Debbie Fallon

Apps and Adolescents: A Systematic Review of Adolescents’ Use of Mobile Phone and Tablet Apps That Support Personal Management of Their Chronic or Long-Term Physical Conditions

Background The prevalence of physical chronic or long-term conditions in adolescents aged 10-24 years is rising. Mobile phone and tablet mobile technologies featuring software program apps are widely used by these adolescents and their healthy peers for social networking or gaming. Apps are also used in health care to support personal condition management and they have considerable potential in this context. There is a growing body of literature on app use in health contexts, thereby making a systematic review of their effectiveness very timely. Objective To systematically review the literature on the effectiveness of mobile apps designed to support adolescents’ management of their physical chronic or long-term conditions. Methods We conducted a review of the English-language literature published since 2003 in five relevant bibliographical databases using key search terms. Two independent reviewers screened titles and abstracts using data extraction and quality assessment tools. Results The search returned 1120 hits. Of the 19 eligible full-text papers, four met our review criteria, reporting one pilot randomized controlled trial and three pretest/post-test studies. Samples ranged from 4 to 18 participants, with a combined sample of 46 participants. The apps reported were targeted at type 1 diabetes, asthma, and cancer. Two papers provided data for calculating effect size. Heterogeneity in terms of study design, reported outcomes, follow-up times, participants’ ages, and health conditions prevented meta-analyses. There was variation in whether adolescents received guidance in using the app or were solely responsible for navigating the app. Three studies reported some level of patient involvement in app design, development, and/or evaluation. Health professional involvement in the modelling stages of apps was reported in all studies, although it was not always clear whether specific clinical (as opposed to academic) expertise in working with adolescents was represented. The dearth of studies and the small overall sample size emphasizes the need for future studies of the development, evaluation, use, and effectiveness of mobile apps to support adolescents’ personal management of their conditions. Conclusions A key finding of the review is the paucity of evidence-based apps that exist, in contrast to the thousands of apps available on the app market that are not evidence-based or user or professional informed. Although we aimed to assess the effectiveness of apps, the dearth of studies meeting our criteria meant that we were unable to be conclusive in this regard. Based on the available evidence, apps may be considered feasible health interventions, but more studies involving larger sample sizes, and with patient and health professional input at all stages, are needed to determine apps’ acceptability and effectiveness. This review provides valuable findings and paves the way for future rigorous development and evaluation of health apps for adolescents with chronic or long-term conditions.

Young, gifted, and caring: A project narrative of young carers, their mental health, and getting them involved in education, research and practice

Young carers are a global phenomenon. The UK estimates it has in excess of 175 000 young carers, the onset of their caring role often occurring between 8 and 10 years of age. Of these, 17 000 are caring for a parent who has severe mental illness, a significant factor for children entering the health and social care system, as up to 60% experience mental health difficulties themselves. This paper reports on the outcome of a participatory project aimed at better understanding the needs of young people. A World Café event was hosted, bringing together those involved in promoting the mental health of young people in a partnership consortium. The event was led by young service users and carers. Important issues raised by the young carers were being excluded from being included; stuck in the here and now, ignoring the future; a hole in the net; and ensuring the hidden is on the agenda. The World Café gave the university the privilege of insight into what local young carers need to improve their mental health, and more importantly, how we can utilize our skills to help them achieve their goals.

‘They’re Gonna Think it Now’: Narratives of Shame in the Sexual Health Experiences of Young People

This article explores how shame operated for a group of young females who accessed emergency contraception (EC) following either contraceptive failure or unprotected sex. Accessing EC invoked anticipated judgements and feelings of shame that made them feel out of place – even in youth friendly environments, and this compelled many of them to avoid seeking much needed support. The article explores this issue, highlighting how the complex relationships that young people have with adults around them is often overlooked, and particularly the idea that they may be ‘shamers’ who unwitting evoke feelings of shame, troubling the notion that it is poor relationships that drive young people to avoid communicating with parents about sexual health matters. This has implications for healthcare practice, not least because current approaches suggest that the involvement of parents and the development of a better rapport with service providers may be the key to reducing teenage pregnancy rates.

Mobile Phone and Tablet Apps to Support Young People's Management of Their Physical Long-Term Conditions: A Systematic Review Protocol

Background The prevalence of long-term or chronic conditions that limit activity and reduce quality of life in young people aged 10-24 years is rising. This group has distinct health care needs and requires tailored support strategies to facilitate increasing personal responsibility for the management of their condition wherever possible, as they mature. Mobile phone and tablet mobile technologies featuring software program apps are already well used by young people for social networking or gaming. They have also been utilized in health care to support personal condition management, using condition-specific and patient-tailored software. Such apps have much potential, and there is an emerging body of literature on their use in a health context making this review timely. Objective The objective of this paper is to develop a systematic review protocol focused on identifying and assessing the effectiveness of mobile phone and tablet apps that support young people’s management of their chronic conditions. Methods The search strategy will include a combination of standardized indexed search terms and free-text terms related to the key concepts of young people; long-term conditions and mobile technology. Peer-reviewed journal articles published from 2003 that meet the inclusion and exclusion criteria will be identified through searching the generated hits from 5 bibliographical databases. Two independent reviewers will screen the titles and abstracts to determine which articles focus on testing interventions identified as a mobile phone or tablet apps, and that have been designed and delivered to support the management of long-term conditions in young people aged 10-24 years. Data extraction and quality assessment tools will be used to facilitate consistent analysis and synthesis. It is anticipated that several studies will meet the selection criteria but that these are likely to be heterogeneous in terms of study design, reported outcomes, follow-up times, participants’ age, and health condition. Sub-group analyses will be undertaken and where possible meta-analyses will take place. Results This review will synthesize available knowledge surrounding tablet and mobile phone apps that support management of long term physical health conditions in young people. The findings will be synthesized to determine which elements of the technologies were most effective for this population. Conclusions This systematic review aims to synthesize existing literature in order to generate findings that will facilitate the development of an app intervention. The review will form the first phase of development and evaluation of a complex intervention as recommended by the United Kingdom Medical Research Council. The knowledge gained from the review will be verified in subsequent phases, which will include primary qualitative work with health professionals and young people with long term conditions as research participants. Young people living with long-term conditions will be involved as co-researchers and consumer advisors in all subsequent phases to develop and evaluate an app to support the management of long-term physical health conditions. Trial Registration PROSPERO International prospective register of systematic reviews: CRD42014015418; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014015418#.VRqCpTpnL8E (Archived by Webcite at http://www.webcitation.org/6XREcWqQY).

Adolescent access to emergency contraception: a comment on the UK context

The provision of emergency contraception (EC) in the United Kingdom (UK) has been transformed over the past decade through advances in pharmacology and the implementation of governmental measures to reduce teenage pregnancy rates. This paper considers how these issues have developed in the current social and political context with specific reference to adolescent access to EC in the UK. It highlights the concerns caused by increased availability of EC and the tension between adolescent rights to confidential treatment and advice, and professional anxiety about encouraging secrecy or parental deception. It concludes that adolescents, whilst benefiting from increased access to EC may also face a series of challenges as a result.

Four-year longitudinal impact evaluation of the Action for Children UK Neglect Project: Outcomes for the children, families, Action for Children, and the UK

Neglect has a devastating impact on children and is the most pervasive form of child maltreatment in the United Kingdom. The study purpose was to establish outcomes for neglected children following structured assessment and intervention to ascertain what worked and why it worked. This prospective cohort study included 85 cases of neglected children under 8 years of age from 7 centers across the United Kingdom. Data were collected between 2008 and 2012 through serial quantitative recording of the level of concern about neglect. Serial review of qualitative case-file data was undertaken for detail of assessment, interventions, and evidence of outcomes for the child. Data analysis was undertaken by paired t-test, Chi Square, descriptive statics for categorical data, and, for narrative data, identification of recurring factors and patterns, with correlation of presenting factors, interventions, and outcomes. Paired t-test demonstrated significant decrease in overall Action for Children Assessment Tool scores between assessment (M=43.77, SD=11.09) and closing the case (M=35.47, SD=9.6, t(84)=6.77, p<0.01). Improvement in the level of concern about neglect was shown in 79% of cases, with only 21% showing no improvement. In 59% of cases, concern about neglect was removed completely. Use of the assessment tool fostered engagement by parents. The relationship between lack of parental engagement and children being taken into care was statistically significant, with a large effect size (χ(2) 10.66, df1, p=0.0001, OR=17.24). When parents refused or were unable to respond positively to the intervention, children benefited from an expedited move into care.

A DIFFERENT WORLD?: THE TRANSITION EXPERIENCES OF NEWLY QUALIFIED CHILDREN'S NURSES TAKING UP FIRST DESTINATION POSTS WITHIN CHILDREN'S COMMUNITY NURSING TEAMS IN ENGLAND

The concept of transition is of fundamental concern to those seeking to prepare, recruit, and retain newly qualified staff. The pioneering work of researchers such as Kramer (1974) who explored the transition experiences of nurses has transcended international boundaries (Whitehead & Holmes, 2011) to influence the educational preparation of nurses worldwide. However, much of what we know about the transition experiences of newly qualified nurses is based on research with adult nurses and in the acute care settings. This article outlines the findings from a qualitative study about the experiences of a group of newly qualified children’s nurses in England who had taken up first destination posts in community children’s nursing teams at a time when such posts were novel, and had previously been met with some resistance. Data were collected using semi-structured interviews and fieldwork observation, and analyzed using a combination of thematic analysis (Braun & Clarke, 2006) and the framework approach (Ritchie & Lewis 2003; Smith & Firth 2011). The findings are outlined under the broad headings of “Shadowing,” “The Visits,” and “Emerging Identity” and support previous research that highlights how good formal support and the physical presence of a preceptor is valued by newly qualified nurses since it reduces occupational stress. However, the study also highlights the downside of such support which occurred because some accepted practices inadvertently reduced confidence and therefore inhibited a smooth transition. The ideal transition experience therefore necessitated a more individual approach, allowing for different rates of progression. The primary care environment allowed for such individuality which may account for the significant finding that the nurses in this study did not report feelings of reality shock (Kramer, 1974) as experienced by those in acute care settings. The study therefore highlights how the development of a new professional identity as a community children’s nurse is not just dependent on the actions of the newly qualified nurse, but also of those with whom they work.

Prime time youth development intervention improves contraceptive use and sexual awareness among sexually active adolescent girls

Commentary on: Sieving RE, McRee AL, McMorris BJ, et al. Prime time: sexual health outcomes at 24 months for a clinic-linked intervention to prevent pregnancy risk behaviors. JAMA Pediatr 2013;167:333–40.[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] The causes and consequences of unintended teenage pregnancy have, quite rightly, been the focus of considerable research attention in the industrialised Western world over the past 15 years, since it is associated with disproportionately poor outcomes for young parents and their children. The UK as well as the USA have signalled that despite current historic reductions in teenage pregnancy rates, the statistics only … [1]: {openurl}?query=rft.jtitle%253DJAMA%2BPediatr%26rft.volume%253D167%26rft.spage%253D333%26rft_id%253Dinfo%253Adoi%252F10.1001%252Fjamapediatrics.2013.1089%26rft_id%253Dinfo%253Apmid%252F23440337%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1001/jamapediatrics.2013.1089&link_type=DOI [3]: /lookup/external-ref?access_num=23440337&link_type=MED&atom=%2Febnurs%2F17%2F2%2F49.atom [4]: /lookup/external-ref?access_num=000319825800005&link_type=ISI

Book Review: Allison James, Anne Trine Kjorholt and Vebjort Tingstad (eds), Children, Food and Identity in Everyday Life

Anglo visitors’ (p. 95). What seems the most important conclusion is a ‘peculiar pull between structure and improvisation’ in Italian culture (p. 285). Unhappily, it amounts to a desperately unsatisfactory book. While I was merely sorry not to have been taught anything about visual sociology beyond a few obvious remarks, I was far more disappointed to end up with even more puzzlements. Why, despite a chatty style, was the discussion hard to follow: unaccountable chapter sub-divisions, the conceptual inspiration of Saussure’s distinction between langue and parole introduced (p. 14) but never mentioned again, history bafflingly leaping from the Middle Ages to the films of Bertolucci and Olmi in a few paragraphs (p. 35)? Why, when defiantly defensive about a small sample in a single city are there repeated generalizations to ‘Italians’ and Italian culture? Who is the book for? What is the reader to make of recurrent exclamation marks, of the over-use of food metaphors, of explanations such as ‘[B] eneath the manifest functions of social phenomena are what sociologists call latent functions’ (p. 230)? What is the purpose of the Italian Glossary (including non-Italian entries such as ‘béchamel’, ‘pellagra’ and a third misspelling of caffè) when its contents are explained in the text? Why has the book been so dreadfully badly proofread: missing nouns, superfluous prepositions and misspellings in both Italian and English? Why is a cookery book recommended to ‘those English-speaking gourmands who want to learn to cook the foods of Bologna’ (p. 31)? This last is perhaps the biggest clue. In effect, the book never gets beyond what Rebecca Spang has adroitly dubbed ‘gastro-hagiography’. It would seem that Harper’s love affair with a version of Bolognese cuisine led to casting the study as a search for its essential nature. But ‘what is Italian and wonderful about the food?’ is a gourmet’s question. The sociologist’s question is ‘how does framing the gourmet’s question become possible and deemed unexceptionable?’. The authors miss the opportunity of devising a defensible sociological stance, in good measure by overlooking much of the literature. Indeed, although they do cite Helstosky’s 2004 Garlic and Oil, they appear to miss its explicit observation that what non-Italians regard as typical Italian eating is as much an imagined and invented tradition as it is reality. Had Harper and Faccioli double-checked this source, among many others, they might have been saved from ending where they should have begun.