Background Primary caregivers of children with cerebral palsy (CP) may experience challenges affecting their social participation and inclusion. However, these experiences remain insufficiently understood in the Chinese context. Understanding these experiences is important for family-centred nursing and rehabilitation support. Methods A qualitative descriptive study was conducted with 26 primary caregivers recruited from a tertiary rehabilitation hospital in China. Semi-structured interviews were conducted face-to-face, via WeChat video call, or by telephone. Data were analysed inductively using Braun and Clarke's six-phase approach to reflexive thematic analysis. Results Four themes, each comprising two subthemes, were developed: (1) Emotional distress and withdrawal from social life; (2) Caregiving demands restricting opportunities for participation; (3) Role expectations narrowing social identities and everyday roles; and (4) Stigma and exclusion undermining belonging and acceptance. Conclusions In this study, primary caregivers of children with CP described reduced social participation and limited inclusion associated with overlapping emotional, caregiving, role-related, and social influences.
Introduction Following the relaxation of China's fertility policy, the nation-a rapidly growing group in the platform economy-are predominantly young, of reproductive age, and generally lack adequate social security coverage. Their fertility intentions therefore merit particular attention. Methods We conducted a stratified purposive survey across 23 provinces and municipalities, collecting 604 valid responses from NFE flexible workers. The analytical sample was restricted to ever‑married respondents with at least one child (N = 336). Using Logit, Probit, Poisson, and OLS regression models, complemented by Propensity Score Matching (PSM), we estimated the association between participation in basic pension insurance and two measures of fertility intention: willingness to have a second child (Plan1) and ideal number of children (Plan2). Results Participation in basic pension insurance is significantly negatively associated with both Plan1 and Plan2 across all models. The average marginal effect from the Logit model indicates a reduction of 8.5 percentage points in the probability of intending a second child (p < 0.01). The PSM‑estimated average treatment effect on the treated (ATT) shows that participants have, on average, about 23.5 percentage points lower second‑child intention than non-participants. Heterogeneity analyses reveal that the negative association is stronger for non-agricultural hukou holders and for those who engage in NFE as their sole or primary job, while it is weaker for secondary-job holders. Discussion These findings suggest that basic pension insurance may substitute for the traditional "raising children for old‑age support"motive, thereby dampening fertility intentions among NFE flexible workers. To balance old-age protection with fertility promotion, policy interventions could consider adjusting contribution rates, expanding social security coverage, and strengthening employment protection for female workers. Further research using panel or quasi‑experimental designs is needed to establish causality.
Background Participatory health research and promotion (PHR/P) emphasizes collaborative knowledge production, mutual learning, and redistribution of power between academic and non-academic actors. With children, PHR/P has gained increasing legitimacy under the United Nations Convention on the Rights of the Child, which recognizes children as rights-holders and social actors. However, little is known about how PHR/P with children is framed and enacted in Germany. This review provides the first systematic overview of PHR/P with children in Germany. Methods We conducted a scoping review following Arksey and O'Malley's framework and PRISMA guidelines. Searches were performed in four databases in March-April 2024, supplemented by snowballing of friends' studies. Eligible studies (2000-2024) reported empirical projects in Germany (plus two projects from German-speaking Switzerland) that explicitly applied participatory approaches with children (< 18 years) and addressed health-related topics. Medical intervention studies and studies limited to clinical patient groups were excluded. Data extraction used a structured codebook adapted from the International Collaboration for Participatory Health Research and focusing on objectives, actors, research phases, and reflections. Two reviewers coded each report independently. Results Twelve projects (23 publications) met the inclusion criteria. Most projects were situated in educational or communal contexts. Health-related objectives were consistently reported, often focusing on behavioural change. Participatory objectives were less frequent, remained implicit in several cases, and were rarely defined with children. Children typically participated alongside other adults, rarely as the sole group of non-academic actors. Participation was usually reported in operational phases (e.g. data collection), whereas involvement in conceptual phases (e.g. defining research questions, analysis, dissemination) was uncommon. Creative methods (e.g. photovoice, theater, drawing) were widely used. Reflections focused mainly on ethics, informed consent, and child protection, while sustainability, power relations, and children's perceived benefits were seldom addressed. Reporting practices were often vague, limiting systematic assessment. Discussion PHR/P with children in Germany has gained traction but remains unevenly reported. Health-related goals dominate participatory aims, children's roles are often mediated by adults, and reflections on sustainability and power remain underdeveloped. Greater transparency in reporting participatory processes is essential to strengthen cumulative knowledge and design meaningful child-centred approaches. Trial registration N/A.
Landwehr J, Luetke Lanfer H, Schierenbeck M et al.
Poor mental health among adolescents and young adults in the United States today is a critical concern. Sports team participation, combining physical activity and social belonging, may be an effective component of interventions to improve mental health among this population. This study examines both short and long-term associations between sports team participation in adolescence and anxiety and depression from adolescence to young adulthood, using the Future of Families and Child Wellbeing Study, a population-based longitudinal birth cohort study of urban US children. In this sample of 2766 young adults (52% female, Mage = 22.3), controlling for a rich set of child and family characteristics, including prior mental health, we found that frequent sports participation in adolescence (33% of the sample), compared to none, was associated with substantially lower depression and anxiety symptoms among all adolescents. We also found that sustained sports participation in adolescence was associated with a lower likelihood of depression in young adulthood, but only for young adult males. Exploring heterogeneity in associations further by race/ethnicity and socioeconomic status, the strongest associations were found among young adult males who are non-Hispanic white and Latino, and from higher socioeconomic backgrounds. These results suggest sustained sports team participation throughout adolescence may be a valuable intervention component for improving mental health among adolescents and young adults.
Children with Autism Spectrum Disorder (ASD) present with complex, multi-domain functional challenges that single-domain intervention approaches fail to address adequately. This retrospective case report, with prospective follow-up from age 7 years, applies CanChild's F-words and the F-words Lens Tool to examine intervention planning and developmental outcomes across a five-year trajectory for an eight-year-old autistic girl with co-occurring hypotonia and joint hypermobility. For each developmental period, from 24 months to eight years, we identify the functional challenge encountered, drawing on standardized assessment data (CELF Preschool, Renfrew Action Picture Test, ADOS-2) alongside clinical and family report, and describe how F-words thinking informed clinical decision-making in real time; the F-words Lens Tool, developed subsequently, is applied here, retrospectively for earlier periods and prospectively from age 7, to structure this reasoning transparently, specify the interventions selected and their cross-domain rationale, and report outcomes. The case traces the child's trajectory through the early developmental period, and following transition to mainstream schooling with presenting strengths and challenges. Caregiver accounts (father, grandmother) and the child's own first-person perspective provide the lived experience outcomes across F-words domains. Together, this triangulated account demonstrates how the F-words and F-words Lens Tool can enhance clinical decision-making and family collaboration while preserving child agency, contributing an example to the global discourse on evidence-based, family-centred practice in complex neurodevelopmental presentations.
Govender P, Livingstone RW, Hidalgo-Robles Á et al.
Background Leisure participation is essential for children's health and well-being and is also a fundamental human right; however, children and youth with disabilities face significant barriers to participation compared with their peers without disabilities. The Jooay App was developed to address gaps in information and access to adaptive and inclusive leisure activities. A new gamification-based version of the Jooay App was co-designed with users, including youth with disabilities, parents, and health care professionals. Objective This study aims to describe a study protocol to implement and evaluate the gamified version of the Jooay App using a patient-oriented approach to increase awareness about adaptive and inclusive leisure activities and promote participation in leisure among children and youth with disabilities. Methods A hybrid type II effectiveness-implementation study will be conducted. The Consolidated Framework for Implementation Research (CFIR) will guide implementation strategies, including the expansion of knowledge broker (KB) networks to raise the profile of adaptive and inclusive leisure activities in Canada. An interrupted time series (ITS) design will be used to evaluate implementation outcomes across 5 provinces in Canada. Process evaluation will analyze inner and outer setting characteristics, KB strategies, and community resource mobilization. Effectiveness outcomes will be assessed through two phases: (1) a nonrandomized mixed methods pilot feasibility study of the app, where acceptability, engagement, implementation, and potential benefits will be measured, and (2) an ITS at the population level, where overall app usage (eg, clicks, logins, and time spent), individual gamification feature metrics, and user feedback will assess effectiveness outcomes. Results The project was funded by the CHILD-BRIGHT (Child Health Initiatives Limiting Disability-Brain Research Improving Growth and Health Trajectories) Network through the Strategy for Patient-Oriented Research, Canadian Institutes of Health Research, in September 2025, and data collection is expected to occur from March 2026 to June 2027. As of manuscript submission, 12 KBs have been recruited, the ITS study and data analysis have not yet begun, and the study results for the implementation and effectiveness components are expected to be published in fall 2027. Findings will be disseminated via peer-reviewed publications, conference presentations, educational materials, social media, community events, and reports. Outputs will include a summary of findings in lay language, in both French and English, including short videos, infographics, and posters for various social media platforms. Community organizations will assist in further dissemination through their networks. Conclusions This study will evaluate both the effectiveness and the implementation of the gamified Jooay mobile app to promote participation in leisure among children and youth with disabilities using a hybrid effectiveness-implementation design. By applying the CFIR framework, this study aims to generate evidence about how the Jooay App can be effectively implemented across Canada and expand scholarship on the implementation of technology for equity-deserving groups.
Background Discrete choice experiments (DCEs) are quantitative preference-elicitation methods, developed largely within health economics, in which participants choose repeatedly between hypothetical scenarios composed of systematically varied attributes. Their growing use with children supports children's right to be heard in decisions affecting their care, yet it also raises ethical challenges that general paediatric research ethics guidance does not address in operational detail: sustained cognitive demand, potential emotional distress, assent that can blur under clinical stress, parental influence, clinician-researcher role conflict, and the processing of children's personal data. Methods We developed a prospective ethical governance framework during the preparatory phase of the PREF-ANX Kids study (Preferences for Preoperative Anxiety Management in Children), a planned multicentre DCE examining preferences for nursing interventions to manage preoperative anxiety among children aged 6-12 years undergoing elective surgery in Portuguese public hospitals, their parents, and healthcare professionals. Development combined a pragmatic, non-systematic synthesis of ethical, regulatory, and methodological guidance with iterative structured discussion within an interdisciplinary team. No formal consensus method was applied, and no children or families were involved in development; we identify this as a limitation. Framework The framework comprises four domains operating across the research lifecycle: relational participation, cognitive and emotional safeguarding, reflexive professional responsibility, and privacy stewardship. For each domain it specifies planned procedures (continuous assent and dissent monitoring, adapted task burden, structured reflexive documentation, and a prospective data protection impact assessment) together with their normative justification, and it distinguishes elements specific to PREF-ANX Kids from elements potentially adaptable to other paediatric DCEs. Trade-offs between competing ethical and methodological priorities are made explicit rather than resolved silently. Conclusions The framework is prospective: it has not yet been implemented or empirically evaluated, and no claims of demonstrated effectiveness are made. It is intended to support transparent ethical planning of DCEs involving children aged 6-12 years and will be assessed during the PREF-ANX Kids study. Future refinement should incorporate co-design with children and families and empirical evaluation of feasibility, acceptability, participant experience, and data quality.
Martins Esteves I, Pestana-Santos M, Sampaio F et al.
Purpose This study aimed to determine (1) the psychometric properties of the Child and Adolescent Scale of Participation-French version (CASP-Fr) in children and adolescents with Acquired Brain Injury (ABI), (2) their participation levels, and (3) factors associated with participation. Materials and methods This cross-sectional study included 85 parents of children/adolescents followed in a rehabilitation department after ABI (61% boys, mean [SD] age at injury/assessment 5.6 [3.9]/10.5 [3.4] years). Parents assessed participation using the Child and Adolescent Participation Scale-French version (CASP-Fr) (64% response rate). Demographic, clinical, severity and environmental information were collected from the medical files and a parental questionnaire. Results Internal consistency was good (Cronbach α = 0.85) for the total score. Participation levels were relatively high for home- (94%) and school-related activities (95%), but were relatively lower for complex community activities (82%). Participation was significantly associated with maternal education level, and marginally associated with initial coma and type of ABI (worse in severe TBI). No other demographic, clinical, or severity factor was associated with participation. Conclusions Results demonstrate the good psychometric properties of the CASP-Fr. Participation should be systematically assessed, preferably combining parent- and self-reports. In particular, children (and families) should be questioned about participation in elaborate and complex activities.
The real-world impact of evidence-based parenting programs depends on their ability to engage parents and families. Yet, knowledge about the facilitators and barriers of participation remains limited. A common approach to study parent participation is conducting secondary analyses of clinical trial data, which often yield mixed and inconclusive results. The present study represents one of the largest studies undertaking the secondary analyses approach while addressing key methodological constraints identified in previous research (e.g. low power, narrow sets of predictors). We utilised data collected as part of a cluster randomised trial of a telehealth-delivered Triple P - Positive Parenting Program Seminar Series in Australian primary schools (N = 2272 parents) to assess parent participation. Thirteen participation outcomes were assessed across three domains: registration, seminar attendance, and time spent in sessions. Candidate predictors included child and family demographics, child mental health, parenting and family functioning, and home-school partnership quality. Across 468 exploratory analyses, associations between predictors and participation outcomes were generally small in magnitude, with models explaining only 0.5%-10.3% of the variance in parental participation. After adjustment for multiple comparisons, only one predictor remained statistically significant. These findings highlight the potential limited utility of relying on exploratory secondary analyses of clinical trial data to understand parent participation in parenting programs. Rather than continuing to expand data-driven searches for individual predictors, the field should prioritise theory-driven research and methodological innovations, such as embedding participation experiments within intervention trials.
Children's dignity in hospital care is often framed as a matter of privacy, etiquette, communication, or procedural compliance. A more demanding account is needed. Drawing on the philosophical framework of epistemic injustice, this conceptual article argues that dignity-related harms in paediatric nursing also arise when children are denied credibility, interpretive support, or meaningful authority over knowledge of their own embodied experiences. Children may not always describe pain, shame, embarrassment, fear, or boundary violation through adult-like verbal testimony. Their experiential knowledge may instead appear through silence, withdrawal, humour, bodily resistance, hesitation, gaze avoidance, or apparently compliant behaviour. When such expressions are dismissed as immaturity, difficulty, exaggeration, or non-compliance, the child is harmed not only as a vulnerable patient but also as a knower. This reframing connects paediatric dignity with children's rights to participation, privacy, and respect under the United Nations Convention on the Rights of the Child and the EACH Charter. It also positions paediatric nurses as central agents of epistemic repair because nursing work occurs at the intersection of intimate bodily care, sustained relational proximity, communication, documentation, and advocacy. The article proposes an epistemic justice practice bundle for paediatric nursing: credibility-oriented listening, embodied attunement, developmentally attuned communication, protected communicative spaces, minimal substitution by adult proxies, and voice-preserving documentation. The analysis extends nursing philosophy by showing that dignity is not only protected around the child but co-produced through relational practices that make children's experiences visible, credible, and actionable within clinical care.
