Evaluating the Dyadic Benefits of Early-Phase Behavioral Interventions: An Exemplar Using Data from Couples Living with Parkinson's Disease.

BACKGROUND AND OBJECTIVES: There are a growing number of early-phase (i.e., Stage I, NIH Stage Model) interventions targeted at family care dyads navigating chronic health conditions in older adults. Currently, benefits of these interventions are often evaluated for older adults and their family care partners separately, even when controlling for interdependence. Without understanding benefits (and potential harms) for dyads as a whole, understanding of program impact is incomplete. Moreover, few health behavior interventions involving dyads include relational measures to ensure no unintended consequences for the dyad or account for within-dyad pre-test risk level. RESEARCH DESIGN AND METHODS: We used secondary data from a quasi-experimental trial involving 39 couples in which one member of the dyad was living with Parkinson's Disease as an exemplar demonstration of three proposed approaches: an above-zero approach, a pre-test risk status approach, and an expanded pattern analysis matrix approach. RESULTS: Approaches provided evidence for dyadic benefits of the intervention compared to the wait-list comparison condition, but carry different assumptions that did not always categorize dyads similarly. DISCUSSION AND IMPLICATIONS: Implications of using each approach and selecting different benchmarks for defining success are discussed. The descriptive approaches proposed provide rationale for more intentional evaluation of small-sample, early-phase dyadic interventions.

Parents' Discussions of the COVID-19 Pandemic and Death With Young Children.

Death and loss are often uncomfortable topics for adults to discuss with young children. Disruptions caused by the COVID-19 pandemic, however, made the avoidance of these topics nearly impossible. The current study explored how 20 parents engaged with their young children (ages 3-6) in discussions about death, dying, and loss as they jointly experienced this global crisis. Interviews were conducted both prepandemic (Summer/Fall 2019) and a year later, at the early stage of the COVID-19 pandemic, before vaccines were approved (Summer 2020). Results suggest parents largely sought to balance sheltering children from stress and socializing them with socioemotional competencies. The pandemic context, however, brought parents a sense of urgency to scaffold their children's ability to remain resilient after experiencing losses. Practical implications are discussed regarding how family nurses and other practitioners can provide support to families of young children during the COVID-19 pandemic and potential future global crises.

Family functioning, contributions to college expenses, access to mentors, and college student's health and flourishing: Examining moderation by family structure.

Objective: To evaluate how family functioning, family contributions to college expenses, and access to mentors are associated with college student's self-reported health and flourishing, and to test for moderation by family structure. Participants: Undergraduate college students (N = 238) recruited through an email list-serve at a large midwestern state university. Methods: Participants completed an online survey (distributed through Qualtrics) in February 2020. Data were analyzed using linear regression (in SPSS 28) and simple slope analyses. Results: College students' access to mentors is associated with their self-reported health, and family structure moderates the association between family strengths and self-reported health. Family functioning and access to mentors are both associated with college students' flourishing. Conclusions: College students' health and flourishing may benefit from access to mentors and functional family dynamics. Though students from post-divorce families see fewer benefits from family strengths compared to peers in nuclear biological families.

College students' intentions to assist peers with chronic medical conditions.

Objective This study identified influences on college students' intentions to assist peers with chronic medical conditions. Participants: A panel of 293 U.S. full-time college students completed online surveys in July, 2017. Methods: Participants reported the number of people they knew with chronic medical conditions, and completed measures of general empathy, stigma toward chronic conditions, self-efficacy to provide support, and expected likelihood of assisting a peer with a chronic medical condition. Path Analysis and mediation tests were performed. Results: Low stigma, and high confidence in providing support were directly associated with intentions to assist student peers if needed. Empathy and number of people known with chronic conditions were additional indirect predictors. Conclusions: Peer support is important for students with chronic medical conditions. Intention to provide assistance if needed is partially explained by holding low stigma and high confidence in providing support, both of which may be enhanced through education and intervention.

Parents' Anticipated Discussions About Death With Young Children.

Guided by family communication patterns theory and terror management theory this mixed-methods investigation explored how parents (N = 112) of young children (ages 3-6) described the way they would discuss death when it comes up in conversations. Responses were coded inductively, resulting in four themes: explanations that death is inevitable, explanations that death is in the distance, the use of religion to frame discussions of death, and finally, discussing afterlife connections to deceased family members. Logistic regression analyses were used to evaluate whether parents' conformity or conversation orientations were associated with the frequency with which parents discussed death with their child and the content of parent vignette responses. Quantitative analysis revealed parents' conversation orientations were associated with the frequency with which they discussed death with their child and conformity orientations were associated with parents' use of religion and discussing afterlife connections to deceased family members in their responses.

Family-Centered Care and Positive Developmental Outcomes for Youth With Special Health Care Needs: Variations Across Family Structures.

Drawing on a social determinants of health framework, we evaluated associations between perceived family-centered care (FCC) and positive developmental outcomes for youth with special health care needs across six different family structures (married biological families, cohabiting biological families, married stepfamilies, cohabiting stepfamilies, divorced/separated single-mother families, and never-married single-mother families). Using data from the 2011-2012 National Survey of Children's Health, we found that married biological families perceive greater FCC than do other family structures. Perceived FCC was positively associated with all three positive youth outcomes evaluated (children's health, participation in extracurricular activities, and flourishing) in married biological families, and two of the three outcomes (children's health and flourishing) in married stepfamilies and divorced/separated single-mother families. Implications for health care provision and future research with structurally diverse families are discussed.

Managing chronic conditions in college: Findings from prompted health incidents diaries.

OBJECTIVE: This pilot study assessed an electronic health diary method designed to collect data about critical health incidents experienced by college students who have chronic health conditions. PARTICIPANTS: Nine university students with chronic medical conditions were recruited to complete a series of e-mail-based surveys, sent once every 3 days across the fall 2014 semester. METHODS: In each survey, participants described a health-related incident that occurred within the past day and cited resources that helped or could have helped in that situation. They completed follow-up interviews and ranked the importance of cited resources. RESULTS: The diary completion rate was 78.3% (141/180). Most frequently affected management areas were activities (61.3%), monitoring (34.9%), and problem-solving (34.3%). Resources considered helpful included situational knowledge, campus health professionals, peer support, and relaxation opportunities. CONCLUSIONS: Prompted health incidents diary method achieved a high completion rate and provided data that could be useful for college health researchers and practitioners.

Negotiating a Place in the Family-A Grounded Theory Exploration of Stepgrandmothers' Enactment of Roles.

Purpose: Stepgrandparents are becoming more common, and they can, and often do, provide affective and instrumental support to families. Little is known, however, about how they negotiate and enact their roles within families, especially with stepgrandchildren. Stepgrandmothers warrant special attention because researchers have found that women experience more challenges than men in stepfamilies. Guided by symbolic interactionism, the purposes of our study were: (a) to explore stepgrandmothers' role enactment and (b) to explore the intrapersonal, interpersonal, and contextual factors that contribute to role enactment in intergenerational steprelationships. Design and Methods: Eighteen stepgrandmothers participated in semi-structured interviews, discussing their relationships with 94 stepgrandchildren. Consistent with grounded theory methods, data collection and analysis occurred simultaneously. Results: Interviews with stepgrandmothers revealed that they spend considerable time and energy defining their roles with stepgrandchildren. Stepgrandmothers' role enactment is a complex, reflexive process. A few perceived that their roles were shaped by their own dispositions, desires, and expectations (evidence for role-making), but most stepgrandmothers described their roles as reflecting the dispositions, desires, and expectations of others (evidence for role-taking). Stepgrandmothers reflected on their roles as a delicate balance of intra- and inter-personal negotiations, operating within cultural expectations. Implications: Findings draw attention to the complex nature of role-taking, role-making, and gendered, relational processes in multigenerational stepfamilies. We discuss implications for research and theory related to stepgrandmotherhood as an incomplete institution.

Divorce and Childhood Chronic Illness: A Grounded Theory of Trust, Gender, and Third-Party Care Providers.

Divorced parents face distinct challenges in providing care for chronically ill children. Children's residence in two households necessitates the development of family-specific strategies to ensure coparents' supervision of regimen adherence and the management of children's health care. Utilizing a risk and resilience perspective, a grounded theory study was conducted with 14 divorced parents of children with chronic illnesses. The importance of trust, gender, and relationships with third-party care providers emerged as key themes related to the development of effective coparenting relationships for maintaining children's health. Divorced parents were best able to support the management of their children's chronic conditions when care providers operated as neutral third parties and intermediaries. Collaborative family care may require health care practitioners to avoid being drawn into contentious inter-parental conflicts.