Focus Groups Among Public, Military, and Private Sector Mothers: Insights to Improve the Immunization Process

Abstract The underimmunization of children younger than 2 years old is a major health problem in U.S. cities. Innovative methods to increase immunization rates are being researched and implemented. In 1993, six focus groups were conducted with 41 mothers (25 African Americans and 16 Caucasians) to discuss their views regarding immunizations and the services they received from health care providers in the public health ( n = 27), military ( n = 4), and private ( n = 10) sectors. Participants viewed immunizations positively, but perceived many barriers to immunization. They suggested the following ways to improve the immunization process: enhancing knowledge acquisition, improving reminder and appointment systems, providing transportation and child care, decreasing waiting times, improving the clinic environment, and making the immunizations less traumatic. According to mothers in this study, obtaining an immunization on time is a complex task that requires planning and resources. The fewer resources that are available to mothers, the more difficult it is to succeed. Health care providers must help mothers identify and remove barriers if immunization rates are to be increased.     

Low-Income Mothers' Perceptions of Health in Their Children With Growth Delay

ISSUES AND PURPOSE. Parental characteristics are the strongest predictor of poor health for children. This study examined how low-income mothers of children with growth delay define health for their children, and the behaviors they use to monitor their children's health.
DESIGN AND METHODS. Naturalistic design using Kleinman's Explanatory Model approach and interviews with 22 mothers.
RESULTS. Mothers consider nutritious food as a primary contributor to their children's health and consider healthy children to be chubby. Other indicators of health include children's energy levels, provision of nutritious food, and physical and mental activity balanced with rest.
PRACTICE IMPLICATIONS. A mother's explanatory model of health for her child can guide health promotion targeted to the mother's beliefs.     

Evaluation of Technology to Identify and Assess Overweight Children and Adolescents

PURPOSE.  The current obesity epidemic has produced a generation of children that may be the first to have a life expectancy shorter than their parents. To address the obesity epidemic, experts have published recommendations for providers. Research suggests the publication of guidelines may not change provider behavior.
DESIGN AND METHODS.  This study evaluates computer assistance for implementing obesity guidelines in school-based health centers.
RESULTS.  Significant improvements in identification and assessment of obesity in children with technology support were noted.
PRACTICE IMPLICATIONS.  Computer decision support shows promise for promoting the implementation of current recommendations by supporting providers in identifying, assessing, and providing tailored recommendations for children at risk of obesity.     

Benefits of a school-based health center in a preschool

Although school-based health centers (SBHCs) deliver health care to vulnerable children, their effectiveness has not been well documented. This study compared the benefits of an SBHC with a School Health Survey and selected HEDIS measures in preschool children with and without access to an SBHC. Preschoolers with access to an SBHC (N = 130) and preschoolers without access (N = 131) were compared on (a) HEDIS measures including well-child care, immunizations, dental care, and smoke exposure; (b) measures of access and use of physical and mental health services; (c) satisfaction with health care; (d) barriers and facilitators to care; and (e) health insurance. Significant differences were found in parents' perceptions of children's physical and emotional health, self-esteem, incidence of behavioral problems, difficulty in obtaining care, number of hospitalizations, and satisfaction with care received. Findings suggest that holistic services provided by an SBHC positively impact the health of vulnerable preschool children.     

Childhood obesity: current literature, policy and implications for practice

The problem:  In most of the industrialized world, a childhood obesity epidemic is evident, with the numbers rising each year.
Purpose:  To discuss the current literature in relation to childhood obesity and to provide health practitioners, especially nurses, with the fundamental knowledge that is imperative in the recognition of children who are at risk and thereby tailor appropriate interventions.
Method:  Databases that were accessed for current literature included CINAHL, Science Direct and ProQuest. Keywords used in the search included obesity, childhood, health, relevant national statistics, policy and health risks. The literature was confined to the past 10 years with emphasis on the past 5 years. The 50 most pertinent papers from a variety of countries were chosen, and 35 papers that represented key areas of relevance were selected as the basis of this article. This selection of papers dictated the key areas of discussion such as the acknowledged factors in childhood obesity.
Findings:  Although childhood obesity may be related to specific cultural and national circumstances, universal themes emerged from the literature review. These include social factors, exercise, advertising, public policy and the importance of partnerships in policy.
Conclusion:  Any country that has a high rate or increasing rate of childhood obesity must acknowledge core factors that contribute to this serious health problem. Furthermore, public policy and community partnerships that include all health professionals have a responsibility in the prevention of childhood obesity. This can be implemented through education, research and advocacy of all nurses involved with children and families.     

Deciding to opt out of childhood vaccination mandates

ABSTRACT Objectives: We explore the attitudes and beliefs of parents who consciously choose not to vaccinate their children and the ways in which these parents process information on the pros and cons of vaccines.
Design: In-depth, semistructured interviews were conducted.
Sample: The study population consisted of 25 parents who do not vaccinate their children, identified through snowball and targeted sampling.
Methods: Participants were asked about their processes and actions when choosing not to vaccinate their children. Interviews were taped and transcribed, and the content was analyzed for emergent themes.
Results: Two predominant themes emerged in our data: a desire to collect information on vaccines and trust issues with the medical community. Evidence of sophisticated data collection and information processing was a repeated theme in the interview data. Simultaneously, while participants placed a high value on scientific knowledge, they also expressed high levels of distrust of the medical community.
Conclusions: The challenge for public health is to balance scientific data with popular epidemiology and to maintain legitimacy. Understanding the differences in lay versus expert knowledge has implications for crafting health messages. How experts frame knowledge for consumption has an important impact on this group and their decision-making processes.     

Maternal Perspectives on Lifestyle Habits That Put Children of Mexican Descent at Risk for Obesity

PURPOSE.  This article presents the views that mothers of Mexican descent have related to lifestyle habits that put children at risk for obesity.
DESIGN AND METHOD.  A qualitative, naturalistic design using ethnographic interviews was selected for this study. Informational redundancy was reached with 9 mothers of Mexican descent. Spradley's Developmental Research Sequence guided data collection and analysis.
RESULTS.  Participants held views that were congruent with the American Academy of Pediatrics' recommendations.
PRACTICE IMPLICATIONS.  Findings provide nurses with knowledge on how mothers of Mexican descent view appropriate nutrition, discipline in feeding, and the place of physical activity and television in young preschool children's lives.     

Type 1 diabetes: children and adolescents' knowledge and questions

Title.  Type 1 diabetes: children and adolescents' knowledge and questions.
Aim.  This paper is a report of a study conducted to describe what children and adolescents who have type 1 diabetes know and want to know about the disease.
Background.  Research indicates that young people's knowledge of diabetes may minimize their health complications, because with greater knowledge they may engage in more effective management practices and adherence.
Methods.  In this qualitative study, a purposive sample of 58 children and adolescents with type 1 diabetes were interviewed in 2005 about what they knew and wanted to know about their disease. Through a process of induction, major themes were identified from the data.
Findings.  The six major themes were: (a) Care , including both physical and emotional care, (b) Physiology , (c) Consequences , including both short- and long-term, as well as positive and negative consequences, (d) Cure , (e) Effects on the Family and (f) Experience at Diagnosis . Themes related to the unique challenges associated with type 1 diabetes were also identified.
Conclusion.  Nurses, diabetes educators and parents should provide developmentally appropriate information about diabetes care and management, scaffolding on existing knowledge. They should provide child-centred contexts in which children and adolescents can freely ask questions about their condition and problem-solve. Programmes that allow young people to develop coping skills and share experiences could also prove beneficial.     

The Crossroads of Culture and Health Among the Roma (Gypsies)

Purpose: To alert health care providers to commonly encountered cross-cultural impediments to optimal health care delivery for the Roma (also known as Gypsies) and to offer suggestions for avoiding culturally based problems in treating this subculture.
Organizing framework: Understanding of sociocultural bases of health-related behaviors is necessary for culturally competent and effective health care.
Methods: Review of literature and personal interviews.
Findings: Cultural factors that can affect health care delivery include: concepts of pollution, cleanliness, ideal weight, death, and views of medical procedures such as immunizations and surgery. Responsiveness of health care providers to expectations of Roma about their involvement of family and the hierarchy of age and sex also can enhance patient-provider relationships that in turn can improve compliance and satisfaction with health care regimens .
Conclusion: The Roma have some culturally distinct beliefs and behaviors related to their health and health care. Knowledge of these characteristics and accommodations to cultural differences are important in their health care.     

Latino Disparities in Child Mental Health Services

TOPIC:  Access and utilization of mental health services for Latino children.
PURPOSE:  As Latino children may experience higher rates of unmet needs, this article examines the current literature for the reasons for the disparity and the barriers to the utilization of mental health services for Latino children.
SOURCES:  An integrative literature review was undertaken from child psychiatry and nursing.
CONCLUSIONS:  The literature confirmed a pattern of underutilization of mental health services by Latino children, but did not completely address the reasons for the disparity. Suggested barriers were language and cultural issues. Gaps in the literature include a lack of agreement for definition of a mental health problem and the tools to identify these, insufficient studies into the barriers for Latino children in the access and utilization of mental health services, and cultural and language issues related to Latino research.     

Vaccine verification guide: demystifying childhood immunizations for inpatient and other nurses

Provision of childhood immunizations continues to be an essential component in reducing morbidity and mortality worldwide. Inpatient nurses can play an essential role in assuring that children who are eligible for vaccinations are identified and provided with the appropriate immunizations. However, maintaining current knowledge of the rapidly changing immunization schedule can be a barrier, especially in a setting where immunizations and preventive care are not the main focus. This article emphasizes the importance of hospital nurses advocating for immunization of children and presents a Vaccine Verification Guide that serves as a tool for quickly and accurately identifying the vaccination needs of children, whether on-track or delayed in their immunizations.     

A study on the needs of medical, maternal and child health care in Chinese women students at the University of Tokyo

According to the information provided by the University of Tokyo (UT) in 2001, 317 Chinese women students were enrolled in the UT, and 88% of them were graduate students. Although the surveys on the life of international students at the UT had been conducted in 1989 and 1998, the medical and health issues were not included. With the objective of exploring the medical and heath care needs of Chinese women students at the UT a survey was carried out from December 2001 to January 2002. With the cooperation of the International Students Center at the UT a questionnaire in Chinese was sent to each department in which 317 Chinese women students were studying. Out of 104 students responded, eligible subjects were 98. The results of present study revealed some problems, such as the language barrier, preference for a translator in hospitals or health centers, and a medical guidebook with information on vaccinations in Chinese. They also stated their lack of knowledge about the Japanese medical and health system, and their distress for being separated from their children. In conclusion, the most severe problem was language barrier for Chinese women students in obtaining medical and health care for themselves and their children. It was also noted that lack of knowledge of the Japanese medical and health care system was another obvious problem.     

Exploring Youth Development With Diverse Children: Correlates of Risk, Health, and Thriving Behaviors

PURPOSE.  This study explored the relationships between internal and external assets, risk behaviors, health behaviors, and thriving behaviors in diverse children.
DESIGN AND METHODS.  The strength of relationships existing between measures, differences between group means based on gender, grades earned, and school, and confidence interval ( p ≤  .05) were tested in a sample of 61 urban sixth graders.
RESULTS.  Few assets were related to substance use. Assets were related to delinquency acts, health behaviors, and thriving indicators. Group differences between schools and gender and the total number of assets were noted.
PRACTICE IMPLICATIONS.  Supporting assets are important to consider when nurses perform assessments and design interventions to support youths in their maturation processes.     

Rearing the Child Who Is Technology Dependent: Perceptions of Parents and Home Care Nurses

ISSUES AND PURPOSE. Most children who are dependent on technology for survival live with their families at home. This study explores the perceptions of parents and home care nurses regarding rearing the technology-dependent child.
DESIGN AND METHODS. In this qualitative study, interviews were conducted with 16 parents whose child is technology dependent and 15 registered nurses who provided home care.
RESULTS. Rearing the child who is technology dependent is similar to but different from raising other children. Parental communication and negotiation of child-rearing expectations with home care nurses is essential.
PRACTICE IMPLICATIONS. Improved collaboration and communication between parents and nurses may reduce parental stress and enhance development for children who are dependent on technology.     

Attitudes of nurse professionals and nursing students towards children with disabilities. Do nurses really overcome children's physical and mental handicaps?

Background:  Many health professionals and nurses, who are involved in the care of disabled children, do not exhibit the essential sensitivity and appropriate attitudes towards them, resulting in a poor quality of nursing care.
Aim:  The objective of this study was to investigate the attitudes of nurse professionals (paediatric nurses) and nursing students towards disabled children.
Patients and methods:  The present study is a comparative study. The sample consisted of 228 first-year nursing students, 90 post-diploma nurses attending MSc degree course and 123 nurse professionals who are employed in paediatric hospitals. After obtaining permission from the hospitals and the educational settings and informing about the subjects of the study, data were collected using the paediatric Attitude Towards Disabled Person Scale (ATDP).
Results:  Overall nurses' attitudes appeared to be poor (mean ATDP score 61.7 ± 14.2). However, the post-diploma nurses had significantly higher ATDP scores than first-year students and paediatric nurses ( P  < 0.001). In addition, first-year students had significantly higher scores than paediatric nurses ( P  = 0.047). Across the sample, females hold significantly more positive attitudes than males ( F  = 9.5, P  = 0.002), while age did not have any significant effect.
Conclusions:  Carefully designed curricula can influence the attitudes of nursing students towards children with disabilities. Special courses for treating disabled children should be integrated to the basic nursing studies. Moreover, continuing hospital education can change paediatric nurses' attitudes towards children with disabilities.