Children's adjustment to asthma or diabetes and treatment adherence
This thesis had two main aims. Firstly, to develop separate questionnaires for children with asthma and children with diabetes and their parents, which assess children's adjustment to the illness and treatment adherence. Secondly, to test the hypothesis of an association between children's adjustment and treatment adherence. The essence of asthma and diabetes treatment is self-care and consequently children with asthma or diabetes have to learn to cope with the long-term demands and responsibilities of complying with a strict and complex treatment regimen. It is currently recognized that a major problem in paediatrics is poor treatment adherence, which can result in serious health consequences. This led to a shift in paediatric medicine, from focusing only on the physical treatment of the illness to exploring the psychological impact of the illness and how it affects children's socio-emotional adjustment. However, there is a shortage of adjustment and treatment adherence measures; existing ones have major limitations. Thus, the new questionnaires aimed at assessing both children's adjustment and treatment adherence. Four interlinked studies utilising qualitative and quantitative methods were carried out. Study 1 and study 3 were parallel but separate studies and involved interviewing a group of 15 children with asthma and 15 children with diabetes, their parents and paediatric nurses about the children's experiences and feelings in a range of contexts. The interviews showed that there were commonalities in stressors across children but differences in adjustment and treatment adherence levels. On the basis of these interviews separate questionnaires for children with asthma (study 2) and children with diabetes (study 4) and their parents were developed and administered to a sample of 60 children and their parents. The new questionnaires proved to be reliable and valid and confirmed the hypothesis of a significant relation between children's adjustment and treatment adherence. The development of a new assessment tool involves several steps: This work represents the first steps in developing a new assessment tool. As with any new assessment instrument, further development will be required to examine its validity and reliability.
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