Systematic review of character development and childhood chronic illness

Table 1 Definitions of the five C’s of positive youth development[4]

PYD five C’s	Definitions
Competence	Positive view of one’s actions in domain specific areas including social, academic, cognitive, and vocational. Social competence pertains to interpersonal skills (e.g., conflict resolution). Cognitive competence pertains to cognitive abilities (e.g., decision making). School grades, attendance, and test scores are part of academic competence. Vocational competence involves work habits and career choice explorations
Confidence connection	An internal sense of overall positive self-worth and self-efficacy; one’s global self-regard, as opposed to domain specific beliefs. Positive bonds with people and institutions that are reflected in bidirectional exchanges between the individual and peers, family, school, and community in which both parties contribute to the relationship
Character	Respect for societal and cultural rules, possession of standards for correct behaviors, a sense of right and wrong (morality), and integrity
Caring and compassion	A sense of sympathy and empathy for others

Table 2 Summary of studies measuring character development of youth with chronic conditions

Ref.	n	Subjects	Measures	Results
Sam et al[15]	15	Deaf	Kohlberg Moral Judgment Instrument	Moral reasoning for deaf participants was at a lower/basic stage of development compared to norms
		Ages 12-15 yr
Guse et al[13]	42	21 cancer survivors	Values in Action Inventory for Youth	No difference in mean scores
		21 healthy peers
		Matched on age, race, and gender
		Ages 12-19 yr (mean = 16 yr)
Russell et al[14]	85	Burn survivors	Tennessee Self-Concept scale - Moral subscale	Scores on moral subscale lower than norms (P = 0.036). Subscale includes moral identity, satisfaction, and behavior
		Ages 18-30 yr (mean = 21 yr)