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TEACHER FACTORS RELATED TO ACCEPTABILITY AND ADOPTION OF GROUP CONTINGENCY INTERVENTIONS FOR DISRUPTIVE BEHAVIOR
No full textDisruptive behavior is a frequent problem in many American classrooms, especially in schools with large populations of low income students. Nevertheless, many teachers do not use evidence based behavior management strategies. Group contingency interventions (GCIs), a group of thoroughly researched evidence based interventions for reducing disruptive behavior, have been found to be effective for students from elementary to high school, but the acceptability of these interventions has primarily been studied in elementary schools. The current study surveyed middle school teachers, and sought to identify factors that lead to increased likelihood of teachers finding GCIs acceptable, and possibly worth adopting. First we hypothesized that teaching special education, more previous exposure to GCI, less teacher experience, greater perceived severity of problem was positively related to a higher likelihood of acceptability of GCI over and above the influence of social desirability. Then we hypothesized that teaching special education would lead to greater exposure to GCI and subsequently greater acceptability of GCI. It was also hypothesized that the positive influence of amount of teacher exposure on acceptability would be weakened by perceiving the problem to be less severe and having more years of teaching experience. Finally, it was hypothesized that higher acceptability, greater teacher burnout, and greater intervention specific self-efficacy would be positively related to a higher likelihood of adoption of GCI over and above the influence of social desirability. Teachers (n = 76) from 13 rural, low-income, middle schools within 3 school systems were asked to rate the acceptability of GCIs, and the possibility that they would adopt using GCIs in the future. Teachers also reported whether they taught special education, their years of experience, their intervention self-efficacy, and the level of problem behavior they experienced. In addition, teachers completed measures of burnout and social desirability. Items measuring acceptability and adoption were combined to form one variable based on their internal consistency. A regression model evaluating teacher related variables was used to predict the combined outcome variable (Acceptability) while controlling for social desirability bias. Results indicated that teachers at rural, low-income schools found GCIs to be acceptable interventions for disruptive behavior (M = 21.42, range =10-27), and the majority of teachers endorsed adoption of the intervention in the future (82%). Examination of teacher related factors revealed that intervention self-efficacy predicted the combined Acceptability variable (B = 2.83, p [less than] 0.01) over and above all other teacher related factors after controlling for social desirability. None of the other teacher related factors predicted acceptability or adoption. Results also indicated higher rates of burnout in the current sample than in previous samples of human services workers (t(70) = 4.24, p [less than] .001). Results were discussed within the context of previous literature, and the limitations of the current study. The need for further research relating the implementation of GCIs to environmental, intervention-specific, and other teacher-related factors was described. Strategies to increase implementation of GCIs by teachers were also discussed. The current findings contribute to the limited literature on behavioral interventions for rural schools and middle schools
Multidimensional Conceptualization and Assessment of Fatigue in Pediatric Sickle Cell Disease: Impact of Fatigue on Quality of Life
No full textFatigue is a problematic symptom that has only recently gained attention in the literature for pediatric sickle cell disease (SCD). Research has established that fatigue is prevalent, persistent, and impairing, though much is left to understand about the presentation and impact of this symptom in this population. The current study sought to expand on previous literature by using a multidimensional conceptualization to examine fatigue using multiple indicators to capture a more comprehensive picture of fatigue and its impact on quality of life for youth with SCD. The first specific aim was to describe the experience of fatigue using surveys of self and other report, ecological momentary assessment (EMA) daily electronic diaries, and actigraphy as a proxy of a physiological measure of fatigue. The second aim was to examine relations between multiple fatigue indicators, and the third aim was to explore the impact on fatigue on quality of life (QOL) in youth with SCD. Eighty-nine children and adolescents with SCD ages 8-17 years old and their guardians were recruited from two regional pediatric SCD clinics. They completed structured interviews and measures of fatigue, and measures of quality of life. A subset of this sample, participating in a separate larger study, were asked to complete electronic daily diaries (EMA; N= 28) for up to one month, which included a brief one-item question about daily experience of fatigue. They were also asked to wear an accelerometer actigraphy wristwatch to measure continuous physical activity level for up to two weeks. Correlations and regression analyses were used to determine relationships of fatigue measures and their relation to QOL. Results indicated that youth experience significant symptoms of fatigue, and that their daily report of fatigue on EMA related to a previously validated measure of fatigue in youth with SCD. Fatigue, as measured by self and guardian-report surveys and EMA, was associated with lower QOL. Actigraphy measures of fatigue were not related to other fatigue measures or to QOL, and the structured fatigue interview was not related to QOL. Given these findings, fatigue is a common, problematic, and complex symptom of SCD requiring multiple levels of assessment, as well as additional research to better understand etiology, interaction of factors with other disease-related symptoms and their impact on QOL and daily functioning. With this increased understanding of fatigue, development of clinical prevention and intervention may be next steps to improving the lives of youth with SCD
THE INFLUENCE OF FAMILY FUNCTIONING ON MEDICAL SELF-EFFICACY IN ADOLESCENTS WITH SICKLE CELL DISEASE
No full textObjectives: Medical self-efficacy is defined as an individual’s belief in his or her ability to manage aspects of their disease and to lead to desired health outcomes (Edwards, Telfair, Cecil, and Lenoci, 2001). Prior research has related high medical self-efficacy with positive health outcomes in adolescents and adults with sickle cell disease (SCD; Clay and Telfair, 2007; Edwards et al, 2001). There has been a limited amount of research examining factors related to the promotion of medical self-efficacy in youth with SCD. The purpose of the current study is to investigate the influence of family functioning on medical self-efficacy in adolescents with SCD.
Methods: Fifty adolescents (29 females, 21 males) with SCD, aged 12 to 17 (M=14.68 ± 1.56 years), and their guardians were interviewed for inclusion in a larger study investigating the relationship between sleep and pain in youth with SCD. All participants in the study were required to have experienced SCD-related pain within the past year. Guardians of the adolescents reported on the adolescents’ age, sex, and SCD genotype. They also completed the Structured Pain Interview for Parents to assess adolescents’ SCD-related pain frequency in the past year and the Family Environment Scale to assess family functioning. Adolescents were asked to complete the Sickle Cell Self-Efficacy Scale to measure their level of medical self-efficacy. Correlation coefficients and a multiple regression were calculated to examine the relationship between medical self-efficacy and family cohesion, expressiveness, conflict, and independence promotion.
Results: Correlation coefficients indicated that medical self-efficacy was not related to family cohesion (r=.19, p=.19), expressiveness (r=.26, p=0.07), conflict (r=0.09, p=.51), or independence promotion (r=.14, p=.32). The model predicting self-efficacy using the family functioning factors was also not significant (F=0.65, p=0.68).
Conclusions: These findings suggest that family functioning is not related medical self-efficacy in adolescents with SCD. More research is needed to identify what factors are related to the development of medical self-efficacy in adolescents with SCD. This will aid in the development of programs to promote medical self-efficacy and long term health outcomes for this population.B.A
EXAMINING HEALTH RELATED EXPERIENCES IN ADOLESCENTS WITH SICKLE CELL DISEASE
No full textThis study was focused on investigating the general patterns of self-reported health-related stigma in adolescents with SCD. To date there was little research concerning adolescent experiences with health-related stigma. The study examined how SCD stigma affects other aspects of the adolescents’ lives, including their health-related quality of life, self-efficacy, and functional disability. It was hypothesized that most of the participants will report experiencing moderate levels of stigma, and that higher health-related stigma will be related to poorer health outcomes for adolescents with SCD. The findings reported that low amounts of stigma were experienced. Those that did report stigmatizing experiences reported poorer health outcomes
Understanding Fatigue in Pediatric Sickle Cell Disease
No full textFatigue is a problematic symptom for adults with SCD and other pediatric populations, but less is known about the experience of fatigue for youth with SCD. The present study described the experience of fatigue in children and adolescents with SCD, and examined the combined and unique influences of anemia, sleep quality, and pain on fatigue in this population. Ninety youth with SCD (aged 8 - 17 years) and their guardians were recruited at their outpatient pediatric SCD clinic appointments. They completed interviews and questionnaires concerning the youth's experiences of fatigue, including fatigue frequency, duration, severity, level of interference with daily activities, and how it presents (e.g., general fatigue, sleep/wake fatigue, or cognitive fatigue). They also reported on the youth's pain episodes in the past year (pain frequency, duration, severity), and behavioral sleep quality. Their medical chart were reviewed to determine level of anemia (hemoglobin level) at their clinic visit. The majority (75%) of youths' guardians reported that their youth experienced fatigue in the last month, and that the experience was primarily episodic, occurring an average of 7 times per month, and lasting almost 10 hours on average. Adolescents experienced longer fatigue episodes and worse cognitive fatigue than children. Findings also indicated that poor sleep quality and pain contributed to fatigue experience. Also, sleep quality moderated the relationship between pain and fatigue, such that having poorer sleep quality worsened the effect of pain on fatigue presentation. Findings underlie the importance of fatigue as a common and multidimensional symptom of pediatric SCD that functions in relation to other disease symptoms. Clinically, these findings suggest the need for consistent screenings for fatigue symptoms and sleep problems in youth with SCD, as well as interventions targeting poor sleep and pain to address issues of fatigue in youth with SCD
Effects of Emotional Symptoms on Pain and Social Functioning in Youth with Sickle Cell Disease
No full textSickle cell disease (SCD) is a group of genetic blood disorders primarily affecting people of African, Latino, and Mediterranean descent and has currently been diagnosed in over 100,000 Americans. This chronic disease causes red blood cells (RBC) to take on a sickled or C-shaped form, which obstructs blood flow, consequentially leading to a multitude of complications. The most prevalent complication is acute pain (Steinberg, 1999). SCD pain, also known as vaso-occlusive pain, results in about 70,000-90,000 yearly hospitalizations, and over 200,000 emergency room visits each year (National Heart, Lung, and Blood Institute [NHLBI], 2015). Patients most frequently report pain in the chest, back, and abdomen, while forty percent of all patients will develop a fatal complication known as acute chest syndrome (Steinberg, 1999). Pain episodes that lead to patients being hospitalized are known as pain crises, and they are commonly treated with blood transfusions, hydration, and opiates. To date, there is only one proven cure for SCD, which is a bone marrow transplant. Bone marrow transplants are very rare and associated with host of additional complications.
As patients with SCD grow older, their pain tends to worsen. This is particularly problematic in children and adolescents, because it affects their school attendance and limits their ability to participate in social activities (Shapiro et al, 1995). This makes it difficult to establish and maintain friendships, and may cause some kids to retreat into themselves. Children and adolescents with SCD report more feelings of shyness and loneliness, and are more likely to be victims of bullying (Forgeron et al., 2010).
Studies have suggested that poor emotional functioning may also lead to reduced social interactions among youth with SCD; thus, leading to poorer social functioning in this population. Also, poor emotional functioning may worsen the impact of pain on social functioning. However research exploring the impact of emotional functioning on social outcomes and the impact of pain on social outcomes in the pediatric SCD population is limited. The purpose of the current study is address this lack of research by exploring the influence of emotional functioning on social outcomes and the impact of pain on social outcomes in youth with SCD. The following literature review provides an in depth description of SCD, which is followed by descriptions of social and emotional functioning in youth with SCD
The Influence of Behavioral Factors on Fatigue Presentation in College Students
No full textOn average, college students report that they experience more sleep difficulties in comparison to healthy adults which is related to impairments in memory, learning, and the ability to concentrate and problem solve (Buboltz, Brown, & Soper, 2001; National Institutes of Health, 2012). The impact of poor sleep patterns on daily functioning may be due to increased fatigue during the day. Fatigue, a nationally recognized health concern among adults3 has not been fully examined in college students (Schiffert Health Center, 2010). Also, there is limited research on factors that may impact fatigue presentation or mediate the relationship between poor sleep and fatigue. This information is essential for designing effective intervention programs. Other behavioral factors that may influence fatigue include college students’ poor eating habits, participation in drinking activities, and physical activity patterns. Research in chronically ill populations have linked sleep disturbance and these behavioral factors to fatigue presentation (Strober & Arnett, 2005; Gerber, Stout, McGarvey, Soballe, Shieh, Diao, Pfalzer, 2011). However, the relations between these factors and fatigue have not been examined in healthy college students. This study described fatigue in a sample of college students and examined the relative contributions of sleep, diet, physical activity level, and alcohol consumption on fatigue presentation in college students. Participants included 191 undergraduate college students ranging in age from 18 to 38 years old. The majority of participants reported experiencing fatigue in the past month. Poor sleep quality, and high levels of uncontrolled eating and emotional eating were related to fatigue presentation, however, sleep quality was the only behavioral factor that significantly and uniquely predicted fatigue. Additional research should collect data from a broader age range of undergraduate students and should utilize an electronic diary to collect data. Clinical implications include the identified need to focus on sleep when developing health and wellness programs that target fatigue
Procedural Pain in Pediatric Sickle Cell Disease: The Effect of Parental Behaviors and Anxiety
No full textThis study examined the impact of parental behaviors and anxiety on children's procedural coping behaviors, pain, and distress during venipuncture in a pediatric sickle cell disease (SCD) population. The first specific aim was to examine the influence of parental behaviors on child coping behaviors. The second specific aim was to examine the influence of parental behaviors and child coping on child distress and pain. Thirty children ages 3-8 years old and their female parents/guardians were recruited from a regional pediatric SCD clinic. The average age of pediatric participants was 5.43 years and the average age of parent/guardian participants was 30.83 years. Parents/guardians reported on demographic and disease-related information as well as their pre-procedural state anxiety. The venipuncture procedure was video-recorded and coded for the following behaviors: child coping, child distress, parent coping-promoting, and parent distress-promoting. Parents, children, and staff also gave a pain rating for the child following the procedure. Results indicated that, overall, frequency of parental behaviors was very low. Parental behaviors and anxiety were not related to child coping behaviors. Parental behaviors were also not significantly related to child distress, child-reported pain, or parent reported-pain. However, parent distress-promoting behaviors significantly predicted staff-reported pain. Notably, more child coping behaviors were predictive of less parent-reported pain and less child distress behaviors. Future research should be conducted to determine the effects of high frequency parental behaviors on child distress, coping, and pain in this population. Additional research is also needed to elucidate the impact of staff, non-maternal caregivers, and other family members on the procedural pain experiences of pediatric SCD patients. Intervention development in this population should do more to include parents and other family members and to establish efficacy of other procedural pain interventions within SCD. Clinical implications include the need to increase children's knowledge and use of pain coping skills in SCD. Additionally, the venipuncture experience may prove to be a platform for practicing pain coping skills in hopes that these skills may also generalize to disease-related pain. This would give clinicians the opportunity to train parents and children on pain coping and give real-time feedback while they are practicing in clinic. Future research is needed to determine the effectiveness of such an intervention
Predictors of Grade Retention in Children and Adolescents with Sickle Cell Disease
No full textThis study examined the predictive value of sex, socioeconomic status (SES), disease severity, family achievement-orientation, and family relationship quality for predicting grade retention in children and adolescents with sickle cell disease (SCD). Additionally, this study investigated the extent to which family achievement-orientation and family relationship quality moderated relationships between the other predictor variables and grade retention. Data were extracted from a nationally representative database, the Cooperative Study of Sickle Cell Disease. Participants included 185 children and adolescents with SCD ranging in age from 7-16 years old. Older age and poorer reading achievement were significant predictors of grade retention. In addition, it was found that family achievement-orientation moderated the relationship between age and grade retention, such that high family achievement-orientation buffered against the negative effects of older age on grade retention. Additional research should study the influence of other dimensions of family functioning on grade retention and as a protective factor against other factors. Clinical implications include the identified need for psychosocial interventions that promote achievement-orientation in family members of children and adolescents with SCD. M.A
Treatment Adherence In Pediatric Sickle Cell Disease : Examining Medication Adherence, Appointment Keeping, And Self-Care Behaviors
No full textThe present study sought to ascertain whether treatment adherence in a pediatric SCD population is best described as a multidimensional or global construct by 1) examining the relationship between medication adherence, appointment keeping, and self-care behaviors, and 2) examining biological, psychological, and social factors that may predict aspects of treatment adherence. One hundred and twelve children and adolescents with SCD and their guardians completed an initial interview and reported on the participant's SCD pain, sleep patterns, treatment-related activities, psychosocial/academic functioning, family functioning, and demographic information. Medical chart reviews were also conducted to retrieve information regarding medication adherence as indicated by biological markers (mean corpuscular (MCV) and fetal hemoglobin levels) and appointment keeping behaviors. Results indicated that participants evidenced varying degrees of adherence from poor to good across different aspects of treatment adherence. Specifically, participants evidenced poor to moderate adherence to hydroxyurea as indicated by levels of fetal hemoglobin and MCV, respectively. Participants evidenced an average attendance rate of 85% with an average adherence level for the group across all self-care behaviors of 66%. Appointment keeping was significantly and positively related to fetal hemoglobin levels (r = .62, p < .05), but other indicators of treatment adherence were not significantly inter-correlated. SCD type was a significant predictor of medication adherence as indicated by MCV level ([beta] = .30, p < .05), and being female significantly predicted higher adherence in relation to both MCV ([beta] = .31, p < .05) and fetal hemoglobin ([beta] = .58, p < .01) levels. Other biopsychosocial factors were not significant predictors of aspects of treatment adherence. In conclusion, treatment adherence is best conceptualized as a multidimensional construct, with participants evidencing varying levels of adherence across behaviors with highest rates of adherence in relation to appointment keeping and lower levels of adherence in relation to self-care behaviors. Findings indicate the need for more research to promote better understanding of the use of biological markers as indicators of medication adherence and the exploration of other theoretical models that may contribute to the understanding of patterns of treatment adherence behaviors to facilitate the development of effective treatment interventions.Ph.D
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