Measuring Children’s Stress via Saliva in Surgical and Endoscopic Procedures and Its Measurement Intention in the Community: Reality-Future Prospects
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion and Exlusion Criteria
2.2. Measures
2.2.1. Salivary Parameters
2.2.2. Comments on Elisa Method
2.3. The Theory of Planned Behavior (TPB)
2.4. Sample, Data Collection and Intervention Procedure
- The first, ‘Group Unexplained’, included 45 children and one of their parents: a hardcopy of the questionnaire (TPB) was provided to them to fill in. Then, three saliva samples were collected from the child during the following hours: (T1): 7:00 a.m.–9:00 a.m. in the clinic room, (T2): 9:00 a.m.–12:00 p.m. just before anesthesia administration, and (T3): 5:00 p.m.–7:00 p.m. This group received no explanation related to the surgical or endoscopic procedure. No pre-intra and postoperative information was provided.
- The second, ‘Group Explained’, also comprised 45 children and one of their parents: a hardcopy of the questionnaire (TPB) was provided to them to fill in. After the completion of the questionnaire (TPB), the researcher stayed with the parents so as to provide an explanation for these particular issues, because the understanding of possible hesitations or fears of the participants regarding an operation and the use of biological samples is important. The Theory of Planned Behavior (TPB) in research allows for a complete and in-depth understanding of the multifaceted perceptions regarding the understanding of complex phenomena. It explores the influence of internal factors (such as parents’ beliefs), external factors (such as barriers from the hospital environment itself) and the influence of ‘significant others’ (such as relatives, friends or health professionals) on parents’ intention to adopt a participative behavior. Through dialogue, questions were answered, and the thoughts, needs, expectations and experiences of both the child and parent were recognized. This process also empowers both the parent and the child to gain confidence and a sense of control over a stressful situation for a smooth outcome. At the same time, information was obtained regarding the acceptance of the collection for biological samples from saliva.
2.5. Statistical Analysis
3. Results
4. Discussion
5. Study Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Questions | Explanation |
---|---|
Which are their previous medical experiences? | Both children and parents may develop inaccurate images/scenario. Therefore, correct information was provided to improve, process, expand and correct the existing scenarios. |
What expectation do children have during a medical procedure? | Correct information was provided to minimize the discrepancy between expectation and reality. |
Whether salivary biomarkers testing is important, beneficial, pleasant and necessary. | Both children and parents were provided with information that the procedure is painless with many advantages so as to improve their attitude towards this particular method. Since parents influence their children, it is important that they adopt positive attitudes of managing a situation through the provision of information, communication or persuasive techniques. |
How easy do you think the test is? How confident are you in the case you decide to have your child tested for saliva biomarkers? How much do you feel it is up to you to have your child tested for saliva biomarkers? Will you manage to have your child tested? | Since perceived behavioral control is important, parents were properly trained in saliva sampling. The more individuals control the factors in order to perform a particular behavior, the more likely they are to engage in such behavior helping their children engage themselves in these behaviors. |
Which is their sense of control and how they cope? | Through the provided information, their sense of control and their solving of focused problems were enhanced. |
Further information (explicit or implicit) was collected, e.g., the parent–child relationship. It was also important to identify whether friends and relatives would live to have their child tested for salivary biomarkers, and whether health professionals’ advice is extremely important to parents. | Emphasizing proactive behaviors by influential people leads to an effective change towards a positive direction. Subjective norms had an indirect correlation with parents’ intentions for their children’s behaviors. |
Questions about satisfaction or non-satisfaction regarding the number of people in the hospital room, and the waiting time between admission and the start of the procedure were asked. That was because the environment affects the psychology of both children and parents. | The explanations which were provided and regarded the fact that they would be in hospital for a short period of time and that their primary goal is to get well reassured them. |
Do you intend to have your child tested for biological saliva markers? | Parental intention was predicted by attitude, subjective norm, and perceived control, and the explanations provided were consistent with previous ones. |
Group Unexplained n = 45 | Group Explained n = 45 | ||
---|---|---|---|
Parent’s gender | Male | 15 | 13 |
Female | 30 | 32 | |
Parental education | High School Degree or Less | 18 | 19 |
College Degree or More | 27 | 26 | |
Parental income | <10.000 | 18 | 15 |
>10.000 | 27 | 30 | |
Child’s gender | Male | 30 | 28 |
Female | 15 | 17 | |
Child’s age | <11 | 16 | 21 |
>12 | 29 | 24 | |
Intervention | Endoscopy | 28 | 31 |
Surgical (including): | 17 | 14 | |
splenic cysts | 1 | ||
phimosis | 2 | 2 | |
cryptorchidism | 3 | 3 | |
umbilical hernia | 1 | ||
inguinal hernias | 4 | ||
cysts of the testis | 1 | ||
ear reconstruction | 1 | ||
liver biopsy | 1 | 2 | |
varicoceles | 1 | ||
pilonidal cyst | 1 | 2 | |
appendicitis | 1 | ||
excision of minor lumps | 1 | ||
esophageal achalasia | 1 | ||
hydrocele | 1 | ||
testicular torsion | 1 | ||
biliary | 1 |
Before Intervention | After Intervention | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | S Cortisol | S A Amylase | Mean Difference of S Cortisol Level Τ2–Τ1 | Mean Difference of S A Amylase Level T2–T1 | Mean Difference of S Cortisol Level Τ3–Τ2 | Mean Difference of S A Amylase Level Τ3–Τ2 | ||||||||||
T1 | T2 | T3 | T1 | T2 | T3 | |||||||||||
Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | p Value | Mean (SD) | p Value | Mean (SD) | p Value | Mean (SD) | p Value | |||
Intervention | Surgical | 29 | 14.17 (4.68) | 11.38 (4.14) | 5.27 (5.50) | 66.00 (56.96) | 102.40 (72.58) | 105.10 (82.71) | −2.79 (4.02) | 0.94 | 36.40 (51.48) | 0.154 | −6.11 (6.14) | 0.905 | 2.70 (57.60) | 0.261 |
Endoscopy | 52 | 14.07 (5.36) | 9.32 (4.92) | 3.07 (3.48) | 76.64 (65.20) | 96.27 (60.38) | 115.80 (81.27) | −4.74 (5.41) | 19.64 (49.65) | −6.26 (4.54) | 19.53 (67.47) | |||||
Parental education | High School Degree or Less | 32 | 14.68 (5.16) | 9.99 (4.79) | 4.25 (4.79) | 70.00 (52.16) | 90.46 (54.8) | 103.69(66.03) | −4.69 (5.03) | 0.351 | 20.46 (45.78) | 0.460 | −5.17 (5.17) | 0.518 | 13.35 (62.88) | 0.986 |
College Degree or More | 49 | 13.73 (5.08) | 10.10 (4.75) | 3.60 (4.17) | 74.67 (4.17) | 103.69 (70.3) | 117.30 (90.36) | −3.62 (5.02) | 29.02 (53.77) | −6.50 (5.14) | 13.60 (65.79) | |||||
Parental income | <10.000 | 30 | 13.54 (5.04) | 10.45 (5.09) | 5.34 (5.70) | 68.40 (52.37) | 92.47 (53.88) | 105.52 (70.69) | −3.09 (4.57) | 0.190 | 24.07 (54.71) | 0.832 | −5.11 (4.83) | 0.143 | 13.05 (63.74) | 0.962 |
>10.000 | 51 | 14.43 (5.15) | 9.83 (4.55) | 2.98 (3.18) | 75.43 (67.71) | 101.99 (70.46) | 115.76 (87.60) | −4.61 (5.23) | 26.56 (48.62) | −6.85 (5.24 | 13.77 (65.19) | |||||
Child’s gender | Male | 52 | 13.78 (5.25) | 10.07 (4.72) | 3.87 (4.48) | 71.07 (57.13) | 99.20 (63.88) | 109.09 (81.83) | −3.71 (4.77) | 0.431 | 28.12 (44.86) | 0.557 | −6.20 (4.90) | 0.991 | 9.89 (60.39) | 0.502 |
29 | 14.68 (4.85) | 10.05 (4.89) | 3.83 (4.35) | 75.98 (71.43) | 97.16 (67.07 | 117.14 (81.91) | −4.64 (5.48) | 21.18 (60.25) | −6.21 (5.62) | 19.98 (71.33) | ||||||
Child’s age | <11 | 34 | 12.74 (5.11) | 10.30 (5.34) | 3.86 (5.18) | 78.19 (59.13) | 114.67 (60.42) | 120.45 (80.18) | −2.44 (4.60) | 0.013 | 36.48 (54.78) | 0.102 | −6.43 (6.05) | 0.738 | 5.79 (69.31) | 0.361 |
>12 | 47 | 15.09 (4.91) | 9.89 (4.30) | 3.85 (3.82) | 68.95 (64.72) | 86.75 (65.62) | 105.83 (82.64) | −5.21 (5.03) | 17.80 (46.48) | −6.04 (4.42) | 19.08 (60.49) | |||||
Group | Unexplained | 42 | 14.78 (4.91) | 10.39 (4.62) | 5.94 (5.27) | 93.70 (74.82) | 110.09 (74.42) | 145.12(89.20) | −4.39 (5.12) | 0.521 | 16.39 (59.56) | 0.084 | −4.50 (5.01) | 0.001 | 35.04 (65.80) | 0.001 |
Explained | 39 | 13.38 (5.26) | 9.71 (4.89) | 1.61 (0.98) | 50.35 (33.33) | 85.95 (50.09) | 76.26 (53.42) | −3.67 (4.95) | 35.60 (37.09) | −8.09 (4.62) | −9.69 (54.37) |
Skewness | Kurtosis | Kolmogorov–Smirnov a | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Construct | n | Min | Max | Mean | Std. | Statistic | Std. Error | Statistic | Std. Error | ||
Baseline Hospital | intention | 90 | 2.00 | 7.00 | 5.01 | 1.16 | −0.37 | 0.25 | −0.29 | 0.50 | 0.200 |
attitudes | 90 | 4.00 | 7.00 | 5.62 | 0.80 | −0.19 | 0.25 | −0.80 | 0.50 | 0.200 | |
control | 90 | 2.67 | 6.33 | 4.68 | 0.96 | −0.20 | 0.25 | −0.62 | 0.50 | 0.200 | |
subjective norms | 90 | 3.75 | 6.50 | 5.05 | 0.61 | 0.01 | 0.25 | −0.30 | 0.50 | 0.099 | |
Follow-up community | intention | 43 | 3.33 | 7.00 | 5.29 | 0.92 | 0.02 | 0.36 | −0.33 | 0.71 | 0.053 |
attitudes | 43 | 4.75 | 7.00 | 5.96 | 0.58 | −0.22 | 0.36 | −0.36 | 0.71 | 0.051 | |
control | 43 | 3.67 | 6.00 | 5.07 | 0.63 | −0.23 | 0.36 | −0.64 | 0.71 | 0.064 | |
subjective norms | 43 | 3.50 | 6.00 | 4.90 | 0.62 | −0.31 | 0.36 | −0.46 | 0.71 | 0.090 |
Correlation Coefficient (R) | Determination Coefficient (R Square) | Adjusted Determination Coefficient (Adjusted R Square) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
A | B | A | B | A | B | |||||
0.635 | 0.534 | 0.403 | 0.285 | 0.382 | 0.230 | |||||
ANOVA a | ||||||||||
Sum of Squares | Df | Mean Square | F | P | ||||||
A | B | A | B | A | B | A | B | A | B | |
Regression | 47.85 | 10.23 | 3 | 3 | 15.95 | 3.41 | 19.34 | 5.178 | <0.001 b | 0.004 b |
Residual | 70.91 | 25.68 | 86 | 39 | 0.83 | 0.66 | ||||
Total | 118.77 | 35.91 | 89 | 42 | ||||||
Beta | t | P | ||||||||
A | B | A | B | A | B | |||||
Attitudes | 0.74 | 0.316 | 6.68 | 2.33 | <0.001 * | 0.025 * | ||||
Control | −0.20 | 0.319 | −1.6 | 2.28 | 0.112 | 0.028 * | ||||
Subjective norms | 0.01 | 0.206 | 0.13 | 1.47 | 0.897 | 0.151 |
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Grigoropoulou, M.; Attilakos, A.; Charalampopoulos, A.; Fessatou, S.; Vamvakas, E.; Dimopoulou, A.; Zavras, N. Measuring Children’s Stress via Saliva in Surgical and Endoscopic Procedures and Its Measurement Intention in the Community: Reality-Future Prospects. Children 2023, 10, 853. https://doi.org/10.3390/children10050853
Grigoropoulou M, Attilakos A, Charalampopoulos A, Fessatou S, Vamvakas E, Dimopoulou A, Zavras N. Measuring Children’s Stress via Saliva in Surgical and Endoscopic Procedures and Its Measurement Intention in the Community: Reality-Future Prospects. Children. 2023; 10(5):853. https://doi.org/10.3390/children10050853
Chicago/Turabian StyleGrigoropoulou, Maria, Achilleas Attilakos, Anestis Charalampopoulos, Smaragdi Fessatou, Efstratios Vamvakas, Anastasia Dimopoulou, and Nikolaos Zavras. 2023. "Measuring Children’s Stress via Saliva in Surgical and Endoscopic Procedures and Its Measurement Intention in the Community: Reality-Future Prospects" Children 10, no. 5: 853. https://doi.org/10.3390/children10050853
APA StyleGrigoropoulou, M., Attilakos, A., Charalampopoulos, A., Fessatou, S., Vamvakas, E., Dimopoulou, A., & Zavras, N. (2023). Measuring Children’s Stress via Saliva in Surgical and Endoscopic Procedures and Its Measurement Intention in the Community: Reality-Future Prospects. Children, 10(5), 853. https://doi.org/10.3390/children10050853