An informational support programme within the context of health psychology and its impact on aspects of psychological functioning of parents of children with cystic fybrosis

[摘要] ENGLISH ABSTRACT: This thesis focuses on the emergence of the psychologist in health psychology and theapplication of psychological skills in a multidisciplinary context, with particular referenceto cystic fibrosis. Modem health care provision is being influenced by the consequences ofimproved medical treatment as well as a move away from the model of medical dominance.The concept of parental empowerment (Melnyk, Feinstein, Moldenhouer, & Small, 2001) isbeing promoted in an age of biomedical reductionism (Campbell, 1994).With pressure to innovate in a climate of cost-containment, health care is taking on newforms of service delivery, with the psychologist experiencing greater acceptance in generalhospital environments but, at the same time, needing to adapt to an emerging psychosocialmodel (Jasnoski & Schwartz, 1985) of medical treatment.The aim of this study is twofold. It firstly contextualises the role of the psychologist in adeveloping health psychology and medical environment. It then examines if a particular,informational support programme for parents of children with cystic fibrosis may besuccessful in achieving its objectives of empowering parents and reducing at least some oftheir distress.The shortcomings of psychological involvement alongside general medicine, as well as thehistorical structural barriers inherent in the dominance of the medical model (Parsons, 1970;Karabus 1994) is discussed. Attention is also drawn to the role of collaborative training(Gallo & Coyne, 2001; Kainz, 2002; Waters, 2001) as a facilitating force in the promotionof greater multidisciplinary co-operation.In the context of a serious illness such as cystic fibrosis, the disturbances in normal familylife is noted. Since the usual patterns of parent-child attachment (Bowlby, 1969) are affectedby an anticipated death of the child before the parent, the concept of ~hronic sorrow(Olshansky, 1962) is also mentioned. Consequently, in this strained domestic environment,difficulties in measuring parental functioning are discussed.A pilot study, in the form of a needs analysis on a small group of parents, precedes the mainresearch, directed at a group of parents of pre-school children who had been diagnosed withcystic fibrosis. In the main research, an informational support package is provided to parentsand aspects of their psychological functioning is measured on the General HealthQuestionnaire (Goldberg, 1978), Beck Depression Inventory (Beck & Steer, 1987), StateTraitAnxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1970) and BriefSymptom Inventory (Derogatis, 1993).Bivariate analysis, multivariate analysis and nonparametric comparisons were made todetermine the effect of the informational support programme on aspects of thepsychological functioning of parents. The results were mixed, with parents in theexperimental group showing lower levels of depression, but not anxiety, after use of thesupport programme. While depression and anxiety ordinarily coexist (Lader, 1994;Stavrakaki & Vargo, 1986), it is speculated that the different nature of anxiety experiencedby parents, entrusted with a demanding daily medical treatment regime, may account forthese results. Positive results on the General Health Questionnaire, a measure whichassesses stress responses in the health domain, are also reported.In an environment where the United Kingdom Department of Health (2001) is promotingthe concept of the expert patient, knowledge and empowerment may not be enough. Placingthe research in this study in context, it is argued that innovation and cost-containment willcontribute towards both opportunities and stresses for the psychologist working in abiopsychosocial model incorporating multidisciplinary teams. Shaw and Baker (2004) askExpert patient - dream or nightmare? while Strawbridge (2002) remarks on the pitfalls ofwhat she calls, the emergence of 'McDonaldization or fast food therapy' in psychology, inwhich we find ourselves doing 'McJobs'.This study positions itself in the midst of the new concepts and demands ofmultidisciplinary service delivery and finds that its objectives are compromised by pressuresof time, money and health care policy.

[发布机构] Stellenbosch University