The Extent of Family-Centered Service Implemented in Pediatric Rehabilitation Programs in Metropolitan Taipei: Parents’ Perceptions and Its Influencing Factors

• Main Authors: Yen-Pu Liao, 廖研蒲
• Other Authors: Shou-Hsia Cheng
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/6326ka

碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 101 === Background: Family-Centered Service (FCS) has been acknowledged as the ‘best-practice’ model in pediatric rehabilitation. Parents of children with disabilities have greater parental stress than parents of typically developing children. There is evidence that FCS results in better parental psychosocial well-being and better psychological adjustment of children. However, the extent of FCS implemented in pediatric rehabilitation programs as perceived by parents in Taiwan has not been investigated before, and a limited number of studies have addressed the service-related variables that contribute to parents’ perceptions of FCS in pediatric rehabilitation service. Measure of Processes of Care (MPOC-20) is widely used to evaluate the extent to which the service was family-centered from the parents’ perspectives. The questionnaire had been translated to traditional Chinese. Yet, it has not yet been cross-culturally adapted, neither the cross-cultural validation has been conducted when used in Chinese-speaking society. Objectives: The first part of this study was to cross-culturally adapt the traditional Chinese translation of MPOC-20 and to examine its validity and reliability for use in Taiwanese context (see ‘instrument’ as follows). There were 2 aims in the second part of this study: (1) to describe parents’ perceptions of the extent to which FCS behaviors occurred in outpatient pediatric rehabilitation facilities in metropolitan Taipei, and (2) to examine factors influencing parents’ perceptions of the family centeredness of care. Instrument: MPOC-20, a 20-item self-report measure, originally comprises of five scales:(1)Enabling and partnership; (2)Providing general information; (3)Providing specific information about the child; (4)Coordinated and comprehensive care and (5)Respectful and supportive care. The answers are given on a seven-point scale from ‘to a great extent (7)’ to ‘never (1)’, with an additional alternative of ‘not applicable (0)’. We conducted the cross-cultural adaptation by consulting 11 experts in the field of pediatric rehabilitation twice to confirm the content validity, in terms of the applicability and clarity of each item in the traditional Chinese translation of MPOC-20. After we accomplished a revision based on experts’ comments, we carried out a field test to make sure that the wording of the traditional Chinese (Taiwanese context) version of MPOC-20 is understandable by parents. The Confirmatory Factor Analysis (CFA) showed that the original model which contained 5 factors extracted from 20 items is not fit with Taiwanese sample, so we further performed the Exploratory Factor Analysis (EFA) which indicated there are 3 factors among the 20 items including ‘cooperative, integrated and supportive care’, ‘Providing general information’, and ‘Providing specific information about the child’. The concurrent validity was confirmed by positive correlations between MPOC-20 scale scores and a Parent Satisfaction Questionnaire(r 0.54~0.78). The internal consistency analyses (Cronbach’s α 0.83~0.95) and the test-retest analyses (intraclass correlation coefficients (ICCs) 0.80~0.87) showed that the traditional Chinese (Taiwanese context) version of MPOC-20 is a reliable tool. Subjects：476 parents and 68 therapists from 12 outpatient pediatric rehabilitation facilities in metropolitan Taipei participated in this study from November 16th, 2011, to January 12th, 2012. Parents answered the traditional Chinese (Taiwanese context) version of MPOC-20 and an attached demographic questions sheet, while therapists were asked to provide demographic information. Statistics: Descriptive analyses were used for showing demographic characteristics of the participants and the results of the traditional Chinese (Taiwanese context) version of MPOC-20. Multiple linear regressions with both service providers/receivers variables entered were performed to determine whether service-related variables affecting parents’ perceptions of FCS. Results: (1) Parents rated higher in ‘cooperative, integrated and supportive care’ (M=5.39, SD=1.04), while the lower 2 ratings were given to ‘Providing general information’ (M=4.41, SD=1.32) and ‘Providing specific information’ (M=4.80, SD=1.38). (2) Controlling the variables of service providers/receivers, we found that individual therapy, length of each therapy session between 40 to 60 minutes, and duration of therapy beyond 1 year are the positive factors associated with some or all aspects of FCS, while frequency of therapy is not significantly associated with FCS in the view of parents. Conclusions and policy implications：The parents in metropolitan Taipei felt the services respectful, supportive, coordinated, and comprehensive; however, parents perceived they received insufficient information from therapists. In order to promote the health and well-being of children with developmental problems and their families, FCS provision should be considered as a priority in policy of early intervention, payment system in Taiwan national health insurance, clinical service delivery and service evaluation; furthermore, service-related variables should be taken into account in the planning and delivery of FCS.