Parental Perceptions Of Care Research Articles

Attitudes towards body and perception of parental care and close relationships in anorexia nervosa (AN)

IntroductionThe links between body image disturbances and distorted relationships with parents were supposed since the early conceptualizations of AN by Hilde Bruch. The empirical studies however were concerned with perceptual aspects of body image and much less is known about how the attitudinal aspects and the body-related behaviors are affected.ObjectivesTo study the attitudinal and behavioral aspects of body image in adolescents with AN in relation to perceived parental care and the attachments to close people.MethodsThe Body Investment Scale (BSI), Parental Bonding Instrument (PBI) and Attachment Style Questionnaire (ASQ) were used. 53 girls with Anorexia Nervosa were compared to 63 controls (adjusted by age).Results Girls with AN scored significantly higher on BIS Body attitude (p<.001) and Protection scales (p<.01), while displayed equal results on Body Care scale. They displayed lower Confidence in relationships (p<.01), higher Need for approval, Discomfort and preoccupation in close relationships (p<.05). No differences were found on PBI, excerpt for AN group perceiving less paternal control (p<.05). The correlation analysis, while showing a number of similar correlations within groups, suggests that in AN group positive Body image was more closely linked to perceived early care, especially from father (r=.6), in contrast with controls. In current relationships negative Body image for AN is stronger related to Discomfort and Need for approval (r>0.6), while Discomfort with Touch is less linked to problems in relationships than in controls.ConclusionsResults suggest the importance of studying the father’s mediating role in the formation of body attitudes in AN.DisclosureNo significant relationships.

Experiences at the End of Life From the Perspective of Bereaved Parents: Results of a Qualitative Focus Group Study.

Palliative care principles are known to support the experiences of children and their families throughout the illness trajectory. However, there is little knowledge of the parental perceptions of care delivered and gaps experienced by families receiving end-of-life care. We report the most helpful aspects of care provided during the end of life and identify opportunities to improve care delivery during this critical time. This study consists of 2 one-hour focus group sessions with 6 participants each facilitated by a clinical psychologist to explore the experiences of bereaved parents of pediatric oncology patients at the end of their child's life. The data were transcribed and coded using constant comparative analysis and evaluated for inter-rater reliability using intraclass correlation coefficient. Four common themes were identified through qualitative analysis: (1) valued communication qualities, (2) valued provider qualities, (3) unmet needs, and (4) parental experiences. The most prevalent of these themes was unmet needs (mentioned 51 times). Subthemes were identified and evaluated. Parents described struggling with communication from providers, loss of control in the hospital environment, and challenges associated with transition of care to hospice services. Interventions that support the complex needs of a family during end-of-life care are needed, especially with regard to coordination of care.

Youth and parent perceptions of parenting in childhood cancer survivors and healthy peers.

Having a child diagnosed with cancer may have a long-term impact on parenting practices. The aims of this study were to (a) examine possible differences in youth and parent perceptions of parenting between childhood cancer survivors and healthy comparisons, (b) determine the concordance between youth and parent perceptions of parenting, and (c) explore differences in parent-youth concordance between survivors and healthy comparisons. Participants were youth aged 8-18years (N = 170 childhood cancer survivors, N = 114 healthy comparisons) and one of their parents. All patients were ≥ 3years from diagnosis (M = 6.52, SD = 3.60). Both youth (Parental Bonding Instrument (PBI)) and parents (Parenting Relationship Questionnaire (PRQ)) reported on their perceptions of parenting. Two separate MANCOVA's (PBI and PRQ) were conducted to determine possible differences between childhood cancer survivors and healthy peers. Concordance between youth and parent perceptions of parenting was examined. Survivors did not differ from healthy peers in their perception of parental care and overprotection (p = .890). Likewise, parents in the survivor and healthy peer groups did not differ in their perceptions of involvement, attachment, communication, confidence, or relational frustration (p = .360). Youth's report of a caring parent-child relationship was positively associated with parent-reported involvement, attachment, communication, and parenting confidence and negatively associated with parent-reported relational frustration. Youth-perceived overprotection was positively associated with parent-reported relational frustration. No differences were found in parent-youth concordance between survivors and healthy comparisons. A history of childhood cancer does not appear to adversely influence parenting behavior, as perceived by both youth and their parents.

The relation of modelling and the perception of parental care with adolescent smoking: a cross-sectional study

The smoking of tobacco among adolescents is due to several influential factors, both individual and social. The present study aimed at comparing the effects of different variables on adolescent cigarette smoking, specifically, peer and parent modelling, self-regulatory efficacy, and parental degree of care as perceived by the adolescent. Data were collected by means of a self-report questionnaire administered to a sample of 229 secondary school students aged between 15 and 20 years (mean = 16.69, SD = 1.14). To test the influence of different variables, we performed a binary logistic regression analysis. Results indicated that the father is a key figure in that his care and affection can prevent adolescents from becoming a smoker and his modelling is a risk factor. The significant influence of friends was also confirmed and indicated that peer modelling is a strong predictor of adolescent cigarette smoking. Finally, the results revealed that self-regulatory efficacy is a relevant psychological variable capable of preventing smoking initiation during adolescence.

Effects of a Medical Home Program for Children with Special Health Care Needs on Parental Perceptions of Care in an Ethnically Diverse Patient Population

The Pediatric Medical Home Program at UCLA enrolled 41 patients in a primary care model focused on providing intensive care coordination for medically complex, ethnically diverse children with special health care needs (CSHCN) in our Pediatric Resident Continuity clinic. We sought to determine the effect of our program on parental satisfaction, and to compare differences in parental satisfaction between English and Spanish speaking patients. The Medical Home Family Index, developed by the Center for Medical Home Improvement, was administered to a total of 22 participating parents, in the family's primary language by a native speaker, at various times after enrollment in the program. Survey data and language effects were analyzed. The 36 standardized mean scores for the 15 Spanish speaking families were significantly higher (8.5 points higher) than the mean scores from the seven English speaking families (p = 0.003). Although no statistically significant differences were noted in individual questions between Spanish and English speakers, a trend towards more positive responses by Spanish speakers was noted in questions regarding physician-patient communication (p = 0.054) and family-centeredness (p = 0.053). Our results suggest that a primary care model focused on providing intensive care coordination produces positive parental perceptions of the organization and delivery of primary care services in a medically complex population of CSHCN. The main finding of the study is that utilizing the AAP's approach to the medical home model, emphasizing family-centered and culturally competent care, can produce higher satisfaction scores in Spanish speaking parents when compared to English speaking parents.

Parental Perceptions of Care of Children at End of Life

Little is known regarding the perceptions of parents about end-of-life care for their children. This study describes parental perceptions of the care of hospitalized, terminally ill children in the areas of (1) clinical management, (2) interdisciplinary support, and (3) pain and symptom management. Through a mixed methods design, researchers interviewed a representative sampling of bereaved parents via telephone. Data provided evidence of areas which lack satisfaction with elements of end-of-life care of hospitalized children. Parental satisfaction with their child's care during end of life indicates need for improvement in pain management, communication, and parental involvement in decision making. While education cannot guarantee desired changes in attitudes or behaviors, it may provide the essential foundation of knowledge, skills, and ethical understanding needed by professional providers.

The impact of a complex care clinic in a children's hospital

The number of medically complex and fragile children (MCFC) cared for in children's hospitals is growing, necessitating the need for optimal care co-ordination. The purpose of this study was to describe the impact of a nurse practitioner/paediatrician-run complex care clinic in a tertiary care hospital on healthcare utilization, parental and primary care provider (PCP) perceptions of care and parental quality of life. MCFC and their parents were recruited for ambulatory follow-up by the hospital team to complement care provided by the PCP in this mixed methods single centre pre- or post-evaluative study. Parents participated in semi-structured interviews within 48 h of discharge; further data were collected at 6 and 12 months. Healthcare utilization was compared with equal time periods pre-enrolment. Parental health was assessed with the SF-36; parental perceptions of care were assessed using the Larsen's Client Satisfaction Questionnaire and the Measure of Processes of Care; PCPs completed a questionnaire at 12 months. Parental and PCP comments were elicited. Comparisons were made with baseline data. Twenty-six children and their parental caregivers attended the complex care clinic. The number of days that children were admitted to hospital decreased from a median of 43 to 15 days, and outpatient visits increased from 2 to 8. Mean standardized scores on the SF-36 increased (improved) for three domains related to mental health. A total of 24 PCPs responded to the questionnaire (92% response); most found the clinic helpful for MCFC and their families. Parents reported improvements in continuity of care, family-centredness of care, comprehensiveness and thoroughness of care, but still experienced frustrations with access to services and miscommunication with the team. A collaborative medical home focused on integrating community- and hospital-based services for MCFC is a promising service delivery model for future controlled evaluative studies.

Motor Conversion Symptoms and Pseudoseizures: A Comparison of Clinical Characteristics

The authors prospectively studied consecutive neurological inpatients with either motor conversion symptoms or pseudoseizures of recent onset. Patients were administered a structured psychiatric diagnostic interview, a measure of perceived parental care, and a life events inventory. They found that patients with pseudoseizures (N=20, mean age=27 years): 1) were younger than patients with motor conversion symptoms (N=30, mean age=39 years), 2) were more likely to have a borderline personality disorder), 3) were more likely to have a lower perception of parental care and to report incest, and 4) reported more life events in the 12 months before symptom onset. These differences in their characteristics and associated factors raised the question of whether it is helpful to group patients with pseudoseizures and motor conversion symptoms in a single diagnostic category of conversion disorder. An alternative view, that gives primacy to the symptoms rather than a disorder, may enable more precise research questions to be posed.

Substance Use Among High-School Students: Relationships with Temperament, Personality Traits, and Parental Care Perception

Alcohol use, “alcohol abuse,” and illicit drug use were investigated in a representative sample of 1076 urban, northern Italian high school students aged 14 to 19 years in 2001. In addition to questions on substance use, the participants were asked about school achievements and perceived substance use among friends. All the students were submitted to Zuckerman Sensation Seeking Scale (SSS) scale, Eysenck Personality Questionnaire (EPQ), Buss-Durkee Hostility Inventory (BDHI), and Parental Bonding Instrument (PBI). Lifetime alcohol use was found in 80.5%, “alcohol abuse” in 37.7%, cannabis use in 26.2%, ecstasy in 2.8%, heroin in 3.8%, and cocaine in 8.3% of the students: gender differences were significant for alcohol use, “alcohol abuse” and ecstasy use, with male subjects outnumbering females, but not for reported cannabis, heroin, and cocaine use. Early substance use onset among adolescents aged 14–16 years was detected. Higher sensation seeking on SSS, social coping impairment on EPQ, direct aggressiveness on BDHI, poor school achievements, and lower parental care on PBI were found associated with illicit drug use and “alcohol abuse” (multiple drugs users). Increased levels of aggressiveness and sensation seeking were evidenced both in minimal experimenters (ME) and habitual users (HU), without any significant difference, in comparison with abstinent students. Similarly, ME scored higher than abstinent subjects on EPQ for social coping impairment, but lower than HU. Parental care perception was lower in HU, but not in ME with, respect to abstinent subjects. Pearson inverse correlation was demonstrated between PBI scores and EPQ maladaptation and BDHI aggressiveness. Data from this preliminary pilot study suggest that temperamental traits and personality changes may be associated to early substance use “proneness” and reduced perception of parental care.

Using the measure of processes of care with parents of children hospitalized for head injury.

Despite recommendations that rehabilitation programs adopt family/patient satisfaction as an outcome measure, few studies have addressed satisfaction with services for children with head injury. This report describes our use of the Measure of Processes of Care (MPOC) to document the perceptions of care of parents whose children were hospitalized with a head injury and to compare parental perceptions of care with those of the service providers (n = 16). The MPOC is a self-administered questionnaire consisting of 56 items, each of which is included in one of five care-giving scales: (1) enabling and partnership; (2) providing general information; (3) providing specific information about the child; (4) coordinated and comprehensive care; (5) respectful and supportive care. The MPOC was mailed to parents of children with a head injury who were consecutively admitted to a pediatric trauma center during a 5-mo period. The results, based on the responses of 73 parents (response rate, 59.3%), revealed that the needs of these parents are being met to varying degrees. Mean scores for the five scales ranged from 4.6 to 6.4 and from 5.9 to 6.6 for parents and providers, respectively. Significant differences between the groups were found for two scales: providing general and specific information. Because of the low percentage of valid responses for three of the five scales, the MPOC appears to be an inappropriate tool for use with parents of children with mild head injury (89%) in the acute care setting. The MPOC, however, is applicable for parents of children who are more severely injured (e.g., average hospital stay, 9 days) and is informative for rehabilitation service providers.

Parental Care and Intrusiveness as Predictors of the Abilities‐Achievement Gap in Adolescence

In this study we examined relations between adolescents' perception of parental care and intrusiveness and the abilities-achievement gap. Cognitive abilities and academic achievement were assessed for 200 Israeli 10th graders. Representations of maternal and paternal care and intrusiveness and externalizing and internalizing symptoms were self-reported. Gender differences were found for the abilities-achievement gap. Boys' achievement in mathematics and language was significantly lower than could be expected from abilities in these domains. Representations of maternal care predicted achievement while aptitude and socioemotional symptoms were controlled and moderated the relations of abilities and achievement. Paternal representations were unrelated to abilities or achievement. Among boys, maternal intrusiveness had a unique contribution to the prediction of achievement, above and beyond abilities, socioemotional symptoms, and maternal care. The relevance of the findings to cognitive and attachment perspectives on adolescent achievement is discussed.