Despite advances in diagnosis, management, and control of illness, chronic illness in childhood remains a major health problem that affects up to 20% of all children. Adverse responses to childhood illness for the child and family are a recurrent theme in the literature. However, few generalizations can be made due to conceptual and methodological issues. As a result, there are gaps in the existing knowledge base about the health of these children and families and the multiple factors that influence health over time. Such knowledge is essential to provision of effective nursing care. The long term objective is to provide a theoretically based and empirically verified basis for early identification of families and children at risk for long term health problems and develop Intervention strategies to decrease these problems for these high risk groups. The proposed research builds on the investigators initial studies of health and social support in children with diabetes mellitus (IDDMl) and expands that work to another Illness group, children with asthma. A middle range theory of family health, child health, child's self-care, and social support, derived from King's conceptual framework for nursing, guides the proposed research.
Specific aims are: 1) to develop a reliable and valid measure of asthma related self-care practices. 2) describe, compare and contrast selected dimensions of family health (adaptation, cohesion, coping, and resources), child health (functional, physical, biological dimensions, perceived health status), child's self-care (health and illness related), and social support (parent's and child's general support, illness support and satisfaction with support), and illness factors (duration and age at onset) over time for each group, and 3) identify common and unique patterns within and between illness groups. Following instrument development, a longitudinal design will be used to follow 80 families with children with IDDMl and 80 families with children with asthma over a 3 year period. Several multivariate analyses will be used to examine the relationship among the indicators, the relationships among the variables, and the changes over time for each group. The proposed research is an important extension of the research to date and addresses many of the methodological and substantive limitations of prior work. The approach to understanding family and child factors in chronic Illness differs from other approaches in that it is guided by a theoretical model derived from a nursing conceptual framework, uses longitudinal design, uses multiple indicators of variables, and combines health as well as illness related traits and measures. This, combined with the focus on both similarities and differences between and within two groups, potentially offers an efficient method of building the science of nursing.
