Sharon D. Horner

Youth Resilience Framework for reducing health-risk behaviors in adolescents.

Adolescents engage in risky behaviors that compromise their health. Leading causes of morbidity and mortality are associated with a few preventable health-risk behaviors initiated in childhood and early adolescence. Interventions that enhance protective factors in childhood are needed to offset these vulnerabilities and thus promote the health of adolescents. The Youth Resilience Framework is presented that addresses individual and sociocultural risk factors and protective resources that can influence health outcomes throughout adolescence. This framework incorporates a developmental approach to address precursors and health-risk behaviors that may be amenable to early health-promoting interventions.

Personal strengths of homeless adolescents living in a high-risk environment

Health-risk behaviors and associated adverse health outcomes in homeless adolescents are well documented. Strengths of these youth that contribute to their health and well-being are seldom acknowledged. The purpose of this secondary analysis of qualitative data was to identify strengths that protect homeless youth. Two types of strengths emerged: resources and self-improvement. Resources served as the foundation for survival whereas self-improvement served as a process that enabled youth to consider a more healthy future. By recognizing the many strengths of homeless youth, nurses may develop community-based programs to help this population reenter society.

Using focus group methods with middle school children

Focus group methods are an effective way to clarify middle school childrens perceptions of health and illness. Children between 11 and 14 years of age, who are undergoing the developmental transition from child to adolescent, tend to be reticent when talking with adult strangers. However, they are more relaxed and willing to share perceptions when discussions are held with a group of peers. Conducting focus groups involves developing an interview guide, arranging the meeting place, supporting group building, and encouraging participation by the group members while discouraging domination by influential members. Data analysis begins during the focus group session as issues emerge in the context of group discussions.

Improving readability of patient education materials.

Functional illiteracy contributes to negative long-term health consequences for patients who must understand and adhere to complex health care instructions and, therefore, is of primary importance to community health nurses. This problem is compounded when English is the patients second language. A process for improving patient education materials (PEMs) through adaptation or creation of new materials to meet the health needs of diverse groups is presented.1 The process was applied to a popular health education program used with school-age children and their parents to teach them home management of asthma. Target parents were known to read at a 5th-grade level, and English was a second language for many of them. Therefore, extensive revision of the existing PEMs was required. The steps to successful revision included assessing readability and comprehensibility, editing the materials, and evaluating the new PEMs to determine the effectiveness of the revision measures.

Family‐centered collaborative negotiation: A model for facilitating behavior change in primary care

PurposeTo describe a parent–child-based model that melds a family-centered interaction approach, Touchpoints, with brief negotiation strategies (an adaptation of motivational interviewing) to address health risks in children. An application of the model for addressing childhood overweight in the primary care setting is presented. Data SourcesSelected research, theoretical, and clinical articles; national recommendations and guidelines; and a clinical case. ConclusionsLifestyle health behaviors are learned and reinforced within the family; thus, changes to promote child health require family involvement. Interventions that engage parents and support parent–child relationships, while enhancing motivation and the abilities to change behavior, are recommended. Implications for PracticePrimary care is an appropriate setting for addressing lifestyle health behaviors. A collaborative partnership, rather than a prescriptive manner, is advocated for primary care providers when working to facilitate health-promoting behavior.

Improvement of Rural Children's Asthma Self-Management by Lay Health Educators

BACKGROUND The purpose of the present analysis is to examine changes in rural childrens asthma self-management after they received lay health educator (LHE)-delivered classes. METHODS Elementary schools were randomly assigned to the treatment or attention-control condition and their participating students received either asthma education or general health promotion education, respectively. The triethnic sample was composed of 183 children (46% Hispanic, 29.5% non-Hispanic white, 22% African American, and 2.6% other categories) who had a mean age of 8.78 years (SD = 1.24). The time frame from baseline to postintervention was 12 weeks. RESULTS Repeated measures analysis of variance found main effects in changes in scores for childrens asthma knowledge, asthma self-management, self-efficacy for managing asthma symptoms, and metered dose inhaler (MDI) technique and significant group interaction effects for the treatment intervention on the measures of childrens asthma knowledge, asthma self-management, and MDI technique. CONCLUSIONS The delivery of an asthma health education intervention by trained LHEs to school-aged children was an effective means for improving childrens knowledge and skills in asthma self-management.

Catching the asthma: Family care for school-aged children with asthma

The purpose of this study was to explore how families with school-aged children diagnosed with asthma incorporate asthma care into their daily lives. Twelve families with a school-aged child who had asthma participated in this study. Data collection involved a series of three in-depth interviews with family members in which the process of catching the asthma before it gets out of hand was uncovered, clarified, and validated. Learning the ropes, dealing with asthma, and coming to terms with asthma are the tasks engaged in by parents and their children to catch the asthma.

Computer-assisted survey interviewing of school-age children.

Longitudinal surveys of children in school settings can yield large volumes of data for use in exploring research questions that may influence development of intervention programs. However, traditional methods of data collection such as paper-and-pencil questionnaires or person-to-person interviewing present major threats to validity throughout the process of data collection, data management, and data analysis. The use of computer-assisted survey interviewing is an alternative that has both advantages and disadvantages. Lessons learned in the first wave of a longitudinal study of approximately 1161 children in fourth, fifth, and sixth grades illustrate both the strengths and limitations of this method.

Evaluating the effect of an asthma self-management intervention for rural families.

Abstract Objective: To present outcomes of an asthma self-management educational intervention delivered to children (grades 2–5) at school and to parents in a home visit. Methods: The intervention effectiveness was tested in a 12-month longitudinal study with randomization by elementary schools into treatment and attention-control groups with 183 children who had a diagnosis of asthma. Data were collected at four time points. Change over time was examined with linear mixed models. Results: Quality of life (QOL), hospitalizations, and emergency department visits improved significantly for all the children. African American and Mexican American children had worse asthma-related QOL than did White children. Asthma management behaviors, asthma self-efficacy, and coping likewise improved with girls improving significantly more than the boys. Significant improvements in inhaler skill and asthma severity were seen in the treatment group children when compared to the control group. Treatment group parents showed significant improvements in home asthma management and self-efficacy. Conclusions: The improvement in inhaler skill is an important finding for practitioners as this is a behavior that can be addressed in the clinical setting. The reduction in the treatment group’s asthma severity scores may reflect the improvement in medication delivery as their inhaler skill improved. The differential improvement between boys and girls points to the need for testing other formats in asthma education that can address different learning styles. The individualized parent asthma education enabled the intervener to incorporate neighborhood and home environmental information thereby allowing for tailoring of parental instruction.

Measuring Asthma Severity: Instrument Refinement

The focus of this study is to evaluate a brief parent-report instrument, the Severity of Chronic Asthma (SCA) scale, that conforms to the national guidelines for assessing asthma. Convergent validity was found between the SCA and other measures related to asthma severity including an illness severity scale (How Bad is the Asthma?), asthma management scales for parents and children, and the pediatric quality-of-life scale. The SCA is a multidimensional scale with appropriate evidence of reliability and validity that may be a heuristic and effective measure in both clinical practice and research endeavors.