The pediatric self-management model in asthma: A theory analysis and evaluation.

THEORETICAL PRINCIPLES: The Pediatric Self-management Model (PSMM) is a middle-range theory geared at understanding the relationship between factors influencing chronic illness management in children. PSMM is a family-centered model that focuses on the unique factors present in the pediatric population. PHENOMENA ADDRESSED: Pediatric asthma is a leading chronic respiratory illness in the United States, affecting over 4.6 million children in 2020. Over 40% of children with asthma will have at least one exacerbation per year. On average, a child with asthma will miss nine additional school days annually. Using the Walker and Avant framework for theory analysis, the PSMM is examined through the lens of pediatric asthma to evaluate its applicability to pediatric asthma shared management and adherence. RESEARCH LINKAGES: The PSMM has been used as a framework for understanding the roles of managing chronic illness in children, but it has yet to be applied to pediatric asthma. Asthma outcomes inherently depend on preventative medicine and home care strategies for symptom management and response outside the healthcare facility. The PSMM is a new framework for understanding barriers and facilitators within pediatric asthma management and highlights the importance of the dyadic relationship between child and parent to successfully share healthcare responsibility.

Eating experiences in people living with dementia: A concept analysis using Rodgers's methodology.

AIMS: To analyse the concept of eating experiences in people living with dementia. DESIGN: Rodgers' evolutionary method of concept analysis was used as a framework for the paper. DATA SOURCES: The literature was searched using electronic databases PubMed, Google Scholar, CINHAL, PsycInfo, Web of Science, Embase and Elsevier databases. These databases cover a variety of disciplines, including but not limited to nursing, medicine and occupational therapy. The relevant literature published from 1989 to April 2023 was thoroughly examined. Any quantitative or qualitative studies published in English focused on eating or dining experiences in people with dementia were included. REVIEW METHODS: Rodgers' evolutionary method for concept analysis was used. The attributes, antecedents, consequences and case examples of the concept were identified. RESULTS: Twenty-two articles met the inclusion criteria, identifying key attributes of self-connection, the special journey of life and self-interpretation. Antecedents, as framed by the socio-ecological model, were categorized to represent intrapersonal (personal preferences, individual culture, mealtime routines), interpersonal (social interaction) and environmental (dining room environment, policies) factors. Consequences were divided into external (nutritional health, physical health and quality of life) and internal (personhood, autonomy and independence, dignity and feeling valued and mental well-being) domains. CONCLUSION: A theoretical definition and conceptual model of eating experiences in people living with dementia was developed. The identified attributes, antecedents and consequences can be utilized in nursing education, research and intervention approaches. IMPACT: This article allows nurses and other healthcare professionals to better understand people living with dementia through the relationship between eating and interpersonal, intrapersonal and environmental aspects to develop personalized interventions and care strategies to achieve an optimal quality of life. PATIENT OR PUBLIC CONTRIBUTION: Not applicable.

Usability testing of a mobile health application to support individuals with active tuberculosis: a mixed methods study.

Poor adherence to tuberculosis (TB) treatment leads to further disease transmission, worsened outcomes, and the development of drug resistance. Digital adherence technologies may facilitate a more patient-centered approach for improving TB treatment outcomes than current strategies. The objective of this study was to evaluate and explore improving usability of the TB Treatment Support Tools (TB-TST) mobile application. We used an iterative convergent mixed-method design consisting of two quantitative surveys and a qualitative think-aloud interview. Testing was conducted in three testing cycles consisting of a total of 16 interviews and 26 surveys. Results were thematically analyzed and reported to the development team during weekly team meetings. Participants rated the TB-TSTs application as having high usability and the iterative approach resulted in several refinements to the application in response to participant feedback. These refinements were well received during qualitative interviews but did not result in a statistically significant improvement in usability testing scores between cycles. Using an iterative convergent mixed-method design was an effective method for refining our mHealth application. Data collected from think-aloud interviews, the MAUQ, and the Health-ITUES identified key areas of application design that needed refinement.

Facilitators and Barriers to Pediatric Nurse Practitioner Practice in the United States: A Systematic Review.

INTRODUCTION: The pediatric nurse practitioner (PNP) workforce was designed to improve child health equity. We aimed to systematically review the evidence on facilitators and barriers to PNP practice. METHOD: We included empirical studies on PNP practice in the United States and excluded studies with non-identifiable PNP data. We applied Joanna Briggs Institute tools to appraise studies and applied critical interpretive synthesis principles to synthesize. RESULTS: The final sample is 26 studies, mostly published before 2013 and observational. Prescriptive privileges, training program availability, organizational climate, and telehealth are facilitators. Mandated physician supervision, reduced pediatric curricula, geographically disparate training programs, and poor data infrastructure are barriers. The sample is limited by a moderate to high risk of bias. DISCUSSION: Evidence suggests modifiable factors impact PNP practice and could have important implications for child health equity. We offer a theoretical model to guide robust research studying the PNP workforce and health equity.

The Cost of Caring During COVID-19: A Clarion Call to Action to Support the Pediatric Advanced Practice Nursing Workforce.

INTRODUCTION: This study reexamined the holistic impacts of COVID-19 on the pediatric advanced practice registered nursing (APRN) workforce two years after the 2020 assessment. METHOD: This cross-sectional descriptive study used a convenience sample of pediatric APRNs affiliated with the National Association of Pediatric Nurse Practitioners (NAPNAP). A modified NAPNAP survey explored numerous impacts of COVID-19 on the pediatric APRN workforce. RESULTS: Study participants (n = 1,087) reported widespread pandemic impacts across personal and professional domains. Alarmingly, 87% reported professional burnout, and 80% expressed concern over their overall mental health. The impacts of the pandemic on child health are ominous, with 94% of participants reporting pediatric mental health concerns, a devastating increase from the previous study. DISCUSSION: The pediatric APRN workforce is in crisis amid a national pediatric mental health emergency. Multilevel interventions are critically emergent to sustain the APRN workforce and promote the health and well-being of children and families.

Analysis, evaluation, and reformulation of social cognitive theory: Toward parent-child shared management in sleep health.

THEORETICAL PRINCIPLES: Social Cognitive Theory (SCT) is a middle-range theory with triadic determinism between behavioral, environmental, and personal. SCT has been a guiding framework in health promotion research as it helps understand people's behaviors. PHENOMENA ADDRESSED: Behavioral Insomnia of Childhood (BIC) is highly prevalent, affecting up to 45% of typically developing children and 80% of children with special healthcare needs. BIC leads to sleep deficiency, disrupted physical and psychological health, poor school performance, behavioral dysfunction, and negatively affects parental and family functioning. Using Fawcett's framework, we analyzed and evaluated SCT in a pediatric sleep context and propose a reformulation of SCT to better inform sleep research. RESEARCH LINKAGES: SCT is individually focused and does not account for interdependence within relationships. Pediatric sleep interventions have limited long-term effects and sustainability without considering the parent-child dyadic interdependency. We advance the argument that the parent-child shared management (PCSM) perspective is beneficial for understanding pediatric sleep health. PCSM is a concept that reflects the shared responsibility and interdependence that parent and child have for managing child health. It assumes that with parents' ongoing support, children's responsibility for their health management increases over time, along with developmental progression and health-related experiences. We propose reformulating SCT by integrating PCSM in the pediatric sleep context: SCT with Shared Management (SCT-SM). The proposed SCT-SM accounts for parent-child interdependence and role transition. Shared management interventions that engage parents and children in active roles in managing sleep have potential sustainable effects in improving sleep and quality of life. (250).

Pediatric Nurse Practitioner Knowledge of and Attitudes Toward Human Trafficking: A Psychometric Evaluation.

INTRODUCTION: Human trafficking is an urgent health threat. This study sought to psychometrically validate the novel Pediatric Nurse Practitioner Knowledge and Attitudes Toward Human Trafficking scale. METHOD: Using data from a 2018 study of pediatric-focused advanced practice registered nurses (n = 777), this secondary analysis examined dimensionality and reliability of the survey. RESULTS: The Cronbach α for scale constructs was < 0.7 for knowledge and 0.78 for attitudes. Exploratory and confirmatory analyses identified a bifactor model for knowledge with relative fit indexes within standard cutoffs, root mean square error of approximation = 0.03, comparative fit index = 0.95, Tucker-Lewis index = 0.94, and standardized root mean square residual = 0.06. The attitudes construct indicated a 2-factor model with root mean square error of approximation = 0.04, comparative fit index = 0.99, Tucker-Lewis index = 0.98, and standardized root mean square residual = 0.06, within standard cutoffs. DISCUSSION: The scale is a promising tool in advancing nursing response to trafficking but needs further refinement to increase utility and uptake.

The mediating role of anxiety/depression symptoms between adverse childhood experiences (ACEs) and somatic symptoms in adolescents.

INTRODUCTION: This study examines the relationships among recent adverse childhood experiences (ACEs), somatic symptoms, and anxiety/depression symptoms during adolescence and whether anxiety/depression symptoms mediate the relationship between ACEs and somatic symptoms. METHODS: Longitudinal prospective data from the Longitudinal Studies of Child Abuse and Neglect study of 1354 children and their primary caregivers in the United States was used in this study. A longitudinal cross-lagged path analysis among recent ACEs, anxiety/depression symptoms, and somatic symptoms at three points during adolescence (ages 12, 14, and 16 years) was conducted. RESULTS: The sample was 51% female and 53% African American. The results indicated significant concurrent associations between recent ACEs and increased anxiety/depression symptoms at ages 12, 14, and 16 (ß = .27, p < .001; ß = .15, p < .001; ß = .07, p < .05) and between anxiety/depression symptoms and increased somatic symptoms at ages 12, 14, and 16 years (ß = .44, p < .001; ß = .39, p < .001; ß = .49, p < .001). Moreover, anxiety/depression symptoms significantly mediated the relationship between recent ACEs and concurrent somatic symptoms at ages 12, 14, and 16 years (ß = .12, p < .001; ß = .06, p < .001; ß = .04, p < .05). However, there was no significant relationship between recent ACEs and somatic symptoms. CONCLUSION: The findings suggest that anxiety/depression symptoms mediate the concurrent relationships between recent ACEs and somatic symptoms at ages 12, 14, and 16. Clinicians should consider assessing anxiety/depression symptoms and possible concurrent exposure to ACEs when caring for adolescents who present with somatic symptoms.

Improving Asthma Care Together (IMPACT) mobile health intervention for school-age children with asthma and their parents: a pilot randomised controlled trial study protocol.

INTRODUCTION: Asthma is an incurable, lifelong condition that places children at increased risk for exacerbation, hospitalisation and school absences. Most paediatric asthma interventions target parents alone and are overly prescriptive. Improving Asthma Care Together (IMPACT) is a novel shared management system comprised of a mobile health (mHealth) application, symptom watch and tailored health intervention that pairs parent and child together as an asthma management team. IMPACT helps families monitor asthma status, tailor asthma management strategies and facilitate intentional transition of asthma management to the child. The purpose of this study is to determine the feasibility, acceptability and preliminary efficacy of the IMPACT intervention. METHODS AND ANALYSIS: This pilot randomised controlled trial will recruit 60 children with asthma (7-11 years) and one parent. All parent-child dyads will complete data collection sessions at baseline, postintervention and follow-up. Dyads randomised to the intervention group (IMPACT) will complete the 8-week intervention comprised of weekly activities including symptom monitoring, goal setting and progress monitoring. Dyads randomised to the control group will receive usual care but then be provided access to IMPACT at the end of the study. Feasibility will be measured by the proportion of eligible dyads enrolled and retained. Acceptability of IMPACT will be assessed using the Acceptability of Intervention Measure, the System Usability Scale and a semistructured interview. Preliminary efficacy is determined based on change in primary outcomes, parent-reported and child-reported asthma responsibility and asthma self-efficacy scores, from baseline. ETHICS AND DISSEMINATION: This study has been approved by the University of Washington Institutional Review Board; study ID: STUDY00010461. Participants gave informed consent to participate in the study before taking part. Study results will be disseminated in peer-reviewed journals and scientific conferences. A lay summary will be provided to study participants. TRIAL REGISTRATION NUMBER: NCT04908384 (ClinicalTrials.gov identifier).

Refinement of a Parent-Child Shared Asthma Management Mobile Health App: Human-Centered Design Study.

BACKGROUND: The school-age years, approximately ages 7 through 11, represent a natural transition when children begin assuming some responsibility for their asthma management. Previously, we designed a theoretically derived, tailored parent-child shared asthma management mobile health app prototype, Improving Asthma Care Together (IMPACT). OBJECTIVE: The purpose of this study was to use human-centered design (HCD) to iteratively refine IMPACT to optimize user experience and incorporate evidence-based longitudinal engagement strategies. METHODS: This study used a mixed methods design from December 2019 to April 2021. Our app refinement used the HCD process of research, ideation, design, evaluation, and implementation, including 6 cycles of design and evaluation. The design and evaluation cycles focused on core app functionality, child engagement, and overall refinement. Evaluation with parent-child dyads entailed in-person and remote concept testing and usability testing sessions, after which rapid cycle thematic analyses identified key insights that informed future design refinement. RESULTS: Twelve parent-child dyads enrolled in at least one round of this study. Eight of the 12 child participants were male with a mean age of 9.9 (SD 1.6) years and all parent participants were female. Throughout evaluation cycles, dyads selected preferred app layouts, gamification concepts, and overall features with a final design prototype emerging for full-scale development and implementation. CONCLUSIONS: A theoretically derived, evidence-based shared asthma management app was co-designed with end users to address real-world pain points and priorities. An 8-week pilot study testing app feasibility, acceptability, and preliminary efficacy is forthcoming.

Exploring the Effect of a Nature-based Virtual Reality Environment on Stress in Adolescents.

Adolescent mental health is a growing public health issue, with 30% of teens reporting increased stress and 20% of adolescents suffering from depression. Given the scarcity and lack of scalability of mental health services available, the use of self-administered, evidence-based technologies to support adolescent mental health is both timely and imperative. We conducted a mixed-methods pilot study with 31 adolescents ages 14-19 (m = 17.97) to explore the self-administration of a nature-based virtual reality tool. Participant use of the VR environment ranged from 1 to 10 sessions (m = 6.6) at home over a 2-week period while reporting their daily stress and mood levels. All participants completed all of the study protocols, indicating our protocol was feasible and the VR environment engaging. Post-study interviews indicated that most participants found the VR tool to be relaxing and helpful with stress. The themes of Calm Down, Relaxation, and Escape emerged to articulate the participants' experiences using the VR environment. Additionally, participants provided rich data regarding their preferences and activity in the VR environment as well as its effect on their emotional states. Although the sample size was insufficient to determine the impact on depression, we found a significant reduction in momentary stress as a result of using the VR tool. These preliminary data inform our own virtual reality environment design, but also provide evidence of the potential for self-administered virtual reality as a promising tool to support adolescent mental health.

Exhausted and Burned Out: COVID-19 Emerging Impacts Threaten the Health of the Pediatric Advanced Practice Registered Nursing Workforce.

INTRODUCTION: The purpose of this study was to describe the holistic impacts of COVID-19 on pediatric advanced practice registered nurses (APRNs). METHOD: AA convenience sample of APRNs affiliated with the National Association of Pediatric Nurse Practitioners participated in this cross-sectional descriptive study. An investigator-developed survey explored multifocal, holistic impacts of COVID-19. RESULTS: A total of 886 participants were provided the survey, with 796 (90%) completing the entire survey. Respondents indicated adverse impacts across personal, clinical, educational, and research foci. Among the most alarming findings, 34% indicated moderate or extreme concern for feeling professionally burned out, 25% feeling nervous or anxious, and 15% feeling depressed or hopeless. DISCUSSION: The pediatricAPRN workforce pipeline is at significant risk for provider burnout and compromised mental health. Acknowledgment of pandemic-related trauma on families, children and APRNs is essential. Sustained intentional efforts to cultivate holistic wellness are critically emergent.

Associations of Pre- and Postnatal Air Pollution Exposures with Child Blood Pressure and Modification by Maternal Nutrition: A Prospective Study in the CANDLE Cohort.

BACKGROUND: Limited data suggest air pollution exposures may contribute to pediatric high blood pressure (HBP), a known predictor of adult cardiovascular diseases. METHODS: We investigated this association in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study, a sociodemographically diverse pregnancy cohort in the southern United States with participants enrolled from 2006 to 2011. We included 822 mother-child dyads with available address histories and a valid child blood pressure measurement at 4-6 y. Systolic (SBP) and diastolic blood pressures (DBP) were converted to age-, sex-, and height-specific percentiles for normal-weight U.S. children. HBP was classified based on SBP or DBP ≥90th percentile. Nitrogen dioxide (NO2) and particulate matter ≤2.5µm in aerodynamic diameter (PM2.5) estimates in both pre- and postnatal windows were obtained from annual national models and spatiotemporal models, respectively. We fit multivariate Linear and Poisson regressions and explored multiplicative joint effects with maternal nutrition, child sex, and maternal race using interaction terms. RESULTS: Mean PM2.5 and NO2 in the prenatal period were 10.8 [standard deviation (SD): 0.9] µg/m3 and 10.0 (SD: 2.4) ppb, respectively, and 9.9 (SD: 0.6) µg/m3 and 8.8 (SD: 1.9) ppb from birth to the 4-y-old birthday. On average, SBP percentile increased by 14.6 (95% CI: 4.6, 24.6), and DBP percentile increased by 8.7 (95% CI: 1.4, 15.9) with each 2-µg/m3 increase in second-trimester PM2.5. PM2.5 averaged over the prenatal period was only significantly associated with higher DBP percentiles [ß= 11.6 (95% CI: 2.9, 20.2)]. Positive associations of second-trimester PM2.5 with SBP and DBP percentiles were stronger in children with maternal folate concentrations in the lowest quartile (pinteraction= 0.05 and 0.07, respectively) and associations with DBP percentiles were stronger in female children (pinteraction= 0.05). We did not detect significant association of NO2, road proximity, and postnatal PM2.5 with any outcomes. CONCLUSIONS: The findings suggest that higher prenatal PM2.5 exposure, particularly in the second trimester, is associated with elevated early childhood blood pressure. This adverse association could be modified by pregnancy folate concentrations. https://doi.org/10.1289/EHP7486.

Pivoting to "No Contact": A Protocol for Conducting a Virtual Reality Relaxation Home Study for Teens Amidst the COVID-19 Pandemic.

Prior to the COVID-19 pandemic, our team planned to pilot a self-administered virtual reality environment for stress reduction. The purpose of this manuscript is to describe our pivot to a "no contact" protocol, including participant feedback and lessons learned. Our protocol included virtual reality study kit sanitization, delivery, and return; remote screening, consent, enrollment, and data collection; and virtual study visits. All study participants found the protocol to be acceptable. Lessons learned include strategies for institutional review board approval and improved orientation to the study technology. Despite a global pandemic, our "no contact" protocol was feasible and acceptable.

Associations Between Maternal Nutrition in Pregnancy and Child Blood Pressure at 4-6 Years: A Prospective Study in a Community-Based Pregnancy Cohort.

BACKGROUND: The intrauterine environment may influence offspring blood pressure, with effects possibly extending into adulthood. The associations between prenatal nutrition and offspring blood pressure, alone or in combination with other sociodemographic or behavioral factors, are unclear. OBJECTIVES: To investigate the associations of maternal dietary patterns and plasma folate concentrations with blood pressure in children aged 4-6 years, and assess the potential effect modifications by child sex, maternal race, pre-pregnancy overweight or obesity, maternal smoking, and breastfeeding. METHODS: Participants were 846 mother-child dyads from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study. Maternal nutrition was characterized by the Healthy Eating Index 2010 (HEI) scores and plasma folate concentrations in pregnancy. We calculated the systolic blood pressure (SBP) and diastolic blood pressure percentiles, incorporating sex, age, and height, and categorized children as either having high blood pressure (HBP; ≥90th percentile) or normal blood pressure. Linear regressions were performed to quantify the associations between maternal nutrition and continuous blood pressure percentiles, and Poisson regressions were used to estimate the incidence rate ratio (IRR) of binary HBP. We examined the effect modifications using interaction models. RESULTS: Mean HEI scores and folate concentrations were 60.0 (SD, 11.3) and 23.1 ng/mL (SD, 11.1), respectively. Based on measurements at 1 visit, 29.6% of the children were defined as having HBP. Maternal HEI scores and plasma folate concentrations were not associated with child blood pressure percentiles or HBP in the full cohort. Among mothers self-identified as white, there was an inverse relationship between maternal HEI score and child SBP percentile (ß, -0.40; 95%CI: -0.75 to -0.06). A maternal HEI score above 59 was associated with a reduced risk of HBP in girls (IRR, 0.53; 95% CI: 0.32-0.88). No modified associations by pre-pregnancy overweight or obesity, maternal smoking, or breastfeeding were indicated. CONCLUSIONS: We found little evidence for effects of maternal nutrition during pregnancy on childhood blood pressure, but detected sex- and race-specific associations. The study contributes to the evolving scientific inquiry regarding developmental origins of disease.

A model for systems-level influences on toddler immunization completion.

Toddler immunization completion rates vary across populations in the United States, and this variation may be contributing to the national rise in vaccine preventable diseases. Yet existing theoretical scholarship for improving toddler immunization uptake is largely focused on the individual level, neglecting the multiple system-level environments that should be considered. Population characteristics are distinct from the sum of individual characteristics. Thus, a reformulation of the ecological systems theory is proposed to provide theoretical direction and guide future population health research regarding system-level influences on vaccine coverage.

Family science and family-based research in integrated and health care contexts: Future considerations for Families, Systems, & Health.

The focus on families and application to health sets Families, Systems, & Health apart from other sister journals. Family science is a thriving field of study experiencing rapid advances in the discovery, verification, and application of knowledge about families (Burr, Day, & Bahr, 1993; Doherty, Boss, LaRossa, Schumm, & Steinmetz, 1993; National Council on Family Relations [NCFR] Task Force on the Development of a Family Discipline, 1988). It is essential that these advances in family science are transferable to research focused on families in integrated health care contexts, and it is our hope that Families, Systems, & Health with be at the forefront in disseminating this work. While there is an abundance of research focused on families and health outcomes, there is much less focused on the dissemination and implementation of family-based interventions in health care and integrated health care contexts. In order to advance our understanding how family members are included in family-based interventions, it is essential to operationalize how family-based interventions involve and assess families. In this editorial, we describe the foundations of family science and health, how these foundations inform family-based research, and the translational bridge of family-based research in health care. We conclude by describing a tiered approach for family involvement and assessment in family-based interventions taking place in health care, with specific attention on dissemination and implementation research in integrated care settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Sleep intervention for children with asthma and their parents (SKIP Study): a novel web-based shared management pilot study.

STUDY OBJECTIVES: The objective of this study was to describe the feasibility, acceptability, and preliminary efficacy of a novel Sleep Intervention for Kids and Parents (SKIP). Parent and child primary sleep outcomes were total sleep time, wake after sleep onset (WASO), sleep efficiency (SE), and bedtime range. METHODS: Children 6-11 years of age with asthma and 1 parent, both with behavioral sleep disturbance, enrolled in this single-group pilot. The 8-week shared management intervention included weekly online educational modules, goal setting, and progress reporting. Feasibility was measured by the number of dyads who were eligible, enrolled, and retained. Acceptability was measured by survey and semistructured interview. Total sleep time, WASO, SE, and bedtime range were measured by actigraphy at baseline, after the intervention, and 12-week follow-up. Mixed-effects regression models were used to determine change in sleep outcomes from baseline. RESULTS: Thirty-three of 39 eligible dyads enrolled; of 29 dyads that started the intervention, 25 (86%) completed all study visits. SKIP was acceptable for 61% of children and 92% of parents. Compared with baseline, at follow-up, children had significantly improved WASO (-37 minutes; 95% confidence interval [CI], -44.5 to -29.7; P < .001), SE (5.4%; 95% CI, 4.2-6.5; P < .001), and bedtime range (-35.2 minutes; 95% CI, -42.9 to -27.5; P < .001). Parents also had significantly improved WASO (-13.9 minutes; 95% CI, -19.5 to -8.2; P < .001), SE (2.7%; 95% CI, 1.7-.7; P < .001), and bedtime range (-35.3 minutes; 95% CI, -51.0 to -19.7; P < .001). CONCLUSIONS: SKIP was feasible, acceptable, and we observed improved child and parent sleep outcomes except total sleep time. Following refinements, further testing of SKIP in a controlled clinical trial is warranted. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Sleep Intervention for Kids and Parents: A Self-Management Pilot Study; URL: https://www.clinicaltrials.gov/ct2/show/study/NCT03144531; Identifier: NCT03144531.

Parent- and Child-Reported Asthma Responsibility in School-Age Children: Examining Agreement, Disagreement, and Family Functioning.

INTRODUCTION: The school-age years represent a critical time for children to begin assuming shared asthma management responsibility. This study aimed to describe parent- and child-reported asthma responsibility, examine agreement and disagreement, and explore family functioning as a predictor of agreement/disagreement. METHODS: Twenty children (age range = 6-11 years) and one of their parents participated in this cross-sectional study. Parent-child dyads independently reported on their asthma management responsibility and asthma control. Parents also completed family functioning and demographic questionnaires. RESULTS: There was a significant difference between parent and child asthma responsibility scores (t(19) = 2.46, p < .05), indicating that children saw themselves as assuming greater responsibilities than their parents did. A regression analysis showed that collectively, family functioning predicted 74% of the variance in parent-child disagreement (F(6,15) = 4.17, p < .05). DISCUSSION: Family functioning may be an important factor in promoting shared management of asthma in school-age children.

Exploring the intersection of executive function and medication adherence in school-age children with asthma.

Asthma is one of the most common chronic diseases of childhood. For children with persistent asthma, asthma control is largely related to controller medication adherence. With increasing calls for children to be involved in their own asthma management, there is a gap in our knowledge about the executive functioning of children with asthma. OBJECTIVE: The purpose of this study was to explore the relationship between executive function, asthma, and medication adherence among school-age children with asthma. METHODS: Thirty-one children ages 7 to 11 years (M = 8.9 ± 1.51) and one of their parents were enrolled in this study. Parents reported on asthma control while children reported on asthma control, medication beliefs, medication adherence, and completed an executive function battery that assessed inhibition, updating, shifting and planning. RESULTS: Compared to the reference sample, children in this study had significantly lower composite scores in inhibition, t (31) = -3.84, p =. 001, and shifting, t (30) = -3.73, p =. 001. Controlling for age and asthma control, hierarchical regression analyses revealed that shifting accounted for 16% of the variance in child-reported medication adherence. CONCLUSIONS: This study revealed lowered executive functioning scores among school-age children with persistent asthma. Furthermore, it appears executive functioning and controller medication adherence are intertwined and warrant future exploration.