Academic journal article New Zealand Journal of Occupational Therapy

Occupational Therapists' Health Literacy Interventions for Children with Disordered Sleep And/or Pain

Academic journal article New Zealand Journal of Occupational Therapy

Occupational Therapists' Health Literacy Interventions for Children with Disordered Sleep And/or Pain

Article excerpt

Pain and disordered sleep (DS) are very common in children with chronic health conditions and neurodevelopmental disorders (CHCND). Prevalence rates are cited as being in the range of 50 to 70% (Goodlin-Jones, Tang, Liu, & Anders, 2009; Newman, O'Regan, & Hensey, 2006). Developing a chronic health condition or having a neurodevelopmental disorder in childhood is life-changing. This places a high demand on both the child and the family to access, understand, retain, and put into practice new information to cope with the ramifications of the CHCND. The child and his/her family must also learn how to manage side effects of medications and other disease-related symptoms interfering with functional abilities and the typical stages of development. This multi-faceted learning is commonly considered to be a key component in health literacy (Canadian Council on Learning [CCL], 2008).

Health literacy is defined as "the cognitive and social skills that determine the motivation and ability of individuals to gain access to understanding and to use information in ways that promote and maintain good health" (Department of Health, 2007). A recent CCL report highlighted that the public have poor health literacy skills (CCL, 2008). Health literacy (HL) is critical to successfully self-managing the complexities of a range of chronic health conditions and disorders and has been linked to mortality and morbidity (Baker, Wolf, Feinglass, Thompson, Gazmararian, & Huang, 2007). Poor HL is an area of concern as it impacts an individual's ability to cope with his/her CHCND (Aronsohn, Whitmore, Van Cauter, & Tasali, 2009; Giannotti, Cortesi, Cerquiglini, Miraglia, Vagnoni, & Sebastiani, et al., 2008; Newman, O'Regan, & Hensey, 2006). CHCND often contribute to disordered sleep and/or chronic pain (DS/P), which can lead to lost productivity (Hossain & Shapiro, 2002). Inadequate HL skills may impact a person's ability to cope with DS/P. Understanding the reciprocal connections between DS/P and HL is important to the overall management of life with many CHCND.

Literature review

Research shows that faciliating a patient's HL is not as simple as providing handouts and brochures (Nutbeam, 2008). Although cognitive abilities and education are determinants of HL, other determinants such as motivation, learning supports, values, beliefs, and the contextual environment are also important. To faciliate this complex process and help patients acquire needed HL skills requires the application of knowledge translation and exchange of skills not commonly included in most health care professionals' education (Stallings & Bacon, 2007). Health literacy is particularly relevant to the work of occupational therapists who partner with their clients and clients' families to facilitate access to the resources and opportunities needed to participate in meaningful and productive activities. A large proportion of occupational therapy interventions involve HL teaching to facilitate self-management skills and healthy lifestyles (Canadian Association of Occupational Therapy [CAOT], 2006).

Children's experience of disordered sleep

Disordered sleep (DS) in children may be a result of musculoskeletal problems, chronic diseases, or a range of neurological and sensory processing problems (Finley, Franck, Grunau, & von Baeyer, 2005; International Association for the Study of Pain [IASP], 2004). DS can refer to problems which include hypersomnia, parasomnia, insomnia and sleep-wake cycle disturbances. Estimates are that 40 to 70% of children with neurodevelopmental disorders have some form of DS (Goodlin-Jones, Tang, Liu, & Anders, 2009). DS in early childhood has also been linked to substance abuse and aggressive behaviors in adolescents (Ireland & Culpin, 2006; Wong, Brower, & Zucker, 2009). Children with Autistic Spectrum Disorder (ASD) and DS have higher rates of anxiety, depression, and aggressive behavior compared to children with ASD without sleep problems (Ireland & Culpin, 2006). …

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