Eileen K. Kintner

Randomized clinical trial of therapeutic music video intervention for resilience outcomes in adolescents/young adults undergoing hematopoietic stem cell transplant: A report from the Children's Oncology Group

To reduce the risk of adjustment problems associated with hematopoietic stem cell transplant (HSCT) for adolescents/young adults (AYAs), we examined efficacy of a therapeutic music video (TMV) intervention delivered during the acute phase of HSCT to: 1) increase protective factors of spiritual perspective, social integration, family environment, courageous coping, and hope‐derived meaning; 2) decrease risk factors of illness‐related distress and defensive coping; and 3) increase outcomes of self‐transcendence and resilience.

Psychometric Properties of the Herth Hope Index in Adolescents and Young Adults with Cancer

The Herth Hope Index (HHIndex), originally developed for adults, was examined for appropriateness in two studies of adolescents and young adults with cancer—those at various stages of treatment (N = 127) and those newly diagnosed (N = 74). The internal consistency reliability (Cronbach’s alpha) of the index was .84 and .78, respectively, in the two samples. Construct validity was supported by discriminant correlations in the moderate to low range between the HHIndex and measures of uncertainty in illness and symptom distress, and by moderate convergent correlations with measures of resilience (self-esteem, self-confidence, and self-transcendence) and quality of life (index of well-being). A four-step factor analysis procedure was done, and confirmatory factor analysis suggested that a one-factor solution best fit the data in this population. Findings indicate that the HHIndex is a reliable measure of hope in adolescents and young adults with cancer. Evidence of discriminant and convergent validity in measuring hope in adolescents and young adults with cancer was also generated. Further exploration of the HHIndex factor structure in adolescents and young adults is needed.

The resilience in illness model, Part 1: Exploratory evaluation in adolescents and young adults with cancer

Background: Resilience is a positive health outcome identified by the Committee on Future Direction for Behavioral and Social Sciences as a research priority for the National Institutes of Health. The Resilience in Illness Model (RIM) was developed from a series of qualitative and quantitative studies, to increase understanding of how positive health protective factors (ie, social integration, family environment, courageous coping, and derived meaning) may influence resilience outcomes. The RIM also includes 2 risk factors: illness-related distress and defensive coping. Objective: The purpose of this 2-part article was to report on evaluation of the RIM for adolescents/young adults (AYAs) with cancer. Here, in part 1, our purpose was to describe the exploratory RIM evaluation, and in part 2 we describe the confirmatory RIM evaluation. Methods: An exploratory evaluation of RIM was done using exploratory latent variable structural equation modeling with a combined sample from 2 studies of preadolescents and AYAs with cancer aged 10 to 26 years (n = 202). Results: Results, including goodness-of-fit indices, support the RIM as a theory with a high level of explained variance for outcomes of resilience (67%) and self-transcendence (63%). Variance explained for proximal outcomes ranged from 18% to 76%. Conclusions: Findings indicate that, following confirmatory testing, the RIM may be a useful guide to developing targeted interventions that are grounded in the experiences of the AYAs. Implications for Practice: Understanding of the AYA cancer experience to improve holistic care is increased.

Adolescent Process of Coming to Accept Asthma: A Phenomenological Study

Health care team members in the clinical setting frequently comment that if adolescents would just accept their asthma and the need for continued treatment they would not experience so many problems. A review of the literature reveals researchers have not explored the process of acceptance or what effect acceptance may have in the lives of adolescents experiencing asthma. The purpose of this study was to identify the essential structure of the process of acceptance of chronic illness by adolescents experiencing asthma/reactive airway disease. Phenomenological design, method, and analysis within a life-span developmental framework guided this study. The sample consisted of 6 adolescents diagnosed with asthma who were identified by health care professionals as verbalizing and demonstrating acceptance of their chronic illness. The results have implications for diagnosing lack of acceptance and developing and testing interventions to facilitate acceptance.

Testing the Acceptance of Asthma Model With Children and Adolescents

Older school-age children and early adolescents with asthma have demonstrated and verbalized difficulty in accepting their condition. Although researchers have explored adult acceptance, few have explored child or adolescent acceptance. The purpose was to explore the fit of the data to a specified latent variable acceptance of asthma model. School-age children and early adolescents (N = 118), ages 9 to 14 years enrolled in Grades 4 to 9, diagnosed with asthma and their parents completed self-report instruments. EQS was used for structural equation modeling analyses. The specified model was a good fit to the data and accounted for more than 70% in the explained variance of vigilance, 30% of participation in life activities, 25% of taking control, and 20% of asthma health behaviors. Support for the model possess implications for development of theory-based education and counseling interventions to support participation in life activities by targeting cognitive, behavioral, and psychosocial aspects of living with the asthma.Older school-age children and early adolescents with asthma have demonstrated and verbalized difficulty in accepting their condition. Although researchers have explored adult acceptance, few have explored child or adolescent acceptance. The purpose was to explore the fit of the data to a specified latent variable acceptance of asthma model. School-age children and early adolescents (N = 118), ages 9 to 14 years enrolled in Grades 4 to 9, diagnosed with asthma and their parents completed self-report instruments. EQS was used for structural equation modeling analyses. The specified model was a good fit to the data and accounted for more than 70% in the explained variance of vigilance, 30% of participation in life activities, 25% of taking control, and 20% of asthma health behaviors. Support for the model possess implications for development of theory-based education and counseling interventions to support participation in life activities by targeting cognitive, behavioral, and psychosocial aspects of living...

Randomized Clinical Trial of a School-Based Academic and Counseling Program for Older School-Age Students

Background: Up to 17% of children in the United States have been diagnosed with asthma; children ages 9-14 years experience higher morbidity and mortality compared with other age groups. An academic and counseling program for older elementary students with asthma was developed in collaboration with school personnel, healthcare professionals, and community members: Staying Healthy-Asthma Responsible and Prepared (SHARP). The life span development perspective and the Acceptance of Asthma Model were used to guide development and implementation. Objectives: This study aimed to establish the preliminary efficacy of SHARP to improve cognitive, behavioral, psychosocial, and quality-of-life outcomes. Methods: A two-group, longitudinal, prospective, cluster randomized clinical trial design was used. The sample of fourth- to sixth-grade students (N = 66) with asthma aged 9-12 years (M = 10.5, SD = 0.9) was 52% male, was racially diverse (30% Black, 36% White, and 18% biracial), and had a wide range of incomes. Three schools (n = 38 students) were randomized to receive SHARP, and two schools (n = 28 students) were assigned to usual care. Self-report instruments were used. Results: Compared with the usual care group, statistically significant improvements in the SHARP group were found in student knowledge of asthma, reasoning about asthma, use of risk reduction behaviors, and participation in life activities (p < .01, effect sizes >0.7). Improvements in use of episode management behaviors and acceptance of asthma outcomes were clinically significant with medium effect sizes of 0.3-0.5. Discussion: The SHARP Student and Community Components demonstrated preliminary efficacy for improving asthma knowledge, reasoning about asthma, use of episode management and risk reduction behaviors, acceptance of asthma in taking control and vigilance, and participation in life activities.

Effectiveness of a school- and community-based academic asthma health education program on use of effective asthma self-care behaviors in older school-age students

PURPOSE The purpose was to evaluate the effectiveness of Staying Healthy-Asthma Responsible & Prepared, an academic asthma health education and counseling program, on fostering the use of effective asthma self-care behaviors. DESIGN AND METHODS This was a phase III, two-group, cluster randomized, single-blinded, longitudinal design-guided study. Caregivers of 205 fourth- and fifth-grade students completed the asthma health behaviors survey at preintervention, and 1, 12, and 24 months postintervention. Analysis involved multilevel modeling. RESULTS All students demonstrated improvement in episode management, risk reduction/prevention, and health promotion behaviors; Staying Healthy-Asthma Responsible & Prepared students demonstrated increased improvement in episode management and risk reduction/prevention behaviors. PRACTICE IMPLICATIONS Working with schoolteachers, nurses can improve the use of effective asthma self-care behaviors.

Effectiveness of a school‐based academic asthma health education and counseling program on fostering acceptance of asthma in older school‐age students with asthma

PURPOSE The purpose of this study was to evaluate the effectiveness of the academic asthma education and counseling Staying Healthy-Asthma Responsible and Prepared™ (SHARP) program on fostering psychosocial acceptance of asthma. DESIGN AND METHODS This was a phase III, two-group, cluster-randomized, single-blinded, longitudinal study. Students from grades 4 and 5 (N = 205) with asthma and their caregivers completed surveys at pre-intervention and at 1-, 12-, and 24-months post-intervention. Analysis involved multilevel modeling. RESULTS All students demonstrated significant improvement in aspects of acceptance; students in SHARP demonstrated significant improvement in openness to sharing and connectedness with teachers over students in the control condition. PRACTICE IMPLICATIONS The SHARP program offers a well-tested, effective program for psychosocial acceptance of asthma, which is welcomed by schools.

Feasibility and benefits of a school-based academic and counseling program for older school-age students with asthma.

An asthma education program for older school-age students with asthma was developed in collaboration with school personnel, healthcare professionals, and community partners. Feasibility and benefits were evaluated using a single-group, prospective, quasi-experimental design. The convenience sample, consisting of 28 grade 6 and 7 students with asthma, had 50% males, a diverse racial background, and a wide range of incomes. Feasibility and benefits were demonstrated by comparing pre-intervention to 1- and 12-month post-intervention evaluation of students who completed more than 70% of the 10 sessions. Statistically significant improvements in cognitive, behavioral, psychosocial, and quality of life outcomes were seen from pre-intervention to 1-month post-intervention (all p < .03). Severity of asthma significantly improved from 1- to 12-month post-intervention (p= .04).

Development and preliminary evaluation of the participation in life activities scale for children and adolescents with asthma: an instrument development study

BackgroundBeing able to do things other kids do is the desire of school-age children and adolescents with asthma. In a phenomenology study, adolescents identified participation in life activities as the outcome variable and primary motivator for behavioral changes in coming to accept asthma as a chronic condition. In preparation for testing an acceptance model for older school-age children and early adolescents diagnosed with asthma, the Participation in Life Activities Scale was developed. The purposes of this paper are to describe development, and report on face and content validity of the scale designed to measure one aspect of quality of life defined as level of unrestricted involvement in chosen pursuits.MethodsItems generated for the instrument evolved from statements and themes extracted from qualitative interviews. Face and content validity were evaluated by eight lay reviewers and 10 expert reviewers. Rate of accurate completion was computed using a convenience, cross-section sample consisting of 313 children and adolescents with asthma, ages 9–15 years, drawn from three studies. Preliminary cross-group comparisons of scores were assessed using t-tests and analysis of variance.ResultsFace and content validity were determined to be highly acceptable and relevant, respectively. Completion rate across all three studies was 97%. Although cross-group comparisons revealed no significant differences in overall participation scores based on age, race or residence groupings (p > .05), significant difference were indicated between males and females (p = .02), as well as the highest and lowest socioeconomic groups (p = .002).ConclusionAssessing content validity was the first step in evaluating properties of this newly developed instrument. Once face and content validity were established, psychometric evaluation related to internal consistency reliability and construct validity using factor analysis procedures was begun. Results will be reported elsewhere.