Factors associated with positive mental health in Japanese young adults with a history of chronic diseases during childhood: A qualitative study.

PURPOSE: Factors associated with positive mental health in children with chronic diseases remain unclear. Supporting the development of positive mental health in children with chronic diseases can enhance their mental health throughout childhood and adulthood. This study aimed to identify the factors associated with positive mental health among Japanese young adults with a history of chronic pediatric diseases. DESIGN AND METHODS: Participants aged 18-25 years, with a history of chronic pediatric diseases, were recruited from a population of students at a university. Semi-structured interviews were conducted. The data were analyzed using thematic analysis. After the initial coding of each transcript, the researchers discussed and identified a set of main themes, categories, and subcategories. RESULTS: Ten participants aged 19-22 years were interviewed. Their chronic diseases were diverse and included childhood cancers and allergic diseases. Seven themes (proactive coping, positive coping, negative coping, eudaimonia, hedonia, independence, and awareness) emerged from 21 categories and 70 subcategories identified. A thematic map was applied to two domains (protective factors and well-being factors) and to three inter-related constructs (individual, family, and community/society). CONCLUSIONS: The findings indicated that within the well-being factors, meaning in life was prominent, and within the protective factors, stress coping was found to facilitate positive mental health among individuals with a history of chronic pediatric diseases. PRACTICE IMPLICATIONS: In children with chronic diseases, support for finding appropriate coping strategies that enhance their optimism and symbiotic relationships in the community/society are important, including valuing little things in their lives, such as play and learning.

Development and Feasibility of a Mobile Asthma App for Children and Their Caregivers: Mixed Methods Study.

BACKGROUND: Mobile health apps can support the self-management of pediatric asthma. Previous studies on mobile apps for children aged >7 years with asthma are limited, and most reports on asthma apps do not consider interactions between the children and their caregivers. Therefore, we developed an asthma app for children aged 0-12 years and their caregivers based on the results of our previous study regarding user needs. OBJECTIVE: The aim of this study was to evaluate the feasibility of a developed mobile app for children with asthma and their caregivers and to modify and complete the app according to the feasibility results. METHODS: We recruited children diagnosed with persistent asthma by an allergy specialist at 2 children's hospitals, 1 university hospital, 2 general hospitals, and 1 pediatric clinic. Thereafter, the app usage was assessed, and questionnaires were administered. This study used convergent mixed methods, including providing user feedback about the pediatric asthma app, completing questionnaire surveys regarding preferences, and obtaining quantitative data about app usage. Quantitative data were analyzed based on the ratings provided for the app features used by the participants, and the usage of the app features was analyzed using descriptive statistics. Qualitative data were analyzed via a descriptive qualitative research analysis and were used to identify codes from the content-characteristic words. RESULTS: In total, 30 pairs of children aged 2-12 years and their caregivers responded to the 3-month survey, and 20 pairs of children aged 4-12 years and their caregivers responded to the 6-month survey. In the 3- and 6-month surveys, "record" was the most commonly used feature by both caregivers and children. The average access logs per month among the 20 pairs ranged from 50 to 79 in the 6-month survey. The number of access logs decreased over time. In the qualitative results, app utilization difficulties were identified for 6 categories: record, preparing, alert settings, change settings, mobile phone owner, and display and motivation. Regarding app feasibility, 60% (12/20) of the caregivers strongly agreed or agreed for all evaluation items, while 63% (7/11) of the children strongly agreed or agreed for 6 items, excluding satisfaction. In the qualitative results, feasibility evaluation of the app was classified into 3 categories: high feasibility of the app, improvement points for the app, and personal factors preventing app utilization. Based on the results of the feasibility analysis, the final version of the app was modified and completed. CONCLUSIONS: The app feasibility among children with asthma and their caregivers was generally good. Children aged 7-12 years used elements such as record, quiz, and manga. This app can support the continuous self-management of pediatric asthma. However, efforts must be taken to maintain and improve the app quality. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000039058; https://tinyurl.com/3na9zyf8.

Emotional experiences of reading health educational manga encouraging behavioral changes: a non-randomized controlled trial.

OBJECTIVE: Educational health manga are used to promote health behavior change. This study thus seeks to achieve the following objectives: identify the emotional experience of reading educational health manga, understand the effects of facilitating the psychological mediators of behavior change through emotional experiences, and compare the effectiveness of educational health manga with conventional materials. DESIGN: A non-randomized controlled trial with six conditions was conducted. Target behaviors were physical activity and healthy diet. Individuals aged 20-69 years (n = 1,680) were assigned three manga intervention conditions and three control conditions (visual image-based, narrative text, and general text material). MAIN OUTCOME MEASURES: Participants were asked about their emotional experience while reading either intervention material or control material and its perceived positive influence on enhancing psychological mediators. RESULTS: Four factors relevant to emotional experiences were identified: risk perception, familiarity, satisfaction, and realism. Emotional experience strongly predicted the psychological mediators of behavior change. Analysis of differences among the six conditions revealed that exposure to educational health manga led to greater satisfaction and increased knowledge. Participants assigned manga conditions experienced superior emotional experiences and outcomes. CONCLUSIONS: Those assigned manga conditions experienced superior emotional experiences and outcomes. The efficacy of educational health manga in encouraging psychological mediators of change was confirmed.Trial registration: UMIN Japan identifier: UMIN000034369.

Beneficial Features of a mHealth Asthma App for Children and Caregivers: Qualitative Study.

BACKGROUND: mHealth and uHealth apps are available for children with asthma and their caregivers. However, previous studies on mHealth apps for children older than 7 years old with asthma are limited, and most studies on asthma apps do not consider interactions involving communication between children and caregivers. Therefore, a prototype mHealth child asthma app was developed for children and their caregivers, with features of tailored feedback messages in continuing self-management and interactions between children and caregivers. OBJECTIVE: The aim of this study was to identify the beneficial features of a prototype mHealth app developed for children with asthma and their caregivers. METHODS: Children diagnosed with persistent asthma by allergy specialists at the National Center for Child Health and Development were recruited. The features of a prototype mHealth app for children with asthma and their caregivers were investigated using semistructured interviews after they tried the app. Data were analyzed using thematic analysis. Content-characteristic words were named and grouped together as categories to explore themes. RESULTS: We recruited 27 children with asthma aged 2 to 12 years and 26 their caregivers. Findings on the good aspects of the app for children older than 7 years old and caregivers suggested 4 themes (confirmation of asthma knowledge, child-caregiver interaction, design of the app, and child's interest), and 6 categories were identified. Findings on the good aspects of app for children 7 to 12 years old and caregivers suggested 5 themes (new knowledge, manga as a Japanese-style comic, child's interest, trigger of self-management, and design and operability), and 11 categories were identified. Findings on the beneficial features of app suggested 6 themes (asthma knowledge, elements for continuous, universal design, notification, monitoring, and functions), and 12 categories were identified. CONCLUSIONS: Children with asthma and their caregivers perceived that the good aspects of the app were learning asthma knowledge with fun, including manga; interaction between child and caregiver; and easy-to-read design, such as colors. They wanted not only the asthma knowledge but also the universal design and enhanced elements, monitoring, and notification functions of the app.

Use of health promotion manga to encourage physical activity and healthy eating in Japanese patients with metabolic syndrome: a case study.

BACKGROUND: The present case study investigated the feasibility of using manga (Japanese-style comic books) to promote physical activity and healthy eating behavior in Japanese patients with metabolic syndrome. METHODS: A one-arm pre-post intervention was conducted in a Japanese suburban community. Twenty participants with a diagnosis of metabolic syndrome were recruited via health checkups. Health promotion manga were developed by the researcher, a publishing specialist, and a professional illustrator. We measured participants' self-reported physical activity, eating behavior, and psychological readiness to change toward engaging in healthy behavior. RESULTS: At 1 month after the intervention there were no significant differences in physical activity scores, but small positive changes in vigorous (R2 = 0.02) and moderate (R2 = 0.01) physical activity scores were observed. Total healthy eating behavior scores were significantly improved (p < 0.05, R2 = 0.47). In addition, participants reported positive change in psychological readiness, such as increased intention to engage in healthy behavior, enhanced self-efficacy, and benefits of using manga. CONCLUSIONS: This study demonstrates that manga interventions have potential to encourage healthy eating in patients with metabolic syndrome.

Stressors of School-age Children With Allergic Diseases: A Qualitative Study.

PURPOSE: Most studies of stress in children with chronic diseases have been geared toward parents and caregivers have not considered allergic diseases together. This study aimed to identify the stressors associated with allergic diseases in Japanese school-age children. DESIGN AND METHODS: Stressors associated with allergic diseases of 11 school-age children (seven boys and four girls; age range: 9-12 years) were investigated using semi-structured interviews. RESULTS: In the qualitative thematic analysis of stressors about allergic diseases, two themes: allergic disease-specific stressors and common stressors in chronic diseases, and 12 categories were identified. A thematic map was applied to four domains of stressor: physiological factors, psychological factors, social factors, and environmental factors. CONCLUSIONS: The results showed that school-age children with allergic diseases have a variety of stressors. Future studies should aim to develop an allergic disease-specific stress management program with school-age children. PRACTICE IMPLICATIONS: In children with allergic diseases, not only is stress management in daily life important, but also stress management for disease-specific matters to control the symptoms and maintain mental health. Stress management should be supported for school-age children with allergic diseases.

Tailored Education to Increase Self-Efficacy for Caregivers of Children With Asthma: A Randomized Controlled Trial.

We examined the efficacy of a tailored education program using touch-screen computers for caregivers of young children with asthma, aged 0 to 6 years. Fifty-three caregivers (mean age, 36.54 years; 51 mothers and two fathers) were recruited during typical visits to a national children's hospital. Caregivers were assigned randomly to 28 in the tailored education or 25 in the booklet education groups. The tailored education group received messages generated by a computer program, and the researchers provided them with counseling. The booklet education group only received an educational booklet. The primary outcome variable was parental self-efficacy and its subscales (ie, medication behavior, environmental behavior, barriers to self-management, and consultation behavior). The tailored education group showed an increase in barriers to management and asthma knowledge compared with the booklet education group. Over time, caregivers' quality of life improved significantly in both groups. Tailored education programs for caregivers of asthmatic children require further educational content modifications to match the learners' characteristics more closely. This study supports the notion that the development of patient education with tailored computer programs improves parental quality of life of asthma.

Exploring physical activity with a low psychological burden and high feasibility in Japan: a qualitative study.

Previous research has shown that physical activity with a low psychological burden and high feasibility (i.e. a focus on small lifestyle changes) contributes to the adoption of and long-term success in behavior change intervention. The present study aims to explore the physical activity with a low psychological burden and high feasibility in which people already engage in their everyday life in Japan. Sixty-four participants (22 males and 42 females ranging in age from 36 to 89) participated in a qualitative research survey that asked what type of physical activity they engaged in on a daily basis to maintain good health. Results of a thematic analysis revealed nine themes (behavioral categories), which included four core themes of exercise, gymnastic exercises, stretch exercises, sports, and strength training, and five core themes of nonexercise activity, walking, cleaning, using the stairs, engaging in agriculture, and gardening based on a description analysis. A thematic map was constructed based on Japanese physical activity guidelines. Key findings of this study are as follows: (1) walking has a low psychological burden and high feasibility; (2) gymnastic exercise is efficacious from a physical and psychological perspective; (3) nonexercise activities are more acceptable than exercise activities; and (4) a focus on intervention with nonexercise activities has the potential for high engagement in the Japanese population. The study indicates that significant resources are available for promoting health behavior change interventions that would increase physical activity in the Japanese population.

Construction of a short form of the healthy eating behaviour inventory for the Japanese population.

INTRODUCTION: The present study constructed a short form of the Healthy Eating Behavior Inventory suitable for use in the Japanese culture (HEBI-J) and confirmed the scale's preliminary reliability and validity. METHODS: In Study 1, Japanese adults (N=75) completed a free-response questionnaire about healthy eating behaviours. Thematic analysis was used to identify three factors-balance, pattern, and restriction-associated with healthy eating behaviours and 12 items related to these healthy eating behaviours. In Study 2, Japanese office workers (N=784) completed two questionnaires regarding 12 items of healthy eating behaviours and the dietary stages of change. RESULTS: Confirmatory factor analysis demonstrated that the three-factor model was appropriate (GFI=.94, AGFI=.90, CFI=.90, RMSEA=.08, SRMR=.53). Reliability was confirmed by alpha coefficients and the Spearman-Brown formula. Concurrent validity was confirmed by the relationship between the healthy eating stages. CONCLUSIONS: This study demonstrated the preliminary reliability and validity of the HEBI-J.

[Development and effectiveness of a tailored education program for caregivers of asthmatic children].

BACKGROUND: We developed a tailored education program using a touch-screen computer for changing management behavior with asthmatic children and their caregivers. The purpose of this study was to examine the effect of the tailored education program. METHODS: Caregivers including children with asthma were recruited during visits to a national children's hospital and those whose month-long asthma condition on the JPAC (Japanese Pediatric Asthma Program) score was 14 and below were included. Caregivers were randomized to the tailored education (intervention group) or non-tailored education (control group). The intervention group underwent a patient education program using a touch-screen computer, and they received tailored messages generated by a computer program. A research nurse and clinical psychologist used a computer-based resource to tailor the education messages and provided counseling using motivational interviewing for the caregivers including children with asthma. The control group received only a booklet on asthma. RESULTS: Forty-seven subjects aged 1 to 6 years were enrolled. Forty-seven caregivers were randomized to the tailored education (n=22) or non-tailored education (n=25) group. The results of two-way ANOVA showed that interactions between groups were observed in the score of JPAC and asthma knowledge for preschool children whose asthma onset was within one year and a half. The main effects of time were observed in the total and subscale score of QOL (Quality of Life) and the total score of P-CASES (Parental Childhood Asthma's Self-efficacy Scale). CONCLUSION: These findings indicate the benefit of a tailored education program to control symptoms in such caregivers.

[Factors influencing parental medication adherence in pediatric asthma].

PURPOSE: To identify the factors influencing parental medication control behaviors (inhaling corticosteroids and medication-taking) in pediatric asthma management. METHODS: A specially-designed questionnaire survey was conducted on 942 parents with asthmatic children in hospitals and elementary schools. RESULTS: Factor analysis on inhalation behaviors resulted in five factors: understanding of benefit, mastering on inhalation skills and medication management, family support, anxiety of side effects, and explanation from a doctor (cumulative contribution ratio=51.3%). Factor analysis on medication-taking behavior resulted in five factors: understanding of medication effectiveness and benefit, family support, anxiety of side effects, skills on giving medicines, and family routine (cumulative contribution ratio=50.6%). CONCLUSION: The results indicate the importance of recognizing factors influencing parental medication control behaviors in developing education strategies to maintain and reinforce their asthma management behaviors.