Health-related behaviors and weight-related outcomes within sibling pairs: A systematic review.

BACKGROUND: Siblings reciprocally contribute to mutual social and physical development. The aim of this review was to examine the health-related behaviors and weight-related outcomes within child-sibling pairs and to determine how these factors vary by sibling composition. METHODS: Following the PRISMA guidelines, a systematic review of studies published since 2000 obtained from MEDLINE, CINAHL, PubMed, Cochrane Reviews, Web of Science, PsycINFO, Health and Wellness, and Science Direct was performed. The eligibility criteria for inclusion were: 1) peer-reviewed and published in English; 2) included children ages 2 to 20 and their siblings; and 3) explored health-related behaviors (i.e., diet) and/or weight-related outcomes (i.e., body weight) within child-sibling dyads. RESULTS: A total of 13 studies were included in the review. The study findings are summarized according to three major themes: 1) sibling concordance in health-related behaviors and weight-related outcomes, 2) differences in health-related behaviors within weight-concordant/weight-discordant sibling dyads, and 3) influence of sibling composition on health-related behaviors and weight-related outcomes. CONCLUSIONS: Family-based interventions for childhood obesity may benefit from including siblings as key family members in promoting children's health-related behaviors and preventing excessive weight gain. Future studies should explore variable sibling dynamics (e.g., adoptive siblings) in more culturally/racially diverse families to further explore the role of a sibling in a child's health. IMPLICATIONS TO PRACTICE: The findings of this study may help healthcare providers in developing effective family-based obesity interventions for families with more than one child in their household.

Aggressive parenting behavior among grandparents providing childcare for grandchildren: A case study of Shenzhen, China.

BACKGROUND: Grandparents play an essential role in childrearing and fill the parenting gap for dual-earner Chinese families. Many Chinese grandparents engage heavily in childcare, which may increase the risk of child abuse. OBJECTIVE: This study aimed to examine grandparental use of psychological and physical aggression toward children and explore its associated risk factors. PARTICIPANTS AND SETTING: This was a cross-sectional study which involved purposive sampling of 278 grandparents (204 females and 74 males) taking care of at least one grandchild below 18 years old in Shenzhen, China. METHODS: Information on childcare was collected, including grandparents' use of psychological and physical aggression and their involvement in childcare in terms of intensity and activity. RESULTS: An alarming percentage (57.1 %) of grandparents had used psychological aggression, while 26.5 % had used corporal punishment, in the past year. The average use of psychological aggression and corporal punishment was 16.10 times and 10.08 times per year, respectively. Grandparents taking care of two or more grandchildren were more likely to use psychological aggression and corporal punishment compared to those taking care of only one grandchild. Higher mental and physical health summary scores were associated with lower likelihood of psychological and physical aggression of grandparents. CONCLUSIONS: This study advances our understanding of negative grandparenting behavior in childcare. As grandparents play a significant role in childcare, we need to improve their grandparenting skills, provide more formal childcare services to ease their childcare burden, and support their physical and mental well-being to reduce the risk of child abuse.

Needs of Grandparents Raising Grandchildren: A Qualitative Study.

This study identified custodial grandparents' perception of sources of stress that may affect their health and better understand their needs. Findings from this qualitative study are based on thematic analysis of interviews with 10 custodial grandparents. The following themes emerged: 1) grandparents' stress from perceived lack of readiness to care for grandchildren; 2) need for effective communication between and among family members; 3) sufficiency of financial and legal resources; 4) access to community resources, and 5) raising grandchildren reenergizes and revitalizes grandparents' physical and mental health. These findings provide insight into the stressful aspects of the role of raising grandchildren. Understanding stressors affecting custodial grandparents and their grandchildren will help school nurses, social workers, teachers, school administrators and other professionals collaborate to address their challenges.

Mediation of Self-Management and Treatment Adherence Health-Related Quality of Life for Adolescents With Congenital Heart Disease.

BACKGROUND: Improved autonomy, relatedness, competence, self-management, and treatment adherence have been linked to better health-related quality of life (HRQOL) in adolescents with chronic illnesses. Nonetheless, potential mediating relationships among these concepts have not been investigated. Mediation research is necessary to fully examine ways to improve health and other outcomes for adolescents living with chronic illnesses. OBJECTIVES: The purpose of this study was to examine the relationship among the three innate needs (autonomy, relatedness, and competence) of the self-determination theory (SDT)-self-management and treatment adherence-and its relationship to HRQOL for adolescents with congenital heart disease (CHD). The current study examined the potential mediation effects of self-management and treatment adherence on the relationship between the three SDT variables on HRQOL. METHODS: Ninety-two adolescents with CHD completed self-report surveys (Basic Psychological Needs Autonomy and Relatedness subscales, Generalized Self-Efficacy Scale, UNC TRxANSITION Scale, and Pediatric Quality of Life 4.0 Generic Core Scale). Exploratory multiple regression and the bootstrap method were used to examine the relationship between the SDT variables and HRQOL and test whether these relationships were mediated by self-management and treatment adherence after controlling for covariates. RESULTS: The mediation hypothesis was not supported, indicating that self-management and treatment adherence do not mediate the relationship between the SDT variables and HRQOL for adolescents with CHD. However, multiple regression findings suggest optimizing autonomy and competence contributes to better self-management and treatment adherence and that better autonomy, competence, and relatedness improves HRQOL. DISCUSSION: The findings in this study indicate that studies with larger samples are needed if self-management and treatment adherence mediates the innate needs and HRQOL in adolescents with CHD. Future research focusing on other potential mediators affecting the relationship with HRQOL is warranted to improve the transition into adulthood.

Attitudes toward Grandparental Involvement in Hong Kong: A Trend Analysis.

This article examines individuals' attitudes toward the involvement of grandparents in family issues in Hong Kong. While existing studies have largely focused on the nature and types of grandparents' involvement in childcare, it is worth conducting a quantitative investigation of the attitudes in the general population about grandparental involvement. Drawing on the 2011, 2013, 2015, and 2017 waves of the Family Surveys, the study examined the trend in attitudes toward grandparental involvement with 8932 HK residents. Multivariate linear regression analyses were performed to assess individual and family relationship factors associated with the attitudes toward grandparental involvement. Results show that although most people held positive attitudes toward grandparental involvement, there was a significant drop in the agreement with grandparental involvement in 2017 across all age groups. The findings imply that intergenerational support tends to be weakened in HK in recent years. Involving grandparents in family issues in HK was more likely to be need-driven rather than value-driven, as parent respondents had relatively more positive attitudes toward grandparental involvement compared with non-parents. Positive family and intergenerational relationships were significantly associated with the positive attitudes toward grandparental involvement. Policymakers and service providers should recognize the changes in people's attitudes toward family lives and provide appropriate support such as family counselling, (grand)parenting programs and childcare support to promote the wellbeing of families and older adults.

Recruiting custodial grandmothers using Facebook.

OBJECTIVES: Recruitment through Facebook is gaining favor as an approach for research, including clinical trials, because of the platform's ability to reach broad and diverse populations. As older adults increase their social media use, recruitment through Facebook has become a viable option. The purposes of this paper are to report the methodological process and lessons learned from recruiting custodial grandmothers (CGMs) for a cross-sectional study examining parenting self-efficacy and psychological well-being. PARTICIPANTS: A total of 113 people consented and accessed the survey online, with 40 (35.4%) completing surveys. The final sample comprised 68 grandmothers, with 59% recruited via Facebook. METHODS: Facebook recruitment for the online survey included creating a dedicated Facebook study page, accessing existing Facebook pages for custodial grandparents, and using paid advertising. Face-to-face recruitment strategies also were used with paper surveys. RESULTS: We compared the characteristics of those completing online surveys versus paper surveys. CGMs completing the survey online were significantly younger and more likely to be Caucasian than those completing the paper survey. CONCLUSIONS: Findings indicated online recruitment via Facebook is an advantageous method to reach CGMs. However, additional research is needed to determine if other online and social media platforms would be useful in recruiting this population.

The Self-Determination Theory: Health-Related Quality of Life in Adolescents with Congenital Heart Disease.

The purpose of this paper is to present a conceptual-theoretical-empirical model addressing variables associated with self-management of care and adherence to treatment and its relationship to health-related quality of life for adolescents with congenital heart disease. There is limited research on adolescents with congenital heart disease regarding the relationship between autonomy, relatedness, competence, self-management of care and adherence to treatment, and health-related quality of life. The proposed Health-Related Quality of Life and Transition of Adolescents With Congenital Heart Disease to Self-Manage in Adulthood model, adapted from the Self-Determination Theory, will help to better understand these relationships.

Applying the Self-determination Theory to Health-related Quality of Life for Adolescents with Congenital Heart Disease.

PURPOSE: The purpose of this study is to examine the relationship among the three innate needs of Self-Determination Theory (SDT), self-management of care and adherence to treatment, and the relationship to health-related quality of life (HRQOL) for adolescents with congenital heart disease (CHD). DESIGN AND METHODS: A non-experimental, cross-sectional, correlational design was conducted in a sample of 92 participants with CHD, ages 13 to 18 years. For data analysis, Pearson's correlations were used to explore associations between variables, and the hypotheses were tested using multiple linear regression. RESULTS: Demographic and clinical data were collected: 15 ±â€¯1.6 yrs; 59% male; 65% White; 43% mild CHD; 25% severe CHD. After controlling for covariates, regression analyses revealed relatedness (ß = 0.64) and competence (ß = 0.79) contributed significant variance to HRQOL, R2 = 0.56, p < .001; however, autonomy and self-management of care and treatment adherence did not contribute significant variance to HRQOL. CONCLUSIONS: This study found that relatedness and competence were significantly associated with HRQOL in adolescents with CHD; however, autonomy and self-management of care and adherence to treatment were not. These findings demonstrate the importance of further examining relatedness and competence in adolescents with CHD. PRACTICE IMPLICATIONS: Nursing care should focus on the improvement of social support systems and interventions to increase self-efficacy for adolescents with CHD.

Nurses' Perceptions of Quality of Life for Adolescents with Congenital Heart Disease.

The purpose of this study was to understand nurses' perceptions and experiences regarding Quality of Life (QOL) of adolescents with complex congenital heart disease (CHD). Interpretive, hermeneutic, phenomenology was used to explore the perceptions and experiences of nurses who care for adolescents with complex CHD. The participants included 6 female registered nurses with experience taking care of adolescents with complex CHD. Data were collected using semi-structured interviews. Data analysis revealed 4 themes: QOL depends on how the psychological and social issues are interwoven with the physical; finding that balance between overprotection and too much freedom; setting goals to envision a future; and not being defined by a CHD. These results indicate that understanding nurses' perspectives and experiences may contribute to effective guidance for adolescents with complex CHD transitioning into adulthood.

Mental Health Stress, Family Resources and Psychological Distress: A Longitudinal Mediation Analysis in African American Grandmothers Raising Grandchildren.

OBJECTIVES: This study examines the effectiveness of a multidisciplinary intervention for African American grandmothers raising grandchildren on the relationship between dichotomized levels of mental health stress (low vs. high) and elevated levels of psychological distress, mediated by perceptions of family resources. METHOD: A nonrandom sample of African American grandmothers (N = 679) was assessed to test the predictive relations among study constructs in the context of a prospective mediational model. RESULTS: Perception of family resources contributes to lower psychological distress among custodial grandmothers exhibiting low and high levels of mental health stress. There was no significant difference in the strength of the mediated effects between the 2 mental health stress groups. CONCLUSION: The findings suggest appropriate resource-focused interventions can enhance grandmothers' subjective assessments of family resources and reduce psychological distress. However, additional research is needed to ascertain the consistency and generalizability of findings.

Depression, Social Support, and Mental Health: A Longitudinal Mediation Analysis in African American Custodial Grandmothers.

Custodial grandparents raising grandchildren experience intense levels of stress that can lead to depression and other forms of psychological distress. Drawing on a coping model of family stress, adjustment, and adaptation, we explored the relationship between depression and mental health quality of life mediated by social support and moderated by grandparent's age. The sample consisted of 667 African American custodial grandmothers, dichotomized into two age groupings, ≤55 (n = 306) and 55 + (n = 361). All grandmothers participated in a 12-month support intervention. The prospective analysis revealed social support was a mediator in the association between depressive symptoms and mental health quality of life for older African American grandmothers; however, this same relationship did not hold for their younger counterparts. Study limitations and future research directions are discussed.

Psychological distress in African American grandmothers raising grandchildren: the contribution of child behavior problems, physical health, and family resources.

Diminished psychological health has been identified among caregiving grandmothers. The intent of this investigation was to examine psychological distress levels, as well as their predictors, in a sample of 480 caregiving African American grandmothers, mean age 56 years. Almost 40% (39.8%) of participants had clinically elevated psychological distress scores. Results of hierarchical multiple regression indicated that internalizing and externalizing child behavior problems, poor grandmother physical health, younger age of grandmother, and lack of family resources predicted 31% of the variance in psychological distress. Results provide direction for nursing interventions aimed at enhancing the psychological well-being of caregiving grandmothers.

African American caregiving grandmothers: results of an intervention to improve health indicators and health promotion behaviors.

The purpose of this study was to examine the efficacy of an intervention to improve the health of grandmothers raising grandchildren. A pre- and post-test design was employed with 504 African American grandmother participants. The intervention included monthly home-based visitation by registered nurses (RNs) and social workers, participation in support groups and parenting classes, referrals for legal services, and early intervention services for children with special needs. The Health Risk Appraisal was used to assess health indicators and health promotion behaviors. A comparison of pre- and post-test scores indicated significant (p < .002) changes in the desired direction for a number of health indicators and health promotion behaviors, including blood pressure, annual routine cancer screenings, frequency of weekly exercise, and improved dietary intake, as well as participants' perception of their health and life satisfaction. No improvements were observed in the proportion of participants who were obese or overweight.

Grandmothers raising grandchildren: results of an intervention to improve health outcomes.

PURPOSE: To examine the impact of an intervention to improve the health of grandmothers raising grandchildren in parent-absent homes. DESIGN: A longitudinal, pretest-posttest design. METHODS: The sample was composed of 529 female caregivers with a mean age of 56.7 years (range 38-83) who were predominantly low-income African Americans. Data were collected prior to the intervention and again at 12 months when the intervention was complete. The intervention involved home visitation by registered nurses and social workers, as well as other support services. The Short Form-36 was used to assess physical and mental health, using eight multi-item scales. RESULTS: A comparison of pre- and posttest mean scores on the SF-36 indicated significantly (p < .003) improved mean scores for vitality, physical effects on role functioning, emotional effects on role functioning, and mental health. No significant differences were found for other attributes. CONCLUSIONS: These preliminary findings suggest that grandmothers raising grandchildren may benefit from a home-based intervention designed to improve health attributes. Implications for nursing practice, policy, and research are presented. CLINICAL RELEVANCE: The health of grandmother caregivers is critical to their ability to parent grandchildren successfully. Nurses practicing in a variety of settings are in a unique position to identify and address the health challenges of grandmothers who are raising grandchildren.

A home-based nutrition and physical activity intervention for grandparents raising grandchildren: a pilot study.

Five African American grandparents raising their grandchildren participated in a home-based nutrition and physical activity intervention. The primary goals were to increase grandparents' knowledge and skills in selecting and preparing healthy foods and to increase the grandparents' and grandchildren's physical activity levels. Results revealed that grandparents' concerns regarding their chronic diseases and desire to prevent health problems in their grandchildren served as motivators. Following the intervention, grandparents scored higher on nutrition and physical activity knowledge and their self-efficacy improved, although most health status indicators remained unchanged. Self-reported changes included walking more, reading food labels, and switching to a healthier type of fat.

Grandparents raising grandchildren: a response to a nutrition and physical activity intervention.

This pilot study explored the impact of an educational program on nutrition and physical activity knowledge of urban African-American grandparents raising their grandchildren. The program was integrated into a community-based intervention, Project Healthy Grandparents, and was implemented during the first 15 minutes of 10 grandparent support groups and parenting classes. Subjects included 22 grandparents who attended at least six sessions and completed pre- and posttests of nutrition and physical activity knowledge. Participants' posttest scores were significantly higher than their pretest scores (P<0.05), indicating an increase in knowledge. Eighteen grandparents provided insights about diet and physical activity and barriers to lifestyle changes during an audiotaped focus group. Based on analysis of the focus group's discussion, three major influences on healthful eating and physical activity emerged, including financial considerations, presence of grandchildren in the home, and preference for traditional cultural foods. Themes from the focus group were consistent with responses on the nutrition and physical activity knowledge test. Satisfaction with the program was very high and no specific recommendations for improvements were made. Results can guide future nutrition interventions for this target group and potentially contribute to grandparents' improved health and ability to care for their grandchildren.