Academic literature on the topic 'Parents-initiated interventions'

This study explored factors influencing parents’ and adolescents’ decisions to initiate, continue, and discontinue medication for attention deficit hyperactivity disorder (ADHD). Three focus groups were conducted with parents (n = 23) of children with ADHD, and 2 with adolescents diagnosed with ADHD (n = 11). Parents and adolescents independently discussed the complexities surrounding their decisions to adhere to ADHD medication. Parents’ negative beliefs about medication (fear of side effects) discouraged them from initiating therapy. Once initiated, parents struggled in balancing the need to medicate (improvements in learning and behavior) and concerns (weight loss, perceived delayed development) about the medication. Parents who had more concerns about the medication were more in favor of discontinuation. For adolescents, the desire for self-expression without being medicated was the primary factor determining nonadherence and/or discontinuation of the medication. Adolescents’ medication-related concerns were relatively different from the parents. Phase- and group-specific interventions are required to improve medication adherence in people with ADHD.

Purpose To examine US and United Kingdom (UK) parents’ approaches to care and treatment when standard therapy has failed and consider implications for clinical practice. Methods We conducted a prospective, ethnographic study of parents, patients, and staff, including participant-observation; open-ended, semistructured interviews; and review of medical records at a US and UK pediatric oncology center. Thirty-four children (n = 17 US, 17 UK), whose disease had recurred with less than 30% chance of cure, were enrolled between March 2001 and June 2002 and followed until death (n = 11 US, 14 UK) or close of study in December 2005 (n = 6 US, 3 UK). Results There were no major differences between parents’ approaches in the US and UK despite differences in health care systems, institutions, and parents’ religion or ethnicity. All parents continued to have or request meetings with the oncologist and investigative procedures. No parent initiated discontinuation of cancer- or symptom-directed interventions. In 28 of 34 cases (13 US, 15 UK), parents continued to pursue cancer-directed therapies; in 16 of 28 cases (seven US, nine UK), parents initiated inquires beyond what was offered. Conclusion Understanding parents’ behavior requires attention to the reason and emotion they bring to decision making and their children's care, their unique responsibilities as parents, and what they learn throughout the illness. Parents do not see cancer-directed therapy and symptom-directed care as mutually exclusive, alternative approaches. Parents will not be constrained by what the oncologist offers. Physicians and parents discuss and negotiate care and treatment throughout the illness. Our findings suggest developing integrative care models incorporating cancer-directed, symptom-directed, and supportive care throughout the illness; they are most consistent with parents’ approaches and advances in pediatric oncology.

The objective of this study was to observe parent–child interactions in tiendas, limited assortment food stores catering to Latinos in the United States, and to examine the extent to which child involvement influenced these interactions and their purchase outcomes. Two confederates, one posing as a tienda employee and one posing as a customer, observed the entire shopping trip of 100 Latino parent–child (mean age = 8 years) dyads and coded the following: number and type of parent- and child-initiated request interactions, types of purchase influence attempts used by children and how parents responded, and whether the product was purchased. Level of child involvement was examined as a potential influencing factor on purchasing. The observations were relatively short (mean duration of 10 minutes), reflecting the “quick trip” nature of the observed shopping trips. From the 100 parent–child dyads, 144 request interactions were observed, and among dyads with at least 1 request interaction during the shopping trip, the average number of request interactions per dyad was 2. Children initiated most of the request interactions by asking for a product or simply placing it in the basket; parents initiated 24% of the request interactions. Child involvement in shopping and checkout were associated with spending and purchase outcomes. These results indicate that children and parents influence each other during grocery shopping, and children who are more involved have greater influence over purchases. Furthermore, this study identified a number of targets for future family/parent and consumer food environment interventions.

Abstract Background Effective prevention of HPV is possible, but < 50% of adolescents in the Midwest complete the recommended vaccine series. Strategies to increase HPV vaccination rates have demonstrated efficacy, however widespread implementation of these interventions has not been realized. Behavioral nudges have demonstrated efficacy in increasing uptake of desired heath behaviors among providers (e.g. hand hygiene, judicious antibiotic prescribing). This trial assessed the impact of an assessment and feedback, communication training, and behavioral nudge (i.e. poster-sized vaccine commitment statements) intervention (T3) on adolescent vaccination rates and parental satisfaction at four Midwestern pediatric practices. Methods Practices were randomly assigned to receive either 1) assessment and feedback or 2) T3 intervention. Providers (n=16) completed surveys regarding vaccine polices and parents of vaccine eligible adolescents (n=230) reported their child’s vaccine history and satisfaction with the consultation. Practice- level vaccination rates for Tdap, Meningococcal, and HPV were calculated through billing data queries from an integrated pediatric health network. Vaccination rates and provider/ parental responses were compared by intervention arm. Results All practices evidenced increased adolescent vaccine rates, ranging from 0.8% to 3.4% for Meningococcal and 1.3% to 12.1% for Tdap. Three of the four practices had increased HPV vaccination rates (1% to 10%), however there was no statistically significant difference by study arm. Most parents (M age 41.34; SD 8.05; 85% female, 68% White) indicated their child had previously initiated the HPV vaccine series (61%) and 72% indicated receipt of an HPV vaccine during the study visit. Concerns among HPV vaccine hesitant parents (n=60) included concerns about vaccine safety and necessity. Most (97%) of parents were satisfied with their consultation. Conclusion Practices in both intervention groups evidenced an increase in adolescent vaccination rates. While some parents had concerns about HPV vaccine safety and necessity, parents welcomed discussions about HPV vaccine and were satisfied with their provider’s communication regardless of their vaccine decisions. Disclosures Brian R. Lee, MPH, PhD, Merck (Grant/Research Support)

AbstractObjectivesPremature coronary artery disease is the most common preventable cause of death in developed countries, and familial hypercholesterolemia (FH) is the most common monogenetic disorder of lipid metabolism, predisposing for premature coronary artery. FH is the most common preventable cause of death in developed countries. In 2016, the national lipid screening program in school-age children has been started in Turkey. In this study, we aimed to evaluate the efficacy of lipid screening program, lipid-lowering treatments, and the challenges of treatments in children diagnosed with FH.MethodsPatients diagnosed with FH in the pediatric metabolism outpatient clinic were retrospectively evaluated. Changes in lipid profile with dietary interventions and statin treatments were assessed. The results of cascade screening were analyzed.ResultsFifty-one patients diagnosed with FH were enrolled in the study. Twenty-four (47.1%) were female. The mean age of the patients was 9.8 ± 3.2 years. Heterozygous LDLR gene mutation was detected in all patients. Three novel pathogenic variations were revealed with the genetic investigation. Forty-one (80.4%) patients had high adherence to CHILD-2 dietary recommendations. The mean low-density lipoprotein cholesterol (LDL-C) level decreased by 14.5 ± 7.6% after dietary intervention. Parents refused to start statin treatment in 8 (15.7%) patients. Statin treatment was initiated to 22 (43.1%) patients. Mean LDL-C level decreased from 204.1 ± 19.1 mg/dL to 137.0 ± 13.1 mg/dL. In cascade screening, 7 (13.7%) parents without a diagnosis of FH were diagnosed with FH. After the screening program, statin treatment was initiated for 18 (35.3%) parents and 7 (16.3%) siblings.ConclusionsWe can conclude that screening for FH in children is crucial for diagnosing FH not only in children but also in their relatives. Although statins are safe and effective in achieving the target LDL-C level, we determined significant resistance for initiating statin treatment in patients.

A comprehensive review of literature was conducted to identify the barriers and facilitators, from the parents'/guardians' and primary care providers' (PCPs) perspective, that are associated with the uptake of Human Papillomavirus (HPV) vaccine among adolescent females. Findings from 14 peer-reviewed articles indicate that 37% of adolescent females, 9 to 17 years of age, initiated the HPV vaccine, compared to the national average of 13- to 15-years-olds, which is 50%. The overall uptake and completion rates of the vaccine were low across all racial and ethnic groups. Barriers included parents'/guardians' knowledge, perceptions, and attitudes toward the HPV disease and the vaccine, along with the convenience in receiving the vaccine. Six studies reported that HPV vaccine initiation was highly likely if the parents/guardians had received a doctor’s recommendation. Learning what interventions school nurses currently utilize could positively affect the HPV vaccine uptake and completion rates by other nursing disciplines realizing this ongoing effort.

School nurses work in an educational setting. Due to budget cuts, different goals, and confusion between educators and nurses regarding the school nurse role, school nurses are being asked to demonstrate their effectiveness and justify their presence in elementary and secondary schools. Although school nursing was first initiated 100 years ago, a review of the literature published since 1965 indicates that 15 studies have been conducted that examine the impact of school nurses on academic performance. However, today many articles have recommended more research linking school nursing to educational outcomes. This article synthesizes the results of 15 research articles. Findings from these studies indicate that nursing interventions targeted at specific populations, including parents, have had significant effects. A relationship between school nurses’ interventions and absenteeism is also suggested. Limitations of these studies are discussed, along with suggestions for future research.

Abstract Addressing family needs for social/emotional support is part of the duty of oncology care teams. This research presents a (2020) scoping review and a (2019) focus group initiated to explore pediatric neuro-oncology parent experience of social/emotional support in conjunction with developing an online peer application to address family needs. Currently, the value of online support is in the forefront of clinical conversation. The focus group queried eight parents whose children were under neuro-oncology treatment in the Northwest USA. Thematic findings include—parents want supportive peers who have (1) a personal and deep understanding of parenting a child with serious illness (they “get it”); (2) particular characteristics and skills that promote and sustain relationships, including—(a) good social skills, (b) ability to engage in “balanced” (cancer/non-cancer) conversations, (c) individual similarities (beliefs, age of children, cancer diagnosis/treatment), (d) logistic commonalities (location, availability), (e) pro-social personal characteristics (i.e. sense of humor, emotional/social flexibility), and an (f) ability to navigate and maintain social/emotional boundaries. Parents also initiated discussion about “the burden of supportive relationships” and supporting families doing “normal” activities without worrying about treatment side effects and contagions. The literature review supports finding (1) above; reveals the paucity of evidence-based supports available to this population; underscores the critical need for practitioners and researchers to develop more evidence-based supports and interventions for families of children experiencing cancer; and supports practitioners’ consistently assessing parent and sibling social and emotional needs and then consistently referring or intervening when needs are identified.

Background. Obesity rates are disproportionately high among rural and American Indian (AI) children. Health behaviors contributing to child obesity are influenced by parents at home. Engaging parents remains a challenge, particularly among low-income and ethnic minority families. Aims. The aim of this study was to learn how AI parents living on a rural AI reservation support and engage with their children’s nutrition and physical activity behaviors at home. Methods. Parents with children ages 6 to 12 years living on one, rural AI reservation participated. Focus groups and interviews were conducted, using a 14-question moderator’s guide. A systematic, iterative content analysis was applied to the transcripts. Results. Twenty-five parents (52% AI or Alaska Native) participated in 3 focus groups (n = 17) and interviews (n = 8). Themes related to enhancers included role modeling and whole family and child-initiated activities. Barriers included resources, child safety concerns, driving distances, and competing family priorities. Themes related to strategies for change included opportunities for peer learning from other local families, creating fun, program support for all supplies and incentives, and incorporation of storytelling and multicultural activities. Discussion. This study advances knowledge to promote parental engagement with child health behavior in the home, including unique themes of inclusiveness, culture-focused, and intergenerational activities. Conclusion. Results may inform interventions seeking to engage parents living in rural and AI reservation communities in home-based child behavior change efforts.

The purpose of this research was to examine the utilization of enhanced practice standards for children in care with Fetal Alcohol Spectrum Disorder (FASD). Children in care with FASD represent a vulnerable population and require multiple supports from a cross-disciplinary perspective. Children removed from the care of their parents were identified as having needs beyond standard care provided within Children’s Services in Alberta. To address this concern a project was initiated in 2002 and completed in 2005 which identified positive benefit from an increase in caseload hours for workers responsible for children with FASD in the Aboriginal Unit including more contact with children and additional supports for foster parents. Standards regarding family visitation are also highlighted. An additional casework position was developed in order to decrease caseloads and meet the standards. Changing the way child welfare and foster care services are delivered for children with FASD is an important phenomenon to study and this research may guide future interventions.

Research has identified the important role that effective parent-adolescent communication about sex and relationships signifies in reducing the chances of adolescents engaging in risky sexual behaviour. However, many parents find it difficult to discuss issues related to HIV prevention at family level because HIV prevention is inherently linked to sex, which is still regarded as a taboo in some countries, including the country of the study, Swaziland. In addition to cultural barriers related to effective parent-adolescent communication, parents seem to lack the knowledge, approach as well as the confidence regarding communication about sex and relationships. The purpose of the study was to use appreciative inquiry (AI) to engage parents of adolescents in the design of interventions to prevent HIV among adolescents in Swaziland. Non-probability, purposive sampling was used to select parents of adolescent children (10-19 years) attending school at the two purposively selected high schools in Manzini. Twenty-four (24), 23 female and 1 male parents took part in AI. Participatory action research was conducted to involve participants actively in the process of initiating interventions for preventing HIV among adolescents. The process was guided by appreciative inquiry. Data was collected by means of appreciative interviews, comprising paired and focus group interviews according to different phases of the 4-D cycle of AI. Thematic analysis of data was done throughout the 4-D cycle of AI. The themes that emerged from appreciative stories of exceptional experiences shared during the discovery phase were perceived gains and open communication. The findings of the dream phase included expressed wishes for open parent-adolescent sexual health communication, support for parents and a community of HIV free adolescents. In the design phase, parents constructed and initiated interventions for effective parent-adolescent sexual health communication and parental comfort with communication about sex. In the destiny phase, parents made statements, which were based on what they committed to do to prevent HIV among adolescents.
Lucwaningo lukhombisa bumcoka bekukhumisana kahle kwemtali nemtfwana loyinsha ngetindzaba tebundlelwane bebantfu labatsandzanako netekulalana kuze kutsi kunciphe kutsi intsha ingabi sengotini yekutfola ligciwane HIV. Kodvwa kubatali labanyenti kulukhuni kukhulumisana nentsha ngetindzaba tekutivikela kuHIV emakhaya ngoba kukhuluma ngalendzaba kufaka ekhatsi tekulalana lokuselichilo kukhuluma ngako emaveni lamanyeti lokufaka ekhatsi leSwatini lapho kwetiwa khona lolucwaningo. Lokunye lokuvimbela kutsi batali bangakhulumi ngalendzaba ngaphandle kwekutsi kulichilo, kutsi batali baswele lwati nekutsi abati kutsi bangayingena njani intsha, kanye nekutsi abatetsembi kutsi bangakhona kukhuluma ngebudlelwane bebantfu labatsandanako kanye nekulalana. Injongo yalolucwaningo bekukusebentisa indlela yekubuketa lokuhle kubatali labakwentako mayelana nekukhulumisana nentsha kuze kutsi bakhe tindlela letingito tokutivikela intsha kuHIV Eswatini. Indlela labakhetfwe ngayo batali labangene lolucwaningo bakhetfwe ngokutsi banebantfwana bentsha labaneminyaka lelishumi kuya kulabo labanelishumi nemfica labafundza etikolweni letimbili letiphakeme letikhetsiwe kaManzini. Babangemashumi lamabili nesine batali labatfolakala kungenela lolucwaningo. Batali babamdzibi munye nebacwaningi kuloluhlelo lokuhlela tindlela tekuvikela iHIV kubantfwana labayintsha. Kwakusetjentiswa tindlela letibuka lokuhle lokwetiwe batali. Imibuto beyihlose kubuta ngalokuhle kodvwa. Imivo yebatali yatfolakala nekutsi bacale babutana bodvwana besebakhulunyiswa baticagogwana ngekwehlukana kwaletigaba letine talolucwaningo. Kuhlanganisa kwemivo kwentiwa ngekutsi kubuketwe tingcikitsi kutotonkhe tigaba talolucwaningo. Tingcikitsi letaphuma kuletingcoco esigabeni sekucala lapho bebakhuluma ngetikhatsi letinhle letabayimphumelelo lapho bebakhumisana nentsha ngekulalana nangeHIV, batsi bevakunemphumelelo nekubhobokelana ekhatsi kwebatali nebantfwana. Ngalesikhatsi sesigaba sekubeka emaphupho abo basho batsi bafisa kube nekubhobokelana phakatsi kwebatali nentsha mayelana nekulhulumisana ngekulalana. Lokunye labakufisile kutsi basekelwe basitwe ngekutsi intsha ikhulunyiswa njani. Ngesikhatsi sesigaba sesitsatfu sekubuketwa kutsi kungentiwani kutsi batali nebantfwana bakhulumisana ngetindzaba tekutsandzana kanye nekulalana batali babhala imivo labo. Ngemuva kwaloko benta tivumelwano tekutsi batakwentanjani uma sebabuyela emakhaya kuze bakhone kuvikela bantfwana bentsha kuHIV.
Health Studies
D. Litt. et Phil. (Health Studies)

“Issues Faced by Special Educators Around the World During the Pandemic” examines the context of various countries and the education they provide to students when the COVID-19 pandemic hit the world. Within this context, various concerns which arose at the outset as well as interventions which have been initiated to provide education to children and youth, support to families, and efforts to empower teachers and parents to provide alternatives to in-person instruction are examined. Discussion follows considering which of these interventions may be continued after the end of the COVID-19 pandemic.

Since antiquity, cot death was explained as accidental suffocation, overlaying, or smothering. Parents were blamed for neglect or drunkenness, and a cage called arcuccio was invented around 1570 to protect the sleeping infant. Up to the 19th century, accidents were registered as natural causes of death. From 1830, accidental suffocation became unacceptable for physicians and legislators, and ‘natural’ explanations for the catastrophe were sought, with parents being consoled rather than blamed. Prone sleeping originated in the 1930s and from 1944 was associated with cot death. However, from the 1960s many authors recommended prone sleeping for infants, and many countries adopted the advice. A worldwide epidemic followed, peaking at 2% in England and Wales and 5% in New Zealand in the 1980s. Although epidemiological evidence was available by 1970, the first intervention was initiated in the Netherlands in 1989. Cot death disappeared almost entirely wherever prone sleeping was avoided. This strongly supports the assumption that prone sleeping has the greatest influence on the disorder, and that the epidemic resulted from wrong advice.