Investigating the relationship between children's self-reported coping strategies and repeated needle pain

Abstract

While the majority of school-aged children associate immunizations with low levels of anxiety, fear, and pain, there is a small subset for whom needles are highly distressing (Humphrey, et al., 1992). Poorly managed, these individuals may come to avoid medical treatment (Ollendick, King, & Muris, 2002). Using Lazarus and Folkman’s (1984) transactional theory of coping and Reid and colleagues’ (1998) development and validation of the Pain Coping Questionnaire as frameworks, the present program of research elaborated on existing knowledge about how children cope with needles. As part of Studies 1 (N = 176) and 2 (N = 302), a Coping with Needles Questionnaire (CNQ) was developed and validated; both two- and three-subscale versions of the questionnaire were examined. The resulting CNQ was composed of and scored as two separate subscales: problem-focused and emotion-focused coping. Construct validity testing demonstrated that emotion-focused coping was robustly associated with more negative experience with needles (i.e., higher anxiety, fear, pain, and lower self-efficacy). There was no main effect of problem-focused coping but it tended to moderate the negative effect of emotion-focused coping when the two interacted. Study 3 (N = 78) was designed to investigate (1) the percentage of participants who are high on only one type of coping (i.e., dominant copers) and (2) how coping responses change over time in response to repeated presentations of the same stressor. Presently there are gaps in the existing literature regarding these two targeted areas of investigation. Results of this investigation indicated that most children engage in high amounts of both problem- and emotion-focused coping when initially queried about their experience with an immunization, with approximately 30% showing a pattern of coping dominance. When participants were followed and queried about a second experience with immunization, it was found that most of them engaged in low amounts of both types of coping. This pattern of change in the distribution of coping over time was not consistent with learning effects. In other words, participants did not seem to improve their coping with experience. However, lack of a clearly positive type of coping and a six-month time-lag may have inhibited the potential for learning to occur. The utility of the CNQ for screening purposes and implications of these findings for interventions are discussed.