Chinese Family Management Of Childhood Chronic Disease And Family Intervention Study

BackgroundThe incidence of childhood chronic disease has increased rapidly.It not only triggers psychological,social and behavioral problems of children but also damages family fuction.Families' response to chronic diseases result from difference in how family members define and manage diseases,so studies including individual variables such as coping or stress can't comprehensively explain family as a unit reaction patten.Then, research turn to family responsse and management style of chronic diseases.Knafl and Gallo's team has made a unique contribution to this area.They conducted a series of qualitative research on family response to childhood chronic diseases.And,they already developed Family Management Measure guided by Family Management Style Framework to assess family reation toward disease and management pattern.Few studies involve childhood chronic disease or family nursing interventions in China.PurposeDescribe management style of Chinese families who suffered with childhood chronic illness.Determine the relationship among family management style,family fuctionning and individual functionning.Provide disease related written materials,conduct family task intervention and evaluate its effectiveness.Methods1.Survey:the study is cross-sectional,correlational designed.Convenient sampling was adoped to recruit 399 caregivers whose children have chronic illnesses.The children were admitted to 4 hospitals from February 2008 to April 2009,either in Beijing or Shanghai.The caregivers were asked to complete qustionairs on family management style,family functionning and children's psychosocialbehavioral prolems.2.Pilot intervention:provide educational brochure and conduct family intervention based on Burke family stressors and task framework.43 children and their caregivers who repeat hospitalized from October 2008 to April 2009 participanted in the program.3 moths later,the effectiveness of the intervention had been evaluated.Results1.Results from survey:①The scores on Family Management Measure and 6 subscales indicated enduring type of Chinese families.②6 subscales of Family Management Measure were associated with each other,r=0.23-0.69,p＜0.05。③Parents were more confident and competent to manage diseases if they lived in cities,had one child,had college education,maintained job,earned more than 1500 yuan per month or children were not taken care of by their grandparents or they were junior or high school students, hospitalized once per year and had renal,rheumatic or endocrinopathic diseases.On the contrary,parents tended to complain difficulty or burden in management if they lived with children's grandparents,quit the job,earned less than 3000 yuan or their children were girls,hospitalized more than 3 times and renal,rheumatic or genetic diseases lasted 1-3 years.④Family functionning of families with childhood chronic diseases decreased compared with normal families,t=11.79,p＜0.05。⑤The predictors for family fuctionning were parents' employ status,child's daily life,view of condition impact, parent maturity,renal disorders and the course of diseases less than 3 years.⑥CBCL scores for boys and girls of 6-11 year and 12-16 year groups were significantly higer than corresponding normal children,t=7.08,33.56,27.69和35.88,p＜0.05。⑦The predictors for children's psycosocialbehavioral problem were living with grandparents,fathers' educational level,mother's employ status,child daily life and parent maturity.⑧Child daily life,condition management ability,parent maturity were positively correlated with children's social competence,however,they were negtively associated with children's behavioral problems and their family functioning,r=0.140-0.51,p＜0.05.On the other hand,view of condition impact,condition management difficuty scale and condition management effort were negtively correlated with children's social competence and positively associated with children's behavioral problems and their family functioning, r=0.10-0.41,p＜0.05.⑨Family functionning was positively associated with children's behavioral problems and negtively correlated with children's social competence, r=0.12-0.32,p＜0.05.2.Results from intervention:①The disease related knowledge of main caregivers increased after intervention,x~2=4.20-61.85,p＜0.05。②The state anxiety of caregivers decreased 2 weeks and 3 months after intervention,compared with pretest,F=85.78, p＜0.05。③Parents' perspections of family management were better 3 months after intervention than at pretest,t=-3.17,p＜0.05。Conclusion1.Family management style varied with diffirent family circumstance and children's factors.Families whose chidren had chronic diseases had lower family functionning and individual functionning than normal families.Family management style had an impact on family functionning and individual functionning.2.Written disease related educational materials combined with Burke stressors and tasks famework effectively increased the knowledge,alleviated anxiety of caregivers and promoted family management style to more posive and thriving direction.