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Original research
Changing contexts of child health: an assessment of unmet physical, psychological and social needs of children with common chronic childhood illness
  1. Raghu Lingam1,2,
  2. Nan Hu1,
  3. Elizabeth Cecil2,
  4. Julia Forman2,
  5. James Newham3,
  6. Rose-Marie Satherley4,
  7. Marina Soley Bori5,
  8. Simon Cousens6,
  9. Julia Fox-Rushby5,
  10. Ingrid Wolfe7
  1. 1 School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2 Department of Women & Children’s Health, King's College London, London, UK
  3. 3 Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
  4. 4 Department of Psychological Interventions, University of Surrey, Guildford, UK
  5. 5 Department of Population Health Sciences, King's College London, London, UK
  6. 6 LSHTM, London, UK
  7. 7 Department of Women & Children’s Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
  1. Correspondence to Raghu Lingam, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia; r.lingam{at}unsw.edu.au

Abstract

Background We assessed the biopsychosocial needs and key health drivers among children living with a common chronic illness, as baseline for a cluster randomised controlled trial of a child health system strengthening intervention.

Methods Cross-sectional data were analysed from a large population sample of children from South London with asthma, eczema or constipation, as exemplar tracer conditions of a new integrated care service. Descriptive and regression analyses, accounting for sociodemographic factors, investigated social needs, psychosocial outcomes and quality of life associated with poor symptom control.

Results Among 7779 children, 4371 children (56%) had at least one uncontrolled physical health condition. Across the three domains of physical health, mental health and social needs, 77.5% of children (n=4304 of 5554) aged 4–15 years had at least one unmet need, while 16.3% of children had three unmet needs. Children from the most socioeconomically disadvantaged quintile had a 20% increased risk of at least one poorly controlled physical condition (risk ratio (RR)=1.20, 95% CI: 1.11 to 1.31, p<0.001) compared with those from the least disadvantaged quintile. There was an 85% increased risk of clinically important mental health needs among children with uncontrolled asthma (RR=1.85, 95% CI: 1.65 to 2.07, p<0.001), 57% for active constipation (RR=1.57, 95% CI: 1.12 to 2.20, p<0.01) and 39% for uncontrolled eczema (RR=1.39, 95% CI: 1.24 to 1.56, p<0.001). Health-related quality of life was associated with poor symptom control.

Conclusions There is a large burden of unmet biopsychosocial needs among children with chronic illness, signalling an urgent need for prevention, early intervention and integrated biopsychosocial care.

  • Epidemiology
  • Paediatrics
  • Child Health

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/archdischild-2023-326766

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • RL and NH are joint first authors.

    • Contributors RL, as co-principal investigator and external evaluation lead, conceptualised the work, developed the methodology and led the investigation and analyses, wrote, reviewed and edited the manuscript. NH carried out the analysis, wrote, reviewed and edited the manuscript. EC, as trial coordinator, oversaw data collection, carried out data analysis, wrote, reviewed and edited the manuscript. JF, as trial statistician, carried out data analysis, wrote, reviewed and edited the manuscript. JN, as trial coordinator, oversaw data collection, reviewed and edited the manuscript. R-MS carried out data collection, reviewed and edited the manuscript. MSB, SC and JF-R advised on data collection, reviewed and edited the manuscript. IW, as principal investigator, conceptualised the work, acquired funding, developed the methodology and oversaw the investigation and analyses, and edited the manuscript. RL is guarantor.

    • Funding The CYPHP trial was funded by Guy’s and St Thomas Charity, Lambeth and Southwark Clinical Commissioning Groups (ref. HIF180101KCL). RL is supported through the Financial Markets for Children Charity. IW and JF are supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust.

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.