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Stenkjaer RL, Egerod I, Moszkowicz M, Collet MO, Weis J, Ista E, Greisen G, Herling SF. The parent perspective on paediatric delirium and an associated care bundle: A qualitative study. J Adv Nurs 2024. [PMID: 38186225 DOI: 10.1111/jan.16048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
AIMS To explore how parents experienced their child with delirium and how parents viewed our delirium management bundle. DESIGN We conducted a qualitative exploratory descriptive study using semi-structured individual or dyad interviews. METHODS Twelve semi-structured interviews with 16 parents of 12 critically ill children diagnosed with delirium in a paediatric intensive care unit were conducted from October 2022 to January 2023 and analysed through a reflexive thematic analysis. FINDINGS We generated five themes: (1) knowing that something is very wrong, (2) observing manifest changes in the child, (3) experiencing fear of long-term consequences, (4) adding insight to the bundle, and (5) family engagement. CONCLUSION The parents in our study were able to observe subtle and manifest changes in their child with delirium. This caused fear of lasting impact. The parents regarded most of the interventions in the delirium management bundle as relevant but needed individualization in the application. The parents requested more information regarding delirium and a higher level of parent engagement in the care of their child during delirium. IMPACT This paper contributes to understanding how parents might experience delirium in their critically ill child, how our delirium management bundle was received by the parents, and their suggestions for improvement. Our study deals with critically ill children with delirium, their parents, and staff working to prevent and manage paediatric delirium (PD) in the paediatric intensive care unit. REPORTING METHOD The consolidated criteria for reporting qualitative research guidelines were used to ensure the transparency of our reporting. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution to the research design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL COMMUNITY?: - It increases awareness of the parent's perspective on PD in critically ill children. - It shows how PD might affect parents, causing negative emotions such as distress, frustration, and fear of permanent damage. - It shows that the parents in our study, in addition to the care bundle, requested more information on delirium and more involvement in the care of their delirious child.
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Affiliation(s)
- Rikke Louise Stenkjaer
- Department of Intensive Care for Infants and Toddlers, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mala Moszkowicz
- Child and Adolescent Mental Health, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marie Oxenbøll Collet
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Janne Weis
- Department of Intensive Care for Infants and Toddlers, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Erwin Ista
- Division of Pediatric Intensive Care, Department of Neonatal and Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gorm Greisen
- Department of Intensive Care for Infants and Toddlers, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Suzanne Forsyth Herling
- Department of Neuroanaesthesiology, Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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McCarty TV, Light JC. "It's like a guessing game all the time": parent insights on barriers, supports, and priorities for children with cortical visual impairment and complex communication needs. Augment Altern Commun 2023; 39:256-269. [PMID: 37158794 DOI: 10.1080/07434618.2023.2206904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/05/2023] [Indexed: 05/10/2023] Open
Abstract
Parents of children with both cortical visual impairment (CVI) and complex communication needs offer unique perspectives on their children's journeys to receiving proper diagnoses, supports, and interventions, such as augmentative and alternative communication (AAC). This study explored the lived experiences, supports, and barriers identified by parents through a qualitative phenomenological approach. Nine parents of children with both CVI and complex communication needs were interviewed virtually. Results indicated five themes descriptive of the parents' experiences: Challenges Piecing Together a CVI Diagnosis; Dealing with Low Expectations of Others; Parents Empowered to Take Action; Guessing Game to Determine Appropriate AAC to Accommodate CVI; and Aligning Professional Practice with Parent Priorities. Whereas some of these themes echoed the experiences of parents of children with complex communication needs (such as those with cerebral palsy) who were not specifically diagnosed with CVI, other themes were unique to this set of parents including the uncertainty of AAC design and intervention given the challenges of CVI and the necessity of more than one way for children to communicate given their visual challenges. This study highlighted the dire need for continued investigation to determine effective AAC interventions for individuals with CVI.
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Affiliation(s)
- Tara V McCarty
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, PA, USA
| | - Janice C Light
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, PA, USA
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DiBari JN, Rouse L. Parent Perspectives: Part 2-Considerations for the Transition Home Post-NICU Discharge. Children (Basel) 2023; 10:1835. [PMID: 38136037 PMCID: PMC10741701 DOI: 10.3390/children10121835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023]
Abstract
This paper is part two of a series of papers written by the mothers of Neonatal Intensive Care Unit (NICU) graduates. The companion paper, "Parent Perspectives: Part 1-Considerations for Changing the NICU Culture", considers all aspects of the NICU experience and provides recommendations for interventions and improvements from a life-course perspective while families are in the NICU. In part two, the focus is the transition home post-NICU stay. The time after NICU discharge is a critical and sensitive developmental period for NICU babies and their families, and an important life course transition. This paper provides a parent's perspective of how to improve the transition home post-NICU stay. Our perspectives draw on the Life Course Health Development approach, which regards health as an active process that is developed over time based on a person's internal biologic and physiologic systems, their external environment and circumstances, and the interactions or relationships between them. This paper describes a collaborative care model where parents and their healthcare teams work together to develop shared care plans. It also describes how we can build trust and family capacity to support long-term care, ensure family well-being, and link families to needed resources and support that can ease the transition from the NICU back to the home and optimize family health trajectories.
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Affiliation(s)
- Jessica N. DiBari
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD 20857, USA
| | - LaToshia Rouse
- Certified Doula at Birth Sisters Doula Services and Patient Engagement Consultant, Knightdale, NC 27545, USA
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Newbury J, Eagle J. The complexities of diagnosis: New Zealand parents' knowledge, perceptions, and experiences of identification of their children's language and literacy difficulties. Int J Speech Lang Pathol 2023:1-15. [PMID: 37991717 DOI: 10.1080/17549507.2023.2272587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
PURPOSE This study reported the experiences of New Zealand caregivers of children with language and literacy difficulties in having their child's needs identified. METHOD The participants were 14 mothers of children with idiopathic language and literacy difficulties, recruited through social media language and literacy difficulties support groups. Two mothers identified as Māori and 12 New Zealand European. Data were collected through semi-structured interviews. A phenomenological approach using reflexive thematic analysis was used. RESULT These mothers had learned about language, literacy, and the education system to advocate for their child and perceived a lack of knowledge on the part of schools. Nearly all had sought a diagnosis, with understanding and access to support reported as positive consequences and stigma as a negative. Some preferred labels emphasising difference rather than disorder, consistent with traditional Māori and neurodiversity views. The mothers described their experience as a fight, due to their concerns being ignored, the need to pay for private diagnostic assessments and difficulty accessing services. They appreciated assessors who gave useful, comprehensible information and supported school liaison. CONCLUSION These mothers wanted improved teacher training and publicly funded diagnostic assessment services to improve access to best practice language and literacy instruction for their children.
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Affiliation(s)
- Jayne Newbury
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jessica Eagle
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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Synnes A, Luu TM, Afifi J, Khairy M, de Cabo C, Moddemann D, Hendson L, Reichert A, Coughlin K, Nguyen KA, Richter LL, Bacchini F, Aziz K. Parent-Integrated Interventions to Improve Language Development in Children Born Very Preterm. Children (Basel) 2023; 10:953. [PMID: 37371185 DOI: 10.3390/children10060953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023]
Abstract
Neurodevelopmental challenges in children born very preterm are common and not improving. This study tested the feasibility of using Evidence-based Practice to Improve Quality (EPIQ), a proven quality improvement technique that incorporates scientific evidence to target improving language abilities in very preterm populations in 10 Canadian neonatal follow-up programs. Feasibility was defined as at least 70% of sites completing four intervention cycles and 75% of cycles meeting targeted aims. Systematic reviews were reviewed and performed, an online quality improvement educational tool was developed, multidisciplinary teams that included parents were created and trained, and sites provided virtual support to implement and audit locally at least four intervention cycles of approximately 6 months in duration. Eight of ten sites implemented at least four intervention cycles. Of the 48 cycles completed, audits showed 41 (85%) met their aim. Though COVID-19 was a barrier, parent involvement, champions, and institutional support facilitated success. EPIQ is a feasible quality improvement methodology to implement family-integrated evidence-informed interventions to support language interventions in neonatal follow-up programs. Further studies are required to identify potential benefits of service outcomes, patients, and families and to evaluate sustainability.
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Affiliation(s)
- Anne Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Women's Hospital and Health Centre, Vancouver, BC V5Z 4H4, Canada
- BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Thuy Mai Luu
- Department of Pediatrics and Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Division of Neonatal Perinatal Medicine, IWK Health Centre, Halifax, NS B3K 6R8, Canada
| | - May Khairy
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Cecilia de Cabo
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
| | - Diane Moddemann
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
| | - Leonora Hendson
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Amber Reichert
- Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7, Canada
| | - Kevin Coughlin
- Children's Hospital at London Health Sciences Centre, London, ON N6A 5W9, Canada
| | | | - Lindsay L Richter
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Fabiana Bacchini
- Canadian Premature Babies Foundation, Etobicoke, ON M8X 1Y3, Canada
| | - Khalid Aziz
- The Office of Lifelong Learning, University of Alberta, Edmonton, AB T6G 1C9, Canada
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Wallace-Watkin C, Sigafoos J, Woods L, Waddington H. Parent reported barriers and facilitators to support services for autistic children in Aotearoa New Zealand. Autism 2023; 27:13623613231168240. [PMID: 37129303 PMCID: PMC10576898 DOI: 10.1177/13623613231168240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
LAY ABSTRACT Parents might have problems in getting support services for their autistic child due to certain barriers. However, there might also be things that can ease or facilitate parents' access to support services. In this study, New Zealand parents were asked about their experiences in getting support services for their autistic child. We also looked at differences in reported barriers and facilitators based on several demographic factors with a focus on family level of financial resourcing. A total of 173 parents completed a survey. The results suggested that parents experienced several barriers, particularly related to service pathways. Facilitators were also experienced, predominantly related to providers. Financial resourcing predicted the number of parent-reported barriers. Both lower level of family financial resourcing and having a non-binary child predicted parents' rating of the extent of barriers. Child age and level of speech were predictors for reports of experiencing a higher number of facilitators, with parents of younger children or of non-speaking autistic children reporting a greater number of facilitators. We discuss how these results may be useful to support service delivery and identify areas for future research.
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Affiliation(s)
| | | | - Lisa Woods
- Victoria University of Wellington, New Zealand
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Caruso CG, Warren JB, Carney PA. Parent experiences of a remote patient monitoring program enabling early discharge from the neonatal intensive care unit with nasogastric tube feeding. J Neonatal Perinatal Med 2023:NPM221181. [PMID: 37092242 DOI: 10.3233/npm-221181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND This exploratory study examined parents' experiences with "Growing at Home" (G@H), a remote patient monitoring program for stable infants discharged from the Neonatal Intensive Care Unit (NICU) with continued need for nasogastric tube feeding. METHODS We used classical content analysis to identify and refine emergent themes from 13 semi-structured key informant interviews. RESULTS The primary emergent theme was the desire to return to normalcy, which was expressed as a primary motivator for participating in G@H. Parents reported G@H assisted them in transitioning from the NICU's highly medicalized setting to establishing a new normal with incorporation of their infant into their lives and families. Parental preparation is important, as some parents experienced challenges that indicate the program may not be suitable for all families. CONCLUSIONS Parental experiences offer insight into benefits and challenges of early discharge from the NICU and highlight opportunities to support families beginning in the NICU and as they transition home.
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Affiliation(s)
- C G Caruso
- Division of Neonatology, Oregon Health & Science University, Portland, OR, USA
| | - J B Warren
- Division of Neonatology, Oregon Health & Science University, Portland, OR, USA
| | - P A Carney
- Professor of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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8
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Whooten R, Horan C, Aguirre A, Dartley AN, Taveras E. Parent and Pediatrician Perspectives on Physical Activity Promotion in Pediatric Primary Care: A Preliminary Mixed Methods Study. Am J Health Promot 2023; 37:65-76. [PMID: 35817761 DOI: 10.1177/08901171221113317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To elicit preliminary pediatrician and parent perspectives on physical activity (PA) counseling and identify opportunities for improvement. DESIGN Mixed methods, including a cross-sectional survey and semi-structured interviews. SETTING AND PARTICIPANTS Primary care pediatricians (N = 73; 40% response rate) within a single large healthcare system and parents of students (N = 20) participating in a local school-based PA program in eastern Massachusetts. METHODS Electronic survey of pediatricians assessing opinions of American Academy of Pediatrics (AAP) PA guidelines and potential PA promotion tools; semi-structured qualitative interviews with parents assessing overall discussion, education, and recommendations relating to PA. ANALYSIS We report descriptive statistics for survey items and bivariate analyses comparing responses by physician characteristics. We performed thematic analysis of qualitative interviews and present results through an implementation science framework. RESULTS In this preliminary study, pediatricians reported adoption, appropriateness, and lower perceived effectiveness of PA counseling. School-based programs and educational materials were most often chosen as PA promotion tools. Responses varied by pediatrician characteristics. While parents reported satisfaction, opportunities for improvement included connections with community resources and continued conversations with the child about PA. CONCLUSIONS Pediatricians and parents highlighted gaps in PA counseling in primary care. While results are preliminary given small sample size, this study provides actionable targets to support PA promotion as a preventive health priority in this setting.
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Affiliation(s)
- Rachel Whooten
- Division of General Academic Pediatrics, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
- Division of Endocrinology, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
| | - Christine Horan
- Division of General Academic Pediatrics, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
| | - Annabelle Aguirre
- Division of General Academic Pediatrics, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
| | - Anna Nicole Dartley
- Division of General Academic Pediatrics, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
| | - Elsie Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Kraft Center for Community Health, 2348Massachusetts General Hospital, Boston, MA, USA
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Wallace-Watkin C, Sigafoos J, Waddington H. Barriers and facilitators for obtaining support services among underserved families with an autistic child: A systematic qualitative review. Autism 2022; 27:588-601. [PMID: 36081366 DOI: 10.1177/13623613221123712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Families from underrepresented ethnic or racial groups and those with limited financial resources could experience more difficulty in accessing support services for their autistic child due to certain types of barriers. We searched academic journals, websites, and other sources for studies which looked at what barriers might be present for such families and what might help families access support services for their autistic child. The search found 18 studies. Results from each study were examined and coded into themes. Parents reported that accessibility, diversity of support services, and stigma influenced their experiences with support services. We discuss what these findings might mean for future research and for service delivery.
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10
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Johnston SS, Blue CW, Stegenga SM. AAC barriers and facilitators for children with Koolen de Vries syndrome and childhood apraxia of speech: parent perceptions. Augment Altern Commun 2022; 38:148-160. [PMID: 35726705 DOI: 10.1080/07434618.2022.2085626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite the potential positive impact of augmentative and alternative communication, the literature suggests that many individuals with disabilities experience barriers in developing communication skills and access to appropriate supports. Parents can provide valuable insight into the barriers and facilitators experienced by their children with complex communication needs. Previous studies exploring parent perspectives of the complex communication needs of children with various disabilities have revealed similarities and differences in experiences. This supports the need to examine the barriers and facilitators experienced by different populations, including individuals with Koolen de Vries syndrome (KdVS). As a newly identified syndrome, information on individuals with KdVS is limited, and studies examining parent experiences in supporting the communication needs of children with KdVS have not been conducted. This study obtained parents' perspectives regarding the communication barriers and facilitators experienced by their children with KdVS. Fifteen parents participated in one of two focus group sessions. The data were analyzed through qualitative content analysis, resulting in 13 categories discussed in relation to previous research and conceptual frameworks. Research and practical implications for developing a deeper understanding of the barriers experienced by children with KdVS are proposed.
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Affiliation(s)
- Susan S Johnston
- Department of Special Education, University of Utah, Salt Lake City, UT, USA
| | - Cheri W Blue
- Department of Special Education, University of Utah, Salt Lake City, UT, USA
| | - Sondra M Stegenga
- Department of Special Education, University of Utah, Salt Lake City, UT, USA
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Crossen K, Berry L, Myers MF, Leslie N, Goueli C. A Qualitative Study: Mothers' Experiences of Their Child's Late-Onset Pompe Disease Diagnosis Following Newborn Screening. Int J Neonatal Screen 2022; 8:ijns8030043. [PMID: 35892473 PMCID: PMC9326644 DOI: 10.3390/ijns8030043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
Pompe disease was added to the United States recommended uniform screening panel in 2015 to avoid diagnostic delay and implement prompt treatment, specifically for those with infantile-onset Pompe disease (IOPD). However, most newborns with abnormal newborn screening (NBS) for Pompe disease have late-onset Pompe disease (LOPD). An early diagnosis of LOPD raises the question of when symptoms will arise which is challenging for parents, patients, and providers managing an LOPD diagnosis. This study aimed to characterize mothers' experiences of their child's LOPD diagnosis and medical monitoring. A qualitative descriptive approach was chosen to gain an in-depth understanding of parental experiences. Eight mothers were interviewed about their experiences with positive NBS and diagnosis, experiences with living with the diagnosis, and experiences with medical monitoring. Interview transcripts were analyzed through conventional content analysis. Negative emotions like fear were more frequent with communication of NBS results. Participants expressed uncertainty surrounding age of symptom onset and the future. The medical monitoring experience increased worry but participants expressed that being vigilant with management reassured them. Parental emotions shifted to thankfulness and reassurance with time and education. These findings can provide guidance to providers about the psychosocial implications of receiving positive NBS results and an LOPD diagnosis.
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Affiliation(s)
- Kaylee Crossen
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA; (L.B.); (M.F.M.); (N.L.); (C.G.)
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267, USA
- Genetic Center, Akron Children’s Hospital, 215 West Bowery Street, Level 5, Akron, OH 44308, USA
- Correspondence:
| | - Lisa Berry
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA; (L.B.); (M.F.M.); (N.L.); (C.G.)
| | - Melanie F. Myers
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA; (L.B.); (M.F.M.); (N.L.); (C.G.)
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Nancy Leslie
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA; (L.B.); (M.F.M.); (N.L.); (C.G.)
| | - Cecilia Goueli
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA; (L.B.); (M.F.M.); (N.L.); (C.G.)
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12
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Elliott LK, Weiss JA, Lloyd M. Beyond the Motor Domain: Exploring the Secondary Effects of a Fundamental Motor Skill Intervention for Children With Autism Spectrum Disorder. Adapt Phys Activ Q 2021; 38:195-214. [PMID: 33540383 DOI: 10.1123/apaq.2020-0024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022] Open
Abstract
Early motor skill interventions have been shown to improve the motor skill proficiency of children with autism spectrum disorder; however, little is known about the secondary effects associated with these types of interventions (e.g., influence on behavior, social skills, family dynamics). The purpose of this qualitative study was to (a) investigate parents' perceptions of the child-level benefits associated with a fundamental motor skill intervention for their 4-year-olds with autism spectrum disorder and (b) explore how child-level benefits influenced the family unit. Eight parents (N = 8) were interviewed (semistructured) about their experiences with the intervention for their child(ren); the study was grounded in phenomenology. Five main child-level benefits emerged, including improvements with (a) motor skills, (b) social skills, (c) listening skills, (d) turn-taking skills, and (e) transition skills. The child-level benefits then extended to family members in a number of ways (e.g., more positive sibling interactions). These findings highlight several important secondary effects that should be investigated in future research.
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Lim PS, Lang AC, Davies WH. Parent Ethical Concerns About Patient Feedback Measures to Improve Pediatric Clinical Care. J Empir Res Hum Res Ethics 2020; 16:46-53. [PMID: 33118456 DOI: 10.1177/1556264620969327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are limited studies evaluating parental willingness to complete patient feedback measures to improve pediatric clinical care. Parents were randomly assigned to read a vignette that varied by parent satisfaction and type of feedback measure. Parents were generally willing to participate in the hypothetical research study aimed to improve their child's clinical care. Parents in the dissatisfied condition invited to participate in a potentially identifiable interview, compared to an anonymous survey, reported they would be less likely to respond honestly and more likely to feel obligated to participate. Researchers aiming to improve pediatric clinical care should be encouraged to use patient feedback measures that collect potentially identifiable information; however, researchers must consider the potential impact of parent satisfaction on feedback.
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Affiliation(s)
- Paulina S Lim
- 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Amy C Lang
- 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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14
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Schladant M, Dowling M. Parent Perspectives on Augmentative and Alternative Communication Integration for Children With Fragile X Syndrome: It Starts in the Home. Intellect Dev Disabil 2020; 58:409-421. [PMID: 33032315 DOI: 10.1352/1934-9556-58.5.409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/29/2019] [Indexed: 06/11/2023]
Abstract
Many children with fragile X syndrome (FXS) have complex communication needs and may benefit from augmentative and alternative communication (AAC). This qualitative study explored how four mother-child dyads used AAC in the home. Data were collected using participant observations, open-ended interviews, and record reviews, and analyzed using grounded theory methods. Findings revealed that mothers found AAC to be a useful tool for addressing their children's complex communication needs, but practical and personal factors impacted its use in the home. This study sheds light on how mothers of children with FXS view and utilize AAC as a way to promote communication at home. Understanding parental perspectives can help to guide professionals in planning appropriate AAC interventions specific to FXS.
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Affiliation(s)
| | - Monica Dowling
- Michelle Schladant and Monica Dowling, University of Miami, FL
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Hillier A, Ryan J, Buckingham A, Schena D, Queenan A, Dottolo A, Abreu M. Prospective College Students With Autism Spectrum Disorder: Parent Perspectives. Psychol Rep 2020; 124:88-107. [PMID: 32056494 DOI: 10.1177/0033294120905517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Young adults with autism spectrum disorder (ASD) are attending university in increasing numbers. While those with ASD may be very knowledgeable within their chosen field, a range of academic-related and nonacademic challenges may hinder their success including executive functioning challenges and interpersonal issues. The purpose of this study was to conduct a preliminary investigation into the perspective of parents of high schoolers with ASD regarding their son/daughters' transition to college. Qualitative analysis of parent interviews examined the concerns and challenges they anticipated their son/daughter might experience in a university setting, as well as supports they are seeking as they consider postsecondary options. Prominent themes that emerged as areas of concern were social skills, executive functioning, academics, campus living, and support services. These findings highlight some key potential pitfalls for students with ASD which may be useful targets for prevention and remediation, as well as informing policy for colleges and universities as they consider cost-effective interventions to improve the academic success of students with ASD.
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Affiliation(s)
| | | | | | | | - Alexa Queenan
- Department of Psychology, University of Massachusetts Lowell, MA, USA
| | - Andrea Dottolo
- Department of Psychology, 6747Rhode Island College, Providence, RI, USA
| | - Marlene Abreu
- Department of Psychology, University of Massachusetts Lowell, MA, USA
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16
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Gartrell N, Rothblum ED, Koh AS, van Beusekom G, Bos H. "We Were Among the First Non-traditional Families": Thematic Perceptions of Lesbian Parenting After 25 Years. Front Psychol 2019; 10:2414. [PMID: 31708847 PMCID: PMC6824413 DOI: 10.3389/fpsyg.2019.02414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/10/2019] [Indexed: 12/20/2022] Open
Abstract
In the sixth wave of the U.S. National Longitudinal Lesbian Family Study (NLLFS), when their offspring were 25 years old, the parents were asked to reflect on their most challenging and best experiences raising children in non-traditional families. The responses of 131 parents were interpreted through thematic analysis. The most challenging parenting experiences fell into five major categories: (1) distress about their children's experiences of exclusion, heterosexism, or homophobic stigmatization; (2) family of origin non-acceptance of their lesbian-parent family; (3) the never-ending process of "educating the world about queer parents"; (4) homophobia or hostility toward their non-traditional family; and (5) lack of legal protections for sexual minority parent (SMP) families. Their best parenting experiences included: (1) being role models, leading to a greater acceptance of LGBTQ people; (2) treasuring the LGBTQ parent and family community; (3) teaching their children to appreciate diversity of all types; and (4) witnessing their child's pride in their non-traditional family. Some of these challenges were anticipated by the parents more than a quarter century ago at the time that they were inseminating or pregnant with the index offspring.
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Affiliation(s)
- Nanette Gartrell
- Williams Institute, UCLA School of Law, Los Angeles, CA, United States.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Esther D Rothblum
- Williams Institute, UCLA School of Law, Los Angeles, CA, United States.,Department of Women's Studies, San Diego State University, San Diego, CA, United States
| | - Audrey S Koh
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | - Henny Bos
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
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17
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Malek J, Pereira S, Robinson JO, Gutierrez AM, Slashinski MJ, Parsons DW, Plon SE, McGuire AL. Responsibility, culpability, and parental views on genomic testing for seriously ill children. Genet Med 2019; 21:2791-2797. [PMID: 31186522 DOI: 10.1038/s41436-019-0570-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/28/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE We describe parental perceptions of and experiences with genomic sequencing (GS) in the care of seriously ill children. Understanding parents' perspectives is vital for clinicians caring for children, given the uptake of genomic technologies into clinical practice. METHODS Longitudinal, semistructured interviews were conducted with parents of pediatric cancer patients who underwent exome sequencing (ES) as a part of the BASIC3 study. Interviews were conducted at baseline, one to eight months after results disclosure, and approximately one year after disclosure. Using thematic qualitative analysis, parent interviews were coded with both inductive and deductive approaches. RESULTS Before receiving genomic information, parents indicated that they saw ES as something responsible parents would agree to if their child had cancer. Some parents talked about the possibility of sequencing affecting feelings of culpability for their child's cancer, worrying that they passed on a cancer-causing gene or made parenting decisions that caused the disease. However, after receiving their child's ES results many reported feeling relieved of guilt and worry, and felt they had fulfilled parental duties by agreeing to ES for their child. CONCLUSION These results reveal a layer of meaning that parents associate with GS that may inform clinicians' approach to care.
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Affiliation(s)
- Janet Malek
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA.
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Amanda M Gutierrez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Melody J Slashinski
- School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - D Williams Parsons
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX, USA
| | - Sharon E Plon
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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18
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Loyal J, Weiss TR, Cheng JH, Kair LR, Colson E. Refusal of Vitamin K by Parents of Newborns: A Qualitative Study. Acad Pediatr 2019; 19:793-800. [PMID: 30981025 PMCID: PMC7028442 DOI: 10.1016/j.acap.2019.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/23/2019] [Accepted: 04/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Despite American Academy of Pediatrics recommendations, some parents refuse intramuscular (IM) vitamin K as prophylaxis against vitamin K deficiency bleeding for their newborns. The purpose of our study was to describe attitudes and perceptions of parents who choose to defer IM vitamin K for their newborns. METHODS Using qualitative methodology, we conducted in-depth semi-structured interviews with parents of newborns in 3 hospitals in Connecticut and California. We used the grounded theory approach and the constant comparative method until saturation was reached. RESULTS Nineteen participants (17 mothers and 2 fathers) of 17 newborns were interviewed; 14 newborns did not receive IM vitamin K due to refusal by the parents, and for 3 newborns IM vitamin K administration was delayed due to initial hesitation by the parents. Four major themes emerged: 1) risk-to-benefit ratio, where parents refused IM vitamin K due to a perceived risk to their newborn from preservatives, for example; 2) "natural" approaches, which led to seeking oral vitamin K or increasing the mother's own prenatal dietary vitamin K intake; 3) placement of trust and mistrust, which involved mistrust of the medical and pharmaceutical community with overlapping concerns about vaccines and trust of self, like-minded allopathic and non-allopathic health care providers, the social circle, the internet, and social media; and 4) informed by experiences, reflecting hospital experiences with prior pregnancies and communication with health care providers. CONCLUSIONS Parents' perception of risk, preference for alternative options, trust, and communication with health care providers were pivotal factors when making decisions about IM vitamin K.
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Affiliation(s)
- Jaspreet Loyal
- Department of Pediatrics (J Loyal and TR Weiss), Yale University, New Haven, Conn.
| | - Theresa R. Weiss
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Jessica H. Cheng
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Laura R. Kair
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Eve Colson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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19
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Kulik NL, Thomas EM, Iovan S, McKeough M, Kendzierski S, Leatherwood S. Access to primary care child weight management programs: Urban parent barriers and facilitators to participation. J Child Health Care 2017; 21:509-521. [PMID: 29110523 DOI: 10.1177/1367493517728401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prevalence and comorbidities of childhood obesity among low-income urban children are a significant health issue in the United States. Programs designed to assist families are underutilized. The aim of this study is to describe barriers and facilitators relevant to intervention program participation from the perspective of parents who have children who are overweight or obese. Systematic thematic analysis of focus groups and semi-structured interviews with parents from multiple urban pediatrics and family medicine practices were used to gather data. A framework analysis approach was used and a codebook of themes was developed. Transcripts were coded independently by the research team and consensus among researchers was reached. Forty-eight parents participated in the study. Perceived barriers to participation included (1) varied referral process (lack of follow-up or varying referral experience), (2) costs (time and program fee), (3) logistics (location and program schedule), and (4) child motivation. Perceived facilitators to participation included (1) systematic referral process (in-office referral and timely follow-up), (2) program content and organization, and (3) no cost. Multiple barriers and facilitators affect weight management program participation among families, which should be specifically targeted in future obesity interventions in order to effectively reach urban, minority parents and children.
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Affiliation(s)
- Noel L Kulik
- 1 Kinesiology, Health and Sport Studies and the Center for Health and Community Impact, College of Education, Wayne State University, Detroit, MI, USA
| | - Erica M Thomas
- 1 Kinesiology, Health and Sport Studies and the Center for Health and Community Impact, College of Education, Wayne State University, Detroit, MI, USA
| | - Samantha Iovan
- 1 Kinesiology, Health and Sport Studies and the Center for Health and Community Impact, College of Education, Wayne State University, Detroit, MI, USA
| | - Margaret McKeough
- 2 Department of Pediatrics, Henry Ford Health System, Detroit, MI, USA
| | | | - Stacy Leatherwood
- 2 Department of Pediatrics, Henry Ford Health System, Detroit, MI, USA
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Abstract
This study is a reflective account of how problem solving was accomplished during the translation of semi-structured interviews from a source language to a target language. Data are drawn from two qualitative research studies in which Interpretative Phenomenological Analysis was used to obtain insights into the lived experience of parents of children with disabilities in India and Turkey. The authors discuss challenges to interpretation that arise when participants and the main researcher speak the same non-English native language and the results of the study are intended for an English-speaking audience. A common theme in both the Turkish and Indian data relates to parents' understanding of their children's symptomology and the prognosis. Implications include the need for both reflective conversation within the research team to address the translation of problematic utterances, and documentation of the translation process in the presentation of research findings.
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Affiliation(s)
- Judith Oxley
- a Department of Communicative Disorders , University of Louisiana at Lafayette , Lafayette , Louisiana , USA
| | - Evra Günhan
- b Department of Speech and Language Therapy , İstanbul Medipol University , İstanbul , Turkey
| | - Monica Kaniamattam
- a Department of Communicative Disorders , University of Louisiana at Lafayette , Lafayette , Louisiana , USA
| | - Jack Damico
- a Department of Communicative Disorders , University of Louisiana at Lafayette , Lafayette , Louisiana , USA
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21
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Renner LA, McGill D. Exploring factors influencing health-seeking decisions and retention in childhood cancer treatment programmes: perspectives of parents in Ghana. Ghana Med J 2016; 50:149-156. [PMID: 27752189 PMCID: PMC5044796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Developing countries such as Ghana have very poor childhood cancer survival rates. There is a need to determine reasons for late presentation and treatment abandonment which are major causes of poor survival. Understanding these issues could inform effective strategies for childhood cancer control in resource-constrained settings. AIM To explore factors influencing parental decision-making for children with cancer in Ghana with regard to health seeking and retention in treatment, in order to provide information that will guide Public Health interventions for childhood cancer control. METHOD This exploratory qualitative study was conducted based on an interpretative epistemology using a social constructionist approach. Purposive sampling of parents attending the Paediatric Oncology Unit, Korle Bu Teaching Hospital in Accra, Ghana was undertaken. Twelve semi-structured moderate interviews and two small focus group discussions with a total of seven participants were undertaken. Data analysis was through thematic content analysis. RESULTS Five major themes emerged. Knowledge and perceptions revealed a total lack of appropriate knowledge prior to diagnosis. Health-seeking behaviour was determined by interplay of individual and environmental factors. Orthodox medical treatment was largely perceived favourably. The impact of cancer on parents and children included psychological, physical and socioeconomic effects. Financial, spiritual and psychosocial support helped in coping. Parents recommended public education and health financing to address the major barriers. CONCLUSION Broad social determinants and experiences influence parental decision making for children with cancer. This implies Health Promotion strategies with multi-sectorial involvement will be required for effective implementation of the National Strategy for Cancer Control. FUNDING Funded by authors.
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Pullen PC. Prevalence of LD From Parental and Professional Perspectives: A Comparison of the Data From the National Survey of Children's Health and the Office of Special Education Programs' Reports to Congress. J Learn Disabil 2016; 50:701-711. [PMID: 27516407 DOI: 10.1177/0022219416659447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Since the emergence of the field of learning disabilities (LD) in the late 1960s and early 1970s, controversy has surrounded issues regarding methods used for identification. The prevalence of students identified as LD increased steadily from the 1970s until the beginning of the 21st century, at which time it has decreased until at least 2011 (the most current data available from the U.S. Office of Education). In this article, I compare the prevalence rates of children aged 6 to 17 years being served in schools according to the Office of Special Education Programs with the prevalence rates as reported by parents on the National Survey of Children's Health. To date, no such comparison has been made that takes into account parents' knowledge of their children's disabilities. Results of the analyses reveal that parents report that their children have LD at a significantly higher rate than what is reported by schools of students receiving LD services. Most important, the longitudinal trend from 2001 to 2011 indicates that parents are reporting a slight increase whereas the Office of Special Education Programs is reporting a dramatic decrease in LD.
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23
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Nelson BB, Coller RJ, Saenz AA, Chung PJ, Kaplan A, Lerner CF, Klitzner TS. How Avoidable are Hospitalizations for Children With Medical Complexity? Understanding Parent Perspectives. Acad Pediatr 2016; 16:579-86. [PMID: 27142492 DOI: 10.1016/j.acap.2016.04.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Children with medical complexity (CMC) are a small group that utilizes large amounts of health care resources. Although parents are the primary healthcare decision-makers for their children, little is known from their perspective about why CMC are hospitalized. We sought to understand what parents think about factors leading to hospitalization and whether any recent hospitalizations might have been avoidable. METHODS We conducted qualitative, semistructured interviews with 35 parents of hospitalized CMC who receive care in the Pediatric Medical Home Program, a complex care program at University of California, Los Angeles. Interviews were conducted in English and in Spanish, audio-recorded, transcribed and translated, then coded in ATLAS.ti (Scientific Software Development Gmbh, Berlin, Germany) for qualitative analysis. We sorted qualitative codes into groups with shared concepts, to generate emergent themes. RESULTS Parents described their experiences leading up to their children's hospitalization, but no one suggested that the hospitalization was potentially avoidable. Most parents perceived their children as having higher susceptibility because of underlying conditions, perceived the symptoms they observed as high-risk, and described seeking emergent care only when they no longer were comfortable at home. Decisions about where to seek care were influenced by health care system factors such as accessibility and continuity of care. Most parents expressed a desire to learn more about their children's conditions and how best to care for them at home. CONCLUSIONS Parents of CMC believe that hospitalizations are largely unavoidable because of higher susceptibility and higher risk. Increasing parents' self-efficacy in caring for children at home might influence their decisions to seek emergent care.
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Affiliation(s)
- Bergen B Nelson
- Department of Pediatrics and Children's Discovery and Innovation Institute, Mattel Children's Hospital and David Geffen School of Medicine, University of California, Los Angeles, Calif.
| | - Ryan J Coller
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Adrianna A Saenz
- Department of Pediatrics and Children's Discovery and Innovation Institute, Mattel Children's Hospital and David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Paul J Chung
- Department of Pediatrics and Children's Discovery and Innovation Institute, Mattel Children's Hospital and David Geffen School of Medicine, University of California, Los Angeles, Calif; Department of Health Policy and Management, Fielding School of Public Health at UCLA, University of California, Los Angeles, Calif; RAND Health, RAND Corporation, Santa Monica, Calif
| | - Avery Kaplan
- University of Southern California, Los Angeles, Calif
| | - Carlos F Lerner
- Department of Pediatrics and Children's Discovery and Innovation Institute, Mattel Children's Hospital and David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Thomas S Klitzner
- Department of Pediatrics and Children's Discovery and Innovation Institute, Mattel Children's Hospital and David Geffen School of Medicine, University of California, Los Angeles, Calif
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