Need and acceptability of story books intended to help with the process of informing children about their HIV status in Malawi: a mixed methods study.

The rate of disclosure of HIV status to children living with HIV in sub-Saharan Africa remains low despite the World Health Organisation's recommendation that children should be told about their HIV status by the age of 12 years. Authors of previous studies have identified lack of disclosure materials as the main barrier to disclosure of HIV status. This study aimed to assess the need and acceptability of a series of age-appropriate children story books intended to help with informing children about their HIV status. Questionnaires, interviews, and focus group discussions were used to collect data from caregivers, healthcare workers, and school teachers, adolescents living with HIV, and community leaders across the three administrative regions of Malawi. Information about the need and acceptability of the story books and the sociodemographic characteristics of the participants was collected using reliable instruments. Quantitative data were tabulated while thematic analysis was used to analyse qualitative data. Almost 600 participants responded to the survey questionnaire, and 19 interviews and 12 focus groups were conducted with 106 participants. Ninety-eight per cent of participants supported the idea of developing the proposed series of story books and reported that they would use the books once they are developed. Most of the participants expressed that the books will help to improve their knowledge and understanding of HIV disclosure, increase their confidence on how to disclose and help to provide consistent information about HIV disclosure to children.The results of this study show a high acceptability rate of the story books. The process of HIV disclosure to children is a very complex issue that will require the development of guidelines and materials that are rigorously evaluated prior to dissemination.

Prevalence and factors associated with emotional and behavioural difficulties among children living with HIV in Malawi: a cross-sectional study.

BACKGROUND: Approximately 84,000 children under the age of 15 years are living with HIV in Malawi. Although the survival rate of children living with HIV in Malawi has improved due to the increased availability of antiretroviral medications, these children continue to experience numerous challenges negatively impacting on their mental health. The aim of this study was to investigate the prevalence of, and factors associated with, emotional and behavioural difficulties in children aged between 6 and 12 years living with HIV in Malawi. METHODS: A random sample of 429 primary caregivers of children living with HIV drawn from the three main administrative regions of Malawi was recruited in a cross-sectional study. They completed a questionnaire about family socio-demographic characteristics, HIV disclosure, and child demographic and clinical characteristics, as well as the Strengths and Difficulties Questionnaire, Life Stress Scale, Support Function Scale, and Impact on Family Scale which were pre-tested and translated into the local Chichewa language. Data were analysed using descriptive statistics and logistic regression. FINDINGS: Using the newer band categorisations of the Strengths and Difficulties Questionnaire, parent version, 31% of primary caregivers reported that their child had a slightly raised to very high level of total difficulties. Factors that were associated with difficulties were: primary caregivers' young age (adjusted odds ratio [aOR] 3.6; 95% confidence interval [CI]: 1.4-9.5); low level of education (aOR 2.6; 95% CI: 1.2-5.7); lack of employment (aOR 2.7; 95% CI: 1.2-5.9); the report of a substantial impact of the child's illness on the family (3.1; 95% CI: 1.5-6.5); and a low level of family functional support (aOR 2.0; 95% CI: 1.1-4.1). Neither non-disclosure of HIV status nor any of the child demographic or clinical factors were significant in multivariate analysis (p > .0.05). CONCLUSION: Close to one-third of children living with HIV in this study had high scores indicative of emotional and behavioural difficulties. Emotional and behavioural difficulties in children living with HIV were associated with family demographic and psychosocial factors, but not HIV disclosure. Effective policies and programs that promote the mental wellbeing of children living with HIV in Malawi are indicated.

Measuring 8 to 12 year old children's self-report of power imbalance in relation to bullying: development of the Scale of Perceived Power Imbalance.

BACKGROUND: While power imbalance is now recognized as a key component of bullying, reliable and valid measurement instruments have yet to be developed. This research aimed to develop a self-report instrument that measures power imbalance as perceived by the victim of frequent aggressive behavior. METHODS: A mixed methods approach was used (468 participants, Grade 4 to 6). This paper describes the exploratory (n = 111) and confirmatory factor analysis of the new instrument (n = 337), and assessment of reliablity and construct validity. RESULTS: A 2-factor model represented physical and social aspects of power imbalance (n = 127: normed chi-square = 1.2, RMSEA = .04, CF1 = .993). The social factor included constructs of group and peer valued characteristics. CONCLUSIONS: This research will enhance health and education professionals understanding of power imbalance in bullying and will inform the design and evaluation of interventions to address bullying in children.

Primary caregivers, healthcare workers, teachers and community leaders' perceptions and experiences of their involvement, practice and challenges of disclosure of HIV status to children living with HIV in Malawi: a qualitative study.

BACKGROUND: The World Health Organisation has recommended that healthcare workers, teachers and community leaders work with parents to support children living with HIV. The aim of this study was to assess the perceptions and experiences of primary caregivers and other care providers such as healthcare workers, teachers, and community leaders regarding their involvement, practice and challenges of HIV disclosure to children aged between 6 and 12 years living with HIV in Malawi. METHODS: Twelve focus group discussions and 19 one-on-one interviews involving a total of 106 participants were conducted in all three administrative regions of Malawi. The interviews and focus group discussions explored perceptions and experiences regarding involvement, practice and challenges of disclosure of HIV status to children. Data were analysed using thematic analysis. RESULTS: Primary caregivers, healthcare workers, teachers, and community leaders all reported that the disclosure of HIV status to children was not well coordinated because each of the groups of participants was working in isolation instead of working as a team. A "working together" model emerged from the data analysis where participants expressed the need for them to work as a team in order to promote safe and effective HIV status disclosure through talking about HIV, sharing responsibility and open communication. Participants reported that by working together, the team members would ensure that the prevalence of HIV disclosure to young children increases and that there would be a reduction in any negative impact of disclosure. CONCLUSION: Global resources are required to better support children living with HIV and their families. Healthcare workers and teachers would benefit greatly from training in working together with families living with HIV and, specifically, training in the disclosure process. Resources, in the form of books and other educational materials, would help them explain HIV and its effective management to children and families.

Healthcare workers' perspectives and practices regarding the disclosure of HIV status to children in Malawi: a cross-sectional study.

BACKGROUND: In 2011 the World Health Organisation recommended that children with a diagnosis of HIV be gradually informed about their HIV status between the ages of 6 and 12 years. However, to date, literature has focused mainly on primary caregiver and child experiences with HIV disclosure, little is known about healthcare workers' perspectives and practices of HIV status disclosure to children. The aim of this study was to assess healthcare workers' perspectives and practices regarding the disclosure of HIV status to children aged between 6 and 12 years in Malawi. METHODS: A cross-sectional survey was used to collect data from 168 healthcare providers working in antiretroviral clinics in all government District and Tertiary Hospitals in Malawi. Participants were asked questions regarding their knowledge, practice, and barriers to HIV disclosure. Data were analysed using binary logistic regression. RESULTS: Almost all healthcare workers (98%) reported that it was important to disclose HIV status to children. A significant proportion (37%) reported that they had never disclosed HIV status to a child and about half estimated that the rate of HIV disclosure at their facility was 25% or less. The main barriers to disclosure were lack of training on disclosure (85%) and lack of a standard tool for disclosure (84%). Female healthcare workers (aOR) 2.4; 95% CI: 1.1-5.5) and lack of training on disclosure (aOR 7.7; 95% CI: 3.4-10.7) were independently associated with never having disclosed HIV status to a child. CONCLUSIONS: This study highlights the need for providing appropriate training in HIV disclosure for healthcare workers and the provision of standardised disclosure materials.

The Factors That Influence and Protect Against Power Imbalance in Covert Bullying Among Preadolescent Children at School: A Thematic Analysis.

In this article, the perceptions of preadolescent children (ages 9-11) regarding factors that influence and protect against power imbalance associated with covert aggression and bullying are explored. In aggression research, the term covert has been typically used to describe relational, indirect, and social acts of aggression that are hidden. These behaviors contrast with overt physical and verbal aggression. Children have previously conveyed their belief that covert aggression is harmful because adults do not see it even though children, themselves, are aware. We used focus groups to explore children's understanding of covert aggression and to identify children's experience and perception of adult support in relation to bullying. Thematic analysis supported the definition of covert aggression as that which is intentionally hidden from adults. Friendship, social exclusion, and secret from teacher were identified as factors that influence power imbalance, while support from friends and adult support protected against power imbalance.

Barriers to Addressing Social Determinants of Health in Pediatric Nursing Practice: An Integrative Review.

PROBLEM: Despite a substantial body of knowledge regarding the importance of the social determinants of health, recognizing and responding to the psychosocial circumstances of seriously and chronically ill children and their families is not well established in routine pediatric nursing care. ELIGIBILITY CRITERIA: The search process focused on psychological and social determinants and care in the healthcare setting. Searches were limited to research and review publications written in the English language. The quality of evidence was graded using the National Health and Medical Research Council evidence hierarchy. RESULTS: Thirteen publications were identified for inclusion. Healthcare providers do recognize emotional distress experienced by patients, but feel unable to address psychosocial issues due to the lack of time, a lack of confidence in their own communication skills, and the perception that patients and their families prioritize physical care over psychosocial care. For patients and their families the main issue was that the healthcare system was focused on physical care with little opportunity to talk about psychosocial concerns. CONCLUSIONS: The greatest barrier to addressing the social determinants of health in the pediatric context is the dominance of the 'medical model' of care. Also, many healthcare providers believe that they lack the communication skills necessary to talk about psychosocial issues. IMPLICATIONS: The way forward will be to empower nurses through the sharing of knowledge of the social determinants of health, the development of skills in relationship building and therapeutic communication, and the mentorship of compassionate family-centered care.

PATERNAL AND MATERNAL REFLECTIVE FUNCTIONING IN THE WESTERN AUSTRALIAN PEEL CHILD HEALTH STUDY.

While past research on the care of infants has been mostly with mothers, in recent times there has been a renewed attention to the father-infant relationship. This study examined differences between mother and father parental reflective functioning (PRF) or parental mentalizing; that is, the parental capacity to reason about their own and their children's behaviors by taking into consideration intentional mental states. Data were collected from 120 couples with a 1-year-old child who were participants in the West Australian Peel Child Health Study. Parental mentalizing was assessed using the Parental Reflective Functioning Questionnaire (PRFQ; Luyten, Mayes, Nijssens, & Fonagy, ). Results showed that mother and father mentalizing with their children was independent and that mothers scored slightly higher levels of mentalizing than did fathers. Paternal mentalizing was weakly associated with family income and father education, and was more strongly associated with family functioning than with maternal mentalizing. Implications for theorizing on PRF and fatherhood more generally are discussed.

A Scoping Review of Self-Report Measures of Aggression and Bullying for Use With Preadolescent Children.

Bullying in schools is a major health concern throughout the world, contributing to poor educational and mental health outcomes. School nurses are well placed to facilitate the implementation and evaluation of bullying prevention strategies. To evaluate the effect of such strategies, it is necessary to measure children's behavior over time. This scoping review of instruments that measure the self-report of aggressive behavior and bullying by children will inform the evaluation of bullying interventions. This review aimed to identify validated instruments that measure aggression and bullying among preadolescent children (age 8-12). The review was part of a larger study that sought to differentiate bullying from aggressive behavior by measuring the self-report of power imbalance between the aggressor and the child being bullied. The measurement of power imbalance was therefore a key aspect of the scoping review.

Rethinking family-centred care for the child and family in hospital.

AIMS AND OBJECTIVES: This paper presents and discusses an alternative model of family-centred care (FCC) that focuses on optimising the health and developmental outcomes of children through the provision of appropriate support to the child's family. BACKGROUND: The relevance, meaning and effectiveness of FCC have been challenged recently. Studies show that parents in hospital often feel unsupported, judged by hospital staff and uncertain about what care they should give to their child. With no convincing evidence relating FCC to improved child health outcomes, it has been suggested that FCC should be replaced with a new improved model to guide the care of children in hospital. DESIGN: This integrative review discusses theory and evidence-based literature that supports the practice of an alternative model of FCC that is focused on the health and developmental outcomes of children who are seriously ill, rather than the organisational requirements of children's hospitals. METHODS: Theories and research findings in a wide range of disciplines including epidemiology, psychology, sociology, anthropology and neuroscience were accessed for this discussion. Nursing literature regarding partnership building, communication and FCC was also accessed. DISCUSSION: This paper discusses the benefits of applying a bioecological model of human development, the family and community resource framework, the concepts of allostatic load and biological embedding, empowerment theory, and the nurse-family partnership model to FCC. CONCLUSION: While there is no direct evidence showing that the implementation of this alternative model of FCC in the hospital setting improves the health and developmental outcomes of children who are seriously ill, there is a great deal of evidence from community nursing practice that suggests it is very likely to do so. RELEVANCE TO CLINICAL PRACTICE: Application of these theoretical concepts to practice has the potential to underpin a theory of nursing that is relevant for all nurses irrespective of the age of those they care for and the settings within which they work.

Neurological and biological foundations of children's social and emotional development: an integrated literature review.

This article provides an integrated review of the expert literature on developmental processes that combine social, biological, and neurological pathways, and the mechanisms through which these pathways may influence school success and health. It begins with a historical overview of the current understanding of how attachment relationships and social environments influence brain development and plasticity and are, therefore, central to the physical and mental health of individuals and populations. It then expands on the effect of plasticity in relation to behavior and learning at school. This article concludes with a discussion of the role the school nurse may play in supporting health and learning by recognizing signs of relational stress and by advocating for prevention strategies.

Parents' nonstandard work schedules and child well-being: a critical review of the literature.

This paper provides a comprehensive review of empirical evidence linking parental nonstandard work schedules to four main child developmental outcomes: internalizing and externalizing problems, cognitive development, and body mass index. We evaluated the studies based on theory and methodological rigor (longitudinal data, representative samples, consideration of selection and information bias, confounders, moderators, and mediators). Of 23 studies published between 1980 and 2012 that met the selection criteria, 21 reported significant associations between nonstandard work schedules and an adverse child developmental outcome. The associations were partially mediated through parental depressive symptoms, low quality parenting, reduced parent-child interaction and closeness, and a less supportive home environment. These associations were more pronounced in disadvantaged families and when parents worked such schedules full time. We discuss the nuance, strengths, and limitations of the existing studies, and propose recommendations for future research.

Applying an authentic partnership approach to facilitate optimal health of Aboriginal children.

The aim of this development paper is to inform the ongoing implementation of the partnership approach with Aboriginal families in Australia. As almost all Community Health Nurses employed by the Health Department of Western Australia, Country Health Service are non-Aboriginal, there are a number of factors that may, potentially, limit their capacity to work effectively with the primary caregivers of Aboriginal children.Historically, much that has been written about the health and development of Aboriginal people in Australia has been negative and derogatory with wide criticism for their non-participation with health services and healthy lifestyle activities. Not only has this "deficit discourse" approach proved to be unhelpful in terms of improving the health and well-being of Aboriginal people but also there is mounting evidence that it has been detrimental to mental and physical health and capacity to achieve autonomy in all aspects of life.In response to the voices of Aboriginal people, the partnership approach to care has been promoted for use by Community Health Nurses in Western Australia. However, the implementation of the approach is not always genuinely strength based, and it does not always focus on mutual goal setting within authentic partnership relationships. The partnership approach has the potential to improve the lives of Aboriginal people if it is implemented with appropriate cultural sensitivity, shared responsibility, dignity and respect.

Back and neck pain are related to mental health problems in adolescence.

BACKGROUND: There is a high prevalence of mental health problems amongst adolescents. In addition there is a high prevalence of spinal pain in this population. Evidence suggests that these conditions are related. This study sought to extend earlier findings by examining the relationship between mental health problems as measured by the Child Behaviour Check List (CBCL) and the experience of back and neck pain in adolescents. METHODS: One thousand five hundred and eighty participants (mean age 14.1 years) from the Western Australian Pregnancy (Raine) Study provided cross-sectional spinal pain and CBCL data. RESULTS: As predicted, there was a high prevalence of back and neck pain in this cohort. On the whole, females reported more mental health difficulties than males. There were strong relationships between the majority of symptom scales of the CBCL and back and neck pain. Scores on the CBCL were associated with higher odds of comorbid back and neck pain. CONCLUSIONS: These findings strongly support the need to consider both psychological and pain symptoms when providing assessments and treatment for adolescents. Further research is required to inform causal models.

Breastfeeding and early child development: a prospective cohort study.

AIM: Breastfeeding has been associated with multiple developmental advantages for the infant; however, there have also been a number of studies that find no significant benefits to child development. We examined the relationship between breastfeeding for 4 months or longer and child development at age 1, 2 and 3 years. METHODS: Women were enrolled in the Western Australian Pregnancy Cohort (Raine) Study (N = 2900) and their live born children (N = 2868) were followed to the age of 3 years (N = 2280). Infant feeding data were collected at each age, and the mothers completed the Infant/Child Monitoring Questionnaire (IMQ), which measures progress towards developmental milestones in the domains of gross and fine motor skills, adaptability, sociability and communication. Factors adjusted for in multivariable analyses included maternal sociodemographic characteristics and stressful life events. RESULTS: Infants breastfed for 4 months or longer had significantly higher mean scores (representing better functioning) for fine motor skills at age 1 and 3, significantly higher adaptability scores up to age two, and higher communication scores at age 1 and 3 years. Infants who were breastfed for <4 months were more likely to have at least one atypical score across the five developmental domains than those who were breastfed for 4 months or longer. CONCLUSION: Although our effect sizes were small, breastfeeding for 4 months or longer was associated with improved developmental outcomes for children aged one to 3 years after adjustment for multiple confounding factors.

Lifestyle and demographic correlates of poor mental health in early adolescence.

AIM: To determine the constellation of lifestyle and demographic factors that are associated with poor mental health in an adolescent population. METHODS: The Raine Study 14-year follow-up involved primary care givers and their adolescent children (n= 1860). The Child Behaviour Checklist (CBCL) was used to assess adolescent mental health. We examined diet, socio-demographic data, family functioning, physical activity, screen use and risk-taking behaviours with mental health outcomes using linear regression. RESULTS: Adolescents with higher intakes of meat and meat alternatives and 'extras' foods had poorer mental health status. Adverse socio-economic conditions, higher hours of screen use and ever partaking in the health risk behaviours of smoking and early sexual activity were significantly associated with increasing CBCL scores, indicative of poorer functioning. CONCLUSIONS: By identifying the lifestyle and demographic factors that accompany poorer mental health in early adolescence, we are able to better understand the context of mental health problems as they occur within an adolescent population.

Importance of effective collaboration between health professionals for the facilitation of optimal community diabetes care.

Diabetes places a significant burden on the individuals concerned, their families and society as a whole. The debilitating sequelae of diabetes can be limited or prevented altogether through strict glycaemic control. Despite the seemingly uncomplicated nature of the disorder, effective management can be elusive, as the impact of having to deal with diabetes on a daily basis can be profound and appropriate professional support is not always readily available. As the roles of general practitioners (GPs) and allied health professionals have evolved, a major issue now facing all is that of developing and maintaining effective collaborative relationships for the facilitation of optimal community diabetes care. Using a simple survey methodology, the present exploratory study investigated the referral patterns of GPs to diabetic educators (DEs) working for a community health service in an Australian town, and reasons for referral and non-referral in order to identify factors that contribute to a sound and sustainable collaborative relationship. The results provide some evidence that GPs and DEs in this town do work collaboratively towards achieving client-centred goals and highlight the need to inform GPs who are new to communities, such as this one, of the available DE services. Most importantly, the study identified that there are many opportunities to strengthen collaboration so as to facilitate optimal community diabetes care. This information is valuable, because there is limited empirical evidence either nationally or internationally about the process of collaboration between health professionals in the management of chronic diseases, such as diabetes.

How are you sleeping? Starting the conversation with fathers about their mental health in the early parenting years.

BACKGROUND: Approximately 1 in 10 fathers of infants experience symptoms of common mental health disorders, prompting calls for paternal postpartum screening. However, numerous obstacles exist to screening implementation. The aim of this study was to provide preliminary evidence for an alternative approach that starts with asking fathers about their sleep. METHODS: Using self-reported father data at 0 to 36 months postpartum (N=1204) from four Australian cohort studies, we assessed associations between responses to various single-item questions about sleep (good to poor), and scores on validated measures of mental health (depression, anxiety and stress). We conducted regressions, unadjusted and adjusted for father age, child age, household income, education, first or later child, and marital status, to test associations between sleep and each indicator of mental health. We then meta-analyzed effects and assessed interactions between sleep and each of the covariates. RESULTS: Consistent associations between fathers' subjective poor sleep and depression, anxiety and stress were replicated across the four cohorts despite heterogeneity in the sleep questions. At the meta-analytic level, effects ranged from weak to moderate (0.25 to 0.37) and were robust to all adjustments. Interactions were only detected between family income and poor sleep, such that the association was stronger for high income fathers. LIMITATIONS: This study does not address the sensitivity or specificity of single-item sleep questions for assessing paternal mental health risk. CONCLUSIONS: A low-cost, non-stigmatizing single question to postpartum fathers about their sleep may present a gateway opportunity to enquiring about mental health.