Evaluating the parent-adolescent communication toolkit: Usability and preliminary content effectiveness of an online intervention.

Aim: This study aimed to assess the Parent-Adolescent Communication Toolkit, an online intervention designed to help improve parent communication with their adolescents. Participant preferences for two module delivery systems (sequential and unrestricted module access) were identified. Design: Usability assessment of the PACT intervention was completed using pre-test and posttest comparisons. Usability data, including participant completion and satisfaction ratings were examined. Methods: Parents (N = 18) of adolescents were randomized to a sequential or unrestricted chapter access group. Parent participants completed pre-test measures, the PACT intervention and posttest measures. Participants provided feedback for the intervention to improve modules and provided usability ratings. Adolescent pre- and posttest ratings were evaluated. Results: Usability ratings were high and parent feedback was positive. The sequential module access groups rated the intervention content higher and completed more content than the unrestricted chapter access group, indicating support for the sequential access design. Parent mean posttest communication scores were significantly higher (p < .05) than pre-test scores. No significant differences were detected for adolescent participants. Findings suggest that the Parent-Adolescent Communication Toolkit has potential to improve parent-adolescent communication but further effectiveness assessment is required.

Internet-Assisted Parent Training Intervention for Disruptive Behavior in 4-Year-Old Children: A Randomized Clinical Trial.

IMPORTANCE: There is a large gap worldwide in the provision of evidence-based early treatment of children with disruptive behavioral problems. OBJECTIVE: To determine whether an Internet-assisted intervention using whole-population screening that targets the most symptomatic 4-year-old children is effective at 6 and 12 months after the start of treatment. DESIGN, SETTING, AND PARTICIPANTS: This 2-parallel-group randomized clinical trial was performed from October 1, 2011, through November 30, 2013, at a primary health care clinic in Southwest Finland. Data analysis was performed from August 6, 2015, to December 11, 2015. Of a screened population of 4656 children, 730 met the screening criteria indicating a high level of disruptive behavioral problems. A total of 464 parents of 4-year-old children were randomized into the Strongest Families Smart Website (SFSW) intervention group (n = 232) or an education control (EC) group (n = 232). INTERVENTIONS: The SFSW intervention, an 11-session Internet-assisted parent training program that included weekly telephone coaching. MAIN OUTCOMES AND MEASURES: Child Behavior Checklist version for preschool children (CBCL/1.5-5) externalizing scale (primary outcome), other CBCL/1.5-5 scales and subscores, Parenting Scale, Inventory of Callous-Unemotional Traits, and the 21-item Depression, Anxiety, and Stress Scale. All data were analyzed by intention to treat and per protocol. The assessments were made before randomization and 6 and 12 months after randomization. RESULTS: Of the children randomized, 287 (61.9%) were male and 79 (17.1%) lived in other than a family with 2 biological parents. At 12-month follow-up, improvement in the SFSW intervention group was significantly greater compared with the control group on the following measures: CBCL/1.5-5 externalizing scale (effect size, 0.34; P < .001), internalizing scale (effect size, 0.35; P < .001), and total scores (effect size, 0.37; P < .001); 5 of 7 syndrome scales, including aggression (effect size, 0.36; P < .001), sleep (effect size, 0.24; P = .002), withdrawal (effect size, 0.25; P = .005), anxiety (effect size, 0.26; P = .003), and emotional problems (effect size, 0.31; P = .001); Inventory of Callous-Unemotional Traits callousness scores (effect size, 0.19; P = .03); and self-reported parenting skills (effect size, 0.53; P < .001). CONCLUSIONS AND RELEVANCE: The study reveals the effectiveness and feasibility of an Internet-assisted parent training intervention offered for parents of preschool children with disruptive behavioral problems screened from the whole population. The strategy of population-based screening of children at an early age to offering parent training using digital technology and telephone coaching is a promising public health strategy for providing early intervention for a variety of child mental health problems. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01750996.

Exploring the lived experience of adults using prescription opioids to manage chronic noncancer pain.

BACKGROUND: Chronic noncancer pain (CNCP) and prescription opioid use is a highly complex and growing health care issue in Canada. Many quantitative research studies have investigated the effectiveness of opioids for chronic pain; however, gaps remain in the literature regarding the personal experience of using opioids and their impact on those experiencing CNCP. OBJECTIVE: To explore the lived experience of adults using prescription opioids to manage CNCP, focusing on how opioid medication affected their daily lives. METHODS: In-depth qualitative interviews were conducted with nine adults between 40 and 68 years of age who were using prescription opioids daily for CNCP. Interviews were audiorecorded and transcribed, and subsequently analyzed using interpretive phenomenological analysis. RESULTS: Six major themes identified positive and negative aspects of opioid use associated with social, physical, emotional and psychological dimensions of pain management. These themes included the process of decision making, and physical and psychosocial consequences of using opioids including pharmacological side effects, feeling stigmatized, guilt, fears, ambivalence, self-protection and acceptance. CONCLUSION: Although there were many negative aspects to using opioids daily, the positive effects outweighed the negative for most participants and most of the negative aspects were socioculturally induced rather than caused by the drug itself. The present study highlighted the complexities involved in using prescription opioids daily for management of CNCP for individuals living with pain.

Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada).

BACKGROUND: Oppositional Defiant Disorder (ODD) is characterized by angry and noncompliant behaviour. It is the most common disruptive behaviour disorder (DBD), with prevalence estimates of 6-9% for preschoolers and is closely linked to several long-term difficulties, including disorders of conduct, mood, anxiety, impulse-control, and substance abuse. ODD in children is related to parental depression, family dysfunction, and impairments in parental work performance. Children displaying early DBDs exhibit more symptoms of greater severity, more frequent offences, and commit more serious crimes later in life. The goal of the Strongest Families Finland Canada (SFFC) Smart Website intervention research program is to develop and evaluate an affordable, accessible, effective secondary prevention parent training program for disruptive behaviour in preschoolers to prevent the negative sequelae of ODD. Strongest Families is an 11-session program with two booster sessions that focuses on teaching skills to: strengthen parent-child relationships; reinforce positive behaviour; reduce conflict; manage daily transitions; plan for potentially problematic situations; promote emotional regulation and pro-social behaviour and decrease antisocial behaviour. METHODS/DESIGN: This protocol paper describes an ongoing population-based randomized controlled trial (RCT) of high-risk 4 year-olds attending well-child clinics in Turku, Finland and environs to examine the effectiveness of the Strongest Families Smart Website intervention compared to an Education Control condition. Randomization consists of a 1:1 ratio for intervention versus the education group, stratified by the child's sex. The participants randomized to the intervention group receive access to the Strongest Families Smart Website and weekly telephone coaching sessions. The participants randomized to the Education Control condition receive access to a static website with parenting tips. Children are followed using parental and daycare teacher measures at 6 and 12 months after randomization. DISCUSSION: The Strongest Families Smart Website intervention is hypothesized to improve parenting skills, reduce child disruptive behaviour, reduce parental distress and improve family functioning. These results will likely inform subsequent investigations, public policy, and early treatment of childhood disruptive behaviour problems. TRIAL REGISTRATION: ClinicalTrials.gov # NCT01750996.

The ethics of Canadian entry-to-practice pain competencies: how are we doing?

BACKGROUND: Although unrelieved pain continues to represent a significant problem, prelicensure educational programs tend to include little content related to pain. Standards for professional competence strongly influence curricula and have the potential to ensure that health science students have the knowledge and skill to manage pain in a way that also allows them to meet professional ethical standards. OBJECTIVES: To perform a systematic, comprehensive examination to determine the entry-to-practice competencies related to pain required for Canadian health science and veterinary students, and to examine how the presence and absence of pain competencies relate to key competencies of an ethical nature. METHODS: Entry-to-practice competency requirements related to pain knowledge, skill and judgment were surveyed from national, provincial and territorial documents for dentistry, medicine, nursing, pharmacy, occupational therapy, physiotherapy, psychology and veterinary medicine. RESULTS: Dentistry included two and nursing included nine specific pain competencies. No references to competencies related to pain were found in the remaining health science documents. In contrast, the national competency requirements for veterinary medicine, surveyed as a comparison, included nine pain competencies. All documents included competencies pertaining to ethics. CONCLUSIONS: The lack of competencies related to pain has implications for advancing skillful and ethical practice. The lack of attention to pain competencies limits the capacity of health care professionals to alleviate suffering, foster autonomy and use resources justly. Influencing professional bodies to increase the number of required entry-to-practice pain competencies may ultimately have the greatest impact on education and practice.

The experience of paediatric residents participating in a child protection rotation: A qualitative study.

BACKGROUND: Practitioners working in the field of child maltreatment are at risk for vicarious traumatization. For Canadian paediatric residents, exposure to child abuse during training is limited. OBJECTIVE: To explore how paediatric residents experience a mandatory rotation within a hospital-based child protection team (CPT) from an emotional and professional development standpoint. METHOD: Eight paediatric residents were interviewed following their CPT rotation and transcripts were analyzed using a phenomenological approach. Exemplar quotes were then highlighted. RESULTS: FOUR MAJOR THEMES WERE IDENTIFIED: baseline experiences; individual resident factors; intrinsic CPT rotation factors; and overall rotation assessment. The themes and their subthemes were used to inform a conceptual model of residents' experiences. CONCLUSIONS: The knowledge provided through residents' accounts can be applied to strengthen future educational opportunities in the field of child maltreatment and offer insight to help guide the development of support systems and debriefing processes that are important in this challenging field.

HISTORIQUE: Les praticiens qui exercent dans le domaine de la maltraitance des enfants sont vulnérables aux traumatismes transmis par personne interposée. Les résidents en pédiatrie canadiens sont peu exposés à la maltraitance d'enfants pendant leur formation. OBJECTIF: Explorer comment des résidents en pédiatrie ont vécu leur rotation obligatoire au sein d'une équipe de protection de l'enfance en milieu hospitalier (PEH) sur le plan affectif et professionnel. MÉTHODOLOGIE: Huit résidents en pédiatrie ont subi une entrevue après leur rotation en PEH. Les chercheurs en ont analysé la transcription au moyen d'une démarche phénoménologique. Ils ont ensuite fait ressortir des citations exemplaires. RÉSULTATS: Quatre grands thèmes ont été dégagés : expériences de base, facteurs propres à chaque résident, facteurs intrinsèques à la rotation en PEH et évaluation globale de la rotation. Les chercheurs ont utilisé les thèmes et les sous-thèmes pour étayer un modèle conceptuel des expériences des résidents. CONCLUSIONS: Les connaissances acquises grâce aux comptes rendus des résidents peuvent servir à renforcer les futures possibilités de formation dans le domaine de la maltraitance d'enfants et offrent un aperçu pour orienter l'élaboration de systèmes de soutien et les processus de retour sur les événements importants dans ce milieu difficile.

A systematic review of cross-cultural comparison studies of child, parent, and health professional outcomes associated with pediatric medical procedures.

UNLABELLED: The purpose of this review was to evaluate systematically all published and unpublished research concerning culture and medical procedural pain in children. Databases, reference lists, and electronic list servers were searched as data sources. Fifteen studies met the inclusion criteria. Most studies (80%) were conducted solely in the United States comparing Caucasian American groups to other local subculture(s) (ie, African American, Hispanic, or Japanese). The studies compared, cross culturally, pediatric pain-related outcomes in children, parents and/or health professionals. The medical procedural experiences included surgery, immunization, spinal tap, bone marrow aspiration, needle procedures, orthopedic, and wound-related injuries. The evidence published to date suggests that cultural factors may be associated with children's pain experiences when elicited by medical procedural pain, specifically children's pain behavior. Nevertheless, research using more sophisticated research methods is needed to develop culturally sensitive behavioral pain measures. Measures that include physiological pain parameters in addition to other behavioral outcomes may be helpful. Culturally comparative research would benefit from the use of theoretical frameworks to advance our understanding of the cultural underpinnings of child pain development and guide future research. PERSPECTIVE: The current evidence supports that children and parents belonging to cultural minority groups, and in need of health care, are a vulnerable population. Together, researchers and clinicians are encouraged to explore this understudied area, and take advantage of sophisticated methods developed by disciplines like cross-cultural psychology.

Embedded spirituality: gardening in daily life and stressful life experiences.

BACKGROUND: There is a limited body of research examining the relationship between spirituality and leisure, or the impact of leisure in the context of daily life, and life with stressful events. AIM: To examine the meaning of gardens and gardening across different life experiences using hermeneutic phenomenology to focus on the lived experience of leisure gardening. METHODS: Most participants were interviewed once in each season over a 1 year period usually in their home. There were 42 participants (27 women and 15 men) in this study. Fifteen individuals had been diagnosed with cancer and were in varying stages of diagnosis and treatment. Three people had a chronic and progressive disease. Four women were grieving the death of their spouse. Participants ranged in age from 32 to 80 years. RESULTS: In this paper, we focus on the spirituality-related themes in this study: spirituality as connectedness; spirituality as an expression of inner being; the garden as a spiritual place and gardening as spiritual activity; gardening as a spiritual journey; and, stewardship. Participants with religious views saw their garden as an extension of their spirituality and a confirmation of their beliefs. Participants with secular or sacred views of spirituality that was not related to any religious beliefs were more likely to embed their spirituality in their relationship with nature as manifested in their garden. CONCLUSION: This study extends current theory regarding leisure and its contribution to meaning focused coping, and spirituality as a significant component of leisure in living with stressful health and life events.

Yoga for chronic pain management: a qualitative exploration.

OBJECTIVE: To explore patients' perceptions of their pain while participating in a weekly yoga program. METHODS: A consecutive convenience sample was recruited from a Multidisciplinary Pain Centre. Seven adult patients (six women), agreed to participate in an 8-week Hatha yoga program, including weekly group sessions and at-home practice. Data were gathered from participant observation and in-depth interviews. Interviews explored the experience of practicing yoga and its relationship to the participant's pain experience. An inductive analysis of the interviews explored emergent themes from participants' descriptions of their experience. RESULTS: Analyses identified three themes: renewed awareness of the body; transformed relationship with the body in pain; and acceptance. DISCUSSION: Participants' data suggested that they reframed what it meant to live with chronic pain. Some participants reported that the sensory aspects of pain did not change but that pain became less bothersome. They were better able to control the degree to which pain interfered with their daily life. Other participants reported less frequent or less intense pain episodes because they could recognize body signals and adjust themselves to alleviate painful sensations. The findings suggest that patients who benefit from yoga may do so in part because yoga enables changes in cognitions and behaviours towards pain.

Spirituality, religion, and pain.

Understanding the relationships between spirituality and health has become increasingly important in health research, including nursing research. Very little of the research thus far has focused on spirituality, religion, and pain even though spiritual views have been intertwined with beliefs about pain and suffering throughout history. Spiritual views can have a substantial impact on patients' understanding of pain and decisions about pain management. The author reviews the research literature on spirituality and pain from a historical perspective. The analysis is concerned with how spirituality and religion have been used to construct a meaning of pain that shapes appraisal, coping, and pain management. The clinical implications include respectful communication with patients about spirituality and pain, inclusion of spirituality in education and support programs, integration of spiritual preferences in pain management where feasible and appropriate, consultation with pastoral care teams, and reflection by nurses about spirituality in their own lives. A discussion of research implications is included.

Reflections on ... writing for successful publication.

BACKGROUND: Most writers feel stuck at some point in the writing process. These reflections are based on what occupational therapists and others have learned from their own experiences about writing papers and publishing their work in peer-reviewed journals. METHOD: In 2004, I invited students and colleagues to send me their top three writing strategies to prepare for an interactive workshop on writing for publication. These writing strategies were later posted on a website and sent to everyone whom I had initially contacted. RESULTS: The writing strategies began with choosing the topic and moving the writing along through the submission process. They concluded with responding to feedback from reviewers and building one's writing skills. PRACTICE IMPLICATIONS: These reflections may provide other writers with ways to pursue their writing projects.

Dalhousie dyspnea scales: construct and content validity of pictorial scales for measuring dyspnea.

BACKGROUND: Because there are no child-friendly, validated, self-report measures of dyspnea or breathlessness, we developed, and provided initial validation, of three, 7-item, pictorial scales depicting three sub-constructs of dyspnea: throat closing, chest tightness, and effort. METHODS: We developed the three scales (Throat closing, Chest tightness, and Effort) using focus groups with 25 children. Subsequently, seventy-nine children (29 children with asthma, 30 children with cystic fibrosis. and 20 children who were healthy) aged 6 to 18 years rated each picture in each series, using a 0-10 scale. In addition, each child placed each picture in each series on a 100-cm long Visual Analogue Scale, with the anchors "not at all" and "a lot". RESULTS: Children aged eight years or older rated the scales in the correct order 75% to 98% correctly, but children less than 8 years of age performed unreliably. The mean distance between each consecutive item in each pictorial scale was equal. CONCLUSION: Preliminary results revealed that children aged 8 to 18 years understood and used these three scales measuring throat closing, chest tightness, and effort appropriately. The scales appear to accurately measure the construct of breathlessness, at least at an interval level. Additional research applying these scales to clinical situations is warranted.

In the eye of the dragon: women's experience of breast cancer and the occupation of dragon boat racing.

BACKGROUND: Women with breast cancer are at risk of developing lymphedema following surgical and/or medical treatment of the disease. Recently, women have challenged traditional advice about limiting upper extremity activity to prevent lymphedema by participation in dragon boat racing. PURPOSE: In this qualitative pilot study, three women were interviewed about the meaningfulness of dragon boat racing in their lives. METHODS: The women were interviewed twice and their interviews analyzed using thematic analysis. RESULTS: Seven themes are discussed: attraction of dragon boat racing; physical and emotional well-being; competition; social support; transcendence/connectedness/oneness; re-occurrence of cancer; and, public awareness. Competition enabled the participants to rebuild self-confidence and to regain control over their physical health and emotional well-being. Balancing support and competition was key to finding satisfaction in this occupation. The women did not believe that dragon boat racing affected their risk for developing lymphedema. PRACTICE IMPLICATIONS: People who engage in the occupation of dragon boat racing find it meaningful and develop new coping strategies. Participating in dragon boat racing can decrease stress and shift the meaning of having breast cancer to a more positive view of the experience.

Reflections on: "So... what do you do?" Occupation and the construction of identity.

BACKGROUND: What we do has always played a leading part in social conversations about who we are. In part, these social questions are about occupational identity. PURPOSE AND METHOD: Occupational identity is an emerging concept in the occupational therapy literature. In this paper, the concept of occupational identity is examined through the observations of a former research participant in a previous study on the meaning of gardens and gardening in daily life, and the recent work of researchers in occupational therapy and occupational science. RESULTS: Three themes are examined in these reflections. They are occupation and continuity of occupational identity, the contributions of productivity, leisure and self-care to occupational identity and, the public and private aspects of occupational identity. PRACTICE IMPLICATIONS: Exploration with a client about what occupations are most meaningful in her or his life may be a means to understanding the person's construction of an occupational identity. Understanding the nature of the client's occupational identity may be a necessary beginning to developing a collaborative approach to what is needed in occupational therapy intervention.

The social context of neonatal pain.

Neonatal pain and neonatal pain management occurs in a social context and is influenced by this context. Changes in the practice of pain management have clearly occurred over the last 20 years. Changes have occurred because of the confluence of scientific research and lobbying, primarily by parents. Although the standard of care for neonatal pain has risen dramatically in the past 20 years, much remains to be done. Procedure pain appears to be a continuing issue, and pain in the cognitively handicapped neonate has not been addressed. Research on the social context of pain is almost entirely lacking.

Spirituality unplugged: a review of commonalities and contentions, and a resolution.

Spirituality is an important and essential component of occupational therapy, but recent publications in occupational therapy literature also raise questions about the adequacy of the Canadian Association of Occupational Therapists' definition of spirituality and the relationship of spirituality to occupational performance. Re-examination of spirituality and occupation is needed to better understand the role of occupational therapists with respect to spirituality. In this paper, the authors examine the common themes that are inherent in definitions of spirituality from diverse professional perspectives. The commonalities and contentions inherent in these definitions are then contrasted with the perspectives of occupational therapists. This discussion is followed by a challenge for re-examination of spirituality in the Canadian Model of Occupational Performance, and an argument that occupational identity rather than spirituality should have a central position. The implications of spirituality and occupational identity for evidence-based occupational therapy are considered.

Children's drawings of their pain.

Children and adolescents with recurrent migraine headaches or musculo-skeletal pain were asked to draw a picture of their pain and another picture of themselves in pain. The drawings were categorized according to content and color. No differences in content or dominant color of drawings was found for sex and there were no changes with age (5-18 years). Children with recurrent migraine more often drew themselves doing something to relieve their pain, than did children with musculo-skeletal pain. Implications for the use of pain drawings in the treatment of chronic and recurrent pain are discussed.