Effectiveness of an Integrated Family Nursing Care Model for Children with Pneumonia (ASTANIA) on Caregiver Independence: A Quasi-Experimental Study

Abstract

Background: Caregivers of young children with pneumonia require preparation that extends from hospitalization into home care. The ASTANIA model integrates family-centered nursing, structured discharge planning, skills training, and community follow-up. Objectives: To evaluate whether ASTANIA was associated with greater family independence than routine nursing care. Methods: This quasi-experimental, non-equivalent control-group study enrolled 76 mothers of children aged 2-59 months with pneumonia (ASTANIA, n = 38; routine care, n = 38) from four public hospitals in Jakarta. Family independence was assessed at baseline and monthly for three months. Repeated binary outcomes were analyzed using generalized estimating equations (GEE). Results: All 76 participants completed Month 3. The proportion classified as independent increased from 15.8% to 71.1% in the ASTANIA group and from 21.1% to 44.7% in the routine-care group. In the final GEE model, ASTANIA was associated with higher odds of family independence than routine care (adjusted odds ratio [aOR] = 2.426, 95% CI 1.004-5.860; p = 0.049). At Month 3, the odds of independence were higher than at baseline (aOR = 7.141, 95% CI 3.733-13.633; p < 0.001). Conclusion: ASTANIA was associated with improved caregiver independence over three months. Because allocation was by site rather than random, the results support cautious effectiveness claims and require confirmation in multicenter randomized studies.