Stressors And Coping Strategies In Children With Chronic Illness And Their Parents: Effects Of An Educational Intervention In Children And Their Parents

Background:Chronic illness is a common occurrence in childhood;it can not only affect normal development of children,but also affect their families,especially their parents.Children with chronic illness and their families have to cope with the chronic conditions for a long time,even for child's whole life.Understanding the stressors,coping strategies and psychosocial states in the chronically ill children and their parents,and providing educational interventions are very helpful for them to cope well with the chronic conditions.There is no evidence that stressors and coping strategies in chronically ill children and their parents have been explored in China.Purpose:(1).To explore the stressors,coping strategies,and psychosocial states in children with chronic illness and their parents.(2).To evaluate the effectiveness of an educational intervention in children with chronic illness and their parents.Methods:(1) The first study is a descriptive study.Purpose sampling was used to select 280 children with chronic illness and 280 parents from Peking Union Medical College Hospital pediatric outpatient and inpatient department between February 2007 and February 2008.The semi-structured interview was used to collect the data of stressors,and several scales were used to evaluate the coping strategies and psychosocial states in children with chronic illness and their parents. (2) The second study is a quasi-experimental design.Inpatients of PUMC Hospital pediatric ward,during February 2007～January 2008,including their parents(mother or father) were collected as the sample.Beside the usual care same as the control group, educational sessions were given to the experimental group,and the content of the sessions included knowledge of chronic disease,drugs,self-care,and coping skills.Results:(1) Part 1:①The stressors in chronically ill children mainly included five aspects:school performance,medication and treatment,daily life,peer relationships,and parent-child relationship.The "acceptance" coping strategies were more used by children.The prevalence of anxiety disorders of children was 54.6%,the prevalence of depression disorders was 33.6%,and 39.6%of the children had lower level of self-concept.②The stressors in parents mainly included six aspects:child's health,medical treatment of children,financial problems,medical care of child,parental role function,and communication.The parents more used the coping strategies of "maintaining family integration,cooperation" and less used "maintaining social support,psychological stability".The prevalence of anxiety disorders of parents was 58.6%,the prevalence of depression disorders was 56.8%,and 49.6%of the parents had both anxiety and depression disorders.③The stressors,coping strategies,and psychosocial states in children and their parents were influenced by demographic information of children and their parents,and the characteristic of children's diseases.④Both children and their parents,the more stressors they had,the less active coping strategies they used;active coping strategies were positively related to the well psychosocial states.(2) Part 2:After providing the educational interventions,comparing to the control group,①the knowledge level of parents of experimental group was higher,and the stressors were less than that of parents of control group,and parents of experimental group used more active coping strategies.②the knowledge level of children of experimental group was higher,and the stressors were less than that of the children of control group. Conclusions:(1) Children with chronic illness had many stressors and high level of stress,though they used active coping strategies,the prevalence of anxiety disorders and the prevalence of depression disorders among them were still high.The children,who were living in rural,absent from school,with serious disease condition,long duration of disease and lower family income,should be paid more attention.(2) Parents of children with chronic illness also had many stressors and high level of stress, they used limited active coping strategies,and the prevalence of anxiety disorders,the prevalence of depression disorders among them were high.The parents,whose children were absent from school and with serious disease condition,and the parents with lower education level and lower family income should be paid more attention.(3) The educational intervention resulted in improved knowledge level and less stressor of children and their parents,and improved coping strategies in parents.There was no evidence that the educational intervention could improve the psychosocial conditions of children and their parents.