Feeding Stressors and Resources Used by Caregivers of Children With Down Syndrome: A Qualitative Analysis

BACKGROUND

Challenging eating behaviors or feeding difficulties, commonly displayed in children with Down syndrome (DS), may amplify perceived stress in caregivers. If caregivers lack resources on how to accommodate the needs of the child with DS, they may find feeding the child stressful and resort to negative coping strategies.

OBJECTIVE

The aim of this study was to understand the feeding stressors, resources, and coping strategies used by caregivers of children with DS.

DESIGN

A qualitative analysis of interview transcripts was undertaken, framed around the Transactional Model of Stress and Coping.

PARTICIPANTS/SETTING

Between September to November 2021, 15 caregivers of children (aged 2 through 6 years) with DS, were recruited from 5 states located in the Southeast, Southwest, and West regions of the United States.

ANALYSIS

Interviews were audio-recorded, transcribed verbatim, and analyzed using deductive thematic analysis and content analysis approaches.

RESULTS

Thirteen caregivers reported increased stress around feeding the child with DS. Stressors identified included concern about adequacy of intake and challenges associated with feeding difficulties. Stress related to feeding was higher among caregivers whose child was learning a new feeding skill or in a transitional phase of feeding. Caregivers used both professional and interpersonal resources in addition to problem- and emotion-based coping strategies.

CONCLUSIONS

Caregivers identified feeding as a stressful event with higher stress reported during transitional phases of feeding. Caregivers reported that speech, occupational, and physical therapists were beneficial resources to provide support for optimizing nutrition and skill development. These findings suggest that caregiver access to therapists and registered dietitian nutritionists is warranted.

Coping with cancer and a history of health-related events

Background

Cancer is a source of stress related to the resulting change in lifestyle. The processes which take place when a patient is coping with a disease may be explained in terms of the transactional concept of psychological stress (Lazarus, Folkman) and the critical life events model (Filipp). These two complementary theoretical approaches set the direction and aim of the study which was to determine the role played by earlier events responsible for health loss due to a chronic, serious disease in the course of a stress transaction in cancer patients.

Materials and methods

The study involved 121 patients with either breast or colorectal cancer undergoing chemotherapy as part of their treatment. They were asked to complete a purpose-designed set of questionnaires which included Revised Illness Perception Questionnaire (IPQ-R), the Mini-Mental Adjustment to Cancer (Mini-MAC) questionnaire, the Hospital Anxiety and Depression Scale (HADS), Acceptance of Illness Scale (AIS). The interdependencies between variables were determined using difference significance tests (Mann-Whitney, Kruskal-Wallis) and the Dunn's correction test. The significance level (alpha) of 0.05 was assumed appropriate for the study.

Results

Patients with previous health-related events were found to expect the struggle with cancer to be a greater and more serious challenge. Those patients had suffered loss of health prior to getting cancer and their emotional reactions were heightened. This finding allowed the identification of patients more prone to creating a negative view of their disease.

Conclusions

When planning a psychological treatment of patients with cancer, an account must be taken of their past life events and earlier experiences of being ill, in order to implement appropriate psychological intervention aimed at reducing their emotional stress.

Factors Related to Behavioral Functioning in Mothers of Children with Type 1 Diabetes: Application of Transactional Model of Stress and Coping

BACKGROUND

Having a child with diabetes creates a great deal of stress for mothers. The transactional model of stress and coping is one of the best conceptual frameworks for stressors.

OBJECTIVES

This study aimed to investigate factors related to health promoting behaviors based on transactional model in mothers of children with type 1 diabetes.

METHODS

This study was conducted on 180 mothers of children with type 1 diabetes. The data was collected using a multi-sectional questionnaire including demographic characteristics and questions about the model constructs. Data were analyzed by SPSS software (version 19) and using statistical tests.

RESULTS

The highest mean score was related to interpersonal relationships (13.8 ± 4.5) and the lowest was related to stress management (10.8 ± 4.2). Linear regression model showed that mother's education, information seeking, and social support had a positive effect, and primary appraisal and emotion-focused coping had a negative effect on the mother's health promotion behaviors. In the regression model R-square accounts for 53.7% of the variance.

CONCLUSIONS

The transactional model was an appropriate framework for explaining the coping outcomes in mothers of children with type 1 diabetes. By mothers' attempts to improve attitude about diabetes and reduce their vulnerability, training to use coping strategies, increasing information and inter-sectoral interventions for attracting sufficient support from patients' families can be hopeful in improving mothers' behavioral Functioning.

Bridging the transition from cancer patient to survivor: pilot study results of the Cancer Survivor Telephone Education and Personal Support (C-STEPS) program

OBJECTIVE

To develop a feasibility study of a theory-driven telephone counseling program to enhance psychosocial and physical well-being for cancer survivors after treatment.

METHODS

Participants (n=66) were recruited from two Colorado hospitals with self-administered questionnaires at baseline and two weeks post-intervention. The one group, intervention only design included up to six thematic telephone counseling sessions over three months. Topics included nutrition, physical activity, stress management, and medical follow-up. Primary outcomes were cancer-specific distress, self-reported fruit and vegetable consumption and physical activity.

RESULTS

Of 66 subjects, 46 completed at least one counseling module and the follow-up assessment (70% retention rate). Mean satisfaction was 9 out of 10, and all participants would recommend C-STEPS to other survivors. Cancer-specific distress (Impact of Event Scale - Intrusion subscale) decreased for entire study population (p<0.001) and stress management session participants (p<0.001). Fruit and vegetable consumption increased for nutrition and exercise session participants (p=0.02) and the entire sample (p=NS). Physical activity increased in the entire group (p=0.006) and for nutrition and exercise session participants (p=0.01).

CONCLUSION AND PRACTICE IMPLICATIONS

C-STEPS is a feasible telephone counseling program that transcends geographic barriers, demonstrating the potential to decrease distress and promote coping and healthy lifestyles among cancer survivors.