveness of these interventions has been conducted. OBJECTIVES To assess the effects of self-management education interventions on improving health outcomes for patients with cystic fibrosis and their caregivers SEARCH STRATEGY We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register (date of the last search: 23 February 2011).We also searched databases through EBSCO (CINAHL; Psychological and Behavioural Sciences Collection; PsychInfo; SocINDEX) and Elsevier (EMBASE) and handsearched relevant journals and conference proceedings (date of the last searches: 30th March 2011). SELECTION CRITERIA Randomised controlled trials, quasi-randomised controlled trials or controlled clinical trials comparing different types of self-management education for cystic fibrosis or comparing self-management education with standard care or no intervention. DATA COLLECTION AND ANALYSIS Two authors assessed trial eligibility and risk of bias. Three authors extracted data. MAIN RESULTS Four trials (involving a total of 269 participants) were included. The participants were children with cystic fibrosis and their parents or caregivers in three trials and adults with cystic fibrosis in one trial. The trials compared four different self-management education interventions versus standard treatment: (1) a training programme for managing cystic fibrosis in general; (2) education specific to aerosol and airway clearance treatments; (3) disease-specific nutrition education; and (4) general and disease-specific nutrition education. Training children to manage cystic fibrosis in general had no statistically significant effects on weight after six to eight weeks, mean difference -7.74 lb (95% confidence interval -35.18 to 19.70). General and disease-specific nutrition education for adults had no statistically significant effects on: pulmonary function (forced expiratory volume at one second), mean difference -5.00 % (95% confidence interval -18.10 to 8.10) at six months and mean difference -5.50 % (95% confidence interval -18.46 to 7.46) at 12 months; or weight, mean difference - 0.70 kg (95% confidence interval -6.58 to 5.18) at six months and mean difference -0.70 kg (95% confidence interval -6.62 to 5.22) at 12 months; or dietary fat intake scores, mean difference 1.60 (85% confidence interval -2.90 to 6.10) at six months and mean difference 0.20 (95% confidence interval -4.08 to 4.48) at 12 months. There is some limited evidence to suggest that self-management education may improve knowledge in patients with cystic fibrosis but not in parents or caregivers. There is also some limited evidence to suggest that self-management education may result in positively changing a small number of behaviours in both patients and caregivers. AUTHORS' CONCLUSIONS The available evidence from this review is of insufficient quantity and quality to draw any firm conclusions about the effects of self-management education for cystic fibrosis. Further trials are needed to investigate the effects of self-management education on a range of clinical and behavioural outcomes in children, adolescents and adults with cystic fibrosis and their caregivers.
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Affiliation(s)
- Eileen Savage
- Catherine McAuley School of Nursing & Midwifery Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
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Balmer DF, Schall JI, Stallings VA. Social disadvantage predicts growth outcomes in preadolescent children with cystic fibrosis. J Cyst Fibros 2008; 7:543-50. [PMID: 18684676 DOI: 10.1016/j.jcf.2008.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 05/28/2008] [Accepted: 06/25/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Dorene F Balmer
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States.
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17
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Abstract
BACKGROUND With increasing survival estimates for cystic fibrosis (CF) long-term management has become an important focus. Psychological interventions are largely concerned with adherence to treatment, emotional and social adjustments and quality of life. We are unaware of any relevant systematic reviews. OBJECTIVES Assess whether psychological interventions for CF provide significant psychosocial and physical benefits in addition to standard care. SEARCH STRATEGY Trials were identified from two Cochrane trial registers (CF and Genetic Disorders Group; Depression, Anxiety and Neurosis Group), Ovid MEDLINE and PsychINFO; unpublished trials were located through professional networks and Listserves. Most recent search: September 2007. SELECTION CRITERIA Randomised controlled trials of a broad range of psychological interventions in children and adults with CF and their immediate family. DATA COLLECTION AND ANALYSIS Two authors independently selected relevant trials and assessed their methodological quality. MAIN RESULTS The review includes 13 studies (five new at this update) representing data from 529 participants. Studies mainly assessed behavioural and educational interventions:1. gene pre-test education counselling for relatives of those with CF;2. biofeedback, massage and music therapy to assist physiotherapy;3. behavioural and educational interventions to improve dietary intake and airway clearance;4. self-administration of medication and education to promote independence, knowledge and quality of life; and5. systemic interventions promoting psychosocial functioning.A substantial proportion of outcomes were educational or behavioural relating to issues of adherence, change in physical status or other specific treatment concerns during the chronic phase of the disease. Some evidence was found for relative's acceptance of a genetic test for carrier status when using home-based rather than clinic-based information leaflets and testing. There is some evidence that behavioural interventions improve emotional outcomes in people with CF and their carers, and that psychoeducational interventions improve knowledge in the short term. There was no consistent effect on lung function, although one small study showed that biofeedback-assisted breathing re-training helped improve some lung function measurements. Some studies point to educational and behavioural interventions aiding nutrition and growth in people with CF. Currently there is insufficient evidence for interventions aimed at other aspects of the disease process. AUTHORS' CONCLUSIONS Currently no clear evidence exists on the best psychological interventions to help people with CF and their carers manage the disease. Trials of interventions to improve adherence to treatment are needed. Multicentre approaches, with consequent funding implications, will increase the sample size of trials and enhance the power and precision of their findings.
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Affiliation(s)
- Claire A Glasscoe
- Academic Child Mental Health Unit, Royal Liverpool Children's Hospital, Eaton Road, Liverpool, UK, L12 2AP.
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Kahana S, Drotar D, Frazier T. Meta-analysis of psychological interventions to promote adherence to treatment in pediatric chronic health conditions. J Pediatr Psychol 2008; 33:590-611. [PMID: 18192300 DOI: 10.1093/jpepsy/jsm128] [Citation(s) in RCA: 254] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the effectiveness of adherence-promoting psychological interventions for pediatric populations with chronic health conditions. METHODS A meta-analysis was conducted on 70 adherence-promoting psychological intervention studies among chronically ill youth using a weighted least squares approach and random effect model. RESULTS Medium effects sizes were found for the behavioral (mean d =.54, 95% confidence interval [CI] = 0.34-0.73, n = 10) and multi-component interventions (mean d =.51, 95% CI = 0.45-0.57, n = 46), while educational interventions displayed a small effect size with adherence (mean d =.16, 95% CI = 0.10-0.22, n = 23). Study designs incorporating pre-post comparisons yielded effect sizes approaching the medium range (mean d =.42, 95% CI = 0.36-0.48, n = 30). CONCLUSIONS Behavioral and multi-component interventions appear to be relatively potent in promoting adherence among chronically ill youth. Recommendations for future research and methodological issues are presented.
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Affiliation(s)
- Shoshana Kahana
- National Institute of Mental Health, Division of Developmental Translational Research, 6001 Executive Blvd, MSC 9617, Room 6190, Bethesda, MD 20892, USA.
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Beranova E, Sykes C. A systematic review of computer-based softwares for educating patients with coronary heart disease. PATIENT EDUCATION AND COUNSELING 2007; 66:21-8. [PMID: 17084058 DOI: 10.1016/j.pec.2006.09.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 09/07/2006] [Accepted: 09/20/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To evaluate the use of computer-based softwares for educating patients with coronary heart disease. METHODS A systematic electronic search for randomised controlled trials and comparison studies published from 1999 to the end of 2005 using the MEDLINE (1999-2005), EMBASE (1999-2005) and CINAHL (1999-2005) was carried out. Articles including the reference lists in the following journals were hand-searched: Patient Education and Counselling and Patient Counselling and Health Education. RESULTS A total of 487 articles were identified. Based on a review of abstracts, five studies fulfilled the inclusion criteria of the review. A scoring sheet was used to assess the papers' quality. All studies reported significantly increased knowledge in patients using the educational software when compared to standard education. The difference in knowledge between the intervention and control groups remained high even at 6 months follow up. Furthermore, patients reported high satisfaction with the educational programs. CONCLUSION Despite there only being five studies that met the inclusion criteria, this review supports the successful use of computer software to increase knowledge in patients with coronary heart disease. The reviewed articles reveal that computer-based education has an important role in increasing patients' knowledge about their condition. PRACTICAL IMPLICATIONS It is commonly reported that patients want more information about their illness. This study shows that computer-based education can be a useful, acceptable to patients and effective way to deliver education about coronary heart disease.
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Affiliation(s)
- Eva Beranova
- Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London SE1 3QD, United Kingdom.
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David V, Iguenane J, Ravilly S. L’éducation thérapeutique dans la mucoviscidose : quelles compétences pour le patient ? Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91012-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Swerissen H, Belfrage J, Weeks A, Jordan L, Walker C, Furler J, McAvoy B, Carter M, Peterson C. A randomised control trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds. PATIENT EDUCATION AND COUNSELING 2006; 64:360-8. [PMID: 16859871 DOI: 10.1016/j.pec.2006.04.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 03/06/2006] [Accepted: 04/10/2006] [Indexed: 05/06/2023]
Abstract
OBJECTIVE This study investigated the effectiveness of the Chronic Disease Self-management Program (CDSMP) when delivered to for people from Vietnamese, Chinese, Italian and Greek backgrounds living in Victoria, Australia. METHOD The CDSMP was administered to 320 people with chronic illnesse(es) in selected low income areas in the State of Victoria, Australia. At 6 months, they were compared with randomised wait-list control subjects (n=154) using analyses of covariance. RESULTS Participants in the intervention group had significantly better outcomes on energy, exercise, symptom management, self-efficacy, general health, pain, fatigue and health distress. There were no significant effects for health services utilisation. Interactions across language groups were observed with the Vietnamese and Chinese speaking participants gaining greater benefit. CONCLUSION Self-management programs can be successfully implemented with culturally and linguistically diverse populations in Australia. Further research is needed to evaluate long-term outcomes; explore effects on service utilisation; and to determine whether the benefits obtained from participating in a self-management program can be maintained. PRACTICE IMPLICATIONS Self-management programs should be considered for people from culturally and linguistically diverse backgrounds. Care also needs to be taken in designing recruitment strategies to minimize withdrawal rates and to ensure harder to reach people are given encouragement to participate.
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Affiliation(s)
- Hal Swerissen
- Australian Institute for Primary Care, La Trobe University, Victoria, Australia.
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22
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Downs JA, Roberts CM, Blackmore AM, Le Souëf PN, Jenkins SC. Benefits of an education programme on the self-management of aerosol and airway clearance treatments for children with cystic fibrosis. Chron Respir Dis 2006; 3:19-27. [PMID: 16509174 DOI: 10.1191/1479972306cd100oa] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Adherence to recommended aerosol medicines and airway clearance techniques (ACT) for children with cystic fibrosis (CF) requires self-management skills. A multi-centre, randomized, controlled trial was conducted to investigate the effectiveness of a self-management education programme called 'Airways' for six- to 11-year old children with CF and their caregivers. Assessments were conducted immediately before and after the intervention period, and six and 12 months after the post-intervention assessment. The pen and paper education programme was completed by the child and caregiver together at home. Participants in the intervention and control groups had similar baseline characteristics. A per-protocol analysis was conducted and for variables that changed significantly, an additional intention-to-treat analysis was performed that included data from participants in the intervention group who withdrew from the study during the intervention period. The intervention group increased the percentage of prescribed aerosols taken (P < 0.001) and this was maintained at 12-month follow-up (P < 0.001). There was no change in the percentage of prescribed ACT performed, although when the child was unwell, caregivers in the intervention group increased the frequency and/or duration of ACT (P = 0.028) in the per-protocol analysis but not in the intention-to-treat analysis. Children in the intervention group increased their knowledge of ACT (P < 0.001) which was maintained at 12-month follow-up (P < 0.001) and felt more positively about their chest treatment regimens immediately following the intervention (P = 0.017) but not at 12-month follow-up. There were no significant changes in the control group for these variables over time. No significant changes occurred in the caregivers' reports of self-management behaviours and self-efficacy in either group. The positive results suggest that 'Airways' is a valuable educational tool for primary school-aged children with CF and their caregiver.
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Affiliation(s)
- J A Downs
- School of Physiotherapy, Curtin University of Technology, Western Australia
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David V, Berville C, Douaud P, Dumas V, Leger P, De Pontbriand U, Bailly C. Éducation thérapeutique et mucoviscidose : l’expérience d’un CRCM pédiatrique. Rev Mal Respir 2005. [DOI: 10.1016/s0761-8425(05)85595-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
AIMS To explore the meanings that parents and children attach to food and eating, and how these influence their approaches to dietary management of cystic fibrosis (CF). METHODS Ethnographic design using in-depth interviews with 32 children with CF (aged 6-14 years) and their parents, and participant observations during visits to CF clinics with a sub-group of 21 children. Data were analysed using the constant comparative method and theoretical sampling was used to further explore and develop emergent themes. RESULTS Dietary management was found to be a demanding task for children and their parents, and priorities differed between them. A priority of feeding for parents was to protect their children's long term physical health and survival by keeping their weight up. A challenge for parents was to ensure their children's cooperation with eating. A priority for children in being healthy was to have energy for physical activities and so energy rather than weight was of immediate relevance to their daily lives. These differences between parents and children gave rise to tensions and conflicts in their interactions with one another in managing diet. CONCLUSIONS Healthcare professionals should take account of the meanings that children and their parents attach to food and eating that can influence their decisions about implementing CF dietary recommendations. The role of children in making food choices has implications for acknowledging them as active participants in their dietary care and for adopting child centred approaches to dietary advice for CF.
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Affiliation(s)
- E Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.
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Abstract
The purpose of this qualitative investigation was to describe the lived experiences of families caring for a child with cystic fibrosis at the time of initial diagnosis. Phenomenological research methodology as described by Colaizzi (1978) was used to guide the investigation. A purposive sample of 9 family members voluntarily participated in the study. Data were gathered through focus groups and written narratives. Data analysis yielded 3 essential theme clusters with subthemes: Falling Apart, Pulling Together, and Moving Beyond. Within the theme of Falling Apart, the subthemes of Devastation of Diagnosis, An All-Encompassing Sense of Fear and Isolation, and An Overwhelming Sense of Guilt and Powerlessness are described. The theme of Pulling Together included the subthemes of Perpetual Vigilance and Returning to Normalcy, and the third theme of Moving Beyond included the subtheme of An Optimal Unfolding of a New Kind of Consciousness. This article describes in detail the themes and subthemes identified during data analysis and the fluid nature of the relationship that exists within the essential structure of caring for a family member with cystic fibrosis. The diagnosis of cystic fibrosis most often comes as a life-shattering experience to families. Lifestyle readjustments are made in an attempt to return to some sense of family normalcy. In order to achieve stability in their daily lives, families are vigilant in the care and monitoring of the health of a child with cystic fibrosis. Ongoing support from health care professionals that is grounded in the realities of living with cystic fibrosis is critical. This study describes how families develop their own unique way of controlling the experience of living with cystic fibrosis, one day and one breath at a time.
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Gallant MP. The influence of social support on chronic illness self-management: a review and directions for research. HEALTH EDUCATION & BEHAVIOR 2003; 30:170-95. [PMID: 12693522 DOI: 10.1177/1090198102251030] [Citation(s) in RCA: 574] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A review of the empirical literature examining the relationship between social support and chronic illness self-management identified 29 articles, of which 22 were quantitative and 7 were qualitative. The majority of research in this area concerns diabetes self-management, with a few studies examining asthma, heart disease, and epilepsy management. Taken together, these studies provide evidence for a modest positive relationship between social support and chronic illness self-management, especially for diabetes. Dietary behavior appears to be particularly susceptible to social influences. In addition, social network members have potentially important negative influences on self-management There is a need to elucidate the underlying mechanisms by which support influences self-management and to examine whether this relationship varies by illness, type of support, and behavior. There is also a need to understand how the social environment may influence self-management in ways other than the provision of social support
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Affiliation(s)
- Mary P Gallant
- Department of Health Policy, Management, & Behavior, School of Public Health, University at Albany, State University of New York, Rensselaer 12144-3456, USA.
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Abstract
BACKGROUND As survival estimates for cystic fibrosis (CF) steadily increase long-term management has become an important focus for intervention. Psychological interventions are largely concerned with emotional and social adjustments, adherence to treatment and quality of life, however no systematic review of such interventions has been undertaken for this disease. OBJECTIVES To describe the extent and quality of effectiveness studies utilising psychological interventions for CF and whether these interventions provide significant psychosocial and physical benefits in addition to standard care. SEARCH STRATEGY Relevant trials were identified from searches of Ovid MEDLINE, the Cochrane trial registers for CF and Depression, Anxiety and Neurosis Groups and PsychINFO; unpublished trials were located through professional networks and Listserves. Most recent search: April 2003. SELECTION CRITERIA This review included RCTs and quasi-randomised trials. Study participants were children and adults diagnosed with CF, and their immediate family members. Psychological interventions were from a broad range of modalities and outcomes were primarily psychosocial, although physical outcomes and cost effectiveness were also considered. DATA COLLECTION AND ANALYSIS Two reviewers independently selected relevant trials and assessed their methodological quality. For binary and continuous outcomes a pooled estimate of treatment effect was calculated for each outcome. MAIN RESULTS This review is based on the findings of eight studies, representing data from a total of 358 participants. Studies fell into four conceptually similar groups: (1) gene pre-test education counselling for relatives of those with CF (one study); (2) biofeedback, massage and music therapy to assist physiotherapy (three studies); (3) behavioural intervention to improve dietary intake in children up to 12 years (three studies); and (4) self-administration of treatments to improve quality of life in adults (one study). Interventions were largely educational or behavioural, targeted at specific treatment concerns during the chronic phase. No completed studies concentrating on complex treatment approaches were found. There is some evidence that behavioural interventions can improve emotional outcomes in people with CF and their carers. There was no consistent effect on lung function although one small study showed that biofeedback assisted breathing re-training was associated with improvement in some measures of spirometric lung function. Insufficient evidence is available at this point for interventions aimed at other aspects of the disease process. REVIEWER'S CONCLUSIONS Multicentre approaches are required to increase the sample sizes of studies in the psychosocial field and to enhance the power and precision of the findings. This has consequent implications for funding.
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Affiliation(s)
- C A Glasscoe
- University Child Mental Health, Royal Liverpool Children's NHS Trust, 1st Floor, Mulberry House, Alder Hey Children's Hospital, Eaton Road, Liverpool, Merseyside, UK, L12 2AP
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Graves KD. Social cognitive theory and cancer patients' quality of life: A meta-analysis of psychosocial intervention components. Health Psychol 2003. [DOI: 10.1037/0278-6133.22.2.210] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. PATIENT EDUCATION AND COUNSELING 2002. [PMID: 12401421 DOI: 10.1016/s0738-3991%2802%2900032-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies.
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Affiliation(s)
- Julie Barlow
- Interdisciplinary Research Centre in Health, Psychosocial Research Centre, School of Health and Social Sciences, Coventry University, Priory St., Coventry CV1 5FB, England, UK.
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Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. PATIENT EDUCATION AND COUNSELING 2002; 48:177-187. [PMID: 12401421 DOI: 10.1016/s0738-3991(02)00032-0] [Citation(s) in RCA: 1658] [Impact Index Per Article: 75.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies.
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Affiliation(s)
- Julie Barlow
- Interdisciplinary Research Centre in Health, Psychosocial Research Centre, School of Health and Social Sciences, Coventry University, Priory St., Coventry CV1 5FB, England, UK.
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Goldbeck L, Babka C. Development and evaluation of a multi-family psychoeducational program for cystic fibrosis. PATIENT EDUCATION AND COUNSELING 2001; 44:187-192. [PMID: 11479059 DOI: 10.1016/s0738-3991(00)00184-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The development, implementation and evaluation of a psychoeducational program for families with a child affected by cystic fibrosis (CF) is described. Aim of the program was to strengthen the families' coping with CF-related problems and to improve adherence with chest physiotherapy. Sixteen families from an outpatient CF-clinic participated. Parents and children were educated both individually as well as together in multi-family groups. Teaching, practicing and group discussions were balanced in each session. In a pre-post-design the following variables were evaluated: parental coping, parental health beliefs, children's coping, adherence, and knowledge about CF. The parental coping patterns and health beliefs remained unchanged in the study group. Children developed more search for social support, whereas their competence and optimism decreased and withdrawal increased slightly as perceived by the parents. There is a subgroup with poor family functioning and adherence at pretest which improves after the intervention.Family-centered psychoeducational intervention may be a promising supportive strategy for children with CF, especially if it is dedicated to families with poor adaptation to the disease.
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Affiliation(s)
- L Goldbeck
- Department for Pediatrics, University Hospital Ulm, Ulm, Germany.
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Bartholomew LK, Parcel GS, Kok G. Intervention mapping: a process for developing theory- and evidence-based health education programs. HEALTH EDUCATION & BEHAVIOR 1998; 25:545-63. [PMID: 9768376 DOI: 10.1177/109019819802500502] [Citation(s) in RCA: 568] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The practice of health education involves three major program-planning activities: needs assessment, program development, and evaluation. Over the past 20 years, significant enhancements have been made to the conceptual base and practice of health education. Models that outline explicit procedures and detailed conceptualization of community assessment and evaluation have been developed. Other advancements include the application of theory to health education and promotion program development and implementation. However, there remains a need for more explicit specification of the processes by which one uses theory and empirical findings to develop interventions. This article presents the origins, purpose, and description of Intervention Mapping, a framework for health education intervention development. Intervention Mapping is composed of five steps: (1) creating a matrix of proximal program objectives, (2) selecting theory-based intervention methods and practical strategies, (3) designing and organizing a program, (4) specifying adoption and implementation plans, and (5) generating program evaluation plans.
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Affiliation(s)
- L K Bartholomew
- Center for Health Promotion Research and Development, University of Texas Health Science Center, Houston 77225, USA.
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