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1.
Background
Monitoring and evaluating changes of quality of primary care for older adult hypertensive patients is part of effective delivery of primary care. This study aimed to investigate changes of older adult hypertensive patients’ perceived quality of primary care over time in Shanghai.Methods
Two rounds of cross-sectional questionnaire surveys were conducted in Shanghai in November 2011 and June 2013. A total of 437 patients participated in the first Round survey and 443 in the second. Primary care attributes were collected from Community Health Center users through on-site face-to-face interview surveys using the validated Primary Care Assessment Tool. Multiple linear regressions were used to determine whether there was any difference in primary quality of care scores between 2011 and 2013 surveys.Results
Compared with those in the first Round, participants in the second Round reported higher scores in total primary care quality (28.73 vs. 27.75, P?<?0.001), as well as primary care attributes including first-contact utilization (2.81 vs. 2.60, P?<?0.001) and accessibility (2.48 vs. 2.44, P?<?0.05), continuity of care (3.38 vs. 3.27, P?<?0.001), coordination of information (3.82 vs. 3.67, P?<?0.001), comprehensiveness of service availability (3.51 vs. 3.39, P?<?0.001) and provision (2.69 vs. 2.43, P?<?0.001), and cultural competence (2.67 vs. 2.49, P?<?0.05), but a lower score in coordination of services (2.45 vs. 2.55, P?<?0.05).Conclusion
Older adult hypertensive patients perceived better primary care quality from 2011 to 2013 in Shanghai. This may be associated with the general practitioner team service in Shanghai where hypertensive patients were targeted.2.
Fitriana Murriya Ekawati Mora Claramita Krishna Hort John Furler Sharon Licqurish Jane Gunn 《Asia Pacific family medicine》2017,16(1):4
Background
The World Health Organization (WHO) recommendation on universal coverage has been implemented in Indonesia as Jaminan Kesehatan Nasional (JKN). It was designed to provide people with equitable and high-quality health care by strengthening primary care as the gate-keeper to hospitals. However, during its first year of implementation, recruitment of JKN members was slow, and the referral rates from primary to secondary care remained high. Little is known about how the public views the introduction of JKN or the factors that influence their decision to enroll in JKN.Aim
This research aimed to explore patients’ views on the implementation of JKN and factors that influence a person’s decision to enroll in the JKN scheme.Methods
This study was informed by interpretative phenomenological analysis (IPA) methodology to understand patients’ views. The interview participants were purposively recruited using maximum variation criteria. The data were gathered using in-depth interviews and was conducted in Yogyakarta from October to December 2014. The interviews were transcribed, translated and analyzed using IPA analysis.Result
Twenty three participants were interviewed from eight primary care clinics. Three superordinate themes: access, trust, and separation anxiety were identified which impacted on the uptake of JKN. Participants acknowledged that whilst primary care clinics were conveniently located, access was often complicated by long waiting times and short opening hours. Participants also expressed lower levels of trust with primary care doctors compared to hospital and specialist care. They also reported a sense of anxiety that the current JKN regulation might limit their ability to access the hospital service guaranteed in the past.Discussion
This study identified patients’ views that could challenge the implementation of the gate-keeper role of primary care in Indonesia. While the patients valued the availability of medical care close to home, their lack of trust in primary care doctors and fear that they might lost the hospital care in the future appears to have impacted on the uptake of JKN. Unless targeted efforts are made to address these views through sustained public education and further capacity building in primary care, it is unlikely that the full potential of the JKN scheme in primary care will be realized.3.
Andres De Los Reyes Candice A. Alfano Michelle A. Clementi Andres Viana 《Child & youth care forum》2017,46(1):1-17
Background
A key element of the evidence-based assessment and treatment movements is ensuring an adequate representation of clients across the different settings in which they receive mental health care (e.g., research and routine or usual care settings). Prior work has focused on comparing clients from research settings to those from usual care settings on various indices of clinical severity, impairment, and symptom levels.Objective
In this study, we focused on examining clients from different types of research studies not only on levels of clinical severity, impairment, and symptoms, but also on the relations among these domains.Methods
We addressed our objective in a sample of 73 youths meeting primary diagnostic criteria for generalized anxiety disorder (GAD); n = 32 were recruited specifically for a treatment study or received services from a university-based clinic (Youths Receiving Treatment; YRT), and n = 41 were recruited for a non-treatment assessment study (Non-Treatment Research Youths; NTRY).Results
Relative to NTRY, YRT displayed greater GAD clinical severity, and higher generalized anxiety and worry levels. However, we observed no differences between groups in relations among measures of GAD clinical severity, generalized anxiety, and worry.Conclusions
These findings have important implications for evidence-based practice and interpreting studies seeking to compare clients from research and clinical settings on clinical characteristics.4.
Nor Azian Mohd Zaki Geeta Appannah Noor Safiza Mohamad Nor Azahadi Omar Mansor Fazliana Rashidah Ambak Siti Shafiatun Mohsin Tahir Aris 《BMC women's health》2018,18(1):110
Background
The prevalence of overweight and obesity among Malaysian women remained high over the past three decades. Collaboration with existing community at-risk may be feasible for wide-scale prevention of overweight and obesity in the country. The aims of this study were to examine the impact of community-based lifestyle intervention among overweight and obese women on their anthropometric and body composition changes as compared to the usual care group.Methods
This was a quasi-experimental study conducted in low-cost flats in Kuala Lumpur, Malaysia. A total of 255 overweight and obesity individuals aged between 18 to 59 years old were assigned to either the lifestyle intervention group (n?=?169) or the usual care group (n?=?146) over a period of 6 months. Individuals in the intervention group received 6 individual lifestyle counselling comprised of physical activity, diet counselling and self-monitoring components aimed to achieve at least 5% weight loss while individuals in the usual care group obtained six sessions of health care seminars from health care providers. These individuals were then followed-up for another 6 months without any intervention as part of maintenance period.Results
An intention-to-treat analysis of between-groups at 6-month of intervention (β, 95% CI) revealed greater changes in weight among intervention individuals’ (??1.09 kg vs. -0.99; p?<?0.018) as compared to the control group. These changes were not sustained during the maintenance phase (between 6 and 12 months). Overall significant improvement at 12th month was found for visceral fat (??0.78 vs. -0.64; p-value?=?0.017), although no significant changes between groups were detected either during intervention or maintenance phase (p?>?0.05). Individuals in the intervention group showed a significant increase for skeletal muscle mass (0.13 kg) than those individuals in the control group (??0.37 kg), p?=?0.033, throughout the study period.Conclusion
This study provides evidence that an overweight and obesity prevention program can be implemented in a community setting, with some reduction of several anthropometric and body composition parameters.5.
Background
The epidemiology of obesity in primary care populations has not been thoroughly explored. This study contributes to filling this gap by investigating the relationship between obesity and different sources of personal stress, mental health, exercise, and demographic characteristics.Methods
A cross-sectional survey using a convenience sample. Five hundred women who attended family planning clinics were surveyed and 274 provided completed answers to all of the questions analyzed in this study. Exercise, self-rated mental health, stress, social support, and demographic variables were included in the survey. Multiple logistic regression analysis was performed.Results
After adjusting for mental health, exercise, and demographic characteristics of subjects, analysis of the data indicated that that being having a large family and receiving no support from parents were related to obesity in this relatively young low-income primary care sample, but self-reported stress and most types of social support were not significant.Conclusion
Obesity control programs in primary care centers directed at low-income women should target women who have large families and who are not receiving support from their parents.6.
Bolaji Samson Aregbeshola Samina Mohsin Khan 《Zeitschrift fur Gesundheitswissenschaften》2018,26(4):399-408
Aim
This study aims to examine the factors affecting the uptake of malaria prevention strategies among pregnant women in Nigeria.Methods
Secondary data from the 2013 Nigeria Demographic and Health Survey were used to examine the factors affecting the uptake of malaria prevention strategies among pregnant women (n?=?4493) in Nigeria. Variables on demographic and socio-economic characteristics of pregnant women were analysed. Data analysis was carried out using STATA version 12 software and univariate, bivariate and multivariate analyses were conducted.Results
We found that only 10.3% of pregnant women received intermittent preventive treatment of malaria in pregnancy, while 17.4% used insecticide-treated bed nets. Multivariate analysis indicated that maternal age (p?<?0.05), geo-political zone (p?<?0.05), socio-economic status (p?<?0.05), religion (p?<?0.05), women’s autonomy (p?<?0.05) and number of antenatal care visits (p?<?0.05) were significant predictors of the uptake of intermittent preventive treatment of malaria in pregnancy. The use of insecticide-treated bed nets was influenced by socio-economic status (p?<?0.05) and women’s occupation (p?<?0.05).Conclusion
Our study shows that there is poor uptake of malaria prevention strategies among pregnant women in Nigeria. In addition, demographic and socio-economic factors affect the uptake of malaria prevention strategies. The design of new policies and improvement in the current malaria prevention programs should target demographic and socio-economic factors which are important in increasing the uptake of malaria prevention strategies among pregnant women. We also recommend economic empowerment of women.7.
L. Claassens C. B. Terwee D. J. H. Deeg M. I. Broese van Groenou G. A. M. Widdershoven M. Huisman 《Quality of life research》2016,25(4):859-870
Purpose
In response to the increased emphasis placed on older people’s self-reliance in many welfare societies, we aimed to develop and validate a measurement instrument, assessing perceived control in health care among older adults with care needs. The target group consists of older people who live (semi-)independently and use professional health care, with or without informal care.Methods
Phase I (development) of the study consisted of the construction of the instrument based on the input from a variety of stakeholders. Phase II (validation) entailed a quantitative study in a sample of 247 respondents selected from the Longitudinal Aging Study Amsterdam, to assess the instrument’s construct validity (structural validity and hypotheses testing) and reliability (internal consistency).Results
The questionnaire consists of 29 items, related to organizing professional care, communication with care professionals, health management in the home situation, planning (more) complex care in the future, and perceived support from the social network. Based on a factor analysis, we identified three subscales: (I.) ‘perceived personal control in health care’; (II.) ‘anticipated personal control regarding future health care’; and (III.) ‘perceived support from the social network,’ with internal consistencies varying from Cronbach’s α = .71 to .90. Factor I was associated with mastery, self-efficacy, self-esteem (r = .31–.35) and factor III with social loneliness (r = ?.42). Factor II correlated less strongly with mastery, self-efficacy, and self-esteem (r < .30).Conclusion
Our questionnaire revealed sufficient construct validity and internal consistency. The instrument provides a basis for further quantitative research regarding control, especially in relation to health care-related outcomes.8.
Tasneem L. Talib Paige DeChant Jacob Kean Patrick O. Monahan David A. Haggstrom Madison E. Stout Kurt Kroenke 《Quality of life research》2018,27(12):3157-3166
Purpose
Sleep, pain, anxiety, depression, and low energy/fatigue (SPADE pentad) symptoms are common, but often unrecognized and undertreated in primary care. In an effort to improve symptom outcomes, primary care clinics are integrating patient-reported outcome measures (PROs), such as the Patient-Reported Outcome Measurement Information System (PROMIS), into practice. Whether patients with SPADE symptoms perceive these measures as useful is unknown. The purpose of this qualitative study was to explore patients’ perceptions of the utility of symptom-based PROs in primary care.Methods
As part of a mixed-methods study, 23 patients (age 24–77 years) with one or more SPADE symptoms participated in one-on-one interviews about the use, implementation and visual display of PROMIS. All interviews were audio-recorded, transcribed, and analyzed using thematic analysis.Results
Five themes emerged: (1) PROs may foster communication about symptoms; (2) data from PROs may prompt clinical actions; (3) the visual display of symptom scores could be useful for patients and providers, though modifications may enhance interpretation; (4) implementation may vary according to patients’ perception of PRO features (e.g., length); and (5) PROs may be useful, but only to the extent that they are valued, prioritized, and used.Conclusions
According to patients, the use of PROs to measure symptoms in primary care clinics has the potential to be useful. However, patients are reluctant to complete PROs if they perceive that clinicians do not use the measures to improve care. Barriers to implementation in primary care (e.g., duration of visit) should be addressed to enhance the utility of PROs. Clinical trial registration ClinicalTrials.gov ID: NCT02383862.9.
Purpose
Obesity is a major public health concern. Despite its multi-factorial etiology, alterations in intestinal microbiota and the immune system are frequently observed. We investigated the effect of Duolac Gold (DG), a probiotic formulation containing 2 Lactobacillus strains (L. acidophilus LA1 and L. rharmnosus LR5), 3 Bifidobacterium (B. bifidum BF3, B. lactis BL3, and B. longum BG7), and Streptococcus thermophilus ST3, on morphometric and metabolic parameters, intestinal microbiota, and intestinal immune responses in a high-fat diet (HFD)-induced obese rat model.Methods
Rats received either a conventional balanced diet or HFD with or without water containing DG for 8 weeks. HFD-induced adiposity, intestinal microbiota, and changes in inflammatory cytokine, chemokine, and metabolite levels in serum were evaluated.Results
DG administration effectively decreased HFD-induced body weight and modulated morphometric and metabolic parameters. Quantitative analysis of fecal microbiota showed that obese rats given DG exhibited significantly increased levels of Bacteroidetes, Lactobacillus, and Bifidobacterium, with significant decreases in the level of Firmicutes. Serum levels of the inflammatory cytokines and the chemokine were also altered. Serum metabolite analysis revealed that DG administration modulated HFD-induced changes in serum metabolites, including fatty acids (FA), lysophosphatidylcholine, lysophosphatidylethanolamine, phosphatidylcholine (PC), and triacylglycerol (TAG).Conclusions
DG administration appears to have the potential to alleviate HDF-induced obesity through the modulation of intestinal microbiota, immune responses, and host metabolism, which supports the use of probiotics to treat obesity.10.
Samy Abdelrazek Abdelazim Hebatallah Nour-Eldein Mosleh Abdelrahman Ismail Lamiaa Al Sayed Fiala Abdulmajeed Ahmed Abdulmajeed 《Zeitschrift fur Gesundheitswissenschaften》2018,26(5):569-575
Background
Smoking is a major risk factor for death-related diseases. Not all healthcare professionals are following evidence-based guidelines for smoking cessation counseling in primary care settings. The WHO, Framework Convention on Tobacco Control (FCTC), and United States Public Health Service (USPHS) guidelines recommend that all healthcare professionals, including students in healthcare training programs, receive education in the management of tobacco use and dependence.Objective
To evaluate the effect of training programs for primary healthcare physicians on the knowledge, attitude, and practice of smoking cessation counseling.Methods
This was a pre-post intervention study. The study included 74 primary care physicians working in primary healthcare centers affiliated with the Ministry of Health and Suez Canal University Hospitals in Port Said City. The study was conducted between June 2015 and March 2016 using a structured questionnaire and observation checklist to assess counseling of patients willing to quit smoking.Results
There were highly statistically significant improvements in the physicians’ median scores of knowledge (30%–80%), attitude (65% -100%), and practice (20%–70%) (p?<?0.001) pre-post intervention. The most frequent correct knowledge was consequences of smoking (73%–87.3%) (p?<?0.001) pre-post intervention. The most favorable attitude was the importance of smoking cessation (70.3%–100%) (p?<?0.001) pre-post intervention. The best observed correct practice was asking about smoking (70.3%–100%) (p?<?0.001) pre-post intervention.Conclusion
Knowledge, attitude, and practice skills regarding smoking cessation counseling among primary healthcare physicians were markedly improved after implementation of the education program.11.
Mary K. Horan Jean M. Donnelly Ciara A. McGowan Eileen R. Gibney Fionnuala M. McAuliffe 《Zeitschrift fur Gesundheitswissenschaften》2016,24(5):427-436
Aim
To examine the association between maternal nutrition and lifestyle factors and offspring adiposity, using baseline and 2-year postpartum follow-up data from a randomised control trial of low glycaemic index diet.Subject and methods
Food diaries and lifestyle questionnaires were completed during pregnancy and infant feeding and maternal lifestyle questionnaires 2 years postpartum for 281 mother and infant pairs from the ROLO study. Maternal anthropometry was measured throughout pregnancy and infant and maternal anthropometry was measured 2 years postpartum.Results
Maternal 2 year postpartum body mass index (BMI) was positively associated with offspring BMI-for-age z-score (B?=?0.105, p?=?0.015). Trimester 2 saturated fat intake was positively associated with offspring subscapular:triceps skinfold ratio (B?=?0.018, p?=?0.001). Trimester 1 glycaemic index was also positively associated with offspring sum of subscapular and triceps skinfolds (B?=?0.009, p?=?0.029).Conclusions
Maternal BMI 2 years postpartum was positively associated with offspring BMI. Pregnancy saturated fat intake was positively and polyunsaturated fat negatively associated with offspring adiposity. While further research is necessary, pregnancy and the postpartum period may be early opportunities to combat childhood obesity.12.
Background
The response of serum cholesterol to diet may be affected by the apolipoprotein E (APOE) ε2/ε3/ε4 polymorphism, which also is a significant predictor of variation in the risk of coronary heart disease (CHD) and CHD death. Here, we test the hypothesis that the APOE polymorphism may modulate the cholesterol-raising effect of coffee.Objective
We determined the effect of a coffee abstention period and a daily intake of 600 mL coffee on serum cholesterol and triglycerides with respect to the APOE polymorphism.Design
121 healthy, non-smoking men (22%) and women (78%) aged 29–65 years, took part in a study with four intervention periods: 1 and 3) a coffee free period of three weeks, 2 and 4) 600 mL coffee/day for four weeks.Results
APOE ε 2 positive individuals had significantly lower total cholesterol concentration at baseline (4.68 mmol/L and 5.28 mmol/L, respectively, p = 0.01), but the cholesterol-raising effect of coffee was not influenced significantly by APOE allele carrier status.Conclusions
The APOE ε 2 allele is associated with lower serum cholesterol concentration. However, the APOE polymorphism does not seem to influence the cholesterol-raising effect of coffee.13.
Correlation of emotional labor and cortisol concentration in hair among female kindergarten teachers
Objectives
The purpose of this study was to explore whether two types of emotional labor, surface acting and deep acting, are related to hair cortisol concentration among kindergarten teachers.Methods
Surface acting and deep acting over the last month were measured with the Chinese version of the emotional labor scale in 43 kindergarten teachers. Hair samples with 1 cm in length were cut from their posterior vertex region to represent cortisol excretion over one month. Cortisol concentrations were analyzed with high-performance liquid chromatography–tandem mass spectrometry.Results
Positive association of emotion labor with hair cortisol concentration was significant for surface acting (r = 0.34, p < 0.05) and not significant for deep acting (r = 0.14, p > 0.05).Conclusions
More surface acting showed to be associated stronger with stress responses or higher HPA axis activity.14.
Jazmin A. Reyes-Portillo Erica M. Chin Josefina Toso-Salman J. Blake Turner David Vawdrey Laura Mufson 《Child & youth care forum》2018,47(3):391-402
Background
No study to date has examined the effectiveness of integrating clinical decision support tools, like electronic health record (EHR) alerts, into the clinical care of youth at-risk for suicide.Objective
This study aimed to examine the feasibility and acceptability of using an EHR alert to increase clinicians’ use of safety planning with youth at-risk for suicide in an outpatient pediatric psychiatry clinic serving an urban low-income Latino community.Methods
An alert intervention was developed to remind clinicians to complete a safety plan whenever they documented that their patient endorsed suicidal ideation, plan, or attempt during a visit in EHR notes. The alert appeared as a separate window containing a reminder message to complete a safety plan once a clinician finished visit documentation.Results
There were 69 at-risk patients between the ages of 13–21 in the intervention period (M = 15.71; SD = 1.86; 66.7% female) and 64 (M = 15.38; SD = 1.93; 68.6% female) in the control period. Logistic regression analyses indicated that patients in the intervention period were significantly more likely than patients in the control period to receive a safety plan (p < .01). The pattern of results remained the same after adjusting for demographic variables (p = .01). Forty clinicians also completed a questionnaire assessing their satisfaction with the EHR alert, indicating moderate satisfaction (M = 3.01; SD = 0.63; range = 1.11–4.11).Conclusions
EHR alerts are associated with changes in clinicians’ behavior and improved compliance with best clinical practices for at-risk youth.15.
Aim
There is growing interest in the contribution of public-private partnerships (PPPs) bridging the shortage of financial resources and management expertise in developing public healthcare infrastructure. However, few studies have evidenced PPPs’ ability in increasing efficiency in public procurement of primary healthcare infrastructure. The aim of this study was to assess to what extent PPPs would increase efficiency in public procurement of primary healthcare facilities.Subject and methods
A qualitative analysis, adopting a realistic research evaluation method, used data collected from a purposive sample of public (n?=?23) and private sector staff (n?=?2) directly involved in the UK National Health Service Local Improvement Finance Trust (LIFT).Results
We find a positive association of LIFT helping to bridge public sector capital shortages for developing primary care surgeries. LIFT is negatively associated with inefficient procurement because it borrows finance from private banks, leaving public agencies paying high interest rates. The study shows that some contextual factors and mechanisms in LIFT play a major part in obstructing public staff from increasing procurement efficiency.Conclusion
PPP’s ability to increase efficiency may be determined by contextual factors and mechanisms that restrict discretion over critical decisions by frontline public sector staff. Developing their capacity in monitoring PPP activities may make partnerships more efficient.16.
17.
Julia Drosselmeyer Louis Jacob Wolfgang Rathmann Michael A. Rapp Karel Kostev 《Quality of life research》2017,26(2):437-443
Goal
The goal of this study was to determine the prevalence of depression and its risk factors in patients with late-onset rheumatoid arthritis (RA) treated in German primary care practices.Methods
Longitudinal data from general practices (n=1072) throughout Germany were analyzed. Individuals initially diagnosed with RA (2009–2013) were identified, and 7301 patients were included and matched (1:1) to 7301 controls. The primary outcome measure was the initial diagnosis of depression within 5 years after the index date in patients with and without RA. Cox proportional hazards models were used to adjust for confounders.Results
The mean age was 72.2 years (SD: 7.6 years). A total of 34.9 % of patients were men. Depression diagnoses were present in 22.0 % of the RA group and 14.3 % of the control group after a 5-year follow-up period (p < 0.001). In the multivariate regression model, RA was a strong risk factor for the development of depression (HR: 1.55, p < 0.001). There was significant interaction of RA and diagnosed inflammatory polyarthropathies (IP) (RA*IP interaction: p < 0.001). Furthermore, dementia, cancer, osteoporosis, hypertension, and diabetes were associated with a higher risk of developing depression (p values <0.001).Conclusion
The risk of depression is significantly higher in patients with late-onset RA than in patients without RA for subjects treated in primary care practices in Germany. RA patients should be screened routinely for depression in order to ensure improved treatment and management.18.
Shamra Boel-Studt Lisa Schelbe Megan Deichen Hansen Lauren Tobia 《Child & youth care forum》2018,47(6):863-880
Background
Lack of engagement in child welfare services is a salient issue impeding client outcomes. Research findings indicate that providing incentives may be a promising strategy for enhancing client engagement.Objective
In response to low youth engagement and repeated re-entry into care, a Southeastern child welfare agency developed an incentive program aimed at increasing youths’ participation and success in meeting treatment goals. This mixed methods study examined elements of effective implementation and the effectiveness of the incentive program piloted in a group home serving adolescent boys (n?=?16).Method
A semi-structured focus group with service providers (n?=?7) was used to inform the development of the pilot incentive program. We used a time-series design to measure youth perceptions of the therapeutic alliance with their therapists and weekly goal attainment. Baseline data was collected for 6 weeks (phase one) followed by 6 weeks of the incentive program (phase two).Results
Results of qualitative analyses revealed four themes related to therapeutic engagement, and two themes related to intervention implementation. Providers emphasized the importance of youth-driven care and building a strong therapeutic alliance. Findings also suggest that staff buy-in is critical to the success of intervention implementation. These results, along with suggested strategies for effective implementation, informed the development of the piloted incentive program. Results of simulation modeling analyses of time series data showed significant increases in therapeutic alliances and goal attainment following the incentive program.Conclusions
This study provides preliminary support for the use of incentive programs to facilitate youth engagement in residential programs.19.
Ellen K. Defenderfer Tiffany M. Rybak W. Hobart Davies Kristoffer S. Berlin 《Quality of life research》2017,26(6):1405-1415
Purpose
Parents of children with chronic illnesses are at risk for poor health-related quality of life (HRQoL), with numerous identified risk factors, but the most informative statistical model considering their combined impact is unclear. The authors conceptualized risk for poor HRQoL using a summed model, comprehensive multivariate model, and latent profile analysis (LPA).Methods
Community parents completed an online survey, providing information about demographics, child’s chronic illness, family functioning, and parent and child HRQoL. Parents reported that their children had a variety of chronic conditions (e.g., asthma, headaches, attention deficit/hyperactivity disorder, neurofibromatosis).Results
The summed model did not account for a significant proportion of variance in parent HRQoL. The comprehensive multivariate model (R 2 ?=?0.614) and LPA (R 2 ?=?0.305) both significantly predicted parent HRQoL. The LPA identified two risk profiles for lower HRQoL: parents who reported milder illnesses, but poorer family functioning; and parents who reported greater disease severity, but better family functioning.Conclusions
Comprehensive multivariate models or LPAs best conceptualize patterns of risk for poor parental HRQoL in the community; though the findings in the current community sample may not extend to parents recruited from specialty clinics whose children may have more severe chronic illnesses. Parents of children with mild chronic conditions are still at risk for poor HRQoL, warranting attention from health care providers.20.