Understanding children's thinking about alcohol advertisements on television : a cognitive developmental approach

A theoretical understanding of the nature of knowledge and its development in children was applied to an under-researched area: children's thinking about television alcohol advertisements. Methodologies were developed which recognise that children have multiple ways of thinking about things, that learning is a dynamic process and that knowledge is not always available for verbal report. Research took two complementary routes. Firstly, cross-sectional studies with children aged 7 to 10 tapped into children's implicit, pre-explicit and explicit knowledge, by means of a categorisation study, a story style paradigm and interviews. Children of all ages found television alcohol advertisements attractive and particular styles of advertising, e. g. humour, cartoon format or the inclusion of an animal, increased the popularity of an advertisement. Children's pre-explicit and explicit responses appeared to be biased by the development of alcohol knowledge. Secondly, a longitudinal study followed a group of over 100 children aged 9 for three years, collecting data every six months and investigating the potential influence of a number of factors on positive alcohol expectancies, a predictor of alcohol behaviour. New measures provided data on children's alcohol expectancies (Alcohol Beliefs and Expectancies in Childhood questionnaire), family and peer influences (The Children's Alcohol Inventory), self-esteem (IAM questionnaire), television viewing habits (TV Viewing Habits Questionnaire), and exposure to television alcohol advertisements (Television Advertising Awareness Questionnaire). The findings suggest a possible long term influence of alcohol advertising around the age of II on later alcohol expectancies, but that this influence is less than that of peer behaviour and parental attitudes. It is also suggested that children as young as seven be included in future research,t hat the style of alcohol advertisements is monitored closely to minimise their appeal to children and, finally, that applied research should include methodologies which reflect the state and complexity of children's developing knowledge

Evaluating and adapting the ASQ-3™ for use in England : Introducing the ASQ-3™ to the health and development review for 2-2.5 year old children

Avril Nash, Sally Kendall, ‘Evaluating and adapting the ASQ-3™ for use in England: Introducing the ASQ-3™ to the health and development review for 2-2.5 year old children’, poster presented at the ASQ Around the World Symposium, San Francisco, USA, 4-5 September, 2014.Evaluating and adapting the ASQ-3 for use in England With the proposed introduction of the ASQ-3 to the child health and development review in England to which all 2-2½ year old children are invited, research was undertaken to evaluate the views of parents and professionals who are already using the measure. Research findings are reported together with details on how the research is informing preparations for wider usage. The latter include the development of a British-English translation of the measure and the creation of a two-part e-learning package as a training tool for health professionals on incorporating the ASQ-3 into the review.Peer reviewedFinal Published versio

Psoriasis today: experiences of healthcare and impact on quality of life in a major UK cohort

Aim: To establish how people with psoriasis in the United Kingdom today experience living with their condition including diagnosis, treatment, healthcare provision and impact on daily life. Background: Psoriasis is a debilitating long-term inflammatory skin disease which can result in severe itching, discomfort and soreness, and may be associated with problems beyond the specific symptoms related to the skin. For many it is accompanied by difficult-to-manage treatment regimes, emotional distress and a negative impact on their quality of life and psychosocial functioning. To date there is little published information about the health experiences of people in the United Kingdom with psoriasis. Methods A postal self-administered questionnaire was completed by members of the Psoriasis Association and the responses analysed (n=1564). Findings The findings suggest some similarities to surveys in other nations, but specifically highlighted that patients feel under-informed and are dissatisfied with current treatment regimes. Responses provided an insight into aspects of the condition that treatments should be targeting. Specific areas of negative impact on psychosocial functioning were identified, including the lack of available support for those experiencing emotional distress. The research provides important information about how the care of patients with psoriasis can be improved, especially at primary care level. This includes: improved training in psoriasis knowledge and awareness at general practitioner level and greater use of dermatology specialist nurses in primary care settings; more effective and manageable treatment regimes that target visible areas and general well-being; greater support for emotional distress and psychosocial functioning.Peer reviewedFinal Accepted Versio

Evaluating the use of a population measure of child development in the Healthy Child Programme Two Year Review

Aims and Objectives The overall aim of this study was to inform the use of ASQ-3™ and of ASQ:SE in the Healthy Child Programme two year review which in turn is intended to contribute to overall improved outcomes for children and their families. Aim To explore the acceptability and understanding of the ASQ-3 and ASQ:SE as measures of child development as part of the Healthy Child Programme two year review among health professionals and parents. Objectives 1. To determine the acceptability of ASQ-3 and ASQ:SE among parents of children who have had a HCP a two year review. 2. To investigate parents’ understanding of ASQ-3 and ASQ:SE used as part of the 2 year review. 3. To determine the acceptability of ASQ-3 and ASQ:SE among health professionals using the measures as part of the HCP two year review. 4. To investigate health professionals’ understanding of ASQ-3 and ASQ:SE as part of the two year review. Methods Four study sites known to be currently using ASQ-3 as part of the HCP two year review were selected to reflect differences in geography and in socio-demographic characteristics of the population. A mixed methods approach was taken and data were collected from 153 parents of children who were due their HCP two year review and 126 health professionals conducting two year reviews using survey questionnaires. Twelve focus groups involving 85 health professionals were conducted, 40 parents interviewed individually and 12 HCP two year reviews observed. Findings The key findings were: ? In general, most parents and HPs accepted the ASQ-3 as a measure that provides useful information about a child’s development at two years. ? Parents and HPs were less certain that ASQ:SE could provide an accurate assessment of social and emotional development. ? Parents enjoyed and found it valuable to observe their own child and make their own observations prior to an assessment visit either in a clinic or at home. ? Parents and HPs were positive about the opportunity to work in partnership in relation to the child’s development. ? There was wide variation both across and within the areas studied as to how the ASQ-3 was used (home, clinic, with parents, put to one side, scored differently, health visitor or community nursery nurse, referrals and re-reviews etc.) ? There was considerable variation around the preparation and training for the ASQ-3 and ASQ:SE amongst HPs. ? There was some evidence of confusion about the purpose of the ASQ-3, namely whether it was for screening developmental delay or for use as an assessment tool. ? There was misunderstanding and criticism of some of the individual questions, especially where there was use of American vocabulary or activities that did not make sense to parents or HPs and also misunderstanding of the possible responses. ? There was evidence of misunderstanding of the scoring of the ASQ-3, potentially leading to over- or under- reporting of developmental delay. ? There were problems in the reporting of the scores and the assessment related to time availability, access to a suitable electronic record system such as RIO, access to computers and internet, over-reliance on hard copy and reporting scores in the Personal Child Health Record (PCHR). ? There was some evidence of variation in practice in making referrals for speech and language or paediatric assessment

Acceptability and understanding of the Ages & Stages Questionnaires®, Third Edition, as part of the Healthy Child Programme 2?year health and development review in England: Parent and professional perspectives

Background The Healthy Child Programme is the universal public health system in England to assess and monitor child health from 0 to 19. Following a review of measures for closer monitoring at age 2 years, the Department of Health for England implemented the Ages & Stages Questionnaires®, Third Edition (ASQ?3™; Hereon, ASQ?3). Aim The aim of this study was to evaluate the acceptability and understanding of the ASQ?3 in England by health professionals and parents. Method A mixed?methods approach was used. This paper reports on the qualitative data drawn from interviews with 40 parents and 12 focus groups with 85 health professionals. The data were analysed using applied thematic analysis. Findings Overall, parents and health professionals found the ASQ?3 acceptable and understandable and could use it as a measure at age 2 years. The ability to work in partnership was valued. Some limitations included potential to cause anxiety, concerns around the safety of some of the items, and use of Americanized language. Health professional's training in the use the ASQ?3 was inconsistent. Conclusion The ASQ?3 is an acceptable and understandable measure to use as part of the 2?year assessment with some adaptations to the English context and some standardized training for health professionals

Inflammatory Bowel Disease and Young People from Black and Minority Ethnic Communities in the UK

Introduction: The research in this report was commissioned by Crohn’s and Colitis UK with the aim of ensuring that, as a support organisation, its policies incorporate evidence-based findings to develop and increase social inclusivity. In this instance, the focus was on young people with Inflammatory Bowel Disease (IBD) from Black and Minority Ethnic (BME) groups. Increased prevalence of IBD among young people from Black and South Asian backgrounds determined the target ethnic population for research and the age range of 16 to 24 was selected as around 20-25% of patients are diagnosed in adolescence. Young people face immense developmental changes during this period that affect them socially, psychologically, physically and emotionally. Learning to cope with IBD has to accompany, interact with, and at times, interfere with typical adolescent development. This research investigated whether, or to what extent, young IBD patients from BME backgrounds experience difficulties, arising from the interaction of their ethnicity and their condition, which exceed those of their non-BME peers with IBD. Research: A literature review identified issues specific to young people with IBD, such as social isolation, delayed independence, restricted living space. However, it also revealed a paucity of research into the non-medical interaction of ethnicity and IBD generally, and an apparent absence of data for young people with IBD from BME backgrounds specifically. The review was followed by qualitative research which comprised interviews with 20 young people (18 British Asian and two British Black) diagnosed with either Crohn’s Disease or Ulcerative Colitis. All participants were recruited through consultant gastroenterologists working in London and South-West England. Key findings: A thematic analysis of the experiences of these young people from BME backgrounds identified many commonalities with other adolescents with IBD. However, ethnicity and cultural identity posed additional challenges for our cohort and two key issues emerged: •Nearly half our sample had parents who had limited proficiency in English, and a paucity in the provision of culturally-appropriate information seriously impacted on their parents’ understanding of IBD. Crucially, this diminished the ability of some parents to provide valuable support and advocacy. Furthermore, it increased stress for several of the young people. •At least two-thirds of the sample experienced difficulties in tolerating the spicy nature of food which is typical of traditional Asian and Black cuisines. This impacted both on everyday life and on young people’s ability to be part of their cultural communities which value the social importance of sharing food. Moreover, the experiences of the young people in our study were compounded by culturally-specific societal norms, such as the need for respect for elders, and by a lack of familiarity with IBD, particularly among the Asian community. For some of the findings it was hard to disentangle how far negative experiences were a result of discrimination, being young, having a complex long-term condition, or a combination of any of these factors. While some schools displayed understanding and adopted supportive practices, the response from other schools to students with IBD in this study was found to be problematic in terms of the in-school management of their condition and their continued education. •Young people’s cumulative narratives indicated that a significant number experienced delays in diagnosis or mis-diagnosis. At primary care level there appeared to be a particular issue with some GPs’ familiarity with the condition and with their skill in communicating with young people. Conclusions and recommendations: As evidenced by the findings in this report, it is crucial that ethnicity and cultural identity is taken into consideration both at diagnosis and when providing healthcare and support for young people with IBD from BME backgrounds. Recommendations arising from the research focus on addressing parental understanding, referral pathways within primary care, educational and social support, and social inclusivity. They include: •greater provision of more culturally-appropriate information and extra support where necessary; •raising awareness and better understanding of IBD within primary care, education, and among South Asian and Black communities; •helping this group of young people to cope and feel socially included within culturally-sensitive contexts. The outcomes of the research are intended for Crohn’s and Colitis UK. However, the findings also have implications for healthcare professionals both within gastroenterology and in other areas of specialism

Young people and IBD : specific challenges for ethnic minority groups

Objective: For young people with IBD, learning to cope with their condition represents a major challenge over and above typical adolescent development: the symptoms and side effects of treatment can have a profound impact leading to social isolation, secretive behaviour and delayed independence. Currently there is a lack of research into the impact of ethnicity in young people with IBD, despite significant increases in the incidence of IBD in Black and Asian communities in the UK and research from other chronic disorders which suggests that ethnicity and cultural identity can affect access to services, health management and social inclusion. This study sought to remedy this. Method: Semi-structured interviews covering a broad range of topics were carried out with 19 young people (16-24y) with IBD of South Asian or Black ethnic backgrounds. The opportune sample was recruited through three NHS gastroenterology departments and was predominantly Asian. Interviews were analysed thematically. Results: The young people interviewed shared many common experiences with young people with IBD who are not Black or Asian, including significant delays in diagnosis and interruptions to education; however, they faced additional challenges related to their ethnicity. The parents of nearly half the sample were not fluent in English and a lack of appropriate information meant that parents and families were inadequately informed about the nature of the illness and, as a consequence, had a poor understanding of IBD, including perceiving it as a short-term illness. This increased stress for the young people and had a negative impact on social support, health care and education. In addition, spicy food, typical of Asian and Black cuisines, triggered or exacerbated the symptoms of IBD for the majority of participants and presented problems exceeding normal IBD dietary-related issues. These were compounded by cultural norms within Asian and Black communities such as the centrality and social importance of sharing food, and respect for elders, and through a lack of familiarity with IBD. Conclusion: Young people with IBD from minority ethnic backgrounds have specific needs, some of which could be readily addressed by healthcare professionals and support organisations. Ensuring that parents have access to appropriate information and raising awareness of the condition within Black and Asian communities would help these young people to receive greater support and understanding.Peer reviewedFinal Accepted Versio

The relationship between television advertising, children's viewing and their requests to Father Christmas

Objective: Children's letters to Father Christmas provide an opportunity to use naturalistic methods to investigate the influence of television advertising. Methods: This study investigates the number of toy requests in the letters of children aged between 6 and 8 (n = 98) in relation to their television viewing and the frequency of product advertisements prior to Christmas. Seventy-six hours of children's television were sampled, containing over 2,500 advertisements for toys. Results: Children's viewing frequency, and a preference for viewing commercial channels, were both related to their requests for advertised goods. Gender effects were also found, with girls requesting more advertised products than boys. Conclusion: Exploring the children's explicit understanding of advertising showed that children in this age group are not wholly aware of the advertisers' intent and that, together with their good recall of advertising, this may account for their vulnerability to its persuasive messages.Peer reviewe

ENHANCE: Enhancing resilience and self-efficacy in the parents of children with disabilities or complex health needs

Avril Nash, Mark Whiting, Sheila Roberts, Sally Kendall, ‘ENHANCE: Enhancing resilience and self-efficacy in the parents of children with disabilities or complex health needs’ poster presented at the Health Psychology in Public Health Network, Welwyn Garden City, UK, 11 February, 2016.Purpose: To develop, pilot and evaluate an intervention aimed at enhancing resilience and parenting self-efficacy in parents of children with disabilities or complex health needs. Background: Parenting a child with a disability or complex health needs can have a significant and negative impact on a parent’s wellbeing. This can have both short-term and long-term outcomes on the health and wellbeing of the parent, the immediate family and the child concerned. This research sought to evaluate the feasibility of enhancing resilience for parents in this situation. Method: A psychosocial support programme, ENHANCE, was developed based on the resilience literature and on the Family Nurse Partnership way of working of a key worker taking a positive approach in structured sessions focussing on key areas. The programme, delivered fortnightly in six half-hour sessions, focusses on four domains (emotional coping, practical coping, support networks) and comprises guided discussions supported by practical exercises/additional resources. Four CCNs were recruited as co-researchers and trained to deliver the programme. The CCNs recruited families coming into the service and, in total, 17 primary caregivers, all mothers, are taking part in the study. The programme is being evaluated through interviews with parents and CCNs, and through pre- and post-test measures including the Tool to measure Parenting Self-Efficacy (TOPSE), the Brief COPE scale and a resilience/distress thermometer. Discussion: The programme is currently on-going with some families still to receive their final sessions. To date feedback has been very positive from both parents and professionals and is informing plans for further research.Peer reviewe