Correlates of mothers' use of medications for their children

This study examines the extent, determinants and quality of mothers' independent use of medications for treating their children's symptoms. Data on mother-initiated medication behavior (MIMB) were obtained from a stratified systematic random sample of 500 mothers of children presenting for a well child visit at two pediatric ambulatory care sites. Six expert pediatric judges each rated every reported medication use (N = 3908) along three dimensions (usefulness, correctness and harmfulness or helpfulness) and also evaluated the overall appropriateness of each mother's MIMB. Results indicate that: (1) mothers keep available and use for children a considerable variety of different medications and medical applicances; (2) a positive linear relationship exists between mothers' socioeconomic status (SES) and degree of MIMB; (3) mothers' attitudes toward medications and toward their children's health are associated with the number of categories of medications and applicances they possess and use; (4) the combination of SES and attitudinal characteristics accounts for substantial portions of the variance in MIMB; and (5) judges' ratings show only minimal-level support of MIMB (extending to mothers in all SES groups) and are linearly related to SES (P less than 0.001). These findings emphasize the need for health care providers to review MIMB, and to provide advice concerning use and misuse of mother-initiated treatments.     

Effects of sociodemographic and attitudinal factors on mother-initiated medication behavior for children

Little is known about the therapies that people initiate for their health problems, and the available research on self-medication has focused primarily on adult populations. Only a few studies have specifically addressed mothers' independent use of medications for their children, and none has described such behavior in depth (for example, relating-perceived symptoms and conditions in the child or attempting to provide an explanation for mothers' decisions in these situations). A stratified systematic random sample of 100 mothers of children between 6 months and 12 years old was obtained at each of 3 pediatric ambulatory care clinics. Mothers were interviewed about their use of medications for their children, their concerns about their children's health, and their medication-related attitudes. The study results suggest that income and education are related to the types of medication and medical appliances mothers keep to treat the various health problems of their children. Mothers' perceptions of their children's potential susceptibility to health problems are related to possession of what they believe are relevant remedies for those problems (as well as to keeping a greater variety of medications on hand). Socioeconomic status appears to be one determinant of the number of different remedies (and especially the number of different medical appliances) that are purchased. Certain attitudes held by mothers about medications also play a role in explaining how great a variety of remedies are kept available for children in the event that they become ill, and these medication-related attitudes are highly correlated with socioeconomic status.     

How mothers treat their children's physical symptoms

An important area of concern in community health is the widespread practice of individuals undertaking courses of treatment in the absence of medical advice or direction. This is especially a problem when it involves the administration of medicines to children. This study examines the extent, determinants, and quality of the independent use by mothers of medications for treating their children's symptoms. Data on mother-initiated medication behavior (MIMB) were obtained from a random sample of 500 mothers of children at two pediatric ambulatory care sites. Six expert pediatric judges rated every reported medication use (N=3,908) along three dimensions (usefulness, correctness, and harmfulness/helpfulness) and also evaluated the overall appropriateness of each mother's MIMB. Results indicate that: 1) mothers keep available and use for their children a considerable number of different medications; 2) clear relationships exist between mothers' socioeconomic status and the different categories of medications they employ; 3) mothers' perceptions of their children's vulnerability to specific illnesses, and of the efficacy of over-the-counter medications for treating those illnesses, were related to the possession and use of relevant medications; and 4) judges' ratings indicated little enthusiasm for the mothers' therapeutic actions. These findings suggest the need for pediatricians to become aware of the medications their patients may be ingesting as a result of MIMB, and to educate mothers concerning use and misuse of over-the-counter (and other) treatments.Lois A. Maiman, Ph.D., is Assistant Professor, Department of Pediatrics, and Department of Preventive, Family and Rehabilitation Medicine, School of Medicine and Dentistry, University of Rochester, New York. Marshall H. Becker, Ph.D., M.P.H., is Professor and Chairman, Department of Health Behavior and Health Education, School of Public Health, and Professor, Department of Pediatrics and Communicable Diseases, School of Medicine, University of Michigan, Ann Arbor, Michigan. Anne W. Katlic, B.A., is Research Assistant, Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York. Address reprint requests to: Dr. Lois A. Maiman, Department of Pediatrics, Box 777, School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642.This research was supported by Grants HD15357 and HD00538 from the National Institute of Child Health and Human Development, National Institutes of Health.     

Mothers' perceptions of the negative impact on TV food ads on children's food choices

This exploratory study investigates the opinions of mothers who have at least one child between the ages of 7 and 12 in terms of the impact of TV food advertising on their children. This research also examines whether there is any third person effect active in mothers' opinions of TV food advertising aimed at children by asking them about both the impact on their own children, and the children of strangers. The results reveal that most mothers in the study have generally negative attitudes toward TV food advertising aimed at children, but they believe that the children of strangers are more negatively impacted by exposure to the ads than their own children.     

The STARK study: a cross-sectional study of adherence to short-term drug regiments in urban Kenya

The purpose of the STARK study (Short-Term Adherence Research in Kenya) was to identify factors that predict adherence to short-term drug regimens in Nairobi, Kenya. The participants (N = 357) in the study were recruited from the RAFIKI Foundation Clinic, a free primary healthcare clinic in Kibera, Nairobi's largest slum. Quantitative surveys were administered to all the participants regarding their adherence patterns and to a subgroup of mothers (N = 233) regarding their adherence in giving medicine to their children. 40 participated in four focus groups. 52% of participants reported taking all of their prescribed medication and 47% took it until they felt better. Over 65% of mothers reported giving all prescribed medication to their children. The most frequently cited barriers to adherence included lack of food and clean water, stress, and financial problems. By identifying obstacles to adherence and strategies to overcome them, this study showed that a community- based clinic with committed healthcare workers in Kenya can empower an economically disadvantaged population to be adherent.     

The STARK Study

Summary

The purpose of the STARK study (Short-Term Adherence Research in Kenya) was to identify factors that predict adherence to short-term drug regimens in Nairobi, Kenya. The participants (N = 357) in the study were recruited from the RAFIKI Foundation Clinic, a free primary healthcare clinic in Kibera, Nairobi's largest slum. Quantitative surveys were administered to all the participants regarding their adherence patterns and to a subgroup of mothers (N = 233) regarding their adherence in giving medicine to their children. Forty participated in four focus groups. Fifty-two percent of participants reported taking all of their prescribed medication and 47% took it until they felt better. Over 65% of mothers reported giving all prescribed medication to their children. The most frequently cited barriers to adherence included lack of food and clean water, stress, and financial problems. By identifying obstacles to adherence and strategies to overcome them, this study showed that a community-based clinic with committed healthcare workers in Kenya can empower an economically disadvantaged population to be adherent.     

Mothering children who have disabilities: a Bourdieusian interpretation of maternal practices

In the last three decades, mothers of children who have chronic illnesses or disabilities have been studied extensively. With some notable exceptions, most research has overlooked the socio-political context of disability and has interpreted maternal behaviours and feelings in negative or psychopathological terms. In this paper we report the results of using Pierre Bourdieu's central concepts to reanalyse three independent qualitative studies focused on mothers' accounts of raising children with severe disabling conditions. We illustrate the logic of mothers' practices and conclude that they represent strategic manipulations of accessible bodily, cultural and symbolic capital consistent with the 'rules of the game' across multiple fields. Mothers struggled to establish and maintain the personhood and value of their children, and to obtain resources within a broader context of body normativeness, exclusion and inequity. This Bourdieusian rendering of the logic of maternal practices has important implications for research and paediatric practices.     

Maternal Attitudes Toward Discipline: A Comparison of Children With Cancer and Non-Chronically Ill Peers

In this study we examined the factors influencing use of discipline and specific discipline strategies of 22 mothers of children diagnosed with cancer receiving treatment and 22 mothers of non-chronically ill controls (ages 3 to 10 years). There were no significant differences between the two groups of mothers in their use of positive reinforcement t(42) = 1.22, p > .05, punishment t(42) = .81, p > .05, force t(42) = 1.07, p > .05, giving in 642) = .25, p > .05, or logic and rationalization t(42) = .09, p > .05, as discipline strategies. However, mothers of oncology patients were rated as expressing more conflict t(36) = 2.85, p < .007 about discipline, and there was a trend for them to feel less in control in situations requiring discipline t(36) = 2.51, p < .017, than mothers of healthy children. There was also a trend for mothers of oncology patients to be rated as less consistent in their discipline t(36) = 2.46, p < .019. A significant negative correlation was found between behavioral intensity on the Eyberg Child Behavior Inventory and parental endorsement of giving in as a discipline technique for the combined sample of children with cancer and healthy controls, r = -.47, p < .01. Similar to other studies of general parenting of children with cancer, this study did not find differences on endorsement of specific discipline strategies by mothers of children with cancer as compared to mothers of healthy peers. However, differences did emerge in mothers' feelings of conflict and sense of control regarding discipline. Future research should explore factors that contribute to mothers' implementation of discipline strategies rather than specific strategies used.     

Educational level of mothers and their knowledge, attitude and practices concerning respiratory infections of their children]

An evaluation was performed on the influence of different variables on the knowledge, attitudes, and practices that mothers of children under the age of 5 have concerning acute respiratory infections (ARIs). Two groups of mothers were interviewed: 1) mothers of children seen in a polyclinic in the province of Havana (n = 221) and 2) mothers whose children were hospitalized in the respiratory unit of a pediatric hospital in the city of Havana (n = 200). The five variables analyzed were the educational level of the mother, her age, place of residence, number of children, and whether or not she was employed in the health service sector, as well as the interactions between the first variable and the other four variables. A questionnaire was used to measure the ARI knowledge, attitudes, and practices (KAP) of the mothers. Two levels of KAP sufficiency were taken into account, "Adequate I" for obtaining 70% or more of the maximum possible score and "Adequate II" for achieving at least a 50% score. For both levels of adequacy, the KAP of the mothers working in the health sector was significantly higher than that of the mothers interviewed in the secondary health care center. This suggests that the poorer knowledge, attitudes, and practices of mothers with hospitalized children may have contributed to the children's hospitalization. The most important variable associated with sufficient knowledge was educational level, which highlights the fundamental and positive influence education exerts on the preventive and curative care that mothers provide their children with ARI.     

健康教育对贫困农村母亲养育行为影响的效果评价

目的:评价健康教育干预对儿童母亲养育行为的影响。方法:在选定的一个经济中等项目县和经济状况相似的一个非项目县(对照县)中采用多阶段分层随机改良整群抽样方法选择对象,运用自行设计的“农村儿童养育情况母亲问卷”对母亲或养护人进行面对面问卷调查,用频数分布描述健康教育干预覆盖情况,比较项目县和对照县母亲养育知识态度和行为得分均数,用t检验和2χ检验进行分析。结果:共获得项目县有效问卷213份及对照县有效问卷201份。项目县97.2%被调查儿童母亲接受了有关养育儿童方法的健康教育;项目县比对照县有较多的母亲通过村医、宣传画、书刊杂志及父母学校获取育儿知识,经2χ检验差异有显著性(P<0.001);项目县儿童母亲养育知识态度行为得分高于对照县,经成组t检验差异有显著性(P<0.01);项目县儿童父亲参与管教孩子及经常与孩子一起玩儿的比例、父母管教孩子态度一致的比例均高于对照县(P<0.05)。结论:健康教育干预在一定程度上改善了贫困农村2岁儿童母亲的养育行为。     

Newborn care giving by primipara and multipara mothers at home in Tanta City

Recent researches are concerned with topics of newborn care giving, maternal knowledge and practices because it facilitates growth and development, protection against infection and detection of any abnormalities. The purpose of this study was to assess the mothers' knowledge and practices of basic newborn care given at home. The total sample included 55 primipara and multipara mothers with newborn babies. They were selected from Obstetric University Hospital in Tanta City. Interview questionnaire and observation checklists were designed to fulfill the aim of the study. The study revealed that mothers' knowledge and practices were within good and satisfactory average scores in most of the studied items related to newborn care giving at home except breast feeding. found between Significant differences were primipara and multipara mothers for most of the studied topics related to different topics of newborn care giving. practices were within good and satisfactory average scores in most of the studied items related to newborn care giving at home except breast feeding. Significant differences were found between primipara and multipara mothers for most of the studied topics related to different topics of newborn care giving.     

Mothers' attitudes and concerns about their children smoking: do they influence kids?

BACKGROUND: The effects of mothers' attitudes and concerns about tobacco use on whether their children take up smoking are largely unknown. This study examined the predictive effects of mothers' attitudes about tobacco and concerns about their children smoking. METHODS: Self-reported data from a large number of 12th-grade students (2,736) and their mothers were used. Mothers' attitudes and concerns were assessed when their children were 3rd graders (age 8), at the start of the smoking acquisition period; their children were then followed prospectively (with attrition of only 5%) for 9 years to the end of the period (12th grade) for the assessment of smoking behavior. RESULTS: In households in which both parents are nonsmokers, strong maternal antismoking attitudes are associated with a statistically significant approximately 50% reduction (P < 0.05) in the prevalence of smoking by adolescent children. In contrast, in households in which one or both parents are current smokers, there was no reduction in adolescent smoking associated with mothers' antismoking attitudes. CONCLUSIONS: Maternal antismoking attitudes when their children are young predict adolescents' adoption of smoking at 12th grade, but only when parental behavior is consistent with these attitudes.     

Paternal involvement in pediatric Type 1 diabetes: fathers' and mothers' psychological functioning and disease management

Psychological functioning in fathers of children with Type 1 diabetes has received relatively little attention compared to mothers. This study examined fathers' perceived involvement in their children's diabetes care as it related to mothers' and fathers' pediatric parenting stress, depression, anxiety, marital satisfaction, and sleep, and to their children's diabetes regimen adherence and glycemic control. Eighty-two mothers and 43 fathers completed questionnaires. Multivariate linear regressions were conducted separately for mothers and fathers to determine the relationships between the perceived amount and the perceived helpfulness of father involvement in child diabetes care on parental psychosocial functioning and child diabetes control. Maternal perceptions of father helpfulness and amount of involvement in illness care were related to improved marital satisfaction and fewer depressive symptoms in mothers. In fathers, perception of their own amount of involvement was related to increased pediatric parenting stress and anxiety. Better child regimen adherence was associated with maternal perceptions of father helpfulness but not the amount of their involvement, while paternal perceptions of their own helpfulness were related to poorer glycemic control. These findings suggest that fathers and mothers may react differently to their roles in childhood illness and that perceptions of their involvement may be differently associated with children's glycemic control and regimen adherence.     

Factors influencing physicians' judgments of adherence and treatment decisions for patients with HIV disease.

New medications for HIV reduce mortality and morbidity but require strict adherence. Thus, physicians treating HIV-positive patients must weigh both disease severity and likelihood of adherence when deciding whether to start patients on treatment. A national sample of 495 physicians surveyed via mail responded to clinical scenarios depicting HIV-positive patients and indicated whether they would start patients on medication (response rate = 53%). Scenarios varied on the patient characteristics of gender, disease severity, ethnicity, and risk group. Physicians predicted that patients with less severe disease, former injection drug users, and African American men would be less likely to adhere. Perceived adherence and disease severity influenced treatment decisions. Results are discussed in the context of attitudes about minority groups and injection drug users, which may influence adherence judgments in practice settings. Psychological research to identify better methods of predicting medication adherence may serve to inform medical decision making.     

Food behaviors of young children: Cognitive and attitudinal factors

Young children's diets are determined to a large degree by their mothers' nutritional knowledge and food attitudes. The primary purpose of this investigation was to determine the effects of mothers' nutritional knowledge and food attitudes on their children's nutritional knowledge and food behavior.

The subjects were 159 children. They ranged in ages from 7 to 9 years old. Their mothers also participated in the study.

Bivariate relationships between pairs of variables were tested using the Pearson product-moment correlation. The major findings were:

(1) Children's nutritional knowledge was related to their mothers' nutritional knowledge and attitudes of sociability.

(2) Mothers' nutritional knowledge was related to their attitudes of sociability and frugality. Nutritional knowledge was negatively correlated with mother's attitudes toward health and social status.

(3) Children's food behavior was related to their nutritional knowledge and their mothers' nutritional knowledge.     

Adherence to an oral health program for HIV infected children and adolescents and the attitudes of their caretakers

This study aimed to evaluate the adherence to an Oral Health Program (OHP) for HIV infected children and adolescents, as well as the attitudes of their caretakers regarding oral care. A total of 58 caretakers that accompany the children in medical appointments at an AIDS ambulatory were interviewed for collecting personal data and data regarding adherence to the OHP or other odontological treatment and attitudes related to oral care. Approximately 70% of the caretakers stated that their children participated in the OHAP, however 20% of them did not return to the recall appointments; such visits were even less frequent when the caretakers were not the parents themselves (p= 0.036). The adherence of this population to dental treatment outside the OHP was small, 48% of the caretakers stated that the child did not conclude the treatment when referred to another place for treatment. The attitude of the caretakers regarding dental care of HIV+ children was not considered satisfactory. Furthermore, it is very important to have pediatric dentists in the multi-professional teams that attend HIV+ children and adolescents and to promote this program among the parents and all medical teams involved with such patients.     

Infant-feeding practices of mothers of known HIV status in Lusaka,Zambia

BACKGROUND: Between 25 and 44% of mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) occurs through breastfeeding. As a result, feeding guidelines for infants of HIV-infected mothers are being formulated in many resource-poor countries. The impact of introducing these guidelines on mothers' actual feeding practices has not previously been examined. Infant-feeding practices of mothers of known HIV status who should have received advice during pre- and post-test HIV counselling were assessed and compared with those of uninfected mothers. METHODS: Mothers of infants aged 2-12 months, 55 HIV-infected and 85 HIV-uninfected, were recruited from the HIV Family Support Unit in Lusaka, Zambia. HIV status was known to 121 of these mothers, who had all received pre- and post-test HIV counselling. Feeding practices were determined by verbal questionnaire. RESULTS: All mothers breastfed but only 35% of infants below 4 months were exclusively breastfed (received breast milk only). HIV-infected mothers introduced fluids and weaned their infants significantly earlier than HIV-uninfected mothers (p = 0.03 and p = 0.002, respectively). Infants of HIV-infected mothers had significantly lower weight for age Z (WAZ) scores indicating poorer nutritional or health status (p = 0.004). Commercial formula milk and cow's milk were used by 36 mothers as breast milk substitutes, and were introduced at a median age of 2.5 months. Thirteen mothers gave cow's milk, and no mother added water to cow's milk (as recommended), with two adding sugar and four adding salt. CONCLUSION: Infant-feeding practices of HIV-infected mothers differed significantly from HIV-uninfected mothers, and this may contribute to their poorer growth. Paradoxically these mothers feeding practice could be putting these infants at greater risk of both non-HIV-related morbidity and HIV transmission, as early introduction of foods other than breast milk may increase MTCT.     

Predicting mothers' decisions to introduce complementary feeding at 6 months. An investigation using an extended theory of planned behaviour

In Australia and other developed countries there is poor adherence to guidelines recommending the introduction of complementary feeding to infants at 6 months of age. We aimed to investigate, via adopting a theory of planned behaviour framework and incorporating additional normative and demographic influences, mothers' complementary feeding intentions and behaviour. Participants were 375 primiparas who completed an initial questionnaire (infant age 13±3 weeks) that assessed the theory of planned behaviour constructs of attitude, subjective norm, and perceived behavioural control, as well as group norm and additional maternal and infant variables of mothers' age, education level, weight status perception, current maternal feeding practices, and infant birth weight. Approximately, 3 months after completion of the main questionnaire, mothers completed a follow-up questionnaire that assessed the age in months at which the infant was first introduced to solids. The theory of planned behaviour variables of attitude and subjective norm, along with group norm, predicted intentions, with intention, mothers' age (older more likely), and weight status perception (overweight less likely) predicting behaviour. Overall, the results highlight the importance of attitudes, normative influences, and individual characteristics in complementary feeding decision-making which should be considered when designing interventions aimed at improving adherence to current maternal feeding guidelines.