Graphics Programs Reference
In-Depth Information
INTRODUCTION
least 21 continuous days or missing at least half
of the class-based instruction due to their medi-
cal condition. In the present study children aged
six to fifteen years old were taken into account.
During the last decades, health-care has moved
from a hospital-based to a rather ambulant treat-
ment because hospitalization periods are shortened
and treatments are often carried out at home. If
children are involved, this evolution also affects
their education. The responsibility for education
shifts from the hospital to the school which the
child attended before school absence. Empirical
exploration, however, reveals that regular schools
in Flanders (the Dutch speaking part of Belgium)
are hardly able to set up high quality instruction
for these home-based pupils. The assumption of
the present paper is that information and com-
munication technologies (ICT) may contribute to
a high quality school experience of children that
are absent from school due to medical reasons. Al-
though earlier attempts to use ICT for that purpose
(e.g., PEBBLES (Pebbles)) exist, they often fail to
illustrate the entire process design, implementa-
tion and evaluation of the technologies used. This
initiative is intended to fill this gap by exploring
the systematic design of an ICT-tool in Flanders.
Systemic Approach of Children with
a Long-Term or Chronic Illness
In this study domain, there has only recently been
a shift from a single-actor approach involving
proxy-measures towards a child-centered ap-
proach involving the sick children themselves
(Borgers et al., 2000; Mukherjee et al., 2000). In
the present study, a child-centered approach is
chosen by adopting an ecological conceptualiza-
tion of children suffering a long-term or chronic
disease. In line with Shields & Heron (1995), a
systemic approach based on the notion of 'shared
membership' is used to identify the key actors
within the environment of a sick child. At school,
the first ecosystem, each child is a 'pupil' and so
are the other children, while the same child is
a 'family member' at home. School and family
are predominant ecosystems in each child's life,
whether they are healthy or sick. However, a third
ecosystem is added to the life of children with a
long-term or chronic health condition: the hospital
or the health-care environment in which the child
becomes a 'patient'. As Shields & Heron (1995)
argue that all ecosystems influence each other, it
is assumed that the central actors of these three
ecosystems, which are teachers and classmates,
parents and health-care personnel, influence a
sick child's experiences. Hence, this study adopts
a multiple actor approach by taking into account
the viewpoints of the different actors and those
of sick children themselves, to fill the gap in
earlier research.
Conceptualization of Children with
a Long-Term or Chronic Illness
To date, several terms are used to define the
population of children with health conditions.
Unfortunately, no consensus has been reached with
regard to the definition of children with chronic
diseases (Thies, 1999). Earlier definitions not
only focus on duration or type of illness: Ramler
& Rice (1997), for example, describe which im-
pact an illness has to have on a child's life to be
categorized as a 'chronic medical condition'. In
line with the definition of Ramler & Rice (1997),
in the present study the impact of the medical
condition was conceptualized as the impact on the
child's school attendance, which affects both social
contacts with peers and academic achievement.
We define children with a chronic or long-term
illness as children being absent from school for at
The Importance of the
Classroom experience
The positive attitude towards school of most chil-
dren with a long-term or chronic illness is related
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