This study was designed to further understand the psychosocial functioning of youth with chronic health conditions or physical disabilities, their need for and use of mental health services, and possible barriers to receiving needed services. Previous research has suggested these youth experience poorer psychosocial functioning compared to peers without special health care needs, and they also underutilize needed mental health services. A mixed-methods design was implemented consisting of a quantitative parent survey and a qualitative semistructured interview with young adults with special health care needs. Children demonstrating poorer psychosocial adjustment in this study experienced more problems related to social functioning than psychopathology (e.g., depression, anxiety). Over half of the youth had accessed mental health services with the majority utilizing community-based outpatient services. Identified barriers to accessing needed mental health services included difficulty finding professionals with experience in working with youth with special health care needs and lack of financial coverage.

This study sought to better understand the experiences of individuals with a chronic health condition utilizing telemedicine during the first twelve months of the COVID-19 pandemic. To do this, an online survey was advertised in two private Facebook support groups for individuals with adrenal insufficiency; a chronic health condition that requires frequent communication with healthcare providers. The survey consisted primarily of closed-response questions which examined the demographic data of respondents, their access to healthcare providers, their comfort levels accessing healthcare providers, and the number of times individuals sought healthcare during the first twelve months of the COVID-19 pandemic to try and predict their preference for telemedicine and in-person healthcare visits going forward. Additionally, the survey included open-response questions which allowed for respondents to describe their experience utilizing telemedicine during the first twelve months of the COVID-19 pandemic. Most respondents described their use of telemedicine as being positive but have indicated there are some health circumstances in which telemedicine may not be the best option for them. Additionally, findings indicate that individual's comfort level in visiting their healthcare providers in-person during that first year of the COVID-19 pandemic is a significant predictor of an individual's preference for telehealth. This gives future studies a starting point to investigate the driving social and health factors that shape an individual's perception of risk influencing their level of comfort and predicting their preference of telemedicine or in-person visits for their non-emergency healthcare needs.

The purpose of this research was to develop and test an instrument to measure or quantify the construct of inner strength. Inner strength was synthesized into a theory based on twelve years of qualitative data from direct participant quotes, defined by Roux et al. (2002) as a central human resource that promotes well-being and healing. The inner strength questionnaire (ISQ) has undergone extensive psychometric evaluation which resulted in several versions. The third version had 37-items and was believed to have four subscales that mirrored the theoretical themes that emerged through the qualitative data. The sample was composed of 281 women with a variety of chronic health conditions including breast cancer, multiple sclerosis, diabetes, and heart disease. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to assess the structure of the ISQ. Internal consistency was used to assess the reliability of each hypothesized subscale and the entire ISQ. Convergent and discriminant validity, were analyzed using the multitrait-multimethod by Campbell and Fiske (1959). For convergent validity, the entire instrument and each of the subscales was correlated with similar theoretical subscales of the Mastery of Stress Instrument (Younger, 1993). For discriminant validity, the Center for Epidemiological Studies in Depression (CESD) was correlated with the entire ISQ. Both the EFA and CFA revealed a four factor model. The four factors were labeled 1) mental, 2) connectedness, 3) knowing and searching, 4) physical. The reliability for all items on the ISQ was 0.91. The reliabilities for each of the subscales were 0.85 for mental, 0.96 for connectedness, 0.85 for knowing and searching, and 0.83 for physical. The multitrait-multimethod matrix revealed correlation coefficients for the relationship between the ISQ and MSI to be 0.55 and a correlation coefficient of -0.19 between the ISQ and the CESD.A four factor model is supported by the statistical data. Through face-to-face interviewing and input from content expert reviewers, ten items were eliminated from the 37-item (version 3) instrument to form a new version of the instrument. The new instrument supports the metasynthesis generated by Roux (2002) except for the fifth theme, entitled "new normal", which was found to be a consequence of having inner strength, not a component of inner strength.

Baksidestext Barnmisshandel är ett omfattande folkhälsoproblem med långsiktiga negativa konsekvenser för den enskilda individen och för samhället i stort. Förebyggande insatser kan vara livsavgörande för de utsatta barnen. Denna avhandlings övergripande syfte var att öka kunskapen om barn som riskerar att fara illa i sin hemmiljö samt att identifiera utmaningar i ett förebyggande perspektiv. Två områden har studerats: (1) Våld mot barn med långvarig sjukdom/funktionsnedsättning (2) Förskolan som upptäckande och stödjande arena Gemensamt för inriktningarna är att barn med långvarig sjukdom/funktionsnedsättning och barn i förskoleåldern utgör särskilt sårbara grupper, som löper ökad risk att fara illa i sin hemmiljö. De har också unik kontakt med professionella med möjlighet att upptäcka och agera vid oro. Avhandlingen bygger på fyra delstudier; en nationell kartläggning riktad till skolelever, en intervjustudie med föräldrar samt två förskolestudier. Resultaten från studierna diskuteras utifrån identifierade utmaningar i ett förebyggande perspektiv. Utmaningarna inkluderar emotionella hinder samt behov av ett mer nyanserat och proaktivt förhållningssätt för att kunna utveckla tidiga insatser till barn och föräldrar. / The aim with this thesis was to increase the knowledge about children at risk of maltreatment and to identify challenges in a preventive perspective. Two areas have been studied; Physical abuse of children with chronic conditions/disabilities and Detection and support within the pre-school environment.  Four data sets were used: a national survey of school children (I), an in-depth interview study with parents (II) and two pre-school studies (III, IV). I-II: Chronic conditions in children increase the risk for physical abuse, but vary with socio-economic circumstances. The highest risk for physical abuse was found among children with chronic conditions born outside Sweden. The subsequent study revealed direct risk factors related to parent and child (emotional demands in precarious situations), and indirect risk factors related to parent and professional (gradual shift in responsibility and emotionally closed environment) and social norms (taboo on talking about abuse). III-IV: Preschool staff suspected child maltreatment for two percent of the preschool children. In less than half of the cases, the parents were informed and a report to social services was made in a third of the cases. The most common reason for not making a report was that the staff believed that the pre-school had sufficient resources to help the child. In the subsequent study, preschool teachers’ concerns about the child’s home environment were explored in a broader perspective over a one year period. The study showed that concern for the children’s home situation related to increased concern for several aspects of children’s health and development, increased need of special support in preschool, insufficient contact with parents, and lower parental socioeconomic status. The results are discussed according to identified challenges in a preventive perspective. These include emotional obstacles for prevention and a need for a more nuanced and proactive professional approach to enable early support to children at risk of maltreatment and their parents.

The purpose of this study was to evaluate the utility of the Adaptive Tasks Framework for assessing parental needs when providing primary care for their child with a chronic health condition. A qualitative descriptive methodology framed the study and two methods were employed to collect data: a secondary analysis of existing interview data from seven parents of children with chronic health conditions and interviews with four parents who were currently providing primary care for their child with a chronic health condition. The data was analyzed using content analysis, whereby interview data was explored to determine if it fit into one or more of the eight adaptive tasks categories. Parents reported needs in all of the eight adaptive tasks categories, with the need for information regarding their child's chronic health condition being the foremost concern among parents. The need for caring, empathetic, and patient health care professionals who are sympathetic to the informational needs of parents, while at the same time acknowledging their expertise, was the second need expressed by the parents in this study. Implications of these findings for nurses is that the Adaptive Tasks Framework provides a useful tool for assessing parental needs when managing their child's chronic health condition and for determining areas in which the parents may require support.

The purpose of this study was to evaluate the utility of the Adaptive Tasks Framework for assessing parental needs when providing primary care for their child with a chronic health condition. A qualitative descriptive methodology framed the study and two methods were employed to collect data: a secondary analysis of existing interview data from seven parents of children with chronic health conditions and interviews with four parents who were currently providing primary care for their child with a chronic health condition. The data was analyzed using content analysis, whereby interview data was explored to determine if it fit into one or more of the eight adaptive tasks categories. Parents reported needs in all of the eight adaptive tasks categories, with the need for information regarding their child's chronic health condition being the foremost concern among parents. The need for caring, empathetic, and patient health care professionals who are sympathetic to the informational needs of parents, while at the same time acknowledging their expertise, was the second need expressed by the parents in this study. Implications of these findings for nurses is that the Adaptive Tasks Framework provides a useful tool for assessing parental needs when managing their child's chronic health condition and for determining areas in which the parents may require support.

The purpose of this study was to evaluate the utility of the Adaptive Tasks Framework for assessing parental needs when providing primary care for their child with a chronic health condition. A qualitative descriptive methodology framed the study and two methods were employed to collect data: a secondary analysis of existing interview data from seven parents of children with chronic health conditions and interviews with four parents who were currently providing primary care for their child with a chronic health condition. The data was analyzed using content analysis, whereby interview data was explored to determine if it fit into one or more of the eight adaptive tasks categories. Parents reported needs in all of the eight adaptive tasks categories, with the need for information regarding their child's chronic health condition being the foremost concern among parents. The need for caring, empathetic, and patient health care professionals who are sympathetic to the informational needs of parents, while at the same time acknowledging their expertise, was the second need expressed by the parents in this study. Implications of these findings for nurses is that the Adaptive Tasks Framework provides a useful tool for assessing parental needs when managing their child's chronic health condition and for determining areas in which the parents may require support. / Applied Science, Faculty of / Nursing, School of / Graduate