Adolescents with chronic conditions: Engagement with children's mental health systems during the Covid-19 pandemic

IF 1.2 4区医学 Q3 NURSING

Journal for Specialists in Pediatric Nursing Pub Date : 2023-02-23 DOI:10.1111/jspn.12403

Suzanne E. Courtwright PhD, PNP, NEA-BC, Jacqueline Jones PhD, RN, Amy Barton PhD, RN, ANEF, Kerry Peterson PhD, DNP, PMHNP-BC, RN, Karen Eigen MD, Jessica Feuerstein DO, Anil Pawa MD, Akhil Pawa BS, Jennifer Northridge MD, Harpreet Pall MD, MBA, CPE

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引用次数: 1

Abstract

Purpose

The Covid-19 pandemic contributed to adverse adolescent mental health outcomes globally. Adolescents with chronic conditions have four times the odds of self-harm than peers. Little evidence exists to guide pediatric nurses on how to engage this vulnerable population with mental health support as the pandemic continues. In adults with chronic conditions, positive health assets (health access literacy, health self-efficacy, and emotional well-being) are directly related to improved patient engagement. The objective of this study was to gain a deeper understanding of engagement with mental health supports in adolescents with chronic conditions to inform practice.

Design and Methods

Using mixed methods, we surveyed and interviewed adolescents with chronic conditions aged 10–20 years. Random sampling was applied to avoid bias. Valid and reliable scales were used to measure health access literacy, health self-efficacy, and emotional well-being. Textual data were collected using a semistructured interview guide. Integrated data analysis was conducted using structural equation models and interpretive phenomenology.

Results

One hundred fifty-four participants provided numerical data and 17 participants provided textual data (mean age 15.5 years; 56% female, 5.8% agender; 56% White; 16.9% Black or African American, 4.5% Asian; 51.9% Hispanic or Latinx; 23.4% LGBTQ+). The structural model was an acceptable fit for the data (comparative fit index [CFI] = 0.97, Tucker–Lewis index [TLI] = 0.95). Participants reported higher levels of health access literacy (M = 3.88, SD = 0.848) than health self-efficacy (M = 2.98, SD = 0.646), and engagement (M = 1.78, SD = 1.71). Health access literacy predicted emotional well-being (β = .33, p < .001, 95% confidence interval [CI] [.20, .50]) and health self-efficacy (β = .52, p < .001, 95% CI [0.42, .062]). Emotional well-being positively predicted health self-efficacy (β = .21, p < .003, 90% CI [0.10, 0.033]). Health self-efficacy predicted engagement (β = .20, p < .01, 90% CI [0.07, 0.034]). Participants reported not engaging until “it was really, really bad” citing fear, stigma, and lack of connectedness with providers as barriers.

Practice Implications

Regardless of health access literacy and health self-efficacy, adolescents with chronic conditions may not engage until crisis levels. Pediatric nurses can aim to engage with this vulnerable population proactively.

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患有慢性疾病的青少年:在2019冠状病毒病大流行期间参与儿童精神卫生系统

2019冠状病毒病大流行导致全球青少年心理健康状况不良。患有慢性疾病的青少年自残的几率是同龄人的四倍。几乎没有证据可以指导儿科护士如何在大流行持续的情况下为这一弱势群体提供心理健康支持。在患有慢性疾病的成年人中，积极的健康资产(健康获取素养、健康自我效能感和情绪幸福感)与患者参与度的提高直接相关。本研究的目的是为了更深入地了解慢性疾病青少年的心理健康支持，以便为实践提供信息。设计与方法采用混合方法，对10-20岁的青少年慢性疾病患者进行调查和访谈。为避免偏差，采用随机抽样。采用有效可靠的量表来测量健康获取素养、健康自我效能感和情绪幸福感。文本数据采用半结构化访谈指南收集。采用结构方程模型和解释现象学对数据进行综合分析。结果154名参与者提供数字资料，17名参与者提供文字资料(平均年龄15.5岁;56%为女性，5.8%为性别;56%的白人;16.9%的黑人或非裔美国人，4.5%的亚洲人;51.9%为西班牙裔或拉丁裔;”+ 23.4%)。结构模型对数据的拟合是可接受的(比较拟合指数[CFI] = 0.97, Tucker-Lewis指数[TLI] = 0.95)。参与者报告的健康获取素养水平(M = 3.88, SD = 0.848)高于健康自我效能感(M = 2.98, SD = 0.646)和敬业度(M = 1.78, SD = 1.71)。健康获取素养预测情绪幸福感(β =。33、p <001, 95%可信区间[CI]。20， .50])和健康自我效能感(β =。52、p <001, 95% ci[0.42, 0.062])。情绪幸福感正向预测健康自我效能(β =。21、p <003, 90% ci[0.10, 0.033])。健康自我效能预测敬业度(β =。20、p <0.01, 90% ci[0.07, 0.034])。参与者报告说，直到“情况真的、真的很糟糕”，他们才开始参与，原因是恐惧、耻辱和与医疗服务提供者缺乏联系是障碍。无论健康获取素养和健康自我效能如何，患有慢性疾病的青少年可能直到危机水平才参与。儿科护士可以积极主动地与这些弱势群体接触。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal for Specialists in Pediatric Nursing 医学-护理

CiteScore

2.50

自引率

7.70%

发文量

审稿时长

>12 weeks

期刊介绍： Linking science and practice by publishing evidence-based information on pediatric nursing and answering the question, ''How might this information affect nursing practice?'' The Journal for Specialists in Pediatric Nursing (JSPN) is the international evidence-based practice journal for nurses who specialize in the care of children and families. JSPN bridges the gap between research and practice by publishing peer-reviewed reliable, clinically relevant, and readily applicable evidence. The journal integrates the best evidence with pediatric nurses'' passion for achieving the best outcomes. The journal values interdisciplinary perspectives and publishes a wide variety of peer-reviewed papers on clinically relevant topics.