Biomedical subjects

Li-Chi Chiang

Publications and source records attributed to Li-Chi Chiang.

14 recordsLinked to original sources

PubMed2006

Student nurses' knowledge, attitudes, and self-efficacy of children's pain management: evaluation of an education program in Taiwan.

The purpose of this study was to examine the effectiveness of a pediatric pain education program (PPEP) for student nurses. The sample consisted of 181 licensed student nurses who were enrolled in a nursing school in Taiwan. Student nurses attended a 4-hour PPEP that involved case scenario discussion, video, and lecture. Data were collected by an extensive questionnaire that assessed student nurses' knowledge of, attitudes toward, and self-efficacy in pediatric pain assessment and pharmacological and nonpharmacological pain management. The results demonstrated that student nurses gained significant knowledge of pediatric pain, expressed more appropriate attitudes, and reported greater self-efficacy in children's pain management after attending PPEP. Their knowledge of analgesic pharmacotherapy did not significantly improve. These results suggest that PPEP should be integrated into pediatric nursing curricula to enhance knowledge and skills regarding children's pain management during the early stage of a nursing career.

Attitude of Health Personnel↗

PubMed2006

Survey of asthma care in Taiwan: a comparison of asthma specialists and general practitioners.

BACKGROUND: Asthma is a common disease in Taiwan. The promotion of quality care for asthmatic patients should focus not only on new treatment remedies but also on patient adherence to treatment and a continuous education program integrated into treatment plans. One reason for patients' poor response to treatment is the lack of asthma knowledge on the part of physicians in terms of attitudes toward treatment. OBJECTIVE: To investigate the current status of asthma treatment among asthma specialists and general practitioners and their relative acceptance of and adherence to treatment guidelines. METHODS: One thousand questionnaires were distributed to physicians throughout Taiwan using a randomized sampling procedure. The questionnaire asked about the use of different kinds of medications, including inhaled corticosteroids, to treat asthma; adherence to asthma treatment guidelines; the use of a peak flow meter for monitoring asthma status; and self-efficacy in the treatment of asthma. RESULTS: A total of 526 questionnaires were returned. Of these, 90.4% of specialists and 63.2% of general practitioners would follow the guidelines for patient care (P = .002). It was significant that 79.8% of specialists but only 41.9% of general practitioners would instruct patients to use a peak flow meter to monitor symptoms (P < .001). Asthma specialists also seemed to be significantly more competent than general practitioners regarding asthma knowledge, instruction of inhalation techniques, use of peak flow meters to monitor symptoms, and making an action plan. CONCLUSIONS: To minimize the knowledge gap between specialists and general practitioners regarding asthma treatment, recognized treatment guidelines need to be popularized or simplified. Furthermore, the continuing education of general practitioners in asthma knowledge and management skills is important.

Administration, Inhalation↗

PubMed2006

Physical activity and physical self-concept: comparison between children with and without asthma.

AIM: This paper reports a study comparing levels of physical activity and physical self-concepts between children with and without asthma. BACKGROUND: Childhood asthma has become one of the world's most prevalent chronic illnesses. Its symptoms are thought to prevent children from participating in some forms of physical activity. However, asthma treatment guidelines are increasingly suggesting that children with asthma can participate in the same physical activities as healthy children for the same reasons-- to promote normal growth, physical development and psychological health. METHOD: Between October 2001 and May 2002, 120 children between the ages of 9 and 11 with mild and moderate asthma were recruited from three paediatric asthma clinics in Taiwan, and 309 non-asthmatic children in the same age group were selected from four elementary schools in Taiwan's three largest cities. Participants were asked to record physical activity levels for 3 days out of the past 7 days and to fill out a 29-item Physical Self-Concept Inventory. Physical activities were classified as moderate-to-vigorous physical activity or vigorous physical activity. Physical self-concept was measured in terms of perceived flexibility, endurance, appearance, agility, obesity and strength. RESULTS: Asthma was the primary factor determining vigorous physical activity levels, but gender was the primary factor determining physical self-concept, especially in terms of endurance, obesity and strength. No statistically significant relationships were noted between asthma and gender in terms of effects on physical activity and physical self-concept. CONCLUSIONS: Asthma interferes with children's ability to participate in vigorous physical activity but not in moderate-to-vigorous physical activity. Gender determines primary differences in physical self-concept. Appropriate exercise recommendations are necessary to encourage children with asthma to engage in vigorous physical activity for normal growth.

Asthma↗

PubMed2006

[The sleep problems among children with asthma].

Asthma is one of the most common chronic illnesses in children. Children with asthma often suffer from night coughing, wheezing and breathlessness that disturb their sleep. Nocturnal asthma is often associated with such problems as difficulty falling asleep, restless sleep, difficulty maintaining sleep, daytime sleepiness, and daytime tiredness. These sleep problems not only occur in children but also in their parents, and furthermore affect their daytime activity. People with asthma should be aware that nocturnal asthma is associated with more severe symptoms and increased mortality. Several underlying mechanisms that may shed light on how and why nighttime seems to exacerbate asthma symptoms include the inflammation process, airway resistance, and bronchial hyper-responsiveness (all circadian factors) as well as gastro-esophageal reflux (a non-circadian factor). Nurses should understand the mechanisms of nocturnal asthma and conduct sleep assessments comprehensively in order to design and implement appropriate strategies to improve the sleep quality of children with asthma.

Asthma↗

PubMed2006

Survey of the clinical practice of physicians in the management of asthma in Taiwan.

Asthma is a common problem with a prevalence rate increasing every year. However, not all asthmatic patients receive appropriate treatment, partly due to the disease entity or patients' compliance, and partly due to physicians' knowledge and disposition in terms of treatment. This study was designed to investigate the current status of asthma treatment among clinicians in different practice settings, particularly regarding the acceptance of and adherence to asthma treatment guidelines and asthma patient education. Questionnaires were distributed by randomized sampling to doctors throughout the entire country. The questionnaire had six parts, measuring the following: 1) the use of different kinds of medication in the treatment of asthma; 2) adherence to asthma treatment guidelines; 3) the use of inhaled corticosteroids as part of management; 4) the use of peak flow meters in monitoring asthma; 5) relative efficiency in treating asthma; and 6) the use of a referral system, from general practitioners to specialists. There were 531 respondents out of 1,000 questionnaires distributed. The results revealed the following: 1) 20.2% of physicians use oral corticosteroids for maintenance therapy; 2) 31.8% of physicians do not follow asthma treatment guidelines; 3) 77.2% of physicians use inhaled corticosteroids for maintenance therapy (physicians in medical centers and regional hospitals use inhaled corticosteroids more frequently than private practitioners); 4) 51% of doctors do not use peak flow meters to monitor asthma symptoms because of prohibitive costs; 5) approximately 80% of clinicians have confidence in dealing with asthma problems; and 6) 29.2% of general practitioners do not refer patients to asthma specialists unless there is poor control or a need for further evaluation. Adherence to asthma treatment guidelines is poor, and such guidelines need to be popularized or simplified. There are still many discrepancies among doctors at different levels of hospitals. Re-education and review of asthma knowledge is necessary to keep clinical practitioners at the forefront of standard practice.

Administration, Inhalation↗

PubMed2005

Prevalence of asthma, rhinitis, and eczema from ISAAC survey of schoolchildren in Central Taiwan.

Asthma is a common disease among schoolchildren in Taiwan. It is clearly a trend that the prevalence of asthma, rhinitis, and eczema has been increasing in developed countries such as Taiwan, but the data remain limited. This study is part of an effort to evaluate the epidemiology of asthma, rhinitis and eczema in Taiwan and to assess the prevalence and severity of those disorders among school age in central Taiwan. The International Study of Asthma and Allergies in Childhood (ISAAC, phase III) standard written questionnaire was administered to 7,873 first grade schoolchildren, 6 to 8 years of age from 47 different elementary schools in Changhwa county, which is located in central Taiwan. The overall cumulative and 12-month prevalence of wheezing is 10.4% and 5.0%, respectively. The prevalence of diagnosed asthma by doctor is 7.0%. Rhinitis is 24.6% and eczema 18.0%. Multiple logic regression analysis shows that a higher prevalence of wheezing and rhinitis is associated with males. Among these school-age children, the peak incidence of asthma and rhinitis is in the winter months, especially in December and January.We also compared the prevalence of asthma, rhinitis, and eczema in two severely polluted areas in Changhwa County with the prevalence in less polluted parts of the county. One is the area near a huge petrochemical company, TaiHao Petroleum Company, located in the central area of the county. The other is XiZhao, a rural area located near an incinerator. These were compared with the less-polluted Coast-Area and with the rest Changhwa County area. The school-age children living near the TaiHao Company have a higher prevalence of wheezing, diagnosed asthma, and diagnosed eczema, but there are no differences for rhinitis. As for XiZhao and Coast areas, those children have significantly higher rates of nasal problems, diagnosed rhinitis, and eczema than the rest of the area, but we did not find a significant difference in the prevalence of asthma. Among school-age children who lived in the Coast area, we found a higher prevalence of rhinitis and nasal problems with associated itchy eyes than among children in other areas of the county.

Asthma↗

PubMed2005

A comparison, by quantitative and qualitative methods, between the self-management behaviors of parents with asthmatic children in two hospitals.

This study compared the self-management behaviors of parents with asthmatic children staying in two hospitals and explored barriers to self-management behaviors by interviewing. 227 parents were recruited for quantitative analysis by completing a self-report structured questionnaire, 94 of these parents were from the Taipei area and 133 were from the Taoyuan area. Sixteen parents were interviewed from this population. The results indicated that the parents in theTaoyuan area had younger age, lower socioeconomic status (SES), and higher exercise limitations for children. Their knowledge, enabling factors, and self-management behaviors were also lower than their counterparts in the Taipei area. The determining factors of self-management behaviors were socioeconomic status, self-efficacy, sources of education, and perceived effectiveness (Adjusted R2= .593) in 227 parents. Six major themes about the influencing factors of self-management were deduced from the interview data: lack of understanding and dislike of the asthma label, less self-perceived severity, lack of understanding about asthma medication, lack of confidence in environmental controls, financial burden of anti-mite products, and doubt about effectiveness. Three major barriers to self-management behaviors of parents in the Taoyuan area were inconsistent use of alternative treatments, overdependence on medical service, and lack of use of peak flow meter. Parents with asthmatic children living in the Taoyuan area had poorer self-management behaviors than those in the Taipei area, and SES was one of the determining factors. The health beliefs of Taoyuan parents included many misconceptions. Conducting the educational needs assessment through quantitative and qualitative methods could provide proficiency information for designing educational content appropriate to specific populations.

Adult↗

PubMed2005

Exploring the health-related quality of life among children with moderate asthma.

Asthma is one of the most common chronic diseases, impacting more than 10 % of children in Taiwan. The recurrent signs and symptoms and complexity of disease management impact the life quality of children with asthma. The purpose of this study was to describe the content and dimensions of health-related quality of life (HRQOL) among children with moderate asthma by descriptive qualitative research based on in-depth interviews. Eleven children, aged 6-12 years, and their mothers from two medical centers in central Taiwan were interviewed and tape recorded. The transcripts were analyzed using content analysis. Six themes relevant to the children's QOL with asthma were identified: 1. physical disturbances of signs/symptoms, 2. limitations of activity, 3. emotional distress, 4. discord in parent-child relationships, 5. restrictions in school social life and 6. daily inconvenience of managing the disease. These findings highlight the ways in which the overall quality of life of children is impacted by asthma including the physiological and psychosocial domains. The breadth of these findings may lead to greater insights into the nursing care of children with asthma.

Activities of Daily Living↗

PubMed2005

[Developing a hospital-based asthma case management program].

The case management model, on the basis of current trends, is likely to be the main model for caring for chronic disease in the future. Since 2001, asthma care has been covered under chronic disease-management by Taiwan's Health Insurance Bureau. But there is no report describing a hospital-based asthma case management program. The purposes of this essay were to develop a hospital-based asthma case management model and introduce the procedures for this model: recruitment, monitoring, implementation, evaluation and follow-up. This model can be used as the standard case management model for caring for children with chronic asthma.

Adolescent↗

PubMed2004

Effects of a self-management asthma educational program in Taiwan based on PRECEDE-PROCEED model for parents with asthmatic children.

This study was conducted to evaluate the comparative effectiveness of two different asthma educational programs. One was self-management asthma education based on the PRECEDE-PROCEED model to change the influential factors based on a previous need assessment study in Taiwan. The other consisted of regular outpatient asthma education. The purposes were: 1) to compare differences in the asthma knowledge, self-efficacy, perceived effectiveness, children's cooperation, doctor-patient communication, and self-management behaviors in the experimental and control groups before education, and 2 weeks, 3 months, and 6 months after education; and 2) to compare differences in drug use, medication utilization, asthma severity, signs/symptoms of asthma, school absenteeism, and exercise ability before education, and 2 weeks, 3 months, and 6 months after education. Parents of asthmatic children were recruited from among outpatients of Chang Gung Children's Hospital, Taoyuan, Taiwan. They were grouped by registration number: those with even numbers were assigned to the experimental group, and those with odd numbers were assigned to the control group. Measurements were collected four times from all parents by means of a questionnaire and chart review. The General Linear Model: Repeat Measurement was used to compare variance differences. The following results were found. 1) Asthma knowledge, self-efficacy, perceived effectiveness, children's cooperation, and self-management behaviors significantly improved after the self-management asthma educational program based on PRECEDE-PROCEED. Except for perceived effectiveness, all variables still had good effectiveness after 6 months of follow-up. The experimental group was better than the control group in knowledge, children's cooperation, and self-management behaviors at the 3-month follow up, as well as in knowledge and children's cooperation at the 6-month follow-up. 2) In both the experimental and control groups, the educational program had a good impact on the health outcome. The average degree of drug use was reduced from 2.7 to 2.1. The number of visits was reduced from 4.75 to 3.55 per half year in the experimental group, and from 5.8 to 3.48 in the control group. The severity of asthma was reduced from 2.7 to 2.1. The signs/symptoms of asthma decreased, school absenteeism was reduced, and exercise ability improved after education at the 6-month follow-up in both groups. From the results of this study, the theory-based educational program had a good effect on self-management behaviors. From the repeat measurement analysis, we can understand the changing trend of the determinants, behaviors, and outcome indicators. The trend indicated that educational effects were sustained for at least 3 months, with some for 6 months. In order to maintain the educational effects, further specific series of educational programs can be designed based on the patterns of self-management behavior stages every 6 months. The effects of health outcomes may show significant differences using longer follow-up times in future clinical trials.

Adult↗

PubMed2004

Levels of physical activity among school-age children in Taiwan: a comparison with international recommendations.

Few studies have investigated levels of physical activity among children in Taiwan. The purposes of this study were to explore levels of physical activity among children and examine their rates of compliance with various international recommendations. The sample was comprised 463 children (249 boys and 214 girls) , aged between nine and twelve from four cities in Taiwan. Three-day Physical Activity Logs (3-d PAL) were used as the instrument to measure physical activity in the previous seven days. The mean and percentile of average estimated energy expenditure (EE, kcal/kg/day), moderate-vigorous physical activity (MVPA, min/day) and vigorous physical activity (VPA, min/day) among boys and girls according to age group were reported. Four international physical activity recommendations were used, as the criteria with which were examined compliance rates. Results indicated no significant main effects of age or gender, and no interaction was found between EE and MVPA. VPA significantly increased between the aged nine and eleven. Girls aged 12 engaged less significantly VPA than boys. Over 90% of children met the Physical Activity Guidelines for Adolescents (PAGA) and the United States' Healthy People Objective No. 22.6; 80% met the United Kingdom Expert Consensus Group guideline; and 70% met the Healthy People Objective No. 22.7. These results indicated that physical activity among the majority of children complied with the international recommendations. The only significant difference came in participation rates for vigorous physical activity among children of different ages and gender. Our results provide important information for health policy in the field of children' s physical activity. We would recommend the setting up of national objectives for the physical activity of children and the conducting of a national surveillance study with a more precise and consistent measurement of physical activity for children to offer a comparable data in the future is suggested.

Analysis of Variance↗

PubMed2004

[A concept analysis of self-efficacy].

Over the past decade, self-efficacy has become one of the most measured variables in studies on health behaviors and patient education. The concept was originally proposed in 1977 by Bandura, who initially promoted its use in social science research, especially psychology. It is now considered one of the most important determinants of health-related behaviors. Using Walker and Avant's concept analysis methods, the authors clarify the attributes and characteristics of self-efficacy. Refinement of this concept is proposed as a prerequisite for application to nursing research and practice.

Health Behavior↗

PubMed2003

Educational diagnosis of self-management behaviors of parents with asthmatic children by triangulation based on PRECEDE-PROCEED model in Taiwan.

This assessment study is an educational and behavioral diagnosis based on the PRECEDE-PROCEED model which identifies factors (predisposing, enabling, and reinforcing) that must be changed to initiate and sustain the self-management behaviors of parents with asthmatic children (aged 3-14 years) in the largest children's hospital in northern Taiwan. In the first step, 21 self-management behaviors were induced from the content analysis of qualitative interviews of 16 successful parents. The construct validity of 21 self-management behaviors was established by principal component factor analysis, followed by the rotation method with Varimax and Kaiser normalization. Three extracted components were named: preventing behaviors, managing behaviors, and assessing behaviors. The cumulative percentage of variance of the three factors was 48.2%. In order to identify the determinate factors of self-management behaviors, 133 parents with asthmatic children were recruited and investigated at the outpatient department of the hospital, in the second step. All the instruments were developed based on the results of content analysis from an in-depth interview. The results indicated that the self-management behaviors of this group were middle level. Stepwise multiple regression was used to analyze the predicted rate of self-management behaviors by 12 educational factors. The results indicate that self-efficacy, perceived effectiveness, and children's cooperation can explain 50.2% of the variance in the self-management behaviors. The determinate factors of preventive behaviors were self-efficacy, perceived effectiveness, and children's cooperation with R(2)=0.448. The determinate factor of managing behaviors was perceived effectiveness with R(2)=0.262. The determinate factors of assessing behaviors were perceived severity, knowledge, self-efficacy, and perceived effectiveness with R(2)=0.311. These results suggest the direction of a self-management education program for different parents of asthmatic children with poor management skills. Future research should be conducted to evaluate the effectiveness of treatment by a more specific self-management education program, which focuses on increasing self-efficacy and perceived effectiveness.

Asthma↗

PubMed2003

Primary school nurses' knowledge/competence pertaining to childhood asthma and its management prior to and following a National Asthma Education Program in Taiwan.

The main purpose of the National Asthma Education Program was to provide asthma education to school nurses in Taiwan. It was also designed to enhance the knowledge and competence of school nurses in managing the asthmatic problems that children experience while in school. In addition to providing instruction about current asthma management skills, tools, and other relevant information, the program demonstrated the use of the peak flow meter for asthmatic children. A single, 4-hr session conducted in each county and city in Taiwan, the National Asthma Education Program began on August 1, 1999, and ended December 31, 2000. A total of 829 school nurses joined the program, with an overall attendance rate of 74%. Significant effects of this program on nurses' asthma care knowledge and competence and case management efficacy were noted. The participating school nurses' demographics, however, were found to be irrelevant to these effects. Expecting the training activities to help relieve the anxieties of managing asthmatic cases in the school environment, participants reported that the training was of much benefit to them. Development of a teaching program to elevate school nurses' capabilities in asthmatic student care in the school environment and the implications of such a program within Taiwanese schools were also discussed.

Adult↗