title: How chronic disease affects children's views on being ill and healthy: a comparative study.
abstract: BACKGROUND
  Understanding children's views of illness and health is vital to a child-centred approach in patient education and care. Paediatric healthcare providers should incorporate children's views of health and illness to enable children and their families to participate in self-management plans and achieve better health outcomes. However, there is limited scientific knowledge regarding the views of children with specific diseases.
  
  
  METHODS
  This comparative study investigated whether and in what ways the experience of having different chronic diseases influenced children's views of being ill and healthy. The participants were 82 children aged 8-13 years diagnosed with a chronic disease (31 had asthma, 27 had diabetes and 24 had cancer). A group of 81 healthy children participated as a comparison group. The 'draw-and-write' technique was used to collect the children's views, and the data were analysed using a previously validated coding system (inter-rater agreement of 93%) and subsequently quantified for the examination of any differences in relation to illness.
  
  
  RESULTS
  Statistically significant differences were found in all dimensions of the children's conceptions of health and illness according to whether they had a chronic condition (effect sizes calculated with Cohen's d ranged from 0.35 to 1.22). Globally, the chronically ill children expressed a narrower definition of being healthy and ill than their healthy peers. Moreover, the comparison among the children with asthma, diabetes and cancer showed differences that seemed to reflect their specific experiences with their type of chronic disease and the associated treatments (effect sizes calculated with Eta-squared ranged from 0.07 to 0.25).
  
  
  CONCLUSIONS
  This study's findings can be used to guide education and clinical services tailored to ill children suffering from different chronic conditions.
authors.affiliation: Escola Superior de Enfermagem do Porto (Nursing School of Porto), Porto, Portugal.
authors.forename: Lígia
authors.initials: L
authors.lastname: Lima
authors.affiliation: Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Silva
authors.affiliation: Faculdade de Psicologia e Ciências da Educação, Center for Psychology at University of Porto Research Unit, Universidade do Porto, Porto, Portugal.
authors.forename: Marina S
authors.initials: MS
authors.lastname: Lemos
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D055809:Illness Behavior; D008297:Male; D018802:Patient-Centered Care
keywords: asthma; cancer; child-centred care; children; conceptions of health and illness; diabetes; patient education; self-management