Digital Technologies for Children and Parents Sharing Self-Management in Childhood Chronic or Long-Term Conditions: A Scoping Review

Self-Management in Children and Adolescents With Chronic Illness: An Evolutionary Analysis of the Concept

AIM

To increase conceptual clarity regarding the self-management of school-age children and adolescents with chronic illnesses in a community context.

DESIGN

Concept Analysis: Rodgers' evolutionary approach.

DATA SOURCES

Search conducted in the Cumulative Index to Nursing and Allied Health Literature, Psychology and Behavioural Sciences Collection, Nursing and Allied Health Collection, Academic Search Complete, Cochrane, Web of Science, Medical Literature Analysis and Retrieval System Online, Scopus, Repositório Científico de Acesso Aberto de Portugal, ProQuest Dissertations and Theses, Joanna Briggs Institute Evidence Synthesis. Thirty-one articles were identified, published between 2004 and 2023.

REPORTING METHOD

Followed the Enhancing the Quality and Transparency of Health Research guidelines-Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020.

RESULTS

Self-management in children and adolescents with chronic illness, in school age, in a community context, consists of a process of acquiring knowledge and beliefs that promote the self-efficacy of this population in developing skills to face needs inherent to the health condition.

CONCLUSION

Promoting self-management goes beyond simply educating for skill acquisition. Participants with stronger beliefs in their ability to control their behaviours are more successful in self-management. The activation of resources that position the child as an agent of change is recommended.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

It contributes to the development of strategies that promote self-management across different healthcare disciplines, focusing on education and change, but also on psychological encouragement to foster confidence in change.

IMPACT

Competent self-management during childhood promotes autonomy, empowerment, and control of the condition, with consequent physical and emotional well-being, quality of life, family stability, and social development.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no direct contribution from patients or the public in this work (literature review).

Nursing approaches to self-care, self-management, and adaptation to illness

Nursing approaches to self-care, self-management, and adaptation to illness encompass diverse strategies aimed at enhancing patient well-being and empowering chronic condition management. The BMC Nursing collection "Nursing Approaches to Self-Care, Self-Management, and Adaptation to Illness" invites research advancing knowledge and care quality in these areas.

Healthcare professional and commissioners' perspectives on the factors facilitating and hindering the implementation of digital tools for self-management of long-term conditions within UK healthcare pathways

Physical activity is important in the self-management of long-term conditions (LTCs). However, implementing physical activity into clinical practice is challenging, due to complex barriers including access to programmes, time pressures, and transport costs, for people with comorbidities, managing multiple responsibilities. Various digital tools exist to overcome these barriers and support wide-scale implementation to help people stay physically active. We explored the experiences, needs and preferences of healthcare professionals and commissioners, regarding the use of digital tools to support people with LTCs to self-manage using physical activity. This included barriers and facilitators to implementing digital tools to support people with LTCs in NHS settings. Semi-structured interviews were conducted (April 2021 to January 2022) in Wessex, southern England, UK. Purposive sampling was used to recruit general practitioners and healthcare professionals, and convenience sampling to recruit commissioners (n = 15). Transcripts were coded to develop conceptual themes allowing comparisons between and among perspectives, with the Normalisation Process Theory (NPT)'s four constructs used to aid interpretation. Results showed that most digital tools supporting physical activity for LTCs, are not well implemented clinically. Current digital tools were seen to lack condition-specificity, usability/acceptability evidence-base, and voluntary sector involvement (i.e., NPT: coherence or 'making sense'). Healthcare professionals and commissioners were unlikely to engage with use of digital tools unless they were integrated into health service IT systems and professional networks (i.e., NPT: cognitive participation), or adaptable to the digital literacy levels of service users and staff (i.e., NPT: collective action-needs for implementation). In practice, this meant being technically, easy to use and culturally accessible (i.e., NPT: collective action-promoting healthcare work). COVID-19 changed professional attitudes towards digital tools, in that they saw them being viable, feasible and critical options in a way they had not done before the pandemic. Implementation was also influenced by endorsement and trustworthiness enhancing the perception of them as secure and evidence-based (i.e., NPT: reflective monitoring). Our findings highlight that consideration must be given to ensuring that digital tools are accessible to both healthcare professionals and patients, have usability/acceptability, and are adaptable to specific LTCs. To promote clinical engagement, digital tools must be evidence-based, endorsed by professional networks, and integrated into existing health systems. Digital literacy of patients and professionals is also crucial for cross-service implementation.

Gaining consensus on emotional wellbeing themes and preferences for digital intervention type and content to support the mental health of young people with long-term health conditions: A Delphi study

BACKGROUND

Young people (YP) with long-term conditions (LTCs) are at greater risk of psychological distress than those without LTCs. Despite this, there is a scarcity of quality digital interventions designed to help improve mental wellbeing in this population. The aim of this study was to determine what YP, parents and health professionals preferred for future interventions.

METHODS

Twenty-six YP with asthma, diabetes and/or epilepsy (the three most common LTCs in YP), 23 parents of YP with LTCs and 10 health professionals mainly in paediatric specialisms (total n = 59) took part in an online Delphi study to gain consensus (set at 75% agreement) on four questions across three rounds. Participants ordered psychological themes that may be experienced by YP with LTCs by importance and ranked digital intervention types and delivery modes by importance or usefulness. The most common results were reported if no consensus was reached by round 3.

RESULTS

Participants preferred a mobile phone app (73% agreement) and a mixture of one-on-one and group support for an intervention (75% agreement). The two highest ranked psychological themes were anxiety (44%) and wanting to appear 'normal' (38%), and the top intervention type was 'general counselling' (54% agreement).

CONCLUSION

There was a clear desire for an app to help with the psychological aspects of living with LTCs and for a combination of one-to-one and group intervention elements. Anxiety and wanting to appear 'normal' might be two closely linked psychological challenges that could be addressed by a single intervention.

IMPLICATIONS

The results will be important to consider for a future intervention, although further consultation will be needed for app development.

PATIENT OR PUBLIC CONTRIBUTION

Two YP with a LTC provided feedback on the study protocol including the aims and procedures of the project. Another six YP with LTCs were consulted on an early draft of the study questionnaire (the four questions), which was subsequently revised. Once the project began, a patient and public involvement group consisting of two YP with LTCs and one parent of a YP with an LTC gave feedback on the research process, lay report of the results and dissemination plan.

Telehealth interventions for transition to self-management in adolescents with allergic conditions: A systematic review

Telehealth is an emerging approach that uses technology to provide healthcare remotely. Recent publications have outlined the importance of supporting the transition to self-management of adolescents with allergic conditions. However, no synthesis of the evidence base on the use and impact of telehealth interventions for this purpose has been conducted to date. This review achieves these aims, in addition to exploring the language use surrounding these interventions, and their implementation. Four databases were searched systematically. References were independently screened by two reviewers. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was undertaken. Eighteen articles were included, reporting on 15 telehealth interventions. A total of 86% targeted adolescents with asthma. Mobile applications were the most common telehealth modality used, followed by video-conferencing, web-based, virtual reality and artificial intelligence. Five intervention content categories were identified; educational, monitoring, behavioural, psychosocial and healthcare navigational. Peer and/or healthcare professional interaction, gamification and tailoring may increase engagement. The studies showed positive effects of the interventions or no difference from active controls, in self-management outcomes such as knowledge, health outcomes such as quality-of-life, and economic outcomes such as healthcare utilization. The most common implementation outcomes reported were acceptability, appropriateness, feasibility and fidelity.

Improving the Communication of Dental Findings in Pediatric Dentistry by Using Intraoral Scans as a Visual Aid: A Randomized Clinical Trial

The aim of this first randomized clinical trial (RCT) was to determine whether intraoral scans (IOS) can be used as a visual aid to improve the communication of dental findings in pediatric dentistry. Therefore, 60 children (mean age 10.1 ± 3.3 years) and their accompanying parents/primary caregivers were examined between July 2022 and February 2023. Patients were randomly allocated to two groups: half of the participants were informed of the children's dental findings including treatment plans by verbal explanation alone (control group, n = 30), while the other half were informed using IOS (Trios 4, 3Shape) as a visual aid to support the verbal explanation (study group, n = 30). Both groups then completed a questionnaire regarding their children's diagnosis, treatment needs, planned therapy, and oral hygiene. Statistical analysis was performed using a t-test (p < 0.05). Overall, there was a significant difference between the two groups (p < 0.001) in terms of understanding the current oral situation of their children. While 85.5 ± 17.3% (mean ± standard deviation) of the answers were correct in the study group, only 57.2 ± 17.8% of the participants in the control group were capable of answering the questions correctly. In particular, the control group had difficulties answering the questions about treatment needs and therapy correctly. Within the limitations of this first pilot study, IOS can be clearly recommended as a visual aid to improve the communication of dental findings with PGs in pediatric dentistry.

Educational Technology as a Support Tool for Students with Specific Learning Difficulties—Future Education Professionals’ Perspective

The research presented is framed in the context of educational technology (ET), and specifically in its use as a support tool for students with specific learning difficulties (SLD). This is descriptive quantitative research, the objective of which is to know what students know about the use of educational technology, the perceived usefulness of educational applications, and the use of educational technology as support for students with specific learning difficulties. In order to answer this question, a data-collection instrument was designed that included an ad hoc questionnaire made up of three blocks to evaluate the use of ET, the perceived usefulness of educational applications, as well as ET as a support for students with SLD. The participating sample is made up of students from different teacher training degrees of the Faculty of Education of the University of Burgos (n = 130). After the descriptive analysis was carried out, the results that were obtained allowed us to conclude that ET is an excellent proposal for the classroom, and that, due to its adaptability, it can, and should, be a frequent resource for achieving educational objectives, and especially as support for students with SLD.