Canadian Resources for Siblings of Youth With Chronic Health Conditions to Inform and Support With Healthcare Management: A Qualitative Document Analysis

The co-development and pilot evaluation of the Siblings Training, Empowerment, and Advocacy Kit (Siblings TEAKit) to support youth and young adult siblings of individuals with a disability: A participatory action research qualitative study protocol

INTRODUCTION

Siblings can have multiple roles in the lives of each other over time, including the roles of friend, role model, and caregiver at different time points. These roles may be different for siblings of youth with disabilities, and yet, there are limited resources to support siblings in the health, rehabilitation, and education systems. This protocol outlines a study for which the primary aim is to develop and evaluate a toolkit to support youth and young adult siblings to initiate conversations about their roles and responsibilities with their sibling(s) with a disability and family. The secondary aim of the study is to test a framework for and evaluate the process of partnered research with siblings and other family members.

METHODS

This qualitative descriptive study will adopt a participatory approach where a Sibling Youth Advisory Council (SibYAC) of young adult siblings of individuals with a disability and/or chronic health condition will be engaged as research partners. The long standing partnership with the SibYAC and our team has informed the need to conduct this study. This study will be conducted in two stages to address our primary aim. First, a co-design workshop will be held with siblings (ages 14 to 25 years old) to develop the content and format of the toolkit. Second, focus groups will be conducted with siblings, parents, and healthcare professionals to provide feedback on the toolkit prototypes. Data will be analyzed using directed content analysis with implementation science frameworks as a guide. Specifically, the Theoretical Domains Framework and COM-B model will be used to identify toolkit elements focused on supporting siblings, and the Consolidated Framework for Implementation Research (CFIR) will provide considerations about settings for where the toolkit could be implemented in the future. The secondary aim is addressed where our partnership with the SibYAC will be evaluated through formative discussions and the Public and Patient Engagement Evaluation Tool.

DISCUSSION

This study protocol advances the methods and rigour in participatory research with young people, including siblings. This study is the first step towards the development of a toolkit to support siblings of persons with disabilities to foster dialogue between families, health and education professionals about their roles. Clear expectations about family roles can promote positive health and wellbeing for siblings and the whole family.

Perspectives in childhood-onset disabilities: integrating 21st-Century concepts to expand our horizons

PURPOSE

A powerful aphorism states: "If I hadn't believed it, I wouldn't have seen it!" This challenging notion reminds us how strongly we are influenced by prevailing ideas, and how we interpret things according to current fashions and teachings.

MATERIALS AND METHODS

In this paper we present and discuss contemporary perspectives concerning childhood-onset disability and the evolving nature of how people are thinking and acting. We illustrate these ideas by reminding readers of how we have all traditionally been trained and acculturated to think about many dimensions of neurodevelopmental disability ("What?"); reflect on the impact of these ways of thinking in terms of what we have conventionally "seen" and done ("So What?"); and contrast those traditions with contemporary concepts that we believe or know impact the field ("Now What?").

RESULTS

Many of the concepts discussed here will be familiar to readers. In taking this analytically critical perspective we aim to illustrate that by weaving these individual threads together we are able to create a coherent fabric that can serve children with childhood-onset NDD, their families, service providers, the community, and policy-makers. We do not purport to offer a comprehensive view of the whole field.

CONCLUSIONS

We encourage readers to consider the integration of these new ways of thinking and acting in our still-evolving field of "childhood-onset disability".

Daily life situations and participation of siblings of children with childhood-onset disabilities: a scoping review

BACKGROUND

Siblings of children with disabilities or childhood-onset chronic conditions (eg, autism, cerebral palsy or congenital heart disease) often face challenges in mental health, quality of life and psychosocial adjustment. However, comprehensive knowledge of their participation in daily activities remains limited. Understanding their participation patterns and potential restrictions can help clarify their needs.

AIMS AND METHODS

This scoping review aims to summarise current research on the participation of siblings of children with childhood-onset chronic conditions. Following the Joanna Briggs Institute methodology, we systematically searched MEDLINE, CINAHL, AMED, PsycINFO and ERIC for peer-reviewed studies published in English between 2001 and 2024. Eligible studies focused on siblings of children with disabilities or early-onset chronic conditions (population) and their participation, including attendance and involvement in daily activities (concept) across children's homes, communities and schools (context). The review adheres to the Preferred Reporting Items for Scoping Reviews guidelines.

RESULTS

A total of 62 articles met the inclusion criteria: 45 qualitative (73%) and 7 quantitative (11%) studies, 7 reviews (11%) and 3 meta-studies (5%). The studies covered various chronic conditions (eg, cancer, chronic kidney disease and Down syndrome), with autism being the most common (22 studies). Key participation themes identified include family life, home participation, school involvement, leisure activities, social interactions with peers, information-seeking and continuous meaning-making. Factors such as normalcy, advocacy, identity, gender, age, culture and socioeconomic status were found to intersect with participation.

CONCLUSIONS

This review provides a comprehensive overview of current research and contributes to our understanding of how participation in daily activities has been studied so far in the population of siblings of children with disabilities. It reveals a gap in research specifically measuring participation among siblings. The identified themes enhance our understanding of potential participation restrictions in this population.

"Filling in the gap": A qualitative case study about identity construction of siblings of youth with a neurodisability

INTRODUCTION

In families of children with a neurodisability, siblings have unique experiences that can shape their identity. There is limited information about the developmental process of how siblings form their identity. This study aims to understand the identity construction of young siblings who have a sibling with a neurodisability.

METHODS

As part of a patient-oriented research program, we engaged with our Sibling Youth Advisory Council in Canada. In this qualitative case study, data from semi-structured interviews augmented by photo elicitation and graphic elicitation of relational maps were analyzed using reflexive thematic analysis.

RESULTS

Nineteen sibling participants (median age = 19 years, range = 14-33 years) reflected on the uniqueness of their role during childhood. During adolescence and emerging adulthood, they became closer with their sibling with a neurodisability and increased communication with their parents about how to care for their sibling with a neurodisability. These experiences influenced how they explored and began to reconcile their sibling identity with their professional and social identities.

CONCLUSION

Siblings of youth with a neurodisability discover their unique identity and require support in this developmental process. Future interventions could evaluate how supports for siblings can have an impact on the positive development of their identity.

Being a sibling of a youth with a neurodisability: A qualitative study about the roles and responsibilities during the transition to adulthood

BACKGROUND

During the transition to adulthood, a common challenge that youth with a neurodisability may experience is learning how to navigate services in the adult care system. During this transition youth may rely on their families, including siblings, for support. However, delineation of sibling roles and responsibilities during this transition period are unclear. This study aims to identify the roles and responsibilities that siblings perceive to have with their sibling with a neurodisability during the transition to adulthood, and describe the decision-making process of how siblings chose these roles.

METHODS

In this descriptive qualitative case study, siblings were eligible to participate if they were between 14 to 40 years old, had a sibling between 14 to 21 years with a childhood-onset neurodisability and spoke English. Semi-structured interviews augmented by techniques of photo elicitation and relational maps were conducted. Reflexive thematic analysis was applied to identify sibling roles, as well as the emotional and decision-making process associated with these roles. Our team partnered with siblings with lived experience in all study phases.

RESULTS

Nineteen participants (median age = 19 years, range = 14 to 33 years) from 16 unique families were interviewed. Six unique roles were described: friend, role model/mentor, protector, advocate, supporter, or caregiver. The emotions that siblings experienced with each role, also known as emotional responsibility, were categorized into levels of low, medium or high. Siblings also described a four-phase decision-making process for their roles: (1) acquiring knowledge; (2) preparing plans; (3) making adjustments; and (4) seeking support. Intrapersonal characteristics, including personal identity, values and experiences, influenced roles assumed by siblings.

CONCLUSIONS

Siblings identified needing support as they process their decisions and emotional responsibility in their roles when their sibling with a neurodisability is transitioning to adulthood. Resources should be developed or further enhanced to support siblings.

Programs to Prepare Siblings for Future Roles to Support Their Brother or Sister with a Neurodevelopmental Disability: a Scoping Review

Purpose of Review

To identify and map the characteristics and outcomes of programs designed to prepare siblings for their future roles with their sibling with a neurodevelopmental disability.

Recent Findings

Existing programs to support siblings of individuals with a neurodevelopmental disability often focus on providing information about neurodevelopmental disabilities, creating a community for siblings to connect with each other, and connecting siblings to resources and services to support them in their roles. Some programs are offered to the whole family with specific sessions for siblings. While these program descriptions are provided in the literature, there is limited understanding about the impacts and outcomes of these programs on siblings of an individual with a neurodevelopmental disability.

Summary

Fifty-eight articles (published between 1975 and 2020, with > 50% published since 2010) met the inclusion criteria, representing 54 sibling programs from 11 countries. Extracted data represented 1033 (553 females) sibling participants, between 4 and 67 years old. Twenty-seven programs focused on the outcome of knowledge acquisition for the siblings and thirty-one programs focused on the outcome of empowerment for the siblings to teach skills to their sibling with a neurodevelopmental disability. While there is an increasing number of programs for siblings of individuals with a neurodevelopmental disability in the past decade, there is a lack of siblings as co-developers or facilitators. Future research should consider the various roles that siblings can have in programs to address their needs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40474-023-00272-w.

"We survived the pandemic together": The impact of the COVID-19 pandemic on Canadian families living with chronic pain

Introduction

Pediatric chronic pain is a significant problem in Canada, affecting one in five youth. This study describes the impact of the pandemic on the experiences of Canadian families living with chronic pain through interviews with youth living with chronic pain, parents, and siblings.

Methods

Employing a qualitative descriptive design, in-depth semistructured interviews were completed with Canadian youth living with pain, as well as parents and siblings. Participants were not required to be related. Interviews were analyzed using a reflexive thematic analysis approach.

Results

Forty-four interviews were completed with 14 parents, 19 youth with chronic pain, and 11 siblings from across the country. Three key themes were developed: (1) absorbing and shifting: the toll of the pandemic on the family system (e.g., loss of coping mechanisms, shifting roles to respond to the pandemic), (2) social ambiguity and abandonment (e.g., social sacrifice and abandonment by the health care system), and (3) building community resilience: familial adaptation to the pandemic (e.g., family cohesion, confidence, and self-management).

Discussion/Conclusions

Youth, parents, and siblings reported that the pandemic impacted coping strategies across the family system. These results outline the challenges youth experienced managing their pain and overall health throughout the pandemic and the resilience built within families during this time. Going forward, it would be relevant to examine how racialized and structurally marginalized youth with chronic pain and their families experienced the pandemic. Future research should examine how unexpected benefits of the pandemic (e.g., increased confidence and self-management) may be sustained into the future.

Protocol of the BEST SIBS study: a qualitative case study to investigate the roles and responsibilities of siblings of youth with a neurodisability during health care transition

Background

Children and youth with neurodisabilities may experience different challenges during their transition to adulthood, such as pursuing postsecondary education, finding employment, and navigating a new adult health care system. Families, including siblings, have an important role in the process for when youth with neurodisabilities are transitioning to adulthood. Siblings are in a unique position, where they can have different roles such as a friend, mentor, or caregiver. Siblings can offer various supports to their brother or sister with a neurodisability, but they require knowledge and skills for these different supporting roles. Currently, there are limited programs available for siblings to learn how to support their brother or sister with a neurodisability during transition. A first step to develop these sibling support programs is to understand the experiences of siblings of youth with a neurodisability. The purpose of this report is to describe a protocol of a qualitative case study aimed at examining the experiences of siblings including their roles and responsibilities to their brother or sister with a neurodisability during health care transition.

Methods

An exploratory single case study design will be used. An integrated knowledge translation approach to conducting this study will be used by partnering with the Sibling Youth Advisory Council comprised of siblings who have a brother or sister with a disability throughout all study phases. Participants will include siblings (ages 14–40 years old) with a brother or sister (ages 14–21 years old) with a neurodisability in Ontario, Canada. Semi-structured interviews will be conducted, that will be augmented by photo elicitation and drawings of family tree diagrams. Data will be analyzed using reflexive thematic analysis.

Discussion

Findings from this study will be shared with siblings, families, researchers, and the broader community. It is important to understand the roles and responsibilities that siblings are choosing to have to support their brother or sister with a neurodisability, and how these roles may change over time as their sibling is growing up and transitions to adulthood. Siblings may require knowledge and skills in these roles, and an understanding about siblings’ experiences in certain roles can help to inform the development of a resource to support siblings during health care transition.