Courtwright Suzanne E, Jones Jacqueline, Barton Amy, Peterson Kerry, Eigen Karen, Feuerstein Jessica, Pawa Anil, Pawa Akhil, Northridge Jennifer, Pall Harpreet
Office of Research and Scholarship, University of Colorado College of Nursing, Colorado, USA.
Department of Pediatrics, Hackensack Meridian Health School of Medicine, Nutley, New Jersey, USA.
J Spec Pediatr Nurs. 2023 Apr;28(2):e12403. doi: 10.1111/jspn.12403. Epub 2023 Feb 23.
The Covid-19 pandemic contributed to adverse adolescent mental health outcomes globally. Adolescents with chronic conditions have four times the odds of self-harm than peers. Little evidence exists to guide pediatric nurses on how to engage this vulnerable population with mental health support as the pandemic continues. In adults with chronic conditions, positive health assets (health access literacy, health self-efficacy, and emotional well-being) are directly related to improved patient engagement. The objective of this study was to gain a deeper understanding of engagement with mental health supports in adolescents with chronic conditions to inform practice.
Using mixed methods, we surveyed and interviewed adolescents with chronic conditions aged 10-20 years. Random sampling was applied to avoid bias. Valid and reliable scales were used to measure health access literacy, health self-efficacy, and emotional well-being. Textual data were collected using a semistructured interview guide. Integrated data analysis was conducted using structural equation models and interpretive phenomenology.
One hundred fifty-four participants provided numerical data and 17 participants provided textual data (mean age 15.5 years; 56% female, 5.8% agender; 56% White; 16.9% Black or African American, 4.5% Asian; 51.9% Hispanic or Latinx; 23.4% LGBTQ+). The structural model was an acceptable fit for the data (comparative fit index [CFI] = 0.97, Tucker-Lewis index [TLI] = 0.95). Participants reported higher levels of health access literacy (M = 3.88, SD = 0.848) than health self-efficacy (M = 2.98, SD = 0.646), and engagement (M = 1.78, SD = 1.71). Health access literacy predicted emotional well-being (β = .33, p < .001, 95% confidence interval [CI] [.20, .50]) and health self-efficacy (β = .52, p < .001, 95% CI [0.42, .062]). Emotional well-being positively predicted health self-efficacy (β = .21, p < .003, 90% CI [0.10, 0.033]). Health self-efficacy predicted engagement (β = .20, p < .01, 90% CI [0.07, 0.034]). Participants reported not engaging until "it was really, really bad" citing fear, stigma, and lack of connectedness with providers as barriers.
Regardless of health access literacy and health self-efficacy, adolescents with chronic conditions may not engage until crisis levels. Pediatric nurses can aim to engage with this vulnerable population proactively.
新冠疫情在全球范围内对青少年心理健康产生了不利影响。患有慢性病的青少年自我伤害的几率是同龄人 的四倍。随着疫情持续，几乎没有证据可指导儿科护士如何为这一弱势群体提供心理健康支持。在患有慢性病的成年人中，积极的健康资产（健康获取素养、健康自我效能感和情绪健康）与改善患者参与度直接相关。本研究的目的是更深入地了解慢性病青少年对心理健康支持的参与情况，以为实践提供参考。
我们采用混合方法，对10至20岁的慢性病青少年进行了调查和访谈。采用随机抽样以避免偏差。使用有效且可靠的量表来测量健康获取素养、健康自我效能感和情绪健康。通过半结构化访谈指南收集文本数据。使用结构方程模型和解释现象学进行综合数据分析。
154名参与者提供了数值数据，17名参与者提供了文本数据（平均年龄15.5岁；56%为女性，5.8%为无特定性别者；56%为白人；16.9%为黑人或非裔美国人，4.5%为亚洲人；51.9%为西班牙裔或拉丁裔；23.4%为 LGBTQ+）。结构模型与数据拟合度良好（比较拟合指数[CFI]=0.97，塔克-刘易斯指数[TLI]=0.95）。参与者报告的健康获取素养水平（M=3.88，标准差=0.848）高于健康自我效能感水平（M=2.98，标准差=0.646）和参与度水平（M=1.78，标准差=1.71）。健康获取素养可预测情绪健康（β=0.33，p<0.001，95%置信区间[CI][0.20,0.50]）和健康自我效能感（β=0.52，p<0.001，95%CI[0.42,0.62]）。情绪健康可正向预测健康自我效能感（β=0.21，p<0.003，90%CI[0.10,0.33]）。健康自我效能感可预测参与度（β=0.20，p<0.01，90%CI[0.07,0.34]）。参与者表示，由于恐惧、耻辱感以及与医护人员缺乏联系，直到“情况非常非常糟糕”才会寻求帮助。
无论：无论健康获取素养和健康自我效能感如何，患有慢性病的青少年可能直到危机出现才会寻求帮助。儿科护士应积极主动地与这一弱势群体接触。
