Predictors of Quality of Life among Parents of Children with Chronic Diseases: A Cross-Sectional Study

The impact of raising a child with a developmental or physical health condition in Ethiopia

OBJECTIVE

Raising a child with a developmental disability or physical health condition can have a major impact on the lives of their families, especially in low-income countries. We explored the impact on such families in Ethiopia.

STUDY DESIGN

A total of 241 child-caregiver dyads were recruited from two public hospitals in Addis Ababa, Ethiopia. Of these, 139 children were diagnosed with a developmental disability (e.g. autism, intellectual disability) and 102 children with a physical health condition (e.g. malnutrition, severe HIV infection). The family quality of life was assessed using caregiver reports on the Pediatric Quality of Life Inventory™ (PedsQL-FIM™). The disability weight score, which is a Global Burden of Disease measure to quantify health loss, was estimated for each child.

RESULTS

Families with a child with a developmental disability reported lower quality of life than families caring for a child with a physical health condition (p < .001). Mean disability weight scores in children with a developmental disability were higher than in children with a physical health condition (p < .001), indicating more severe health loss. Disability weight scores were negatively associated with the family quality of life in the whole group (B=-16.8, SE=7.5, p = .026), but not in the stratified analyses.

CONCLUSIONS

Caring for a child with a developmental disability in Ethiopia is associated with a substantial reduction in the family quality of life. Scaling up support for these children in resource-limited contexts should be prioritized.

Validity evidence for the coping strategy indicator-short version (CSI-S) among psychology students

The abbreviated measurement of coping strategies is useful for monitoring and identifying the effects of stress. The Coping strategy indicator-Short version (CSI-S, including the dimensions of seeking support, problem solving and avoidance strategies) is a new adaptation of the full version of this indicator, and additional evidence of its validity is needed. Psychology students (n = 125) from a public university in Lima, Peru, were recruited to help provide such evidence of validity in terms of internal structure, reliability and associations with other variables (perceived stress and general efficacy in cope with difficulties), which were evaluated using nonparametric item response theory procedures. Support-seeking and problem-solving items from the Mokken scale and the avoidance scale exhibited limitations. The correlations between the scales were moderate or low and exhibited theoretical consistency, and the relationship with perceived stress highlighted the predictive capacity of avoidance and problem-solving strategies. In general, the CSI-S exhibits suitable psychometric properties; however, the avoidance score requires further examination or reconstruction of its items.

Development and validation of a Japanese version of The Quality of Discharge Teaching Scale-Parent Form (JQDTS-PF): A cross-sectional observational study

BACKGROUND

Advances in medical care have enabled home treatment and advanced medical care for children with chronic illnesses. Nurses are not only required to teach their caregivers skills but also understand the families' needs and identify their anxieties in discharge teaching. However, no measure is currently available in Japan to evaluate the quality of discharge teaching provided by nurses. Therefore, this study aimed to develop a Japanese version of the Quality of Discharge Teaching Scale Parent-Form (JQDTS-PF) developed by Weiss et al. METHODS: A Japanese version of the scale was created after obtaining permission from the original author. The questionnaire was then distributed to caregivers of children discharged from hospitals in Japan who required some form of medical care after discharge.

FINDINGS

The study population comprised 113 respondents (response rate: 93.3%). The reliability of the scale was 0.88 for "need," 0.86 for "receive," and 0.93 for "delivery." Significant positive correlations were found between the JQDTS-PF subscale and the Japanese version of Readiness for Hospital Discharge Scale (JRHDS-PF). Significant correlations were also found between child and family characteristics and subscales of the JQDTS-PF.

DISCUSSION

The developed Japanese version of the scale was found to be sufficiently reliable. Validity of the scale was also sufficiently confirmed by correlation analysis, which yielded results similar to those of previous studies.

APPLICATION TO PRACTICE

This scale would be useful in improving and evaluating the quality of discharge teaching by nurses in Japan in the future.

Effectiveness of community-based family-focused interventions on family functioning among families of children with chronic health conditions: A systematic review and meta-analysis

Community-based family-focused interventions can offer support to families of children with chronic health conditions. This review aimed to evaluate the effectiveness of community-based family-focused interventions in improving family functioning, disease knowledge, and child health outcomes among families of children with chronic health conditions. Eight electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO, Scopus, Web of Science, and ProQuest Dissertations & Theses Global) and one trial registry (ClinicalTrials.gov) were searched from their dates of inception to October 2022. Meta-analysis was performed under the random-effect model when appropriate otherwise, findings were narratively synthesized. I2 statistics and Cochran's Q chi-squared test were used to determine heterogeneity. Quality appraisal was conducted by the Cochrane risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation approach at the study and outcome level, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided this review. Eight studies were included in this review. Community-based family-focused interventions were viable methods that could support families of children with chronic health conditions. Family-focused interventions that incorporate guided role-playing exercises for parents and children, psychoeducational components, and elements from relationship-focused interventions could support families more effectively. However, current findings are mostly limited to interventions conducted in patients' homes, and the long-term effect of these interventions cannot be determined. Overall, community-based family-focused interventions have the potential to offer valuable support to families of children with chronic health conditions, and future research could seek to improve the effectiveness of these interventions.

Mothers of Children With Special Health Care Needs: Exploring Caregiver Burden, Quality of Life, and Resiliency

INTRODUCTION

This study aimed to explore caregiver burden, quality of life (QOL), and resilience in mothers of children with special health care needs (CSHCN), compare differences between mothers of CSHCN and healthy children, and differences between mothers of CSHCN on the basis of child severity.

METHOD

Mothers (n = 106) with a child aged < 18 years were recruited. A cross-sectional design was used. Measures included the Caregiver Burden Inventory, Quality of Life Scale, and Brief Resilience Inventory. Pearson point-biserial correlations and independent t-tests were used to compare group differences.

RESULTS

Caregiver burden and QOL were negatively correlated (p < .001). Mothers of CSHCN had greater burden (p < .001) and poorer QOL (p = .006). Child severity increased caregiver burden time (p = .003).

DISCUSSION

Study findings expound on research indicating mothers of CSHCN experience greater burden and poorer QOL than their peers, and child severity increases burden via time commitment. Health care providers should assess risk factors for poor QOL and caregiver burden and provide appropriate resources.

Unmet supportive care needs of families of children with chronic illness: A systematic review

BACKGROUND AND AIMS

Unmet supportive care needs (SCN) refer to perceived gaps in the support parents want to manage caregiving activities for children with chronic health conditions (CHC) and the support received. This review aims to systematically identify the unmet SCN of families with children living with five common paediatric CHC and characterise the assessment tools used to measure SCN.

DESIGN

Systematic review methodology with narrative synthesis of data. Reporting followed the PRISMA statement guidelines.

METHOD

Literature searches were conducted in electronic databases Medline complete, PsycINFO, CINHAL and EMBASE to retrieve relevant articles published between 1990 and July 2022. Eligible studies involved (i) children aged 0-18 years diagnosed with either of cancer, congenital heart disease (CHD), diabetes, asthma, renal disease and (ii) assessment of unmet SCN. Studies involving children with genetic or developmental conditions were excluded. The methodological quality of studies was assessed using JBI assessment tool.

RESULTS

Of 6223 articles screened, 34 papers were included (25 quantitative, 5 qualitative and 4 mixed design). Most papers explored unmet needs of families with cancer (n = 26). The remaining articles concerned CHD (n = 5), asthma (n = 2) and mixed CHC (n = 1, renal failure, and diabetes). Information (e.g. treatment, lifestyle, etc.) and health care (e.g. emotional support, practical services, etc.) were the most common unmet need domains across health conditions. A variety of methods and need assessments hampered comparisons between studies both across and within CHC.

CONCLUSION

Irrespective of illness, addressing unmet informational or health care needs may help to optimise outcomes and care for children and families living with common CHC. There was considerable variation in reporting styles, study design and need assessments both within and across conditions.

RELEVANCE TO CLINICAL PRACTICE

Health care professionals must routinely evaluate the type, quality and quantity of psychoeducation and support that families of children with CHC want and receive. Providing nurses with more effective strategies to assess child and family needs across a broad range of domains may help to increase understanding of where further support for families is required.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution to this study as it involved a systematic review of existing literature.

Effects of WeChat follow-up management on the psychological distress, care burden, and quality of life of parents of infants with bronchopulmonary dysplasia: a retrospective cohort study

Objective

The objective was to explore the impact of WeChat follow-up management on the psychological distress, care burden, and quality of life of parents of infants with bronchopulmonary dysplasia (BPD) receiving in-home care.

Methods

This was a retrospective cohort study. A total of 101 parents of infants with BPD who were followed up from January 2016 to January 2022 were included in this study. According to different follow-up methods, these patients were classified into the WeChat group and the routine group. The Depression, Anxiety, and Stress Scale-21 (DASS-21), Zarit Caregiver Burden Interview (ZBI), and WHOQOL-BREF were used. The data on the psychological distress, care burden, and quality of life of the parents in the two groups were analyzed and compared at discharge and at the 3-month follow-up.

Results

There was no significant difference in the DASS-21 and ZBI scores at discharge between the parents in the two groups. During the 3-month follow-up, the scores of the DASS-21 anxiety and stress subscale and the ZBI of parents in the WeChat group were significantly lower than those of parents in the routine group (P < 0.05); however, there was no significant difference in the depression subscale score between the two groups (P > 0.05). A comparison of the WHOQOL-BREF score between the two groups showed that the total quality of life score in the WeChat group was significantly higher than that in the routine group (P < 0.05). The scores of the psychological and social relationship fields in the WeChat group were significantly higher than those in the routine group (P < 0.05). The incidence of adverse events during follow-up was significantly lower in the WeChat group than in the routine group (P < 0.05).

Conclusion

WeChat follow-up management is helpful to decrease the anxiety and stress, reduce the care burden, and improve the quality of life of parents of infants with BPD receiving in-home care.

Comparison Between Burden of Care Partners of Individuals with Alzheimer's Disease Versus Individuals with Other Chronic Diseases

BACKGROUND

Caregiving in Alzheimer's disease (AD) is often provided by informal care partners, who spend more hours per week on average than care partners of individuals with conditions other than AD. However, the burden of care in partners of individuals with AD has not been systematically compared to that of other chronic diseases.

OBJECTIVE

The current study therefore aims to compare the care partner burden of AD to that of other chronic diseases through a systematic literature review.

METHODS

Data was collected from journal articles published in the last 10 years, using two unique search strings in PubMed and analysed using pre-defined patient-reported outcome measures (PROMs) including the EQ-5D-5L, GAD-7, GHQ-12, PHQ-9, WPAI and the ZBI. The data was grouped according to the included PROMs and the diseases studied. The number of participants in the studies reporting burden of caregiving in AD was adjusted to reflect the number of participants in studies reporting care partner burden in other chronic diseases.

RESULTS

All results in this study are reported as a mean value and standard deviation (SD). The ZBI measurement was the most frequently used PROM to collect care partner burden (15 studies) and showed a moderate burden (mean 36.80, SD 18.35) on care partners of individuals with AD, higher than most of the other included diseases except for those characterized by psychiatric symptoms (mean scores 55.92 and 59.11). Other PROMs such as PHQ-9 (six studies) and GHQ-12 (four studies) showed a greater burden on care partners of individuals with other chronic diseases such as heart failure, haematopoietic cell transplantations, cancer and depression compared to AD. Likewise, GAD-7 and EQ-5D-5L measurements showed a lesser burden on care partners of individuals with AD compared to care partners of individuals with anxiety, cancer, asthma and chronic obstructive pulmonary disease. The current study suggests that care partners of individuals with AD experience a moderate burden, but with some variations depending on the PROMs used.

CONCLUSION

The results of this study were mixed with some PROMs indicating a greater burden for care partners of individuals with AD versus other chronic diseases, and other PROMs showing a greater burden for care partners of individuals with other chronic diseases. Psychiatric disorders imposed a greater burden on care partners compared to AD, while somatic diseases in the musculoskeletal system resulted in a significantly smaller burden on care partners compared to AD.

Positive Mental Health Scale (PMHS) in Parents of Children with Cancer: A Psychometric Evaluation Using Item Response Theory

Mental health is currently a public health issue worldwide. However, evidence is lacking regarding the validity of the instruments used to measure and assess positive mental health in specific populations. The objective of this study was to evaluate the psychometric properties of the PMHS using IRT. A cross-sectional retrospective study with non-probabilistic convenience sampling was conducted with 623 parents of children undergoing cancer treatment at the National Institute of Health in Mexico City. The participants responded to a battery of tests, including a sociodemographic questionnaire, the PMHS, Measurement Scale of Resilience, Beck Depression Inventory, Inventory of Quality of Life, Beck Anxiety Inventory, an interview regarding caregiver burden, and the World Health Organization Well-Being Index. PMHS responses were analyzed using Samejima's graded response model. The PMHS findings indicated that the IRT-based graded response model validated the single latent trait model. The scale scores were independent of depression, anxiety, well-being, caregiver burden, quality of life, and resilience. The PMHS scores were associated with low subjective well-being. The PMHS findings reveal that from an IRT-based perspective, this scale is unidimensional and is a valid, reliable, and culturally relevant instrument for assessing positive mental health in parents of children with chronic diseases.

Caregiver burden of families of children with corrosive esophageal injuries

This cross-sectional and descriptive study aimed to determine care burden of families of children with corrosive esophageal injuries. The study involved 112 parents who had children with corrosive esophageal injury. Caregiver's Stress Scale and Reactions to Helping Family Members Scale were used to assess care burden of families. Caregiver's Stress Scale median score was 7.0 [interquartile range 5.0], and Reactions to Helping Family Members Scale median score was 45.0 [interquartile range 14.0]. The burden of family caregivers was thus found to be high. Factors affecting the care burden were found to be child's age, parents' age, child's weight, substance type and pH, surgery status, and number of surgeries. Nurses should consider these factors when advising and educating these families. Additionally, initiatives including support groups should be planned with regard to the needs of these families with a high care burden.

Quality of life and caregiver burden in pediatric glaucoma: A systematic review

Pediatric conditions can lead to significant caregiver burden and poor quality of life (QoL). This systematic review describes research relating to caregiver burden and QoL of caregivers of pediatric glaucoma patients. A systematic database search of Embase, Medline, PsycINFO, CINAHL, Web of Science, and the three journals within the Association for Research in Vision and Ophthalmology (ARVO) was conducted in October 2021. Publications underwent abstract and full-text screening and were included if they reported pediatric caregivers' QoL using quantitative or qualitative methods. Review articles, publications not in English, and articles focusing on adult glaucoma patients were excluded. Studies then underwent risk of bias assessment and data extraction. Of the 105 publications identified, 8 publications with 667 participants were included in the review. Studies indicated significantly higher burden and poor QoL in caregivers. Female sex, lower education level, lower income, and working status of caregivers were associated with poorer QoL and greater burden. Additionally, more severe and longer duration of the child's disease negatively impacted these measures of caregiver wellbeing. Additionally, studies found significant improvement in caregiver QoL after patients underwent surgery with combined trabeculotomy-trabeculectomy. In conclusion, few studies have investigated the impact of pediatric glaucoma on caregivers. This review of the existing studies found poor QoL and high levels of caregiver burden within this population. Given the lifelong nature of pediatric glaucoma, there is a need for further longitudinal research focusing on the caregivers of these pediatric patients. Long-term follow-up would allow for a greater understanding of how caregiver QoL changes over the course of the disease.

The Needs of Parents of Children Suffering from Cancer—Continuation of Research

Background: Parents experience many healthcare needs when caring for their sick children. Research shows that parents of oncological children have a high level of unmet needs, including psychosocial, emotional, physical, informational, financial, educational, and spiritual needs. To date, little quantitative research has been carried out on the specific needs of parents of children with cancer, which creates uncertainty about what areas should be addressed in care. This study investigated the prevalence of unmet needs among parents of children with cancer. Methods: A population survey was conducted between 2015 and 2020. Caregivers of children diagnosed with cancer were invited to participate in the study to assess their problems and needs. Results: The analysis found that 97% of the participants experienced some level of need for one or more items, and 73% of the respondents reported a moderate or high need for one or more items. In the field of medical information, 70% of respondents had moderate or high needs, 55% of parents reported a moderate or high level of need for help in the psychological or emotional field, and 30% in the financial domain. The prevalence of moderate or high need in the remaining domains ranged from 10% to 15%. Conclusions: Parents of children with cancer experience a high level of needs, especially psychological, emotional, and information. These data suggest that the existing healthcare system does not meet the needs of parents of sick children. The results show the need to investigate the mechanisms by which healthcare providers can use the healthcare system to identify and meet needs.

A New Story on the Multidimensionality of the MSPSS: Validity of the Internal Structure through Bifactor ESEM

The internal structure of the Multidimensional Scale of Perceived Social Support (MSPSS) in adolescents has been evaluated with some factorial analysis methodologies but not with bifactor exploratory structural equation modeling (ESEM), and possibly the inconsistency in the internal structure was dependent on these approaches. The objective of the study was to update evidence regarding its internal structure of MSPSS, by means of a detailed examination of its multidimensionality The participants were 460 adolescents from an educational institution in the Callao region, Lima, Peru. The structure was modeled using unidimensional, three-factor and bifactor models with confirmatory factor analysis (CFA) and ESEM approaches. The models showed good levels of fit, with the exception of the unidimensional model; however, the multidimensionality indicators supported the superiority of the bifactor ESEM. In contrast, the general factor was not strong enough, and the interfactorial correlations were substantially lower. It is concluded that the MSPSS can be interpreted by independent but moderately correlated factors, and there is possible systematic variance that potentially prevented the identification of a general factor.

Resilience measurement scale in family caregivers of children with cancer: Multidimensional item response theory modeling

BACKGROUND

Currently, information about the psychometric properties of the Resilience Measurement Scale (RESI-M) in family caregivers of children with cancer according to item response theory (IRT) is not available; this information could complement and confirm the findings available from classical test theory (CTT). The objective of this study was to test the five-factor structure of the RESI-M using a full information confirmatory multidimensional IRT graded response model and to estimate the multidimensional item-level parameters of discrimination (MDISC) and difficulty (MDIFF) from the RESI-M scale to investigate its construct validity and level of measurement error.

METHODS

An observational study was carried out, which included a sample of 633 primary caregivers of children with cancer, who were recruited through nonprobabilistic sampling. The caregivers responded to a battery of tests that included a sociodemographic variables questionnaire, the RESI-M, and measures of depression, quality of life, anxiety, and caregiver burden to explore convergent and divergent validity.

RESULTS

The main findings confirmed a five-factor structure of the RESI-M scale, with RMSEA = 0.078 (95% CI: 0.075, 0.080), TLI = 0.90, and CFI = 0.91. The estimation of the MDISC and MDIFF parameters indicated different values for each item, showing that all the items contribute differentially to the measurement of the dimensions of resilience.

CONCLUSION

That regardless of the measurement approach (IRT or CTT), the five-factor model of the RESI-M is valid at the theoretical, empirical, and methodological levels.

Modifiable personal and environmental factors associated with anxiety in family caregivers of children with disabilities: A comparison between parents and grandparents

BACKGROUND

Caregivers of children with disabilities might face high risk of anxiety, but the specific influencing factors may be different between parents and grandparents. This study is to explore the influencing modifiable factors from personal and environmental dimensions, so as to provide practical reference for effectively preventing and alleviating anxiety of this population.

METHODS

A total of 504 primary caregivers were investigated in Shanghai, China, of which 496 parents and grandparents were included in the analysis. Risk of anxiety was measured by the Generalized Anxiety Disorder 7-item (GAD-7) Scale. Descriptive statistics, univariate analysis, and multivariable logistic regression were performed to describe the personal and environmental characteristics of parents and grandparents, risk of anxiety, and identify the significant factors.

RESULTS

35.1% of the total caregivers had the risk of anxiety, parents (35.8%) were slightly more anxious than grandparents (33.1%). Among parents, children's stable emotion (AOR=0.263, 95% CI=0.113, 0.611), higher household income (AOR=0.664; 95% CI=0.519, 0.850), owning a house (AOR=0.326; 95% CI=0.174, 0.610), and better barrier-free construction (AOR=0.400; 95% CI=0.170, 0.941) were associated with lower odds of anxiety. As for grandparents, significant association was merely found in caregiving time (AOR=2.936; 95% CI=1.064, 8.107).

LIMITATIONS

Given the cross-sectional design, we would not infer causal relationships.

CONCLUSIONS

Anxiety among family caregivers of children with disabilities was not encouraging and need to be urgently concerned. To reach optimal efficiency, intergenerational differences should be considered when health care providers and policy makers taking measures to facilitate the mental health of this population.

The impact of pediatric tracheostomy on the quality of life of caregivers

OBJECTIVE

Pediatric tracheostomy is a challenge in otolaryngology practice and it is associated with greater morbidity and mortality than in adults; hence, constant vigilance by the designated family caregiver is critical. This study was designed to assess the impact of on quality of life of caregivers in a homecare setting as a result of the presence of child with a tracheostomy.

METHODS

This was a combined retrospective and prospective cohort study with caregivers of children younger than 16 years who had undergone a tracheostomy, had been discharged home with a tracheostomy tube and completed 6 months of domiciliary tracheostomy care. The consenting primary caregivers were assessed for their quality of life based on the PedsQL v 4.0 questionnaires across various domains.

RESULTS

We identified the primary caregivers of 85 children who had undergone a tracheostomy during the study period. The children's median age was 3.5 years (range, 9 months to 14 years). The mean caregiver health-related quality of life (HRQOL) score was 59.3, the mean family functioning score was 62.8, and the mean total family impact score was 54.7 with relative deficits seen in caregiver's social functioning (56.9) and emotional functioning (53.2). Good or average quality of physical and social function was seen among 74 % and 65 % of caregivers respectively while only 55 % were reported having good or average emotional function. Emotional disturbance, interfering with everyday family activities, and sleep disturbance were the major concerns among caregivers.

CONCLUSION

The biopsychosocial consequences of caring for a child with a tracheostomy are profound for the family, affecting the quality of life of caregivers and adding to the emotional and social burden of the child's family.

Psychosocial Factors Predicting Resilience in Family Caregivers of Children with Cancer: A Cross-Sectional Study

Chronic diseases in childhood can affect the physical and mental health of patients and their families. The objective of this study was to identify the sociodemographic and psychosocial factors that predict resilience in family caregivers of children with cancer and to define whether there are differences in the levels of resilience derived from these sociodemographic variables. Three hundred and thirty family caregivers of children with cancer, with an average age of 32.6 years were interviewed. The caregivers responded to a battery of tests that included a questionnaire of sociodemographic variables, the Measuring Scale of Resilience, the Beck Depression Inventory, the Inventory of Quality of Life, the Beck Anxiety Inventory, an interview of caregiver burden and the World Health Organization Well-Being Index. The main findings indicate that family caregivers of children with cancer reported high levels of resilience, which were associated positively with quality of life, psychological well-being and years of study and associated negatively with depression, anxiety and caregiver burden. The variables that predicted resilience in families of children with cancer were quality of life, psychological well-being, depression and number of children. Family caregivers who were married and Catholic showed higher resilience scores. We conclude that being a caregiver in a family with children with cancer is associated with symptoms of anxiety and with depressive episodes. These issues can be overcome through family strength, well-being, quality of life and positive adaptation processes and mobilization of family resources.