Abstract
Background
Family‐Centered Care (FCC) is important for self‐management education and partnership building in childhood asthma treatment. This study aimed to gather suggestions for promoting FCC in the asthma treatment of patients aged <5 years.
Methods
We conducted a web‐based survey of pediatric doctors, nurses, and pharmacists in Japan between June and August 2023. We measured the degree of FCC using the Measure of Processes of Care for Service Providers (MPOC‐SP) and assessed its associated factors using multiple regression analysis.
Results
In total, 133 participants responded to the survey. MPOC‐SP scores were 4.70 ± 1.03 for showing interpersonal sensitivity, 3.82 ± 1.34 for providing general information, 4.58 ± 1.28 for communicating specific information about the child, and 5.12 ± 0.95 for treating people respectfully. Their perception of sufficient time for FCC and good interprofessional collaboration was significantly associated with a high degree of FCC.
Conclusions
Adequate provision of information to families and effective information‐sharing within and between families is essential for improving FCC in childhood asthma treatment. To further promote FCC, securing time for FCC, raising awareness of its importance even in limited timeframes, and fostering interprofessional collaboration are key.
Keywords: asthma, family, family‐centered care, health communication, healthcare provider
INTRODUCTION
Childhood asthma is a common chronic disease among children worldwide, with a heavy disease burden. 1 The social impact is also significant, such as absenteeism from school, unscheduled medical visits, and hospitalization. 1 In Japan, the number of hospitalizations for childhood asthma has drastically decreased, and asthma‐related deaths have reached zero owing to the dissemination of the Japanese guidelines for childhood asthma. 2 However, its prevalence rate is approximately 1 in 10 in children aged 6–8 years 3 ; therefore, childhood asthma remains an important chronic disease in Japan.
To treat and manage childhood asthma effectively, domestic and international guidelines state that self‐management education and partnership building are vital. 1 , 2 They also state that healthcare providers should support not only patients but also their families, especially when treating children under 5 years of age. 1 , 2
On the other hand, systematic reviews have highlighted difficulties faced by families with children experiencing asthma, such as “lack of psychosocial support for families” 4 , 5 and “communication problems between family and healthcare providers”. 6 Family‐Centered Care (FCC) has been recommended as a means to address these challenges.
FCC, as defined by the Institute for Patient‐ and Family‐Centered Care, is “an approach to the planning, delivery, and evaluation of health care grounded in mutually beneficial partnerships among healthcare providers, patients, and families”. 7 The core concepts of the FCC are “dignity and respect, information sharing, participation, and collaboration”. 7 FCC improves psychological and physiological outcomes for patients and families, staff satisfaction, and cost‐effectiveness; therefore, it has been recommended as an important approach in various pediatric healthcare situations. 8 A systematic review on the treatment of childhood asthma reported that FCC was associated with enhanced Family‐Provider Partnership, efficient use of services, improved health status, communication, and family functioning. 9 Another systematic review indicated that FCC‐based self‐management education improved asthma control, QOL, and family psychological outcomes. 10
Several measurement scales have been developed to evaluate healthcare providers' FCC. The Measure of Processes of Care for Service Providers (MPOC‐SP) 11 was the most widely used international FCC measurement scale. The original version was developed for a pediatric rehabilitation setting in Canada, and its reliability and validity were confirmed. It has been used for research in various pediatric healthcare settings 12 and has been translated into 15 languages, including Japanese, as of 2023. 13 The Japanese version of the MPOC‐SP is the only measurement scale for healthcare providers to evaluate their FCC in Japan, and its reliability and validity were confirmed. 14 No studies have evaluated healthcare providers' FCC regarding childhood asthma treatment.
Previous studies 15 , 16 , 17 reported “profession” (doctors and therapists were more likely to provide information about children, and social workers were more likely to provide information in general), “longer years of experience,” and “more time spent with patients and families” as individual factors associated with a high degree of FCC. Previous studies 18 , 19 , 20 reported various social environmental factors that may impede FCC, including “problems in medical institutions” (such as poor interprofessional collaboration; insufficient education and training; lack of time, space, and funds; and increased workload), “family‐related issues” (such as lack of understanding of healthcare information and FCC), and “policy issues” (such as FCC not being included in the medical insurance system). No studies on the factors associated with FCC have been conducted in childhood asthma treatment.
Hence, promoting FCC would help in self‐management education and partnership building in childhood asthma treatment. However, to the best of our knowledge, no studies have been conducted on the degree and associated factors of FCC performed by healthcare providers involved in childhood asthma.
Therefore, this study aimed to provide suggestions for promoting FCC in childhood asthma treatment. The research questions for this study were as follows: Among doctors, nurses, and pharmacists involved in asthma treatment for children under 5 years of age in Japan.
RQ1. To what degree is FCC provided?
RQ2. What are the factors associated with the degree of FCC?
METHODS
Participants and design
A web‐based survey was conducted from June 20 to August 13, 2023. We recruited the members of “Tokai Pediatric Allergy Group” (a group to which pediatric allergists in the Tokai region of Japan participate) including 267 physicians and “Japanese Society of Pediatric Clinical Allergy” including 525 doctors, 800 nurses, and 125 pharmacists via their mailing lists. The eligibility criteria for the participants were (1) practicing medicine in Japan and being fluent in Japanese language; (2) a doctor, nurse, or pharmacist involved in pediatric allergy treatment; and (3) working with asthma patients under 5 years of age for at least 1 year as of the survey date. All individuals who fulfilled all eligibility criteria were included in this study.
Measures
The dependent variable was the degree of FCC performed by the participants. The measurement scale used was the MPOC‐SP. 11 , 14 The MPOC‐SP has 27 items and consists of four subscales: showing interpersonal sensitivity (SIS), providing general information (PGI), communicating specific information about the child (CSI), and treating people respectfully (TPR). SIS includes supporting and empowering children and their families. PGI includes providing general information about the child's condition and available services, as well as facilitating communication among family members. CSI includes sharing information specific to the child's health status, treatment options, and prognosis. TPR includes treating children and their families as individuals with valuable insights and equals. Participants responded using a seven‐point Likert scale (7 = to a very great extent; 6 = to a great extent; 5 = to a fairly great extent; 4 = to a moderate extent; 3 = to a small extent; 2 = to a very small extent; 1 = not at all) or indicated “not applicable.” The average score (range 1.0–7.0 points) for each subscale was calculated. Items that the participants responded “not applicable” were not used to calculate the participants' average score for that subscale. Participants who responded “not applicable” to 1/3 or more of the items for each subscale were excluded from the calculation of the average score for that subscale. Participants who responded “not applicable” to half or more of the 27 items were excluded from the analysis. To use the Japanese version of the MPOC‐SP, we purchased the questionnaire and an online survey license from CanChild 13 (questionnaire license No. 15817, online survey license No. 24516). The authors, including health communication experts [NS, TO, HO, and TK] and pediatric allergists [MM, TM, and KI], confirmed the content validity of the Japanese version of the MPOC‐SP in the FCC evaluation of childhood asthma treatment.
Regarding personal factors, we selected the following variables that can be associated with the degree of FCC based on previous studies 15 , 16 , 17 and the clinical experience of pediatric allergists [MM, TM, and KI]. They were sex, type of workplace, whether the workplace was an Allergic Disease Medical Core Hospital (a hospital that has a role to treat severe allergic diseases, provide information, train medical professionals specializing in allergies, and conduct nationwide research), years of experience in pediatric allergy, profession, average outpatient treatment time spent for asthma patients under 5 years of age and their family, average number of childhood asthma patients treated per month, whether they knew about FCC, and whether they learned about FCC. Additionally, we selected the following variables to understand participants' backgrounds: age, workplace area, whether the workplace was a training and teaching facility of the Japanese Society of Allergology (a facility that provides training for fellow of Allergist certified by the Japanese Society of Allergology), certification, average hours of pediatric patient care per week, and the true severity of asthma patients treated in the past year. Measurements regarding social environmental factors were developed based on previous studies. 18 , 19 , 20 The following six questions all end with “in your workplace”: Q1. Is there sufficient time to perform FCC? Q2. Is FCC encouraged? Q3. Are treatment and care well‐coordinated among healthcare providers? Q4. Is it easy to access information on patient/family groups? Q5. Is there an opportunity to receive FCC training? Q6. Is there a common understanding of FCC? In the following two questions, the patient's family refers to the primary caregivers for the patient, such as the patient's parents. Q7. Are the patient's family interested in FCC (do they want to collaborate with healthcare providers to make decisions and participate in treatment and care)? Q8. Do the patient's family want other family members to understand the patient's illness and participate in treatment and care? Participants responded using a four‐point Likert scale (1 = Yes, 2 = Rather yes, 3 = Rather no, and 4 = No).
Statistical method
We calculated scores (Mean, SD) for each subscale of MPOC‐SP. We identified items for which more than 33% of participants responded with a score between 1 and 4, as these are considered areas in need of improvement according to the developers of MPOC‐SP. 11 The dependent variable was the score for each subscale of the MPOC‐SP, and the independent variables were a total of 17 items, including nine personal factors and eight social environment factors. First, we performed an analysis of variance, followed by a multiple regression analysis. The significance level was set at p < 0.05. All statistical analyses were performed using Rstudio (Version 1.2.5042).
Ethical consideration
This study was approved by the Research Ethics Committee of the Faculty of Medicine of the University of Tokyo (No. 2023035NI).
RESULTS
Participant characteristics
Responses were received from 133 participants (7.7% response rate). Five participants were excluded from the analysis involving PGI and CSI because 1/3 or more of their items for PGI and CSI were responded to as “not applicable.” For this reason, we analyzed 133 participants for the analysis involving SIS and TPR and 128 participants for the analysis involving PGI and CSI.
Table 1 shows the participants' characteristics and their associations with their MPOC‐SP scores. Table S1 shows the supplementary data on the participants' characteristics. The average age of the participants in the study was 46.2 ± 9.3 years (mean ± SD), and 48.9% of them were male. Regarding their workplaces, 49.6% worked in a general hospital, and 28.6% worked at an allergic Disease Medical Core Hospital. Their workplaces were 37.9% in the Tokai region, 21.8% in the Kanto region, 20.3% in the Kinki region, and 20.3% in other regions (There were no regional differences in MPOC‐SP scores). In terms of professions, 67.7% were doctors, 22.6% were nurses, and 9.8% were pharmacists. The average outpatient treatment time for asthma patients under 5 years of age and their families was less than 20 min for 93.2% of the participants. The average number of childhood asthma patients treated per month was 11–50 in 50.4% of participants. 78.9% responded negatively to the question, “Did you know about FCC?” Similarly, 94% answered negatively to the question, “Did you learn about FCC?”.
TABLE 1.
Characteristics of participants and their association with MPOC‐SP scores (n = 133 in SIS and TPR, n = 128 in PGI and CSI).
| Variable | Showing interpersonal sensitivity (SIS) | Providing general information (PGI) | Communicating specific information about the child (CSI) | Treating people respectfully (TPR) | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| n | % | Mean (SD) | p‐value | Mean (SD) | p‐value | Mean (SD) | p‐value | Mean (SD) | p‐value | |
| Gender | ||||||||||
| Male | 65 | 48.9 | 4.79 (0.88) | 0.330 | 3.93 (1.33) | 0.388 | 4.77 (1.08) | 0.096 | 5.19 (0.83) | 0.394 |
| Female | 68 | 51.1 | 4.62 (1.16) | 3.72 (1.37) | 4.39 (1.44) | 5.05 (1.06) | ||||
| Others | 0 | 0 | ||||||||
| Workplace | ||||||||||
| Clinic (less than 20 inpatient beds) | 32 | 24.1 | 4.66 (1.20) | 0.474 | 3.63 (1.49) | 0.581 | 4.67 (1.37) | 0.018 | 5.00 (1.09) | 0.060 |
| Hospital (20 or more inpatient beds) | 66 | 49.6 | 4.66 (1.02) | 3.74 (1.31) | 4.45 (1.28) | 5.10 (0.90) | ||||
| University hospital | 22 | 16.5 | 4.90 (0.95) | 4.29 (1.40) | 4.95 (1.22) | 5.25 (0.91) | ||||
| Children's hospital | 7 | 5.3 | 5.07 (0.81) | 3.89 (0.93) | 5.14 (0.74) | 5.71 (0.45) | ||||
| Pharmacy | 6 | 4.5 | 4.27 (0.90) | 3.76 (1.23) | 3.27 (0.92) | 4.85 (1.30) | ||||
| Others | 0 | 0 | ||||||||
| Allergic Disease Medical Core Hospital | ||||||||||
| Yes | 38 | 28.6 | 4.98 (0.76) | 0.114 | 4.17 (1.34) | 0.028 | 4.80 (1.02) | 0.392 | 5.38 (0.71) | 0.122 |
| No | 90 | 67.7 | 4.63 (1.06) | 3.75 (1.31) | 4.52 (1.36) | 5.02 (1.01) | ||||
| Others | 5 | 3.8 | 3.84 (1.77) | 2.44 (1.10) | 4.07 (1.75) | 4.93 (1.42) | ||||
| Years of experience in pediatric allergy | ||||||||||
| ≦10 years | 50 | 37.6 | 4.48 (1.15) | 0.305 | 3.66 (1.42) | 0.034 | 4.30 (1.49) | 0.339 | 4.95 (1.05) | 0.423 |
| 11–20 years | 48 | 36.1 | 4.82 (1.00) | 3.72 (1.19) | 4.80 (1.12) | 5.27 (0.94) | ||||
| 21–30 years | 26 | 19.5 | 4.92 (0.96) | 4.52 (1.39) | 4.71 (1.20) | 5.21 (0.88) | ||||
| ≧31 years | 9 | 6.8 | 4.69 (0.61) | 3.24 (1.03) | 4.50 (1.04) | 5.03 (0.61) | ||||
| Profession | ||||||||||
| Doctor | 90 | 67.7 | 4.81 (0.88) | 0.074 | 3.89 (1.32) | 0.580 | 4.83 (1.06) | 0.001 | 5.21 (0.81) | 0.216 |
| Nurse | 30 | 22.6 | 4.61 (1.39) | 3.78 (1.32) | 4.33 (1.57) | 5.05 (1.24) | ||||
| Pharmacist | 13 | 9.8 | 4.15 (0.94) | 3.41 (1.60) | 3.18 (1.28) | 4.66 (1.08) | ||||
| Average outpatient treatment time for asthma patients under 5 years old and their families | ||||||||||
| <5 min | 9 | 6.8 | 4.11 (1.13) | 0.423 | 3.43 (2.05) | 0.927 | 4.06 (1.74) | 0.497 | 4.60 (1.18) | 0.537 |
| 5–10 min | 60 | 45.1 | 4.68 (1.01) | 3.84 (1.37) | 4.48 (1.34) | 5.11 (1.00) | ||||
| 10–20 min | 55 | 41.4 | 4.80 (0.96) | 3.89 (1.13) | 4.77 (1.09) | 5.21 (0.84) | ||||
| ≧20 min | 9 | 6.8 | 4.80 (1.48) | 3.68 (1.78) | 4.62 (1.61) | 5.15 (1.10) | ||||
| Average number of pediatric asthma patients treated per month | ||||||||||
| 1–10 patients | 38 | 28.6 | 4.44 (1.18) | 0.121 | 3.58 (1.50) | 0.557 | 4.26 (1.50) | 0.012 | 5.01 (1.03) | 0.268 |
| 11–50 patients | 67 | 50.4 | 4.75 (0.96) | 3.88 (1.10) | 4.66 (1.16) | 5.14 (0.91) | ||||
| 51–100 patients | 20 | 15.0 | 4.79 (0.98) | 3.83 (1.71) | 4.47 (1.26) | 5.07 (1.05) | ||||
| ≧101 patients | 8 | 6.0 | 5.31 (0.79) | 4.39 (1.53) | 5.67 (0.79) | 5.60 (0.68) | ||||
| Did you know about FCC? | ||||||||||
| No | 63 | 47.4 | 4.39 (1.08) | <0.001 | 3.40 (1.45) | 0.004 | 4.45 (1.40) | 0.058 | 4.88 (1.00) | <0.001 |
| Rather No | 42 | 31.6 | 4.69 (0.98) | 3.98 (1.21) | 4.44 (1.32) | 5.11 (0.99) | ||||
| Rather Yes | 22 | 16.5 | 5.43 (0.60) | 4.57 (0.99) | 5.03 (0.85) | 5.65 (0.46) | ||||
| Yes | 6 | 4.5 | 5.38 (0.68) | 4.27 (0.73) | 5.17 (0.75) | 5.76 (0.41) | ||||
| Did you learn about FCC? | ||||||||||
| No | 84 | 63.2 | 4.37 (1.05) | <0.001 | 3.46 (1.38) | 0.001 | 4.33 (1.35) | 0.006 | 4.86 (1.02) | <0.001 |
| Rather No | 41 | 30.8 | 5.25 (0.71) | 4.48 (1.07) | 4.93 (1.10) | 5.52 (0.66) | ||||
| Rather Yes or Yes a | 8 | 6.0 | 5.39 (0.78) | 4.05 (1.02) | 5.33 (0.76) | 5.82 (0.44) | ||||
| Is there sufficient time to perform FCC in your workplace? | ||||||||||
| No | 18 | 13.5 | 4.07 (1.16) | 0.025 | 3.41 (1.79) | 0.153 | 3.69 (1.62) | 0.058 | 4.46 (1.24) | 0.056 |
| Rather No | 65 | 48.9 | 4.51 (0.96) | 3.58 (1.25) | 4.38 (1.24) | 5.00 (0.90) | ||||
| Rather Yes | 48 | 36.1 | 5.14 (0.89) | 4.27 (1.19) | 5.11 (0.98) | 5.50 (0.74) | ||||
| Yes | 2 | 1.5 | 6.00 (0.57) | 4.50 (0.99) | 5.50 (1.18) | 5.94 (0.71) | ||||
| Is FCC encouraged in your workplace? | ||||||||||
| No | 30 | 22.6 | 4.16 (1.09) | 0.033 | 3.02 (1.57) | 0.054 | 4.30 (1.52) | 0.156 | 4.64 (1.04) | 0.077 |
| Rather No | 51 | 38.3 | 4.64 (0.84) | 3.83 (1.33) | 4.37 (1.18) | 5.13 (0.84) | ||||
| Rather Yes | 49 | 36.8 | 5.10 (0.99) | 4.20 (1.04) | 4.94 (1.11) | 5.39 (0.91) | ||||
| Yes | 3 | 2.3 | 4.63 (1.98) | 4.47 (1.63) | 4.67 (2.60) | 5.33 (1.39) | ||||
| Are treatment and care well‐coordinated among healthcare providers in your workplace? | ||||||||||
| No | 6 | 4.5 | 4.75 (0.72) | 0.002 | 3.28 (1.11) | 0.043 | 5.00 (1.25) | 0.028 | 5.46 (0.74) | 0.010 |
| Rather No | 32 | 24.1 | 4.04 (1.02) | 3.24 (1.40) | 3.80 (1.43) | 4.55 (1.10) | ||||
| Rather Yes | 75 | 56.4 | 4.81 (0.94) | 3.97 (1.32) | 4.79 (1.14) | 5.22 (0.84) | ||||
| Yes | 20 | 15.0 | 5.32 (0.99) | 4.28 (1.18) | 4.96 (1.14) | 5.54 (0.82) | ||||
| Is it easy to access information on patient/family groups in your workplace? | ||||||||||
| No | 32 | 24.1 | 4.48 (0.99) | 0.076 | 3.44 (1.62) | 0.043 | 4.73 (1.33) | 0.310 | 4.96 (0.95) | 0.168 |
| Rather No | 57 | 42.9 | 4.61 (1.15) | 3.67 (1.24) | 4.41 (1.41) | 5.05 (1.05) | ||||
| Rather Yes | 39 | 29.3 | 4.91 (0.85) | 4.20 (1.21) | 4.65 (1.12) | 5.29 (0.82) | ||||
| Yes | 5 | 3.8 | 5.50 (0.82) | 4.76 (0.97) | 5.20 (0.80) | 5.64 (0.64) | ||||
| Is there an opportunity to receive FCC training in your workplace? | ||||||||||
| No | 76 | 57.1 | 4.54 (1.13) | 0.003 | 3.60 (1.34) | 0.057 | 4.44 (1.33) | 0.219 | 4.99 (1.02) | 0.035 |
| Rather No | 44 | 33.1 | 4.77 (0.85) | 4.03 (1.39) | 4.69 (1.31) | 5.20 (0.86) | ||||
| Rather Yes | 13 | 9.8 | 5.42 (0.71) | 4.34 (1.01) | 4.96 (0.91) | 5.62 (0.71) | ||||
| Yes | 0 | 0 | ||||||||
| Is there a common understanding of FCC in your workplace? | ||||||||||
| No | 54 | 40.6 | 4.45 (1.16) | 0.020 | 3.44 (1.44) | 0.031 | 4.45 (1.39) | 0.397 | 4.96 (1.07) | 0.256 |
| Rather No | 50 | 37.6 | 4.75 (0.94) | 3.98 (1.28) | 4.56 (1.28) | 5.18 (0.89) | ||||
| Rather Yes or Yes a | 29 | 21.8 | 5.08 (0.81) | 4.21 (1.14) | 4.83 (1.11) | 5.31 (0.81) | ||||
| Are the patient's family interested in FCC? | ||||||||||
| No | 14 | 10.5 | 4.60 (1.20) | 0.010 | 4.02 (1.53) | 0.080 | 5.27 (1.04) | 0.021 | 5.27 (0.84) | 0.017 |
| Rather No | 47 | 35.3 | 4.32 (1.05) | 3.45 (1.35) | 4.14 (1.38) | 4.77 (0.98) | ||||
| Rather Yes | 61 | 45.9 | 4.91 (0.92) | 3.93 (1.27) | 4.68 (1.17) | 5.26 (0.93) | ||||
| Yes | 11 | 8.3 | 5.29 (0.87) | 4.58 (1.29) | 5.15 (1.25) | 5.62 (0.76) | ||||
| Do the patient's family want other family members to understand the patient's illness and participate in treatment and care? | ||||||||||
| No | 3 | 2.3 | 3.90 (1.01) | 0.124 | 2.75 (NA) | N/A | 6.00 (NA) | N/A | 4.56 (0.78) | 0.305 |
| Rather No | 33 | 24.8 | 4.45 (1.26) | 3.49 (1.43) | 4.09 (1.52) | 4.85 (1.23) | ||||
| Rather Yes | 79 | 59.4 | 4.73 (0.94) | 3.86 (1.31) | 4.61 (1.17) | 5.20 (0.84) | ||||
| Yes | 18 | 13.5 | 5.17 (0.82) | 4.34 (1.25) | 5.23 (1.05) | 5.33 (0.83) | ||||
Note: We identified variables with significant differences using ANOVA. Significant p‐values were highlighted in bold.
Abbreviations: MPOC‐SP, Measure of Processes of Care for Service Providers; N/A, not applicable; SD, standard deviation.
When there was only one person who answered YES, we grouped them into “rather YES”.
Regarding the social environment factors, the percentage of participants who selected “Yes” or “Rather Yes” was 37.6% for Q1 (sufficient time to perform FCC), 39.1% for Q2 (encouragement of FCC), 39.1% for Q3 (care coordination), 71.4% for Q4 (easy access to information on patient/family groups), 9.8% for Q5 (training for FCC), 9.8% for Q6 (common understanding of FCC), 54.2% for Q7 (the patient's family interest in FCC), and 72.9% for Q8 (the patient's family want other family members to participate in FCC).
Degree of FCC
Table 2 shows MPOC‐SP scores and Cronbach's α for all participants. The scores (Mean, SD) for each subscale were 4.70 ± 1.03 for SIS, 3.82 ± 1.34 for PGI, 4.58 ± 1.28 for CSI, and 5.12 ± 0.95 for TPR. Cronbach's α was 0.71–0.89.
TABLE 2.
MPOC‐SP scores and Cronbach's α.
| Domains | Number of items | n | Mean | SD | Range | Cronbach's α |
|---|---|---|---|---|---|---|
| Showing interpersonal sensitivity (SIS) | 10 | 133 | 4.70 | 1.03 | 1.8–6.8 | 0.89 |
| Providing general information (PGI) | 5 | 128 | 3.82 | 1.34 | 1.0–7.0 | 0.80 |
| Communicating specific information about the child (CSI) | 3 | 128 | 4.58 | 1.28 | 1.0–6.7 | 0.71 |
| Treating people respectfully (TPR) | 9 | 133 | 5.12 | 0.95 | 2.0–6.8 | 0.87 |
Abbreviations: MPOC‐SP, Measure of Processes of Care for Service Providers; SD, standard deviation.
Table 3 shows MPOC‐SP items where 33% or more of participants scored between 1 and 4. The top 5 items with the highest number of participants giving scores between 1 and 4 were as follows: “Provide opportunities for the entire family, including siblings, to obtain information?” (75.8%), “Promote family‐to‐family ‘connections’ for social, informational or shared experiences?” (66.4%), “Provide parents with written information about their child's condition, progress, or treatment?” (64.1%), “Provide advice on how to get information or to contact other parents?” (62.5%), “Help each family to secure a stable relationship with at least one service provider who works with the child and parents over a long period of time?” (57.1%).
TABLE 3.
Items in MPOC‐SP that 33% or more of participants scored between 1 and 4 (n = 133 in SIS and TPR, n = 128 in PGI and CSI).
| Domain | No. | Item | n | % |
|---|---|---|---|---|
| SIS | 4 | Discuss expectations for each child with other service providers, to ensure consistency of thought and action? | 71 | 53.4 |
| SIS | 5 | Tell parents about options for services or treatments for their child? | 48 | 36.1 |
| SIS | 9 | Anticipate parents' concerns by offering information even before they ask? | 51 | 38.3 |
| SIS | 11 | Let parents choose when to receive information and the type of information they wanted? | 44 | 33.1 |
| SIS | 12 | Help each family to secure a stable relationship with at least one service provider who works with the child and parents over a long period of time? | 76 | 57.1 |
| SIS | 21 | Help parents to feel competent in their roles as parents? | 63 | 47.4 |
| PGI | 23 | Promote family‐to‐family ‘connections’ for social, informational or shared experiences? | 85 | 66.4 |
| PGI | 24 | Provide support to help families cope with the impact of their child's chronic condition? | 45 | 35.2 |
| PGI | 25 | Provide advice on how to get information or to contact other parents? | 80 | 62.5 |
| PGI | 26 | Provide opportunities for the entire family, including siblings, to obtain information? | 97 | 75.8 |
| PGI | 27 | Have general information available about different concerns? | 67 | 52.3 |
| CSI | 15 | Provide parents with written information about their child's condition, progress, or treatment? | 82 | 64.1 |
| CSI | 16 | Tell parents details about their child's services, such as the types, reasons for, and durations of treatment/ management? | 60 | 46.9 |
| TPR | 10 | Make sure parents had a chance to say what was important to them? | 59 | 44.4 |
| TPR | 17 | Treat each parent as an individual rather than as a ‘typical’ parent of a child with a ‘problem’? | 51 | 38.3 |
| TPR | 19 | Make sure parents had opportunities to explain their treatment goals and needs? | 59 | 44.4 |
Note: The top 5 items with the most applicable participants were highlighted in bold.
Abbreviations: CSI, communicating specific information about the child; PGI, providing general information; MPOC‐SP, Measure of Processes of Care for Service Providers; SIS, showing interpersonal sensitivity; TPR, treating people respectfully.
Factors associated with the degree of FCC
Tables 4‐1, 4‐2, 4‐3, 4‐4 show the results of the multiple regression analysis for each subscale (SIS, PGI, CSI, and TPR, respectively). “A higher number of childhood asthma patients treated per month” (standardized β = 0.196, p = 0.042), “a perception of sufficient time to perform FCC in their workplace” (standardized β = 0.239, p = 0.014), and “a perception of well care coordination in their workplace” (standardized β = 0.197, p = 0.036) were significantly associated with high SIS scores. “a perception that the patient's family want other family members to participate in FCC” (standardized β = 0.215, p = 0.046) was significantly associated with high PGI scores. “Being a doctor” (standardized β = 0.483, p = 0.001), “a perception of sufficient time to perform FCC in their workplace” (standardized β = 0.302, p = 0.003), and “a perception of well care coordination in their workplace” (standardized β = 0.202, p = 0.031) were significantly associated with high CSI scores. “A perception of sufficient time to perform FCC in their workplace” (standardized β = 0.253, p = 0.016) was significantly associated with high TPR scores.
TABLE 4‐1.
Factors associated with high SIS score (n = 133).
| Variable | β | SE | 95% CI lower | 95% CI upper | Std β | t | p |
|---|---|---|---|---|---|---|---|
| Intercept | 0.838 | 0.610 | −0.371 | 2.047 | 1.374 | 0.172 | |
| Gender (Male) | 0.093 | 0.195 | −0.292 | 0.479 | 0.045 | 0.479 | 0.633 |
| Allergic Disease Medical Core Hospital (Yes) | 0.317 | 0.187 | −0.053 | 0.687 | 0.139 | 1.699 | 0.092 |
| Years of experience in Pediatrics | 0.005 | 0.010 | −0.014 | 0.024 | 0.046 | 0.516 | 0.607 |
| Profession (Doctor) | 0.109 | 0.296 | −0.477 | 0.696 | 0.049 | 0.368 | 0.713 |
| Profession (Nurse) | −0.033 | 0.327 | −0.681 | 0.615 | −0.014 | −0.102 | 0.919 |
| Average outpatient consultation time for asthma patients | 0.136 | 0.112 | −0.086 | 0.359 | 0.098 | 1.211 | 0.228 |
| Average number of asthma patients treated per month | 0.245 | 0.119 | 0.009 | 0.482 | 0.196 | 2.054 | 0.042 |
| Recognition of FCC | 0.125 | 0.144 | −0.161 | 0.410 | 0.106 | 0.865 | 0.389 |
| Learning experience of FCC | 0.290 | 0.202 | −0.110 | 0.690 | 0.177 | 1.435 | 0.154 |
| Sufficient time to practice FCC in your workplace | 0.352 | 0.142 | 0.071 | 0.633 | 0.239 | 2.483 | 0.014 |
| Encouragement of FCC in your workplace | 0.013 | 0.131 | −0.246 | 0.272 | 0.010 | 0.102 | 0.919 |
| Well care coordination in your workplace | 0.277 | 0.131 | 0.019 | 0.536 | 0.197 | 2.124 | 0.036 |
| Easy access to information on patient/family groups in your workplace | 0.000 | 0.116 | −0.230 | 0.231 | 0.000 | 0.003 | 0.998 |
| Training for FCC in your workplace | −0.191 | 0.178 | −0.544 | 0.162 | −0.124 | −1.073 | 0.286 |
| Common understanding of FCC in your workplace | 0.060 | 0.145 | −0.228 | 0.348 | 0.046 | 0.412 | 0.681 |
| The patient's family interest in FCC | 0.090 | 0.127 | −0.161 | 0.342 | 0.069 | 0.711 | 0.478 |
| The patient's family want other family members to participate FCC | 0.165 | 0.147 | −0.127 | 0.457 | 0.107 | 1.120 | 0.265 |
| R 2 | 0.386 | ||||||
| Adjusted R 2 | 0.295 | ||||||
| F | 4.245 | ||||||
| p | >0.001 |
Note: Multiple regression analysis was used to examine the associations. Variables with significant p‐values were highlighted in bold.
Abbreviations: CI, confidence interval; SE, standard error; SIS, showing interpersonal sensitivity; Std β, Standardized β.
TABLE 4‐2.
Factors associated with high PGI score (n = 128).
| Variable | β | SE | 95% CI lower | 95% CI upper | Std β | t | p |
|---|---|---|---|---|---|---|---|
| Intercept | −0.061 | 0.910 | −1.864 | 1.742 | −0.067 | 0.946 | |
| Gender (Male) | 0.225 | 0.279 | −0.328 | 0.777 | 0.084 | 0.806 | 0.422 |
| Allergic Disease Medical Core Hospital (Yes) | 0.457 | 0.271 | −0.079 | 0.994 | 0.155 | 1.689 | 0.094 |
| Years of experience in pediatric allergy | 0.013 | 0.014 | −0.015 | 0.041 | 0.094 | 0.930 | 0.354 |
| Profession (Doctor) | −0.413 | 0.426 | −1.256 | 0.430 | −0.143 | −0.970 | 0.334 |
| Profession (Nurse) | −0.173 | 0.471 | −1.107 | 0.761 | −0.053 | −0.366 | 0.715 |
| Average outpatient consultation time for asthma patients | −0.040 | 0.165 | −0.367 | 0.286 | −0.022 | −0.245 | 0.807 |
| Average number of asthma patients treated per month | 0.244 | 0.174 | −0.101 | 0.588 | 0.150 | 1.402 | 0.164 |
| Recognition of FCC | 0.172 | 0.208 | −0.240 | 0.584 | 0.114 | 0.826 | 0.411 |
| Learning experience of FCC | 0.148 | 0.292 | −0.431 | 0.727 | 0.070 | 0.506 | 0.614 |
| Sufficient time to practice FCC in your workplace | 0.144 | 0.215 | −0.281 | 0.570 | 0.075 | 0.673 | 0.502 |
| Encouragement of FCC in your workplace | 0.268 | 0.189 | −0.108 | 0.643 | 0.158 | 1.414 | 0.160 |
| Well care coordination in your workplace | 0.099 | 0.191 | −0.279 | 0.478 | 0.055 | 0.520 | 0.604 |
| Easy access to information on patient/family groups in your workplace | 0.272 | 0.169 | −0.064 | 0.608 | 0.164 | 1.605 | 0.111 |
| Training for FCC in your workplace | −0.172 | 0.257 | −0.681 | 0.336 | −0.086 | −0.672 | 0.503 |
| Common understanding of FCC in your workplace | 0.125 | 0.210 | −0.290 | 0.541 | 0.073 | 0.597 | 0.552 |
| The patient's family interest in FCC | −0.082 | 0.185 | −0.447 | 0.284 | −0.047 | −0.443 | 0.659 |
| The patient's family want other family members to participate FCC | 0.454 | 0.225 | 0.009 | 0.900 | 0.215 | 2.022 | 0.046 |
| R 2 | 0.268 | ||||||
| Adjusted R 2 | 0.155 | ||||||
| F | 2.365 | ||||||
| p | 0.004 |
Note: Multiple regression analysis was used to examine the associations. Variables with significant p‐values were highlighted in bold.
Abbreviations: CI, confidence interval; PGI, providing general information; SE, standard error; Std β, standardized β.
TABLE 4‐3.
Factors associated with high CSI score (n = 128).
| Variable | β | SE | 95% CI lower | 95% CI upper | Std β | t | p |
|---|---|---|---|---|---|---|---|
| Intercept | −0.310 | 0.817 | −1.930 | 1.310 | −0.379 | 0.706 | |
| Gender (Male) | 0.241 | 0.250 | −0.254 | 0.735 | 0.094 | 0.965 | 0.337 |
| Allergic Disease Medical Core Hospital (Yes) | 0.110 | 0.239 | −0.363 | 0.583 | 0.039 | 0.462 | 0.645 |
| Years of experience in Pediatrics | −0.006 | 0.012 | −0.030 | 0.018 | −0.047 | −0.523 | 0.602 |
| Profession (Doctor) | 1.347 | 0.405 | 0.545 | 2.149 | 0.483 | 3.329 | 0.001 |
| Profession (Nurse) | 0.839 | 0.443 | −0.038 | 1.716 | 0.270 | 1.895 | 0.061 |
| Average outpatient consultation time for asthma patients | 0.254 | 0.143 | −0.030 | 0.538 | 0.146 | 1.775 | 0.079 |
| Average number of asthma patients treated per month | 0.194 | 0.152 | −0.108 | 0.496 | 0.121 | 1.275 | 0.205 |
| Recognition of FCC | −0.149 | 0.182 | −0.511 | 0.213 | −0.103 | −0.816 | 0.416 |
| Learning experience of FCC | 0.452 | 0.255 | −0.055 | 0.958 | 0.224 | 1.768 | 0.080 |
| Sufficient time to practice FCC in your workplace | 0.559 | 0.181 | 0.201 | 0.918 | 0.302 | 3.093 | 0.003 |
| Encouragement of FCC in your workplace | −0.069 | 0.167 | −0.400 | 0.262 | −0.043 | −0.413 | 0.680 |
| Well care coordination in your workplace | 0.366 | 0.167 | 0.034 | 0.697 | 0.202 | 2.186 | 0.031 |
| Easy access to information on patient/family groups in your workplace | −0.188 | 0.147 | −0.480 | 0.104 | −0.118 | −1.277 | 0.204 |
| Training for FCC in your workplace | −0.144 | 0.225 | −0.589 | 0.301 | −0.075 | −0.641 | 0.523 |
| Common understanding of FCC in your workplace | −0.001 | 0.185 | −0.367 | 0.366 | 0.000 | −0.003 | 0.997 |
| The patient's family interest in FCC | −0.016 | 0.166 | −0.345 | 0.313 | −0.010 | −0.097 | 0.923 |
| The patient's family want other family members to participate FCC | 0.287 | 0.193 | −0.095 | 0.670 | 0.142 | 1.488 | 0.140 |
| R 2 | 0.384 | ||||||
| Adjusted R 2 | 0.289 | ||||||
| F | 4.041 | ||||||
| p | <0.001 |
Note: Multiple regression analysis was used to examine the associations. Variables with significant p‐values were highlighted in bold.
Abbreviations: CI, confidence interval; CSI, communicating specific information about the child; SE, standard error; Std β, standardized β.
TABLE 4‐4.
Factors associated with high TPR score (n = 133).
| Variable | β | SE | 95% CI lower | 95% CI upper | Std β | t | p |
|---|---|---|---|---|---|---|---|
| Intercept | 2.399 | 0.607 | 1.197 | 3.602 | 3.952 | 0.000 | |
| Gender (Male) | 0.075 | 0.194 | −0.309 | 0.459 | 0.039 | 0.387 | 0.699 |
| Allergic Disease Medical Core Hospital (Yes) | 0.301 | 0.186 | −0.067 | 0.669 | 0.143 | 1.623 | 0.107 |
| Years of experience in Pediatrics | 0.000 | 0.009 | −0.018 | 0.019 | 0.004 | 0.042 | 0.966 |
| Profession (Doctor) | 0.143 | 0.295 | −0.440 | 0.727 | 0.070 | 0.486 | 0.628 |
| Profession (Nurse) | −0.023 | 0.325 | −0.668 | 0.622 | −0.010 | −0.070 | 0.944 |
| Average outpatient consultation time for asthma patients | 0.083 | 0.112 | −0.138 | 0.305 | 0.065 | 0.744 | 0.458 |
| Average number of asthma patients treated per month | 0.138 | 0.119 | −0.098 | 0.373 | 0.119 | 1.159 | 0.249 |
| Recognition of FCC | 0.093 | 0.143 | −0.192 | 0.377 | 0.085 | 0.645 | 0.520 |
| Learning experience of FCC | 0.299 | 0.201 | −0.099 | 0.696 | 0.197 | 1.486 | 0.140 |
| Sufficient time to practice FCC in your workplace | 0.344 | 0.141 | 0.064 | 0.623 | 0.253 | 2.437 | 0.016 |
| Encouragement of FCC in your workplace | 0.070 | 0.130 | −0.188 | 0.327 | 0.059 | 0.536 | 0.593 |
| Well care coordination in your workplace | 0.152 | 0.130 | −0.105 | 0.409 | 0.117 | 1.171 | 0.244 |
| Easy access to information on patient/family groups in your workplace | −0.020 | 0.116 | −0.250 | 0.209 | −0.017 | −0.175 | 0.862 |
| Training for FCC in your workplace | −0.133 | 0.177 | −0.485 | 0.218 | −0.093 | −0.751 | 0.454 |
| Common understanding of FCC in your workplace | −0.069 | 0.145 | −0.356 | 0.217 | −0.057 | −0.479 | 0.633 |
| The patient's family interest in FCC | 0.041 | 0.126 | −0.209 | 0.291 | 0.034 | 0.322 | 0.748 |
| The patient's family want other family members to participate FCC | 0.119 | 0.147 | −0.172 | 0.410 | 0.084 | 0.810 | 0.419 |
| R 2 | 0.287 | ||||||
| Adjusted R 2 | 0.182 | ||||||
| F | 2.724 | ||||||
| p | 0.001 |
Note: Multiple regression analysis was used to examine the associations. Variables with significant p‐values were highlighted in bold.
Abbreviations: CI, confidence interval; SE, standard error; Std β, standardized β; TPR, treating people respectfully.
DISCUSSION
Degree of FCC
The MPOC‐SP scores for each subscale in this study were slightly higher for CSI and similar for the other subscales compared with other studies involving the MPOC‐SP scores conducted in Japan. 14 , 21 , 22 High CSI scores in this study could be attributed to the following. One of the reasons for this finding was that 67.7% of the participants were doctors, and they played a role in specifically explaining each patient's condition and treatment policy compared to other professions. Second, childhood asthma treatment is based on self‐management (patients and their families are responsible for daily treatment and environmental maintenance), and communicating specific information from healthcare providers to patients and their families is more common than in other pediatric fields. 2 Compared to the results of international MPOC‐SP studies, 12 the participants in this study responded with lower scores on each subscale. The reason for this might be that Japanese people tend to respond in a midpoint response style because of response bias. 23 However, the number of MPOC‐SP studies in Japan remains small, and further studies are warranted.
Next, regarding the trend of scores for each subscale, PGI scores were the lowest. This finding was similar to that of previous studies conducted in Japan and other countries. 12 , 14 , 21 , 22 As shown in Table 3, the results suggested that the participants did not provide sufficient opportunities to share information within and between family members. One reason for this may be the Japanese cultural background in which mothers mainly take on the role of primary care for sick children. 24 However, a systematic review of qualitative studies on the experiences of families caring for children with asthma showed that families needed understanding and support from other family members. 6 Similar needs were also demonstrated in the development of the Quality of Life Scale for Caregiver's of asthmatic children (QOLCA‐24). 25 In our study, the participants who perceived that “the patient's family wanted other family members to participate in FCC” had high PGI scores. Based on the above, we considered it desirable for healthcare providers to care about the family's need for information sharing within and between families and to support them.
Furthermore, according to the results of item No. 15 and item No. 26 shown in Table 3, “providing written information” was insufficient. In addition to oral communication, written information allowed the family to share it with other family members and review it many times. Therefore, we considered that providing written information was also necessary, which may lead to information sharing within families, as mentioned earlier.
Factors associated with the degree of FCC
“A perception of sufficient time to perform FCC in their workplace” was associated with MPOC‐SP's three subscales except for PGI, and the standardized β value was high, suggesting that it was an important factor for FCC. This was consistent with the results of previous content analysis studies in which healthcare providers were asked about barriers to FCC. 18 , 20 , 26 Accordingly, healthcare institutions should secure adequate time for healthcare providers to engage in FCC practices. However, “average outpatient treatment time for asthma patients” was not associated with any of the subscales. This discrepancy may indicate that not only the actual duration of consultations, but also healthcare providers' recognition of FCC as a priority—even under time‐limited conditions—plays a significant role in determining the extent to which FCC is practiced. Previous studies reported that healthcare providers prioritized “technical work,” “tasks directly associated with medical fees and evaluations,” and “education and research” over FCC. 18 , 20 , 26 Therefore, in addition to extending treatment time, raising awareness of the importance of FCC is also essential to perform FCC within competing responsibilities.
“A perception of well care coordination” was associated with SIS and CSI. SIS and CSI involved individual interactions and information provision that are tailored to the background and needs of children and families. In order to understand these backgrounds and needs from multiple perspectives, it is necessary for healthcare providers with different positions and expertise to obtain information from children and families and share and integrate them within the care team. For this reason, we thought that those who perceived well‐coordinated care in their workplace performed more FCC. The finding suggested that dividing roles and complementing each other could promote FCC.
“A higher number of childhood asthma patients treated per month” was associated with SIS. Although this may initially appear to contradict the notion that time is associated with the degree of FCC, we speculate that when physicians are responsible for a large number of patients, the time required for FCC may be distributed among multiple healthcare providers working collaboratively. Furthermore, by caring for many patients, physicians may develop the skills and strategies necessary to deliver FCC more efficiently—for instance, by utilizing explanatory materials, pre‐visit questionnaires, or enhanced communication techniques. Previous research reported that experienced healthcare providers were more likely to perform a high degree of FCC. 18 This was because, through their experience with various children and families, they developed an understanding and sensitivity to their diverse psychosocial backgrounds. 18
Future research should focus on gathering the experiences of healthcare providers who demonstrate a high degree of FCC, along with Pediatric Allergy Educators (a unique qualification in Japan that can be obtained by nurses, pharmacists, and nutritionists specially trained in effective communication for children with allergies and their families). Through these processes, it would be possible to gain a better understanding of how to promote FCC in childhood asthma treatment.
Limitations
Because we only recruited healthcare providers specialized in pediatric allergy, excluding those in general pediatrics and internal medicine, the results may not be generalizable to childhood asthma treatment as a whole. As the response rate was low in the recruitment of participants, there could have been selection bias among the participants. It was not verified whether the degree of FCC measured in our study matched their actual behavior or how the family perceived it, because it was evaluated solely based on the perception of the participants. It was not feasible to determine the direction of causality owing to the cross‐sectional nature of the study. There may exist unknown variables not included in the multiple regression analysis that could have influenced the degree of FCC.
CONCLUSION
This study measured the degree of FCC among healthcare providers involved in asthma treatment for children under 5 years of age using the MPOC‐SP. The results showed that providing general information was the lowest among the subscales, such as the provision of information‐sharing opportunities within and between families. It also showed that participants who treated a higher number of childhood asthma patients, perceived sufficient time for FCC, and perceived well care coordination had a high degree of FCC.
Practice implications
The results of this study serve as an indicator of the extent to which healthcare providers perform FCC in childhood asthma treatment. The findings reveal that there is still room for improvement in terms of the provision of general information. Healthcare providers should ensure that families have opportunities to share information and experiences with other families rather than having to bear the burden alone. In addition, they should provide written information to enable all family members to refer to it multiple times.
To further promote FCC, the necessary clinical changes involve each medical institution and each healthcare provider securing sufficient time and raising awareness for FCC. Additionally, healthcare providers should divide roles and complement each other to perform FCC even while treating a large number of patients in a limited time.
AUTHOR CONTRIBUTIONS
Naomi Sawada: conceptualization, data curation, formal analysis, investigation, methodology, writing – original draft; Tsuyoshi Okuhara: conceptualization, investigation, methodology, writing – review & editing; Hiroko Okada: investigation, methodology, writing – review & editing; Moe Miyagishima: investigation, writing – review & editing; Teruaki Matsui: Investigation, Writing – review & editing; Komei Ito: investigation, writing – review & editing; Takahiro Kiuchi: supervision, writing – review & editing. All authors read and approved the final manuscript.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.
Supporting information
Table S1.
ACKNOWLEDGMENTS
This study was supported by the Japan Society for the Promotion of Science KAKENHI (20 K10397) and a research grant from Kobayashi Aoitori Foundation.
Sawada N, Okuhara T, Okada H, Miyagishima M, Matsui T, Ito K, et al. Family‐Centered Care in asthma treatment for patients under 5 years of age. Pediatr Int. 2025;67:e70196. 10.1111/ped.70196
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
REFERENCES
- 1. GINA committee . Global Strategy for Asthma Management and Prevention 2023 Update. Global Initiative for Asthma; 2023. [Google Scholar]
- 2. Arakawa H, Adachi Y, Ebisawa M, Fujisawa T, Arakawa H, Adachi Y, et al. Japanese guidelines for childhood asthma 2020. Allergol Int. 2020;69(3):314–330. 10.1016/j.alit.2020.02.005 [DOI] [PubMed] [Google Scholar]
- 3. Sasaki M, Morikawa E, Yoshida K, Adachi Y, Odajima H, Akasawa A. The change in the prevalence of wheeze, eczema and rhino‐conjunctivitis among Japanese children: findings from 3 nationwide cross‐sectional surveys between 2005 and 2015. Allergy. 2019;74(8):1572–1575. 10.1111/all.13773 [DOI] [PubMed] [Google Scholar]
- 4. Sattoe JNT, Bal MI, Roelofs PDDM, Bal R, Miedema HS, van Staa AL. Self‐management interventions for young people with chronic conditions: a systematic overview. Patient Educ Couns. 2015;98(6):704–715. 10.1016/J.PEC.2015.03.004 [DOI] [PubMed] [Google Scholar]
- 5. Bal MI, Sattoe JNT, Roelofs PDDM, Bal R, van Staa AL, Miedema HS. Exploring effectiveness and effective components of self‐management interventions for young people with chronic physical conditions: a systematic review. Patient Educ Couns. 2016;99(8):1293–1309. 10.1016/j.pec.2016.02.012 [DOI] [PubMed] [Google Scholar]
- 6. Fawcett R, Porritt K, Stern C, Carson‐Chahhoud K. Experiences of parents and carers in managing asthma in children: a qualitative systematic review. JBI Database System Rev Implement Rep. 2019;17(5):793–984. 10.11124/JBISRIR-2017-004019 [DOI] [PubMed] [Google Scholar]
- 7. Johnson BH, Abraham MR. Partnering with patients, residents, and families: a resource for leaders of hospitals, ambulatory care settings, and long‐term care communities. Bethesda, MD: Institute for Patient‐and Family‐Centered Care; 2012. [Google Scholar]
- 8. Eichner JM, Johnson BH, Betts JM, Jewell JA, Lye PS, Mirkinson LJ, et al. Patient‐ and family‐centered care and the pediatrician's role. Pediatrics. 2012;129(2):394–404. 10.1542/peds.2011-3084 [DOI] [PubMed] [Google Scholar]
- 9. Kuhlthau KA, Bloom S, van J, Knapp AA, Romm D, Klatka K, et al. Evidence for family‐centered care for children with special health care needs: a systematic review. Acad Pediatr. 2011;11(2):136–143. 10.1016/J.ACAP.2010.12.014 [DOI] [PubMed] [Google Scholar]
- 10. Knafl KA, Havill NL, Leeman J, Fleming L, Crandell JL, Sandelowski M. The nature of family engagement in interventions for children with chronic conditions. West J Nurs Res. 2017;39(5):690–723. 10.1177/0193945916664700 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Woodside JM, Rosenbaum PL, King SM, King GA. Family‐centered service: developing and validating a self‐assessment tool for pediatric service providers. Child Health Care. 2001;30(3):237–252. 10.1207/S15326888CHC3003_5 [DOI] [Google Scholar]
- 12. Cunningham BJ, Rosenbaum PL. Measure of processes of care: a review of 20 years of research. Dev Med Child Neurol. 2014;56(5):445–452. 10.1111/dmcn.12347 [DOI] [PubMed] [Google Scholar]
- 13. CanChild . MPOC‐SP. Available from: https://canchild.ca/en/shop/11‐mpoc‐sp [accessed 15 April 2024]
- 14. Himuro N, Miyagishima S, Kozuka N, Tsutsumi H, Mori M. Measurement of family‐centered care in the neonatal intensive care unit and professional background. J Perinatol. 2015;35(4):284–289. 10.1038/jp.2014.204 [DOI] [PubMed] [Google Scholar]
- 15. Tang HN, Chong WH, Goh W, Chan WP, Choo S. Evaluation of family‐centred practices in the early intervention programmes for infants and young children in Singapore with measure of processes of Care for Service Providers and Measure of beliefs about participation in family‐Centred service. Child Care Health Dev. 2012;38(1):54–60. 10.1111/j.1365-2214.2011.01259.x [DOI] [PubMed] [Google Scholar]
- 16. Kang LJ, Palisano RJ, Simeonsson RJ, Hwang AW. Measuring family‐centred practices of professionals in early intervention services in Taiwan. Child Care Health Dev. 2017;43(5):709–717. 10.1111/cch.12463 [DOI] [PubMed] [Google Scholar]
- 17. Mazer B, Feldman D, Majnemer A, Gosselin J, Kehayia E. Rehabilitation services for children: therapists' perceptions. Pediatr Rehabil. 2006;9(4):340–350. 10.1080/13638490600668087 [DOI] [PubMed] [Google Scholar]
- 18. Lotze GM, Bellin MH, Oswald DP. Family‐centered care for children with special health care needs: are we moving forward? J Fam Soc Work. 2010;13(2):100–113. 10.1080/10522150903487099 [DOI] [Google Scholar]
- 19. Zengin Akkus P, Ilter Bahadur E, Coskun A, Koken G, Karahan S, Ozmert EN. Family‐centred service: perspectives of paediatric residents from a non‐Western country. Child Care Health Dev. 2020;46(3):275–282. 10.1111/cch.12753 [DOI] [PubMed] [Google Scholar]
- 20. Nguyen TK, Bauman GS, Watling CJ, Hahn K. Patient‐ and family‐centered care: a qualitative exploration of oncologist perspectives. Support Care Cancer. 2017;25(1):213–219. 10.1007/S00520-016-3414-9 [DOI] [PubMed] [Google Scholar]
- 21. Miyagishima S, Himuro N, Kozuka N, Mori M, Tsutsumi H. Family‐centered care for preterm infants: parent and physical therapist perceptions. Pediatr Int. 2017;59(6):698–703. 10.1111/ped.13266 [DOI] [PubMed] [Google Scholar]
- 22. Asai H. Predictors of nurses' family‐centered care practises in the neonatal intensive care unit. Jpn J Nurs Sci. 2011;8(1):57–65. 10.1111/j.1742-7924.2010.00159.x [DOI] [PubMed] [Google Scholar]
- 23. Chen C, Lee SY, Stevenson HW. Response style and cross‐cultural comparisons of rating scales among East Asian and North American students. Psychol Sci. 1995;6(3):170–175. 10.1111/j.1467-9280.1995.tb00327.x [DOI] [Google Scholar]
- 24. Rothbaum F, Rosen K, Ujiie T, Uchida N. Family systems theory, attachment theory, and culture. Fam Process. 2002;41(3):328–350. 10.1111/j.1545-5300.2002.41305.x [DOI] [PubMed] [Google Scholar]
- 25. Watanabe H, Katsunuma T, Kondo N, Akasawa A, Ohya Y. Development of quality of life assessment scale for caregivers of asthmatic children (QOLCA‐24). Jpn J Allergol. 2008;57(12):1302–1316. [PubMed] [Google Scholar]
- 26. Kiwanuka F, Shayan SJ, Tolulope AA. Barriers to patient and family‐centred care in adult intensive care units: a systematic review. Nurs Open. 2019;6(3):676–684. 10.1002/nop2.253 [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Table S1.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.