Triangulation approach to developing, evaluating, and applying the evolving theory of adolescent acceptance of asthma.

Acceptance is a term used by healthcare professionals regarding patients' psychosocial adjustment to chronic conditions. This paper describes a triangulation approach, applied over 25 years, to develop and evaluate a theory of adolescent acceptance of asthma. The theory was used to guide the development and evaluation of an education and counseling program focused on fostering acceptance. The approach was effective in (a) defining acceptance and isolating its attributes; (b) identifying its antecedents and consequences, and specifying relationships among them; (c) revealing overlooked variables and augmenting theory; and (d) using theory to guide development and evaluation of the self-management program.

Information Needs and Resources and Self-Management Challenges of Parents Caring for a Child with Asthma in China.

The aim of this assessment was to determine the information needs, resources, and resource preferences and self/family-management challenges of parents caring for a child with asthma in China. The acceptance of asthma and consolidated framework for implementation research guided the study. A cross-sectional, descriptive design was used. Seventy-one parents of a child receiving care in an outpatient respiratory clinic completed a three-part, pragmatic, self-report survey. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. Parents, who needed more knowledge about asthma, sought information from internet sources. However, most parents preferred receiving information during in-person consultation with trained specialists. Management challenges revolved around understanding asthma information, formulating beliefs about asthma, experiencing distressing thoughts and feelings, forming supportive networks, and meeting their child's emotional needs. Evidence supports expanding nursing roles in China to include extended time for initial in-person parental interactions and follow-up using reliable clinic-based internet counseling.

The Resilience in Illness Model Part 2: Confirmatory Evaluation in Adolescents and Young Adults With Cancer.

BACKGROUND: Empirically derived and tested models are necessary to develop effective, holistic interventions to improve positive health outcomes in adolescents and young adults (AYA) with cancer, yet few exist. This article is the second of 2 articles reporting on evaluation of the Resilience in Illness Model (RIM) as a predictive model to guide positive health research and practice. OBJECTIVE: The aim of this study was to report the confirmatory model evaluation of the RIM. METHODS: A confirmatory evaluation of RIM was done using baseline data from a sample of 113 AYA aged 11 to 24 years who were undergoing hematopoietic stem cell transplant and enrolled in a randomized controlled trial of a behavioral intervention to enhance resilience. Data were analyzed using latent variable structural equation modeling. RESULTS: Goodness-of-fit indices supported RIM as a confirmed model that accounted for large amounts of variance in the outcomes of self-transcendence (62%) and resilience (72%), and in 3 of 5 mediators, specifically social integration (74%), courageous coping (80%), and hope-derived meaning (87%), as well as small to moderate amounts of variance in the remaining mediators of defensive coping (1%) and family environment (35%). CONCLUSIONS: Findings establish the RIM as a plausible predictive framework for explaining ways AYA with cancer transcend their illness and achieve resilience resolution and for guiding intervention studies in this population. Additional research is needed to explore RIM's transferability based on stage of illness, other chronic diseases, and cultural diversity. IMPLICATIONS FOR PRACTICE: Results support the RIM as an appropriate guide for developing and evaluating interventions to foster positive adjustment in AYA with cancer.

Comparative Effectiveness on Cognitive Asthma Outcomes of the SHARP Academic Asthma Health Education and Counseling Program and a Non-Academic Program.

Asthma morbidity and mortality is higher among older school-age children and early adolescents than other age groups across the lifespan. NIH recommended expanding asthma education to schools and community settings to meet cognitive outcomes that have an impact on morbidity and mortality. Guided by the acceptance of asthma model, an evidence-guided, comprehensive school-based academic health education and counseling program, Staying Healthy-Asthma Responsible & Prepared™ (SHARP), was developed. The program complements existing school curricula by integrating biology, psychology, and sociology content with related spelling, math, and reading and writing assignments. Feasibility, benefits, and efficacy have been established. We compared the effectiveness of SHARP to a non-academic program, Open Airways for Schools, in improving asthma knowledge and reasoning about symptom management. A two-group, cluster-randomized, single-blinded design was used with a sample of 205 students in grades 4-5 with asthma and their caregivers. Schools were matched prior to randomization. The unit of analysis was the student. Certified elementary school teachers delivered the programs during instructional time. Data were collected from student/caregiver dyads at baseline and at 1, 12, and 24 months after the intervention. In multilevel modeling, students enrolled in the academic SHARP program demonstrated significant (p< .001) improvement in asthma knowledge and reasoning over students enrolled in the non-academic program. Knowledge advantages were retained at 24 months. Findings support delivery in schools of the SHARP academic health education program for students with asthma.

Effectiveness of a school-based academic asthma health education and counseling program on fostering acceptance of asthma in older school-age students with asthma.

PURPOSE: The purpose of this study was to evaluate the effectiveness of the academic asthma education and counseling Staying Healthy-Asthma Responsible and Prepared™ (SHARP) program on fostering psychosocial acceptance of asthma. DESIGN AND METHODS: This was a phase III, two-group, cluster-randomized, single-blinded, longitudinal study. Students from grades 4 and 5 (N = 205) with asthma and their caregivers completed surveys at pre-intervention and at 1-, 12-, and 24-months post-intervention. Analysis involved multilevel modeling. RESULTS: All students demonstrated significant improvement in aspects of acceptance; students in SHARP demonstrated significant improvement in openness to sharing and connectedness with teachers over students in the control condition. PRACTICE IMPLICATIONS: The SHARP program offers a well-tested, effective program for psychosocial acceptance of asthma, which is welcomed by schools.

Effectiveness of a school- and community-based academic asthma health education program on use of effective asthma self-care behaviors in older school-age students.

PURPOSE: The purpose was to evaluate the effectiveness of Staying Healthy-Asthma Responsible & Prepared, an academic asthma health education and counseling program, on fostering the use of effective asthma self-care behaviors. DESIGN AND METHODS: This was a phase III, two-group, cluster randomized, single-blinded, longitudinal design-guided study. Caregivers of 205 fourth- and fifth-grade students completed the asthma health behaviors survey at preintervention, and 1, 12, and 24 months postintervention. Analysis involved multilevel modeling. RESULTS: All students demonstrated improvement in episode management, risk reduction/prevention, and health promotion behaviors; Staying Healthy-Asthma Responsible & Prepared students demonstrated increased improvement in episode management and risk reduction/prevention behaviors. PRACTICE IMPLICATIONS: Working with schoolteachers, nurses can improve the use of effective asthma self-care behaviors.

Randomized clinical trial of therapeutic music video intervention for resilience outcomes in adolescents/young adults undergoing hematopoietic stem cell transplant: a report from the Children's Oncology Group.

BACKGROUND: To reduce the risk of adjustment problems associated with hematopoietic stem cell transplant (HSCT) for adolescents/young adults (AYAs), we examined efficacy of a therapeutic music video (TMV) intervention delivered during the acute phase of HSCT to: 1) increase protective factors of spiritual perspective, social integration, family environment, courageous coping, and hope-derived meaning; 2) decrease risk factors of illness-related distress and defensive coping; and 3) increase outcomes of self-transcendence and resilience. METHODS: This was a multisite randomized, controlled trial (COG-ANUR0631) conducted at 8 Children's Oncology Group sites involving 113 AYAs aged 11-24 years undergoing myeloablative HSCT. Participants, randomized to the TMV or low-dose control (audiobooks) group, completed 6 sessions over 3 weeks with a board-certified music therapist. Variables were based on Haase's Resilience in Illness Model (RIM). Participants completed measures related to latent variables of illness-related distress, social integration, spiritual perspective, family environment, coping, hope-derived meaning, and resilience at baseline (T1), postintervention (T2), and 100 days posttransplant (T3). RESULTS: At T2, the TMV group reported significantly better courageous coping (Effect Size [ES], 0.505; P = .030). At T3, the TMV group reported significantly better social integration (ES, 0.543; P = .028) and family environment (ES, 0.663; P = .008), as well as moderate nonsignificant effect sizes for spiritual perspective (ES, 0.450; P = .071) and self-transcendence (ES, 0.424; P = .088). CONCLUSIONS: The TMV intervention improves positive health outcomes of courageous coping, social integration, and family environment during a high-risk cancer treatment. We recommend the TMV be examined in a broader population of AYAs with high-risk cancers.

The resilience in illness model, part 1: exploratory evaluation in adolescents and young adults with cancer.

BACKGROUND: Resilience is a positive health outcome identified by the Committee on Future Direction for Behavioral and Social Sciences as a research priority for the National Institutes of Health. The Resilience in Illness Model (RIM) was developed from a series of qualitative and quantitative studies, to increase understanding of how positive health protective factors (ie, social integration, family environment, courageous coping, and derived meaning) may influence resilience outcomes. The RIM also includes 2 risk factors: illness-related distress and defensive coping. OBJECTIVE: The purpose of this 2-part article was to report on evaluation of the RIM for adolescents/young adults (AYAs) with cancer. Here, in part 1, our purpose was to describe the exploratory RIM evaluation, and in part 2 we describe the confirmatory RIM evaluation. METHODS: An exploratory evaluation of RIM was done using exploratory latent variable structural equation modeling with a combined sample from 2 studies of preadolescents and AYAs with cancer aged 10 to 26 years (n = 202). RESULTS: Results, including goodness-of-fit indices, support the RIM as a theory with a high level of explained variance for outcomes of resilience (67%) and self-transcendence (63%). Variance explained for proximal outcomes ranged from 18% to 76%. CONCLUSIONS: Findings indicate that, following confirmatory testing, the RIM may be a useful guide to developing targeted interventions that are grounded in the experiences of the AYAs. IMPLICATIONS FOR PRACTICE: Understanding of the AYA cancer experience to improve holistic care is increased.

Development, evaluation, and utility of a peer evaluation form for online teaching.

Formative assessment of teaching by peers is an important component of quality improvement for educators. Teaching portfolios submitted for promotion and tenure are expected to include peer evaluations. Faculty resources designed for peer evaluation of classroom teaching are often inadequate for evaluating online teaching. The authors describe development, evaluation, and utility of a new peer evaluation form for formative assessment of online teaching deemed relevant, sound, feasible, and beneficial.

Development and evaluation of an instrument to measure reasoning about managing asthma in older school-age children and adolescents.

BACKGROUND AND PURPOSE: This article describes development and evaluation of a 4-scenario instrument designed to measure reasoning abilities for managing asthma symptoms. METHODS: Existing literature informed creation of a reasoning template and the reasoning scenarios. Think-aloud interviews appraised scenario functionality. Experts assessed content validity. Data from 2 groups of students with asthma aged 9-15 years (N = 132 and 307) were used to evaluate psychometric properties. RESULTS: The scenarios were deemed functional, content was relevant, and readability was age/grade appropriate. Cronbach's alpha was 0.79. Exploratory and confirmatory factor analyses indicated a single component solution and revealed a good fit. Concurrent validity was established using correlations with asthma knowledge. CONCLUSION: The instrument could be used to assess reasoning about symptom management and to evaluate educational interventions.

Feasibility and benefits of a school-based academic and counseling program for older school-age students with asthma.

An asthma education program for older school-age students with asthma was developed in collaboration with school personnel, healthcare professionals, and community partners. Feasibility and benefits were evaluated using a single-group, prospective, quasi-experimental design. The convenience sample, consisting of 28 grade 6 and 7 students with asthma, had 50% males, a diverse racial background, and a wide range of incomes. Feasibility and benefits were demonstrated by comparing pre-intervention to 1- and 12-month post-intervention evaluation of students who completed more than 70% of the 10 sessions. Statistically significant improvements in cognitive, behavioral, psychosocial, and quality of life outcomes were seen from pre-intervention to 1-month post-intervention (all p < .03). Severity of asthma significantly improved from 1- to 12-month post-intervention (p= .04).

Randomized clinical trial of a school-based academic and counseling program for older school-age students.

BACKGROUND: Up to 17% of children in the United States have been diagnosed with asthma; children ages 9-14 years experience higher morbidity and mortality compared with other age groups. An academic and counseling program for older elementary students with asthma was developed in collaboration with school personnel, healthcare professionals, and community members: Staying Healthy-Asthma Responsible and Prepared (SHARP). The life span development perspective and the Acceptance of Asthma Model were used to guide development and implementation. OBJECTIVES: This study aimed to establish the preliminary efficacy of SHARP to improve cognitive, behavioral, psychosocial, and quality-of-life outcomes. METHODS: A two-group, longitudinal, prospective, cluster randomized clinical trial design was used. The sample of fourth- to sixth-grade students (N = 66) with asthma aged 9-12 years (M = 10.5, SD = 0.9) was 52% male, was racially diverse (30% Black, 36% White, and 18% biracial), and had a wide range of incomes. Three schools (n = 38 students) were randomized to receive SHARP, and two schools (n = 28 students) were assigned to usual care. Self-report instruments were used. RESULTS: Compared with the usual care group, statistically significant improvements in the SHARP group were found in student knowledge of asthma, reasoning about asthma, use of risk reduction behaviors, and participation in life activities (p < .01, effect sizes >0.7). Improvements in use of episode management behaviors and acceptance of asthma outcomes were clinically significant with medium effect sizes of 0.3-0.5. DISCUSSION: The SHARP Student and Community Components demonstrated preliminary efficacy for improving asthma knowledge, reasoning about asthma, use of episode management and risk reduction behaviors, acceptance of asthma in taking control and vigilance, and participation in life activities.

Reliability and construct validity of the Participation in Life Activities Scale for children and adolescents with asthma: an instrument evaluation study.

BACKGROUND: The purpose of this study was to evaluate the reliability and construct validity of the Participation in Life Activities Scale, an instrument designed to measure older school-age child and early adolescent level of involvement in chosen pursuits. METHODS: A cross-sectional design was used. The convenience sample consisted of 313 school-age children and early adolescents with asthma, ages 9-15 years. The self-report summative scale of interest is a 3-indicator survey. Higher scores are reflective of higher levels of participation. Internal consistency reliability and construct validity for the entire sample and sub groups of the sample were evaluated. RESULTS: The instrument was deemed sound for the entire sample as well as sub groups based on sex, race, age, socioeconomic status, and severity of illness. Cronbach's alpha coefficient for internal consistency reliability for the entire sample was .74. Exploratory factor analysis indicated a single component solution (loadings .79-.85) accounting for 66% of the explained variance. Construct validity was established by testing the posed relationship between participation in life activities scores and severity of illness. Confirmatory factor analysis revealed a good fit between the data and specified model, chi2(10, n = 302) = 8.074, p = .62. CONCLUSION: This instrument could be used (a) in clinical settings to diagnose restricted participation in desired activities, guide decision-making about treatment plans to increase participation, and motivate behavioral change in the management of asthma; and (b) in research settings to explore factors influencing and consequences of restricted and unrestricted participation, and as an outcome measure to evaluate the effectiveness of programs designed to foster child and early adolescent management of asthma.

Development and preliminary evaluation of the participation in life activities scale for children and adolescents with asthma: an instrument development study.

BACKGROUND: Being able to do things other kids do is the desire of school-age children and adolescents with asthma. In a phenomenology study, adolescents identified participation in life activities as the outcome variable and primary motivator for behavioral changes in coming to accept asthma as a chronic condition. In preparation for testing an acceptance model for older school-age children and early adolescents diagnosed with asthma, the Participation in Life Activities Scale was developed. The purposes of this paper are to describe development, and report on face and content validity of the scale designed to measure one aspect of quality of life defined as level of unrestricted involvement in chosen pursuits. METHODS: Items generated for the instrument evolved from statements and themes extracted from qualitative interviews. Face and content validity were evaluated by eight lay reviewers and 10 expert reviewers. Rate of accurate completion was computed using a convenience, cross-section sample consisting of 313 children and adolescents with asthma, ages 9-15 years, drawn from three studies. Preliminary cross-group comparisons of scores were assessed using t-tests and analysis of variance. RESULTS: Face and content validity were determined to be highly acceptable and relevant, respectively. Completion rate across all three studies was 97%. Although cross-group comparisons revealed no significant differences in overall participation scores based on age, race or residence groupings (p > .05), significant difference were indicated between males and females (p = .02), as well as the highest and lowest socioeconomic groups (p = .002). CONCLUSION: Assessing content validity was the first step in evaluating properties of this newly developed instrument. Once face and content validity were established, psychometric evaluation related to internal consistency reliability and construct validity using factor analysis procedures was begun. Results will be reported elsewhere.

Psychometric properties of the Herth Hope Index in adolescents and young adults with cancer.

The Herth Hope Index (HHIndex), originally developed for adults, was examined for appropriateness in two studies of adolescents and young adults with cancer-those at various stages of treatment (N = 127) and those newly diagnosed (N = 74). The internal consistency reliability (Cronbach's alpha) of the index was .84 and .78, respectively, in the two samples. Construct validity was supported by discriminant correlations in the moderate to low range between the HHIndex and measures of uncertainty in illness and symptom distress, and by moderate convergent correlations with measures of resilience (self-esteem, self-confidence, and self-transcendence) and quality of life (index of well-being). A four-step factor analysis procedure was done, and confirmatory factor analysis suggested that a one-factor solution best fit the data in this population. Findings indicate that the HHIndex is a reliable measure of hope in adolescents and young adults with cancer. Evidence of discriminant and convergent validity in measuring hope in adolescents and young adults with cancer was also generated. Further exploration of the HHIndex factor structure in adolescents and young adults is needed.

Testing the acceptance of asthma model with children and adolescents.

Older school-age children and early adolescents with asthma have demonstrated and verbalized difficulty in accepting their condition. Although researchers have explored adult acceptance, few have explored child or adolescent acceptance. The purpose was to explore the fit of the data to a specified latent variable acceptance of asthma model. School-age children and early adolescents (N = 118), ages 9 to 14 years enrolled in Grades 4 to 9, diagnosed with asthma and their parents completed self-report instruments. EQS was used for structural equation modeling analyses. The specified model was a good fit to the data and accounted for more than 70% in the explained variance of vigilance, 30% of participation in life activities, 25% of taking control, and 20% of asthma health behaviors. Support for the model possess implications for development of theory-based education and counseling interventions to support participation in life activities by targeting cognitive, behavioral, and psychosocial aspects of living with the asthma.

Lack of relationship between acceptance and knowledge of asthma in school-age children and early adolescents.

ISSUES AND PURPOSE: Early adolescents diagnosed with asthma have difficulty accepting their condition. This study is part of an ongoing program of research designed to increase understanding of the adolescent process of coming to acceptance. The purpose was to explore relationships among variables in the Acceptance of Asthma Model. DESIGN AND METHODS: A cross-sectional, theory-testing design with a sample of 94 students ages 9 to 14 years. RESULTS: Acceptance was dependent on psychosocial influences and disease characteristics rather than knowledge of asthma. PRACTICE IMPLICATIONS: Psychosocial interventions are needed to facilitate acceptance.

African American girls' smoking habits and day-to-day experiences with racial discrimination.

BACKGROUND: Although it is recognized that African Americans experience racial discrimination, relatively little research has explored the health implications of this experience. Few studies have examined the relationship between racial discrimination and specific health risks. OBJECTIVES: To examine the relationship between smoking habits and perceptions of racial discrimination among African American adolescent girls and to identify and test potential psychological mechanisms through which racial discrimination may operate to increase smoking among this group. METHODS: A sample of 105 African American adolescent girls (mean age 15.45 years) derived from a larger cross-sectional research project comprised the sample. Univariate analyses were conducted to provide descriptive data on the participants of the study, including information about their use of licit and illicit substances. Bivariate correlational analyses were conducted to evaluate the relationship between perceptions of discrimination and smoking habits. The ability of stress to mediate the relationship between discrimination and smoking was examined by using standard analytical procedures for testing mediation models as outlined by Baron and Kenny (1986). RESULTS: The sample (93%) reported experiencing discrimination and racial discrimination was highly correlated with cigarette smoking (r =.35, p >.001). Removing the effects of stress significantly reduced the relationship between racial discrimination and smoking (r =.17, p <.05), indicating that racial discrimination is related to smoking because of its stressful nature. CONCLUSION: Perceptions of racial discrimination are related to the smoking habits of African American adolescent girls.

Ebb and flow when navigating adolescence: predictors of daily hassles among African-American adolescent girls.

ISSUES AND PURPOSE: To examine the nature of daily hassles as perceived by African-American adolescent females. DESIGN AND METHODS: As part of a larger, cross-sectional study, nonrandom network sampling technique was used to survey 178 adolescent girls between the ages of 11 and 19. RESULTS: This study found that the most common hassles were school and academic, followed by family and economic hassles, peer and social hassles, and personal safety hassles. Socioeconomic factors were strongly associated with the level of hassles reported. PRACTICE IMPLICATIONS: Assess African-American girls' perception of daily hassles, specifically school- and family-related hassles, and also examine the interrelationship between the type of hassles and health problems.