Developing a storybook package for bereaved siblings: a pilot study of the effectiveness for enhancing the perceived knowledge and confidence of health and social care professionals in Hong Kong

Figures & data

Table 1. Contents of the Storybook package.

Storybook c	Supplementary manual
Chapter 1: Introduction on the close relationship between the brothers
Chapter 2: Onset of elder brother’s illness; parents share the diagnosis (leukemia) with the younger sibling	Information on common types of childhood cancer; introduction of leukemia Information on medical checkup (e.g., pictures of X-ray machine and Magnetic Resonance Imaging) and treatment in the early stage of leukemia Body chart illustrating how cancer may affect organs and the metastases of cancer cells
Chapter 3: Worries and anxieties of the younger sibling during elder brother’s illness
Chapter 4: Elder brother’s physical deterioration; younger brother’s first hospital visit to his sick brother	Guidelines for preparing for the hospital visit Introduction of common medical equipment in hospital (e.g., pictures of patient-controlled analgesia, vital signs monitoring machine, and suction machine)
Chapter 5: End of life of elder brother; disclosure of death	Tips for helping young siblings in childhood to express their love of and support for the sick sibling Tips for preparation for and disclosure of death Tips for helping young siblings to express their feelings and convey their blessings to sick siblings in the last days before death Tips on explaining death to and supporting bereaved siblings in childhood Guidelines for preparing young siblings in childhood for attending the funeral
Chapter 6: Grieving the loss; changes in the family; different coping styles in the family	Highlights of the possible changes in the family following the loss, and the effects on bereaved child siblings Tips on maintaining continuing bonds and developing rituals for a memorial
Chapter 7: Living with grief but also valuable memories	Community resources for supporting bereaved siblings and their parents

Table 2. Case scenario: Experiencing the illness, dying, and death of a sibling.

Profile	Details
Ming, aged 7, lives with his parents and his elder sister in Hong Kong	His sister was diagnosed with leukemia. She was always in and out of hospital for cancer treatment. Later, his sister’s physical condition deteriorated, and she died. Imagine you are a worker who is responsible for assisting this family and supporting Ming in facing this experience.

Table 3. Demographic characteristics of participants (n = 41).

		Overall		Intervention group		Control group
		n	(Valid %)	n	(Valid %)	n	(Valid %)	p
Gender	Female	37	90.2	20	95.2	17	85	.269^a
	Male	4	9.8	1	4.8	3	15
Age-M (SD) (Range)		43.27 (9.23) (23–60)		41.62 (8.21) (25–57)		45 (10.12) (23–60)		.246^b
Marital Status	Single	16	39	5	23	11	55	.094^c
	Married	24	58.5	15	71.4	9	45
	Widow	1	2.4	1	4.8	0	0
Religious belief	No religion	17	41.5	9	42.9	8	40	.295^c
	Buddhism	4	9.8	0	0	4	20
	Catholicism	5	12.2	3	14.3	2	10
	Christianity	13	31.8	8	38.1	5	25
	Ancestor worship	2	4.9	1	4.8	1	5
								.48^c
Occupation	Doctor	6	14.6	4	19	2	10
	Nurse	12	29.3	6	28.6	6	30
	Special school teacher	12	29.3	1	4.8	2	10
	Occupational therapist	2	4.9	0	0	2	10
	Social worker	10	24.4	4	19	6	30
	Counselor	3	7.3	2	9.5	1	5
	Other (art/play therapist, chaplain)	5	12.2	4	19	1	5

^a Analyzed with Chi Square.

^b Analyzed with independent t-test.

^c Analyzed with Fisher’s Exact Test.

Table 4. Results of mixed ANOVA on self-perceived knowledge (n = 36).

	Between-group effect				Within-group effect				Time x-group effect
	df	F value	p value	Partial eta squared	df	F value	p value	Partial eta squared	df	F value	p value	Partial eta squared
Self-perceived knowledge
Q1. I know how to explain to him what leukemia is.	1.00	0.94	.76	0.003	1.00	2.78	.11	0.08	1	0.694	.411	0.02
Q2. I know how to psychologically prepare him before he visits his sister in the hospital.	1.00	1.76	.19	0.05	1.00	8.40	.01	0.20	1.00	0.07	.79	0.00
Q3. I know how to explain to him the treatment and medical equipment his sister is using (e.g., intravenous infusion pumps).	1.00	3.30	.08	0.09	1.00	17.41	.00	0.34	1.00	2.45	.13	0.07
Q4. I know how to help him to express love and concern to his sister during the illness.	1.00	0.34	.56	0.10	1.00	1.74	.20	0.05	1.00	1.74	.20	0.05
Q5. I know how to deliver the news that his sister is going to die soon.	1.00	0.21	.65	0.01	1.00	2.85	.10	0.08	1.00	0.11	.74	0.00
Q6. I know how to assist him in giving his blessings and expressing his feelings at the final stage before his sister dies.	1.00	0.23	.64	0.01	1.00	9.50	.00	0.22	1.00	2.93	.10	0.08
Q7. I know how to explain to him his sister died.	1.00	0.03	.86	0.00	1.00	1.45	.24	0.04	1.00	0.06	.81	0.00
Q8 I know what the possible emotions and reactions are when he attends his sister’s funeral.	1.00	0.04	.84	0.00	1.00	8.77	.01	0.21	1.00	0.11	.74	0.00
Q9. I know how to handle his emotions and reactions that might appear at his sister’s funeral.	1.00	1.74	.20	0.05	1.00	12.17	.00	0.26	1.00	8.15	.01	0.19
Q10. I know what changes might occur in the family after the death of his sister.	1.00	0.00	1.00	0.00	1.00	11.33	.00	0.25	1.00	0.00	1.00	0.00
Q11. I know how to assist the family in coping with the family changes caused by the sister’s death.	1.00	1.23	.27	0.04	1.00	23.741	.00	0.41	1.00	0.29	.59	0.01
Q12. I know how to give suggestions to his family regarding the memorial activities that they can do to grieve the deceased sister.	1.00	0.46	.50	0.01	1.00	8.56	.01	0.20	1.00	0.24	.63	0.01

The score of each question ranges from 1 to 4, a higher score indicating a higher level of agreement with the question.

Table 5. Results of mixed ANOVA on confidence (n = 36).

	Between-group effect				Within-group effect				Time x-group effect
	df	f	p	Partial eta squared	df	f	p	Partial eta squared	df	f	p	Partial eta squared
Confidence
1. I am confident I can explain to him what leukemia is.	1.00	0.90	.77	0.00	1.00	1.77	.19	0.05	1.00	3.97	.05	0.11
2. I am confident about how to psychologically prepare him before he visits his sister in the hospital.	1.00	0.159	.69	0.01	1.00	11.77	.00	0.26	1.00	1.31	.26	0.04
3. I am confident about explaining to him the treatment and medical equipment his sister is using (e.g., intravenous infusion pumps).	1.00	0.87	.36	0.03	1.00	29.36	.00	0.46	1.00	3.99	.05	0.11
4. I am confident I can assist him in expressing love and concern to his sister during the illness.	1.00	0.842	.37	0.02	1.00	5.17	.03	0.13	1.00	2.640	.11	0.07
5. I am confident about how to deliver the news that his sister is going to die soon.	1.00	0.25	.62	0.01	1.00	13.00	.00	0.27	1.00	0.08	.78	0.00
6. I am confident about how to help him to give his blessings and express his feelings at the final stage before his sister dies.	1.00	0.99	.33	0.03	1.00	4.95	.03	0.13	1.00	0.00	1.00	0.00
7. I am confident I can explain to him that his sister has died.	1.00	3.37	.08	0.90	1.00	2.96	.09	0.08	1.00	0.06	.81	0.00
8. I am confident about how to handle his emotions and reactions that might appear at his sister’s funeral.	1.00	1.28	.27	0.04	1.00	6.12	.02	0.15	1.00	0.68	.42	0.20
9. I am confident about assisting the family in coping with the family changes caused by the sister’s death.	1.00	0.27	.61	0.01	1.00	4.64	.04	0.12	1.00	0.52	.48	0.02
10. I am confident about giving suggestions to his family regarding the memorial activities that they can do to grieve the deceased sister.	1.00	3.77	.60	0.10	1.00	13.00	.00	0.28	1.00	0.08	.78	0.00

The score of each question ranges from 1 to 4, a higher score indicating a higher level of agreement with the question.

Table 6. Results of paired t-test comparing self-perceived knowledge before and after the workshop (n = 36).

	Intervention group (n = 18)							Control group (n = 18)
	Pretest score		Posttest score					Pretest score		Posttest score
	M	(SD)	M	(SD)	df	t	p	M	(SD)	M	(SD)	df	t	p
Knowledge
Q1. I know how to explain to him what leukemia is.	3.06	(0.54)	3.22	(0.55)	17.00	−1.844	.083	3.06	(0.54)	3.11	(0.68)	17.00	−0.57	.58
Q2 I know how to psychologically prepare him before he visits his sister in the hospital.	3.06	(0.54)	3.33	(0.59)	17.00	−1.761	.96	2.83	(0.62)	3.17	(0.38)	17.00	−2.38	.03
Q3. I know how to explain to him the treatment and medical equipment that his sister is using (e.g., intravenous infusion pumps).	2.83	(0.62)	3.44	(0.51)	17.00	−4.267	.00	2.61	(0.85)	2.89	(0.83)	17.00	−1.761	.10
Q4 I know how to assist him in expressing love and concern to his sister during the illness.	3.17	(0.51)	3.44	(0.62)	17.00	−1.567	.14	3.22	(0.43)	3.22	(0.55)	17.00	0.00	1.00
Q5. I know how to deliver the news that his sister is going to die soon.	2.89	(0.58)	3.06	(0.54)	17.00	−1.844	.83	2.83	(0.62)	2.94	(0.64)	17.00	−0.809	.43
Q6. I know how to help him to give his blessings and express his feelings at the final stage before his sister dies.	2.94	(0.64)	3.33	(0.59)	17.00	−3.29	.00	3.00	(0.59)	3.11	(0.47)	17.00	−1.00	.33
Q7. I know how to explain to him his sister has died.	3.00	(0.59)	3.11	(0.58)	17.00	−0.809	.43	2.94	(0.64)	3.11	(0.47)	17.00	−0.900	.38
Q8 I know what the possible emotions and reactions are when he attends his sister’s funeral.	3.06	(0.42)	3.33	(0.49)	17.00	−2.557	.20	3.06	(0.54)	3.28	(0.46)	17.00	−1.719	.10
Q9. I know how to handle his emotions and reactions that might appear at his sister’s funeral.	2.78	(0.65)	3.33	(0.59)	17.00	−4.610	.00	2.78	(0.55)	2.83	(0.71)	17.00	−0.437	.67
Q10. I know what changes might occur in the family after the death of his sister.	3.06	(0.64)	3.39	(0.50)	17.00	−2.38	.29	3.06	(0.42)	3.39	(0.50)	17.00	−2.380	.29
Q11. I know how to assist the family in coping with the family changes caused by the sister’s death.	2.67	(0.59)	3.11	(0.47)	17.00	−3.06	.01	2.44	(0.51)	3.00	(0.59)	17.00	−3.83	.00
Q12. I know how to give suggestions to his family regarding the memorial activities that they can do to grieve the deceased sister.	3.00	0.59	3.39	0.61	17.00	−3.29	.00	2.94	0.54	3.22	(0.65)	17.00	−1.426	.17

The score of each question ranges from 1 to 4, a higher score indicating a higher level of agreement with the question.

Five participants failed to complete the posttest, so the above analyses were based on complete data of the pretest and the posttest.

Table 7. Results of paired t-test comparing health care professionals’ confidence before and after the workshop (n = 36).

	Intervention group (n = 18)							Control group (n = 18)
	Pretest score		Post-test score					Pretest score		Post-test score
	M	(SD)	M	(SD)	df	t	p	M	(SD)	M	(SD)	df	t	p
Confidence
1. I am confident about explaining to him what leukemia is	2.83	(0.62)	3.11	(0.58)	17.00	−2.56	.20	3.06	(0.54)	3.00	(0.69)	17.00	0.44	.67
2. I have confidence about how to psychologically prepare him before he visits his sister in the hospital	2.38	(0.62)	3.28	(0.57)	17.00	−3.06	.01	2.89	(0.47)	3.11	(0.32)	17.00	−1.719	.10
3. I have confidence about explaining the treatment and medical equipment that his sister is using (e.g., intravenous infusion pumps)	2.67	(0.59)	3.39	(0.50)	17.00	−6.65	.00	2.67	(0.84)	3.00	(0.77)	17.00	−2.06	.06
4. I have confidence about how to assist him to express love and concern to his sister during the illness	3.11	(0.47)	3.44	(0.62)	17.00	−2.38	.29	3.11	(0.47)	3.17	(0.51)	17.00	−0.566	.58
5. I have confidence about delivering the news that his sister is going to die soon.	2.72	(0.67)	3.11	(0.58)	17.00	−2.72	.02	2.67	(0.59)	3.00	(0.49)	17.00	−2.38	.03
6. I have confidence about assisting him to give his blessings and express his feelings at the final stage before his sister dies.	3.11	(0.58)	3.33	(0.69)	17.00	−1.72	.10	2.94	(0.54)	3.17	(0.51)	17.00	−1.46	.16
7. I have confidence about explaining to him that his sister has died.	3.06	(0.54)	3.22	(0.65)	17.00	−1.00	.33	2.78	(0.43)	3.00	(0.11)	17.00	−1.46	.16
8. I have confidence about handling his emotions and reactions that might appear at his sister’s funeral.	2.83	(0.71)	3.17	(0.62)	17.00	−2.38	.03	2.72	(0.46)	2.89	(0.58)	17.00	−1.14	.27
9. I have confidence about assisting the family about how to cope with the family changes caused by the sister’s death.	2.72	(0.67)	3.06	(0.54)	17.00	−2.38	.03	2.72	(0.58)	2.89	(0.58)	17.00	−.900	.38
10. I have confidence about giving suggestions to his family regarding the memorial activities that they can do to grieve the deceased sister.	3.11	(0.68)	3.50	(0.51)	17.00	'-3.29	.00	2.83	(0.38)	3.17	(0.62)	17.00	−2.06	.06

Remarks: The score of each question ranges from 1 to 4, a higher score indicating a higher level of agreement with the question.

Five participants failed to complete the posttest, so the above analyses were based on complete data of the pretest and the posttest.