Objective To critically review, analyze, and synthesize the literature on parenting stress among caregivers of children with asthma, cancer, cystic fibrosis, diabetes, epilepsy, juvenile rheumatoid arthritis, and/or sickle cell disease. Method PsychInfo, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature were searched according to inclusion criteria. Meta-analysis of 13 studies and qualitative analysis of 96 studies was conducted. Results Caregivers of children with chronic illness reported significantly greater general parenting stress than caregivers of healthy children (d ¼ .40; p ¼� .0001). Qualitative analysis revealed that greater general parenting stress was associated with greater parental responsibility for treatment management and was unrelated to illness duration and severity across illness populations. Greater parenting stress was associated with poorer psychological adjustment in caregivers and children with chronic illness. Conclusion Parenting stress is an important target for future intervention. General and illness-specific measures of parenting stress should be used in future studies.

Parenting Stress among Caregivers of Children with Chronic Illness: A Systematic Review

Objective This review evaluates the effectiveness of quality improvement (QI) strategies in reducing disparities in health and health care. Data sources We identified papers published in English between 1983 and 2011 from the MEDLINE® database, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science Social Science Index, and PsycINFO. Review methods All abstracts and full-text articles were dually reviewed. Studies were eligible if they reported data on effectiveness of QI interventions on processes or health outcomes in the United States such that the impact on a health disparity could be measured. The review focused on the following clinical conditions: breast cancer, colorectal cancer, diabetes, heart failure, hypertension, coronary artery disease, asthma, major depressive disorder, cystic fibrosis, pneumonia, pregnancy, and end-stage renal disease. It assessed health disparities associated with race or ethnicity, socioeconomic status, insurance status, sexual orientation, health literacy/numeracy, and language barrier. We evaluated the risk of bias of individual studies and the overall strength of the body of evidence based on risk of bias, consistency, directness, and precision. Results Nineteen papers, representing 14 primary research studies, met criteria for inclusion. All but one of the studies incorporated multiple components into their QI approach. Patient education was part of most interventions (12 of 14), although the specific approach differed substantially across the studies. Ten of the studies incorporated self-management; this would include, for example, teaching individuals with diabetes to check their blood sugar regularly. Most (8 of 14) included some sort of provider education, which may have focused on the clinical issue or on raising awareness about disparities affecting the target population. Studies evaluated the effect of these strategies on disparities in the prevention or treatment of breast or colorectal cancer, cardiovascular disease, depression, or diabetes. Overall, QI interventions were not shown to reduce disparities. Most studies have focused on racial or ethnic disparities, with some targeted interventions demonstrating greater effect in racial minorities--specifically, supporting individuals in tracking their blood pressure at home to reduce blood pressure and collaborative care to improve depression care. In one study, the effect of a language-concordant breast cancer screening intervention was helpful in promoting mammography in Spanish-speaking women. For some depression care outcomes, the collaborative care model was more effective in less-educated individuals than in those with more education and in women than in men. Conclusions The literature on QI interventions generally and their ability to improve health and health care is large. Whether those interventions are effective at reducing disparities remains unclear. This report should not be construed to assess the general effectiveness of QI in the health care setting; rather, QI has not been shown specifically to reduce known disparities in health care or health outcomes. In a few instances, some increased effect is seen in disadvantaged populations; these studies should be replicated and the interventions studied further as having potential to address disparities.

Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).

A large body of research indicates that child development is sensitive to early‐life environments, so that poor children are at higher risk for poor cognitive and behavioral outcomes. These developmental outcomes are important determinants of success in adulthood. Yet, remarkably little is known about whether poverty‐alleviation programs improve children’s developmental outcomes. We examine how a government‐run cash transfer program for poor mothers in rural Ecuador influenced the development of young children. Random assignment at the parish level is used to identify program effects. Our data include a set of measures of cognitive ability that are not typically included in experimental or quasi‐experimental studies of the impact of cash transfers on child well‐being, as well as a set of physical health measures that may be related to developmental outcomes. The cash transfer program had positive, although modest, effects on the physical, cognitive, and socioemotional development of the poorest c...

Does Money Matter? The Effects of Cash Transfers on Child Development in Rural Ecuador

Asthma continues to disproportionately affect minority and low-income groups, with African American and Latino children who live in low-socioeconomic-status urban environments experiencing higher asthma morbidity and mortality than white children. This uneven burden in asthma morbidity has been ever increasing despite medical advancement. Many factors have contributed to these disparities in the areas of health care inequities, which result in inadequate treatment; poor housing, which leads to increased exposure to asthma allergens; and social and psychosocial stressors, which are often unappreciated. Interventions to reduce individual areas of disparities have had varying successes. Because asthma is a complex disease that affects millions of persons, multifaceted comprehensive interventions that combine all evidence-based successful strategies are essential to finally closing the gap in asthma morbidity.

https://www.jacionline.org/article/S0091-6749(09)00689-7/pdf

Asthma disparities in urban environments

This brief summarizes the results of a gender impact evaluation study, entitled Does money matter? : the effects of cash transfers on child health and development in rural Ecuador, conducted in 2003 in Ecuador. The study observed the impact of government-run cash transfer program targeted to poor mothers in rural Ecuador on the health and development of their children on the child level. Relatively modest unconditional cash transfers raised the hemoglobin levels of the poorest children, improved fine motor control, improved cognitive outcomes, and led to a reduction in reported behavioral problems. Program effects on cognitive development were generally larger for girls than boys, and for children with more highly-educated mothers but differences by child gender are not big, and are precisely estimated. The implied program effects are much larger than will be expected from the cross-sectional elasticities of outcomes with respect to expenditures for households in the control group. The findings suggest that these gains may have been accomplished though better nutrition and the use of de-worming medication, although not through the use of growth monitoring check-ups and better parenting. Funding for the study derived from the Center for Economic and Policy Studies at Princeton University, the Government of Ecuador, and The World Bank.

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Does money matter ? The effects of cash transfers on child health and development in rural Ecuador

A correlation study was designed to test the hypothesis that maternal education, perceived family resources, and the importance of family routines would be related to children's dietary patterns. Additionally, the study examined the hypothesis that dietary patterns would be associated with children's cognitive and physical abilities. The sample for this study included 159 African American single-mother families with a 6- to 9-year-old child living in rural areas, most of whom lived in poverty. Children's eating patterns were assessed using a self-report questionnaire administered to the mother in an interview format. Children's cognitive ability was measured by several subscales from the Woodcock Johnson Psycho-Educational Instrument and the Harter Perceived Competence Scale for children. For male children, the mother's higher education was related to more adequate eating patterns at home, and more perceived family resources were related to the likelihood of taking vitamin supplements. For female children, greater milk intake was positively related to cognitive outcomes, including applied problem, passage comprehension, calculation, synonym identification, antonym identification, and quantitative concept scores. Milk intake was clearly related to more optimal cognitive development. The results of this study support the literature related to the importance of nutrition for cognitive and physical abilities in children.

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Maternal Resources, Parenting, and Dietary Patterns Among Rural African American Children in Single-Parent Families

Demands and Resources: Parents of School-Age Children With Asthma

A descriptive cross-sectional study was designed to examine the influence of family resources and coping behaviors on the well-being of African American and Caucasian parents providing care to a school-age child with asthma. A convenience sample of 71 (33 African American and 38 Caucasian) parents of school-age children with asthma were recruited from two private medical practices and one school. Family resources were assessed using the Family Inventory of Resources for Management. Coping behaviors were assessed using the Coping Health Inventory for Parents and well-being was measured by the General Well-being Schedule. For both groups, the findings revealed family resources are significantly related to parental well-being. Also, coping behaviors were significantly related to the well-being of Caucasian parents. The results of this study support the literature related to the importance of resiliency factors such as family resources and coping behaviors on parental well-being.

Influence of family resources and coping behaviors on well-being of African American and Caucasian parents of school-age children with asthma.

Purpose The purpose of the study is to examine the differences in family caregivers’ burden based on the usage of caring device such as bed for preventing bedsore, wheelchair, electric wheelchair etc., and the predictive factors (caregiver age, educational level, daily care time, satisfaction on interactive relationship between caregiver and care-recipient, and perceived stress) of care burden in informal caregivers of people with disability in Korea. Methods A cross-sectional survey study design was used through either telephone interview or self-report using Google form with family caregivers of people with severe disability. Data were collected from December, 2021 to Feb. 2022. A convenience sample of 103 family caregivers were included if they were giving care to people with severe disability who were older than 19 years old and had disability level 1-3, and needed lots of help from others, demonstrating difficulties in performing ADLs by themselves. Measurements were included Zarit Burden Interview-Korean version (Lee et al., 2004; Zarit et al., 1980), Barthel ADL Index (Collin et al., 1988, Kim et al., 2004), and Korean version of perceived stress scale (Hong et al., 2016). Data were analyzed using Pearson’s correlation and hierarchical moderated regression analysis. Results and Discussion Mean age and educational level of the participants were 51.39 years old (SD = 8.64, range = 19 - 72) and 14.37 year (SD = 2.52, range = 6 - 20), respectively. Family members using care objects were significantly low on care burden (t = 3.32, p = .001). Longer daily care time (r=.37, p<.001), lower satisfaction on interactive relationship (r=-.28, p<.001), and higher stress (r=.58, p<.001) were related to higher care burden. With hierarchical multiple regression, perceived stress (Beta = .49, p = .000) was the strongest predictor on caregiver burden, followed by satisfaction on interactive relationship (Beta = -.19, p = .000). Although the variable of usage care device predicted on care burden significantly, it was not that strong predictor on care burden. Future research is suggested to increase sample size, and use detail questions on types of care device and care technology including care robot. Considering in increases in number of disabled older adults, it would be necessary to develop and apply technologies in caring based on personal needs.

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E. Juanita Lee

Papers

Maternal Resources, Parenting, and Dietary Patterns Among Rural African American Children in Single-Parent Families

Demands and Resources: Parents of School-Age Children With Asthma

Influence of family resources and coping behaviors on well-being of African American and Caucasian parents of school-age children with asthma.

Informal caregiver burden of disabled residing in a community according to use of care device