Translation, Adaptation, and Validation of the Portuguese Version of the Exercise of Self-Care Agency Scale.

Assessing a person's capacity to engage in self-care behaviours is another added value in identifying one's potential to care for oneself in the health domain that contributes to planning person-centred care. This study aimed to translate, adapt, and validate the Exercise of Self-Care Agency (ESCA) Scale by Kearney and Fleischer, revised by Riesch and Hauck for the Portuguese version, using a sample of 625 elderly people living at home in Portugal. A cross-cultural adaptation process follows the stages of translation, synthesis, back-translation, and consensual solution for the translation process and pretesting. Construct validity was tested using exploratory factor analysis, and factor structure was subjected to confirmatory factor analysis. Reliability was determined by analysing internal consistency, resorting to Cronbach's alpha coefficient. This resulted in an instrument formed of 29 items, keeping the factor structure conceptually aligned with the underlying theory. Cronbach's alpha coefficient values were 0.87 for the global scale and varied between 0.65 and 0.84 for the subscales. The final four-factor model showed an acceptable quality of fit. The Portuguese version of the ESCA shows appropriate validity and reliability for use in future research and health contexts.

Screen Media Overuse and Associated Physical, Cognitive, and Emotional/Behavioral Outcomes in Children and Adolescents: An Integrative Review.

INTRODUCTION: Screen media overuse is seen as a public health concern because of its negative effects on child and adolescent health. This integrative literature review examines recent empirical evidence on the relationship between screen media overuse and physical, cognitive, and emotional/behavioral outcomes in children and adolescents. METHODS: Empirical research of experimental design, observational studies, and systematic reviews from several data sources was reviewed and synthesized to form the basis of this integrative review. RESULTS: Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems. Bidirectional associations may exist. DISCUSSION: Findings support the importance of understanding the impact of screen media use on health and wellbeing. Generating screen time guidelines and developing effective prevention/intervention strategies are critical to mitigating screen media overuse and its adverse outcomes in children and families.

Analysis of the Efficacy of an Intervention to Improve Parent-Adolescent Problem Solving.

We conducted a two-group longitudinal partially nested randomized controlled trial to examine whether young adolescent youth-parent dyads participating in Mission Possible: Parents and Kids Who Listen, in contrast to a comparison group, would demonstrate improved problem-solving skill. The intervention is based on the Circumplex Model and Social Problem-Solving Theory. The Circumplex Model posits that families who are balanced, that is characterized by high cohesion and flexibility and open communication, function best. Social Problem-Solving Theory informs the process and skills of problem solving. The Conditional Latent Growth Modeling analysis revealed no statistically significant differences in problem solving among the final sample of 127 dyads in the intervention and comparison groups. Analyses of effect sizes indicated large magnitude group effects for selected scales for youth and dyads portraying a potential for efficacy and identifying for whom the intervention may be efficacious if study limitations and lessons learned were addressed.

Attitudes and avatars instrument: development and initial testing.

BACKGROUND: The purpose of the study was to develop and test the initial psychometric properties of the ATTitudes and Avatars INstrument (ATTAIN). The integrated behavior model guided instrument development to measure the young adolescent boys' attitudes, intentions and actions to change their bodies. METHODS: An adolescent health expert panel and young adolescent boys were recruited to test for content validity. Fifty-nine boys 11 to 14 years of age were recruited at a middle school in the USA during physical education class to conduct a pilot study to test for internal consistency and test-retest reliability. RESULTS: The ATTAIN was found to have high content validity, slightly below recommended levels for internal consistency, and varied test-retest reliability. CONCLUSION: The long-term goal of the development and testing of the ATTAIN is to make it available to researchers and professionals to screen and focus on adolescents' perceptions of their bodies and using those perceptions to attain and maintain healthy bodies. The results of this study suggest preliminarily a theoretically derived instrument with appropriate content for young adolescent boys and variable reliability. The attitudes, intentions, and actions survey items and avatars as measured by the ATTAIN, were meaningful to the boys. The ATTAIN has potential to be used as a screening instrument for young adolescents boys and understanding their attitudes toward their bodies; however, it will require continued development and testing to establish construct and discriminant validity.

Community outreach and engagement strategies from the Wisconsin Study Center of the National Children's Study.

The purpose of this methods article was to describe and evaluate outreach and engagement strategies designed to initially build county-wide awareness and support for the National Children's Study (NCS or the study) and subsequently to target the segment communities where recruitment for the study occurred. Selected principles from community outreach, social marketing, and health care system and personal referral formed the foundation for the strategies. The strategies included a celebration event, community advisory board, community needs assessment, building relationships with health care providers and systems, eliciting a network of study supporters, newsletters, appearances at local young family-oriented events (health fairs, parades), presentations to local community leaders, community forums, "branding" with assistance from a women-owned local marketing firm, and mailings including an oversized, second-touch postcard. Six months after study launch, approximately 4,600 study-eligible women were asked in a door-to-door survey if and how they became aware of the study. On average, 40% of eligible women reported being aware of the study. The most frequently cited strategy to cultivate their awareness was study-specific mailings. Awareness of the NCS increased by 7.5% among those receiving a second-touch postcard relative to controls (95% CIs [4.9, 10.7] z = 5.347, p < 0.0000, d = 0.16). Community outreach and engagement strategies, in particular the oversized postcard as a second-touch effort, may be used effectively by researchers for participant recruitment and by public health nurses for delivery of important population-focused messages.

Modifiable family factors among treatment-seeking families of children with high body mass index: report of a pilot study.

PURPOSE: The purpose of this pilot study was to explore parenting style and other potential family and social indicators of an obesogenic or weight-promoting family environment. Modifiable factors were sought on which to base a nursing behavioral intervention that could be combined with diet and exercise to reduce youth weight. METHODS: Twenty-eight parents and their 9- to 18-year-old children who were seeking care for overweight responded to in-home surveys to characterize parenting style (warmth/responsiveness and control). We also examined the extent to which parent modeling of health behavior, child feeding practices, parent knowledge of nutrition, and family social characteristics differed by the control aspect of parenting style. RESULTS: Nearly all youth and parents reported substantial parental love (responsiveness), suggesting little variability in the warmth aspect of parenting style. In contrast, considerable variability was found in the control (moderate versus high) aspect of parenting style. Large effect sizes indicated that mothers with moderate control perceived their lifetime weight to be higher, had more concern about their youth's weight (p = .03), had better knowledge of nutrition, and had a lower body mass index (p = .02) than did mothers with high (firm or restrictive) control. Moderate effect sizes indicated that mothers with moderate control demonstrated better modeling behavior, higher perception of youth weight, practiced less pressure to eat, and had youth with lower body mass index and percent body fat than did mothers with high (firm or restrictive) control. Families who volunteered for the study kept their data gathering appointments, but we recommend a recruitment period of more than 4 months and the inclusion of several referral sites. DISCUSSION: Further study of how parent control is related to youth overweight and how appropriate control can be achieved among families with teens who are overweight is recommended.

Health-risk behaviors among a sample of US pre-adolescents: types, frequency, and predictive factors.

BACKGROUND: Children as young as 10 years old report curiosity and participation in health-risk behaviors, yet most studies focus upon adolescent samples. OBJECTIVE: To document the types and frequencies of health risk behavior among pre-adolescents and to examine the child, family, and environment factors that predict them. METHOD: A sample of 297 pre-adolescents (mean age=10.5, SD=0.6) from two Midwestern US cities and their parents (child-parent dyads) provided data about demographic characteristics, health risk behavior participation, child self-esteem, child pubertal development, child and adult perception of their neighborhood, and parent monitoring. Their participation was at intake to a 5-year clustered randomized controlled trial. RESULTS: Pre-adolescents participated in an average of 3.7 health-risk behaviors (SD=2.0), primarily those that lead to unintentional (helmet and seatbelt use) and intentional (feeling unsafe, having something stolen, and physical fighting) injury. Factors predictive of unintentional injury risk behavior were self-esteem, pubertal development, parent monitoring, and parent perception of the neighborhood environment. Boys were 1.8 times less likely than girls to use helmets and seatbelts. Pre-adolescents whose parents were not partnered were 2.8 times more likely than pre-adolescents whose parents were partnered to report intentional risk behavior. RECOMMENDATIONS: These data demonstrate trends that cannot be ignored. We recommend, focused specifically upon boys and non-partnered families that (a) developmentally appropriate, appealing prevention messages be developed and delivered for parents and pre-adolescents and community interventions targeting both parent and pre-adolescent together be provided to help them establish and monitor behavioral expectations and (b) organized nursing endorse policy in the US and globally that assures adequate family environments for children.

How do treatment-seeking overweight youth and their parents describe weight promoting factors in their family?

The aim of this pilot study is to describe youth and parents' perceptions of potential weight-promoting factors among families seeking treatment for youth overweight. We identified 2 important gaps in the vast multidisciplinary literature: (a) a lack of studies addressing both the youth and the parent perceptions about family factors that are potentially weight-promoting and (b) a lack of interventions that community health nurses could deliver specifically targeting families seeking treatment for overweight youth. Focus group data were content analyzed. Broad themes included: (a) mixed messages, (b) food and exercise as battleground, (c) problem solving, and (d) social aspects of youth overweight. We conclude that youth and parents could benefit from community health nursing interventions to implement healthcare professionals' recommendations incorporating all family members and creating and maintaining an accepting and demanding family climate.

Strengthening families program (10-14): effects on the family environment.

This study examined whether parent-youth dyads participating in the Strengthening Families Program 10-14 (SFP 10-14) would demonstrate greater postprogram family cohesion, communication, involvement, and supervision and if youth would report less alcohol, tobacco, and other drugs involvement in contrast to a comparison group. From 16 randomly selected schools, we recruited 167 parent-youth dyads: 86 from intervention and 81 from comparison schools. The intention-to-treat analysis found one significant change in family environment. Considering dose, it was found that among dyads receiving a full dose, all the outcomes were in the expected direction and effect sizes were moderate. Among dyads receiving a partial dose, 10 of 18 outcomes were in the direction opposite that expected. Youth participation in alcohol, tobacco, and other drugs was very low and did not differ postprogram. Although the expected outcomes were not realized, findings descriptive of dosage effects make a valuable contribution to the field. Study of factors that distinguish intervention completers from noncompleters is recommended.

Analysis of Participant Reactivity in Dyads Performing a Videotaped Conflict-Management Task.

Videotaping is used frequently in nursing research. A threat to the validity of videotaping is participant reactivity, that is, being recorded by a camera may influence the behavior of interest. This paper's purpose is to report how youth ages 10 to 14 years old and their parent viewed participation in a videotaped conflict-management task. Five dyads, who were part of a randomized clinical trial testing an intervention to promote parent-child communication, participated in a structured interview. All parents were mothers. Youth were eighth graders. Three were boys and two were girls. Findings indicated that (a) dyads felt that the videotaped interaction had a progression of feeling unnatural in the beginning to feeling natural toward the end, (b) dyads found it relatively easy to choose a topic of discussion, and (c) dyads felt that the discussions were meaningful. Based on these data, recommendations for researchers to reduce participant reactivity are provided.

Students feeling unsafe in school: fifth graders' experiences.

Children of late elementary school age (fifth grade) provide evidence that many do not feel safe in their schools. The purpose of this study was to examine how children express their experiences of feeling unsafe in school. Questions guiding the study were What percentage of children in this sample report feeling unsafe at school? What are the aftereffects of feeling unsafe? and How do children describe what makes them feel unsafe? Participants included 243 fifth-grade students who, as part of their participation in a larger study, were asked, "Have you felt unsafe at school?" Children responding affirmatively described what made them feel unsafe. Fifty-seven (23.8%) participants indicated they sometimes or always felt unsafe at school, citing teasing, bullying, or other threats that typically occurred when adults were not present. Of these, nearly a third reported being stressed and almost half felt at slight or great risk because of feeling unsafe. When children feel unsafe in school, there are implications for schools, neighborhoods, and larger communities. The related potential for children's increased involvement in health risk behaviors because they feel unsafe merits immediate and thoughtfully planned action.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 5: parent-adolescent and teen parent-child relationships.

PURPOSE: The purpose of this paper is to examine nursing's contribution to understanding the parent-adolescent and the teen parent-child relationships. CONCLUSION: Relationships between parents and adolescents may reflect turmoil and affect adolescents' health and development. The social and developmental contexts for teen parenting are powerful and may need strengthening. Several interventions to help teen mothers interact sensitively with their infants have been developed and tested. PRACTICE IMPLICATIONS: Nurse researchers have begun to provide evidence for practitioners to use in caring for families of adolescents and teen parents to acquire interaction skills that, in turn, may promote optimal health and development of the child.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 4: parent-child relationships at risk.

PURPOSE: The purpose of this integrative review is to synthesize nursing scholarship on parent-child relationships considered fragile because of parent-child's chronic condition or occurrence within a risky context. CONCLUSIONS: Most reviewed studies demonstrated negative effects of risk conditions on parent-child relationships and documented importance of child, parent, and contextual variables. Studies were predominately single investigations. Varying theoretical perspectives complicated interpretation. Mainly White, middle-class, and small samples limited generalizability. Important areas for further research were identified. PRACTICE IMPLICATIONS: Nurse researchers identified factors that may interfere with the parent-child relationship. Nurses are in a position to support families under these circumstances.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 3: Interaction and the parent-child relationship--assessment and intervention studies.

PURPOSE: This integrative review concerns nursing research on parent-child interaction and relationships published from 1980 through 2008 and includes assessment and intervention studies in clinically important settings (e.g., feeding, teaching, play). CONCLUSIONS: Directions for research include development of theoretical frameworks, valid observational systems, and multivariate and longitudinal data analytic strategies. PRACTICE IMPLICATIONS: Observation of social-emotional as well as task-related interaction qualities in the context of assessing parent-child relationships could generate new questions for nursing research and for family-centered nursing practice.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 1: Introduction.

PURPOSE: Understanding the parent-child relationship is fundamental to nursing of children and families. The purpose of this integrative review is to explore nursing scholarship published from 1980-2008 concerning parent-child relationships. Study approaches are examined, critiqued, and future directions for research identified. CONCLUSIONS: A historical review of nursing research is presented and methods described as an introduction to a review series of the parent-child relationship. IMPLICATIONS: Definition and explication of the parent-child relationship is a first-step in understanding factors amenable to nursing intervention. A clear definition of the concept of parent-child relationship will support further study using appropriate theoretical frameworks, and enable development and testing of supportive nursing interventions.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 2: Grasping the early parenting experience--the insider view.

PURPOSE: The purpose of this integrative review is to systematically and critically synthesize nursing scholarship on parents' perspectives of the parent-child relationship during infancy. CONCLUSION: Research has shown that the process of establishing the parent-child relationship is highly individualized and complex. Numerous barriers and facilitators influencing this relationship have been identified that are relevant to nursing. PRACTICE IMPLICATIONS: Nurses have an important opportunity to positively affect the developing parent-infant relationship. Screening parents for depression and providing parents with resources and support are key nursing interventions supporting the parent-infant relationship.

Evaluating content validity and test-retest reliability of the children's health risk behavior scale.

OBJECTIVE: Describe the instrument development process and report the validity and reliability of the Children's Health Risk Behavior Scale (CHRBS), a scale designed to screen for health risk behaviors among youth aged 10-13 Years. METHODS: Domain identification and item generation using the Youth Risk Behavior Surveillance Survey from the Centers for Disease Control and Prevention and testing relevance and test-retest reliability among a target audience sample of 77 fifth graders in their classrooms in two separate public school districts. RESULTS: Youth performed their tasks as expert item reviewers effectively. Twenty-one items comprise the CHRBS with a reading level determined to be at the third grade. CONCLUSIONS: We have developed a reliable and valid measure to assess late elementary youth's participation in health risk behavior.