Continuing Nursing Education
Objectives and instructions for completing the evaluation can be found on page 179.
Children ‘Draw-and-Tell’ Their
Knowledge of Genetics
Martha Driessnack, Agatha M. Gallo
A
n individual’s everyday lay
knowledge about health
and disease is increasingly
being recognized as a po-
tent force in determining how new
health-related information will be
perceived and used. The developmen-
tal precursors of adult lay knowledge
are childhood naïve theories of biolo-
gy, which begin to form as early as 7
years of age. When new information
conflicts with our own foundational
childhood understanding, it is often
rejected. Therefore, engaging children
in conversation during the time when
their naïve theories are forming pro-
vides a rich opportunity to discover
early understandings and misunder-
standings before this information
becomes deeply internalized and re-
sistant to change.
Advances in genetic/genomic
knowledge continue to inform scien-
tific understanding of, and approach
to, health and disease, and today’s
parents are increasingly presented
with genetic information, beginning
with prenatal and newborn screening.
Their children are exposed to genetic
concepts through an ever-expanding
media culture (van der Weele, 2010).
This media exposure begins early,
peaking at 8 hours/day among chil-
dren 9 to 12 years of age (Roberts &
Foehr, 2008). Yet, parents report a lack
Martha Driessnack, PhD, PNP-BC, is
Assistant Professor, School of Nursing,
Orgeon Health & Science University, Portland,
OR.
Agatha M. Gallo, PhD, PNP, RN, FAAN, is
Professor, College of Nursing, the University
of Illinois at Chicago, Chicago, IL.
Source of Funding: Funded through ANF/
WIN grant.
Authors’ Note: For this article, the term
“genetic” will be used in place of “genetic/
genomic.”
Statements of Disclosure: Please see page
179 for statements of disclosure.
PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4
The purpose of this study was to explore children’s early understanding of basic
genetic/genomic concepts using an innovative, child-sensitive approach to data
collection. Exploratory, qualitative study using art-based “Draw-and-Tell
Conversation” interviews with children were used. Each conversational interview
was guided by two drawing completion tasks and a semi-structured interview
guide. Data were analyzed using qualitative content analysis. In this study, 27
children 7 to 10 years of age shared their understanding of basic genetic/
genomic concepts in their drawings and conversations. Data were organized into
four categories: 1) Inside the Body, 2) Under the Microscope, 3) It’s Genetic, and
4) In Our World. Using a child-sensitive approach to data collection, children
revealed a range of understanding about basic genetic concepts, including DNA,
disease causation, risk, and inheritance. Data suggest informal family conversa-
tions and media exposure inform children’s early understanding, highlighting the
need to be aware of the sources and content of information available to children.
Nurses play a central role in assessing children’s genetic/genomic knowledge.
The Draw-and-Tell Conversation is a novel approach that can be used to support
parents as they approach and discuss genetic concepts with their children.
of support and/or advice from health the past two decades, there has been
care providers in how to approach and growing dissatisfaction with Piaget’s
discuss basic genetic concepts with deficit-based view of children (Greene
their children (Clarke & Gaff, 2008; & Hogan, 2005; Melton, 2005; Wink
Forrest, Curnow, Delatycki, Skene, & & Putney, 2002). Using Piaget, ac-
Aitken, 2008; Gallo, Angst, Knafl, counts of children’s health knowledge
Hadley, & Smith, 2005; Metcalfe, Coad, have been dominated by evidence of
Plumridge, & Farndon, 2008). children’s cognitive immaturity and
Although increased attention has limited ability to understand health
focused on the assessment and impact and illness concepts. While it is
of everyday health knowledge on deci- important not to refute the worth of
sion-making and health outcomes in these accounts, what has been chal-
adults, little research addresses the de- lenged is the assumption that chil-
velopmental precursors of this health dren’s misconceptions, confusion, and
knowledge in children, including chil- partial understanding of health and
dren’s early understanding of genetic illness concepts are the inevitable con-
and genomic concepts. Thus, the pur- sequence of cognitive immaturity,
pose of this study was to explore chil- overcome only by advancement in
dren’s early understanding of basic chronological age. Eiser (1989) high-
genetic concepts using an innovative, lighted that the process children use
child-sensitive approach to data col- to acquire knowledge, not their
lection, the Draw-and-Tell Conversa-
chronological age and corresponding
tion (DTC) (Driessnack, 2006, 2009a). stage of cognitive development, most
significantly determines children’s
understanding. In nursing, Holaday,
Children’s Knowledge
LaMontagne, and Marciel (1994) sug-
Development gested using Vygotsky as an alterna-
The classic framework for under- tive framework. Vygotsky’s competen-
standing children’s health-related cy-based view approaches children as
knowledge has been Piaget’s theory of early “theorists,” capable of forming
cognitive development. However, over complex mental structures that func-
173
Children ‘Draw-and-Tell’ Their Knowledge of Genetics
tion as explanatory systems (Wink &
Putney, 2002). Research outcomes
using Vygosky focus on what children
understand and the processes they
use to acquire knowledge, not on
what they cannot yet understand
(Mooney, 2000).
Another shift originated with
Carey (1985), who introduced the
idea that children’s cognitive develop-
ment was domain-specific and in-
volved the construction of naïve the-
ories. Children develop naïve theories
in three domains – physics, psycholo-
gy, and biology – each of which is
considered critical for survival
(Inagaki & Hatano, 2002). These the-
ories develop early in life so children
are able to predict and explain impor-
tant aspects of their worlds wherever
they live (Medin & Atran, 2004;
Rowlands, 2001); however, a child’s
ecological contexts, including family
and school, affect the information
being introduced and reinforced.
Children’s naïve theories of biol-
ogy form between 7 and 10 years of
age (Inagaki & Hatano, 2002). These
early explanations serve as the foun-
dation for future understanding of
biological information, including
basic genetic concepts. When a child’s
early biological understanding is mis-
guided or limited, the child may have
difficulty learning or may choose to
reject new health-related informa-
tion. This phenomenon has been
reported in both science education
and health literacy research, where
research has demonstrated that both
high school and college students con-
tinue to have serious misunderstand-
ings about basic genetics even after
receiving focused instruction (Banet
& Ayuso, 2000; Duncan & Reiser,
2005; Lewis, 2004; Tsui & Treagust,
2007). In one study, few teens pro-
gressed beyond younger, 10-year-old
participants’ levels of genetic under-
standing (Smith & Williams, 2007).
These and other studies propose that
attempts at genetics education that
disregard prior lay understanding
have an increased likelihood of failure
(Richards & Ponder, 1999; Santos,
2006).
The clear challenge for research-
ers and clinicians is to develop meth-
ods for assessing prior lay understand-
ing in children, especially when most
approaches to self-report, such as
interviews, questionnaires, and sur-
veys, are language-based. The integra-
tion of arts-based techniques in the
process of data collection allows chil-
174
dren to tap into their more sensory-
based abilities first, providing them
with the opportunity to organize
their thoughts in familiar ways before
they are asked to share them
(Freeman & Mathison, 2009). It is for
this reason that arts-based techniques
are often referred to as a natural medi-
um for children and are increasingly
being integrated into research studies
and clinical interventions (Driessnack
& Furukawa, 2012).
The purpose of this study was to
explore children’s early understand-
ing of basic genetic concepts using an
innovative, arts-based approach for
data collection.
Design and Methods
This was an exploratory qualita-
tive study (Saldana, 2011) informed
by Vygotsky’s theory of cognitive
development and a child-sensitive
approach to interviewing children,
the Draw-and-Tell Conversation (DTC).
Each conversational interview was
guided by two drawing completion
tasks and a semi-structured interview
guide.
The Draw-and-Tell
Conversation
The DTC (Driessnack, 2006;
2009a) begins with a specific art direc-
tive that includes a drawing or draw-
ing-completion task. The art directive
reflects the study purpose, and along
with the interview guide, helps to facil-
itate the conversation that follows. The
DTC provides children with a transi-
tional space where their thoughts can
be externalized into concrete forms,
and it has been shown to be more
effective in bringing out the complexi-
ties of children’s experience than
adult-centered approaches, such as
directed interviews, surveys, and ques-
tionnaires (Brooks, 2004; Coad, 2007;
Driessnack, 2005; Malchiodi, 1998).
Sample
The sample included 27 children,
7 to 10 years of age (see Table 1).
Participants were selected using maxi-
mum variation sampling (Patton,
2002). Sources of variation included
age, gender, socio-economic level,
ethnicity/race. The children were
equally distributed by age and gender.
Just under half of the children (n = 12;
44%) were European-American, with
the remaining 15 children from various
ethnicity/race categories. The indirect
measure of free/reduced school lunch
PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4
Table 1.
Demographic Characteristics
of Child Participants
Age
(in Years) Male Female Total
7 3 4 7
8 4 3 7
9 3 4 7
10 3 3 6
Total 13 14 27
Socioeconomic Status: Free lunch (9);
Reduced lunch (10); No assistance (8);
Ethnicity/Race: European-American
(12); Hispanic (7); African-American (5);
Mixed Race (2); Asian-American (1).
eligibility was used to identify socioeco-
nomic level and ensure a cross-section
of participants. All participants were
recruited through a metropolitan
YMCA in a large Midwest city.
Data Collection/Analysis
Approval was obtained through
The University of Iowa Institutional
Review Board and from the Midwest
YMCA. Prior to data collection, paren-
tal permission was obtained, followed
by child assent. Data collection was
conducted with each child individu-
ally onsite at the YMCA and lasted no
more than 25 minutes.
Each DTC began by asking chil-
dren to draw the inside of their body
using a provided body outline. When
completed, the conversational inter-
view began with the children talking
about their drawings, followed by spe-
cific questions and probes from the
interviewer using a prepared inter-
view guide (see Figure 1). The second
step was to have each child select two
different “samples” from their body
outline drawing, imagining that he or
she was looking at each of the sam-
ples using a microscope, and then
draw it using provided microscope
drawing outlines (e.g., children might
select samples from their brain and
foot or from their heart and stomach).
Once complete, the children were
again asked to talk about their draw-
ings with the interviewer following
up with specific questions and probes.
These two drawing completion tasks,
along with an interview guide outlin-
ing the questions and probes, stimu-
lated the children’s conversations
about their bodies and basic genetic
 Figure 1. However, there were some discon-
Interview Guide nects. For example, 9 children (33%)
incorrectly connected their stomachs
1. [Ask child] to draw a picture of the “inside” of their body (Provide Body directly to their hearts. As one 10-year-
Outline) old child explained (see Figure 2a):
a. When child is done with the drawing, ask child to describe the drawing.
b. Probe – Where are your genes found? DNA? Chromosomes? Proteins? This is your stomach…when it gets
2. [Ask child] to pick a site(s) from the Body Outline to look at more closely “backed up” with food, it goes to
under a microscope (Provide Microscopic View), have child draw and your heart and burns the inside of
describe what it looks like. it…and then you get heart dis-
a. Probe for genes, DNA, chromosomes, proteins. ease…and have heart attacks when
b. Have child pick another site to look at and repeat directive. Probe for you get older. But if you take your
what is different/same. medicine, it won’t burn, so then you
won’t have to worry about that
3. [Ask child] … [heart disease] later.
a. What does it mean when something is “genetic” or “in your genes?”
b. How do you know when something “runs” in your family? If something Under the Microscope
runs in your family, what do/can/should you do about it? Children’s microscope drawings
4. [Ask child] about familiarity with Harry Potter, Spiderman, and X-Men. If child fell into one of two groups: 1) individ-
responds affirmatively, probe his or her understanding of the basic genetic ualized miniature replicas of each
concepts that provide the background for each one. sampled site, or 2) cellular drawings
a. Harry Potter – How did Harry get his powers? Pattern of inheritance? that were universal, not site-specific.
What will happen when Harry has children? In the first group, for example, if the
b. Spiderman – How did Spiderman get his powers? What will happen sample was from the bone, the micro-
when he has children? scope drawing showed a miniature
c. X-Men – How did the X-Men get their powers? What will happen when bone (see Figure 2c). When a second
they have children? “sample” was taken from another site,
the microscope drawing was a minia-
ture replica of the new, rather than
the former, site. In the second group,
concepts, such as disease risk and of their body using the body outline when a second “sample” was obtain-
inheritance. elicited a kaleidoscope of details. All ed, the child’s microscope drawing
The DTC interviews were audio- of the children drew the brain, heart, was identical to the first one. Further,
taped, transcribed verbatim, and stomach, bones, eyes, and mouth. the content was more cellular, with
checked for accuracy. Field notes were Other named “organs” included the drawings varying from red blood or
recorded for each DTC, and an audit lungs, kidneys, intestines, and gall bacteria to more intricate drawings of
trail was maintained to document re- bladder. At times, the children also DNA (see Figure 2b). As one 8-year-
search decisions, choices, and in- included additional details about old child (see Figure 2b) shared:
sights. Data were analyzed using qual- related “systems.” For example, while
itative content analysis (Graneheim & the brain was included in each draw- This is how it looks…it is the same
Lundman, 2004). The initial sort of ing, some children also included dif- everywhere inside you. It will be the
the data was by question or topic, ferent elements of the nervous sys- same blood here, or here…It looks
which became the four primary cate- tem. As one 7-year-old described, red, but it has all these little cells
gories for coding the transcripts. Data “these are ‘nerves’…connectors from that do different things, but it’s basi-
were reviewed and coded for each the brain out to your whole body, cally red.
child first and then across all the chil- your muscles, and your finger skin.”
dren for overlap and convergence of Additional details were also provided Another 9-year-old (see Figure
content and/or themes (Ayres, for other organs, including one 8- 2b) explained:
Kavanaugh, & Knafl, 2003). An organ- year-old child who drew an elaborate,
izational matrix was developed and colored-coded arterial and venous sys- This is DNA; it is in every cell…it
independently reviewed, along with tem, explaining: has two strands that twist around,
the children’s drawings, by the study but they are staying connected by
consultant, a pediatric and qualitative These are our “lifelines”…the “red” this ladder in the middle. So, it’s the
research expert, until 100% agree- ones come out of the heart, which is same here in this cell…you have
ment of interpretation was reached. here in the middle, and bring oxygen your DNA deep inside…and it’s the
to our cells and muscles…and these, boss of everything.
Findings well, they are “blue” because their
oxygen is used up, and they have to Another 9-year-old child ex-
The findings are organized into come back up here to get more. plained (see Figure 2d):
four primary categories: Inside the
Body, Under the Microscope, It’s Genetic, In most instances, the addition of Now this is your DNA. It’s normally
and In Our World. details included explanations about not all lined up and easy for scien-
how individual organs connected to tists…it looks like these scribbles
Inside the Body each other. These explanations con- here…but when you put a chemical
Children’s drawings of the inside tained fairly accurate interpretations. drop on it under the microscope…it

PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4 175

Children ‘Draw-and-Tell’ Their Knowledge of Genetics

Figure 2.
Children’s Drawings

Figure 2a. Figure 2b.

Connecting Stomach to Heart Microscope Drawings – Universal Samples

Figure 2d.
Microscope Drawing of DNA (Before and After)
Figure 2c.
Microscope Drawing –
Miniature ‘Bone’

Figure 2e.
Microscope Drawing –
Bacterial ‘War Zone’
will line up for you to discover times these guys win…you don’t see
things on. The chemical helps this happening, but it does if you
the scientists a lot. understand how it is inside…

Within the second group, All of the children recognized the

numerous explanations suggest-
ed cellular views that depicted
bacteria. As one 8-year-old child
shared (see Figure 2e):
It is a war zone. You have good
bacteria and bad bacteria…it’s
really just one big battle. Most
of the time the good bacteria
should be in charge, but some-
term DNA (deoxyribonucleic acid), yet
none of the children recognized the
term RNA (ribonucleic acid). Children
did not connect proteins to DNA,
reporting instead that our sole source
of protein was from the outside in the
form of food. For example, one 7-year-
old child shared, “Proteins are the
‘building blocks’ of your body…that’s
why you have to eat meat every day.”

176 PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4

 The children’s understanding of
DNA varied from specific descrip-
tions, as noted in the earlier narra-
tives, to added philosophical or foren-
sic explanations, such as from this
remarkably literate 7-year-old:
DNA, well it’s what makes us alive.
I mean, you can still get your DNA
after you are dead, but ...If some-
thing was never alive in the first
place, well, it would not have
DNA…all living things are the same
because they all have DNA.
This 9-year-old shared a more
forensic understanding of DNA:
DNA is in your hair, your spit, and
your fingerprints…So they can figure
out who the dead person is or if you
are the killer by your hair sample or
prints, like on CSI.
It’s Genetic
The children’s responses to the
meaning of word “genetic” were sort-
ed into three sub-categories: 1) You
were born with it; 2) It’s passed from one
generation to another; and 3) There’s
something wrong.
In the sub-category, You were born
with it, children’s responses varied
from everyday lay language, such as,
“genetic means…it’s in there for
good,” to more scientific language,
“genetic means it is in your DNA from
birth.” In the sub-category, It’s passed
from one generation to another, the chil-
dren’s language was more consistent.
As one 10-year-old child explained,
“It means it’s passed along generation
to generation,” while an 8-year-old
child explained, “It means it’s in your
family…a lot.” In the final sub-cate-
gory, There’s something wrong, chil-
dren’s responses again ranged from
everyday language, such as “it means
something is wrong with you,” to
more scientific language, as from this
8-year-old, “it means you are a
mutant…cool.”
The majority (78%; n = 21) of the
children shared they are able to figure
out if something is genetic through
their own assessment and/or observa-
tions. One 9-year-old said, “You just
figure it out,” while a 10-year-old
child explained, “You are living with
it, I mean it’s all around you, all the
time, and you figure it’s coming your
way soon.” Children identified four
types of genetic traits that run in a
family: 1) physical traits (e.g., “big
bones”), 2) abilities (e.g., “how smart
PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4
you are”), 3) disease (e.g., “diabetes”),
and 4) family beliefs/ traditions
and/or recurrent behavioral phenom-
ena (e.g., “bad luck” or “having babies
when you are too young”).
When something was considered
to be genetic, 10 (37%) children were
somewhat deterministic about their
abilities to change the outcome. As
one 9-year-old child said, “If it’s
genetic, there’s nothing you can
do…,” or as one 8-year-old shared,
“You learn to make the most of it…I
mean you try to work with it, but you
can’t change it.” However, the other
17 children (63%) proposed potential
risk-reduction behaviors, including,
“You need to do something healthy,
like eat better…before it gets in too
deep” [8-year-old], or “you better
wash your hands a lot more” [9-year-
old]. Among their proposed risk-
reduction behaviors, there was a sub-
set of suggestions that were more psy-
chosocial in nature, including one
nine-year-old who shared, “All I know
is that you better marry someone way
different,” and a 10-year-old who stat-
ed simply, “You just have to get out of
the family as soon as you can.”
In Our World
Children’s self-reported sources
of their genetic information included
family members and school, televi-
sion, and/or computer programs. As
one 8-year-old shared, “I heard about
it once on Sponge Bob Square Pants.”
One 10-year-old mentioned, “I have
this science kit that can figure out
your DNA, like on TV…like CSI.”
Seven (26%) children named a specif-
ic family member as their source.
None of the children identified health
care providers. All 27 children referred
to the Internet as a source. As one 9-
year-old child explained, “If I need to
know anything, I can get it off the
Internet…it’s pretty easy.”
As part of the conversational
interview about genetic concepts,
children were also specifically asked
about their exposure to three contem-
porary childhood characters (Harry
Potter, X-Men, Spiderman). These
characters were selected because their
accompanying stories have embedded
genetic concepts. All 27 children rec-
ognized all three characters; however,
with variable familiarity.
Harry Potter. All of the children
identified the source of Harry’s wiz-
ardry powers to be his parents.
Children also went on to explain that
while both of Harry’s parents were
wizards, you could also become a wiz-
ard, even if your parents were non-
wizards, or Muggles. Without using
genetic language, children described
autosomal recessive patterns of inher-
itance, even commenting on the sur-
prise element of this pattern of inher-
itance. As one 8-year-old explained:
You see…you can have the wizard
power in you and not know it ‘cause
it’s silent…but if you hook up with
someone who is the same
way…well, you might just have to
learn to love your surprise wizard
kid.
Some children’s explanations
suggested they might be capable of
understanding complex genetic con-
cepts, such as variable phenotypic
expression and/or incomplete pene-
trance. For example, the children
often offered explanations about how
wizardry powers varied among family
members, either by degree or by the
timing of their expression. Further,
they noted that wizardry powers
could even appear to be totally absent
in someone with clear wizard ances-
try. Some children touched on related
ethical, legal, and social issues,
including genetic discrimination and
eugenics. As one 9-year-old child
shared:
There are some bad problems too,
where the “pure-bloods” are trying
to get rid of the “half-bloods,”
lookin’ down on them…totally
dissin’ them… just because their
parents were Muggles…I mean, they
want to get rid of them.
Children also explained how
Harry’s powers would be passed along
to his children by identifying the vari-
able outcome if Harry married a wiz-
ard, while other children said they
already knew the final outcome. “Well,
he actually marries Ginny, so all their
children are wizards, although they
don’t all get her red hair because Harry
doesn’t have it too.”
X-Men. The children primarily
described X-Men as a group of male
“mutants” who inherited the X-factor
that gave them specific powers that
surface during adolescence. Although
the X-factor was the same for all
X-Men, the powers were different for
each person, which again points to
some level of understanding about
variable phenotypic expression. One
10-year old child said:
177
Children ‘Draw-and-Tell’ Their Knowledge of Genetics
They are mutants…they have the X
in them, and it causes their power to
come out, but it depends on things
what their power is…I don’t know
what things, but it does depend.
The pattern of inheritance of the
X-factor described by the children
was similar to the inheritance of X-
linked conditions. As one 10-year-old
girl insightfully explained, “It is not a
girl thing…it is only in the boys
because they don’t have a good X to
protect them…you know, we have
two.” When children were asked
about the offspring of X-Men, their
responses varied from no explanation
at all to very specific ones, such as
from this 9-year-old girl, “Have you
seen them?…No one is gonna marry
them,” and from a 9-year-old boy,
“It’s pretty complicated…I think it
will get passed down…but only to the
boy children.”
Spiderman. The children uni-
formly identified the origins of Peter
Parker’s “Spiderman” powers as a spi-
der bite. Some children went on to
explain, “It was not a normal spider…
normal spiders won’t do this… this
spider was part of a science experi-
ment” [9-year-old]. Most children
indicated that Spiderman’s children
would be “normal.” As one 8-year-old
said, “His children…they won’t get
any powers…they will just have a
weird dad.” A smaller number of chil-
dren were not as certain as to the out-
come. As one child explained, “I’m
not sure… I don’t think so because it
happened to him when he was
older…” [8-year-old].
Discussion
The current study provided the
opportunity to extend the use of the
DTC into the exploration of genetic
concepts with children. Using this
child-sensitive, arts-based approach to
data collection, children shared their
emerging awareness of basic genetic
concepts both in their drawings and
conversations without hesitation. The
children were immediately engaged
in the process. Of particular note was
the amount of data shared, as well as
the attention to detail, breadth of
understanding of genetic concepts,
and accuracy of many of the chil-
dren’s interpretations. In short, chil-
dren know a lot more than we think
they do, at least about genetics. The
notion that children often surprise
parents and providers by knowing
178
much more than we assume has been
reported by others when efforts are
taken to engage children in conversa-
tion (Gallo et al., 2005). The rich
information provided by children in
this study and the ease with which it
was accessed may reflect the ability to
engage children in conversation by
using a more child-sensitive approach
to data collection.
Vygotsky suggests that irrespective
of how much, how complete, or how
accurate it is, children’s jobs are to
make sense of their worlds on the basis
of what information they have avail-
able to them (Mooney, 2000). In this
study, the children’s individual draw-
ings and responses clearly illustrated
they are trying to make sense of the
world both around and inside them.
Although their informational sources
were not the primary focus of the
study, the children were clearly famil-
iar with contemporary media influ-
ences, including television program-
ming, such as CSI. This insight not
only reinforces literature about media
exposure and its broad impact in chil-
dren’s lives, but it also highlights the
need to assess children’s expanding
networks and information sources
(Driessnack, 2009a; Roberts & Foehr,
2008). Familiar sources can also pro-
vide contemporary contextual oppor-
tunities to engage children and their
parents in conversations about genetic
concepts. For example, children’s
familiarity with the Harry Potter series
can serve as an instructional vignette
for explaining patterns of inheritance,
carrier status, and variable phenotypic
expression (Driessnack, 2009b).
The focus in this study was chil-
dren’s early understandings about
genetic concepts as accessed through
the use of the DTC. The identification
of early understandings and misun-
derstandings about genetics can pro-
vide insight into children’s contem-
porary influences and early thought
processes. These insights can focus
educational interventions so chil-
dren’s misunderstandings are addres-
sed before this information becomes
internalized and resistant to change.
For example, many children connect-
ed their stomach and heart together,
relaying explanations reflective of
“heart burn.” While this explanation
might easily be attributed to media
influence, the early misunderstanding
that preventing heartburn also elimi-
nates one’s risk for heart disease could
confound the broader link between
diet and heart disease.
PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4
In this study, the children’s draw-
ings and resultant conversations also
revealed the presence of genetic deter-
minism in even the youngest of par-
ticipants. Equally interesting were the
range of disease prevention efforts
proposed by the children when con-
fronted with genetic risk. The types of
behaviors suggested by the children,
which ranged from hand-washing to
getting out of one’s family altogether,
have been reported as parallel expla-
nation and notions in studies with
adults (Condit et al., 2009; Dougherty,
2009; McClean & Shaw, 2005). This
intergenerational presence of com-
mon concepts and related behaviors
suggests children’s social networks
may not only provide the ecological
context for developing childhood
theories, but it may also be nurturing
their continuance. This reinforces the
need for family-based interventional
efforts when educating parents or
children about health and disease.
The need for novel interventions that
engage the public in socially and cul-
turally appropriate ways increases in a
world in which personalized medi-
cine and individualized lifestyle rec-
ommendations are based on an indi-
vidual’s genetic profiles (Kosztolanyi,
2011).
Calls for improving genetic and
health literacy continue and echo
calls for the public’s engagement in
the process (Cunningham-Burley,
2006; Forrest et al., 2008; Kenner,
Gallo, & Bryant, 2009). Engaging chil-
dren and learning what they already
know, and how they come to know it,
is an essential place to start. This is
especially important because it ap-
pears children are already assimilating
familial and cultural frameworks
about basic genetic concepts, includ-
ing disease causation, risk, and inher-
itance. It is also important because
today’s children are the future users of
genetic and health information as
well as tomorrow’s health care pro-
viders, educators, decision makers,
and researchers. A list of clinical re-
sources is included (see Figure 3).
Nurses have a long history of
advocating for children’s health educa-
tion and well-being. To improve child
health knowledge and literacy, the
next logical step may well be one with
a “back to the future” approach that
redirects the research and clinical
agenda to the importance of the de-
velopmental precursors of adult health
knowledge and genetic literacy found
in childhood. This study also adds to a
 Instructions For
Continuing Nursing Education
Figure 3. Contact Hours
Clinical Resources Children ‘Draw-and-Tell’
The University of Utah Genetic Science Learning Center has a wealth of
Their Knowledge of Genetics
resources and information aimed at bringing genetics, bioscience, and health Deadline for Submission:
alive, whether the audience is one child or an entire classroom. Additional tools
and resources are provided on two companion Web sites: August 31, 2015
http://learn.genetics.utah.edu PED 1307
http://teach.genetics.utah.edu
To Obtain CNE Contact Hours
The International Alliance of Patients’ Organizations (IAPO) is a global alliance 1. For those wishing to obtain CNE contact
promoting patient-centered healthcare around the world. hours, you must read the article and com-
http://www.patientsorganizations.org/index.pl plete the evaluation through Pediatric
Nursing’s Web site. Complete your eval-
The Human Genome Epidemiology Network (HuGENet™) promotes global uation online and your CNE certificate
collaboration on the relationship between human genomic variation and health will be mailed to you. Simply go to
and on the quality of genetic tests for screening and prevention. www.pediatricnursing.net/ce
http://www.cdc.gov/genomics/hugenet 2. Evaluations must be completed online
by August 31, 2015. Upon completion of
the evaluation, a certificate for 1.4 con-
tact hour(s) will be mailed.
growing body of literature on the Nursing, 20(6), 414-423. Fees – Subscriber: Free Regular: $20
importance of using child-sensitive Driessnack, M. (2006).’Draw and Tell
approaches, such as the DTC and other Conversations’ with children about fear.
Qualitative Health Research, 16(10), Goal
forms of arts-based inquiry, in research 1414-1435.
and practice with children. Driessnack, M. (2009a). Using the Colored To provide an overview of the “draw-and-
Eco-Genetic Relationship Map (CEGRM) tell” method for children to describe their
with children. Nursing Research, 58(5), knowledge of genetics.
References 304-311.
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Objectives
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approaches to qualitative data analysis. information age. Journal of Pediatric 1. Explain how children’s early under-
Qualitative Health Research, 13(6), Nursing, 24(3), 189-193. standing of basic genetic/genomic
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Carey, S. (1985). Conceptual changes in (NARST) Annual Meeting, Dallas, TX. reported no actual or potential conflict of
childhood. Cambridge, MA: MIT Press. Eiser, C. (1989). Children’s understanding of interest in relation to this continuing nurs-
Clarke, A.J., & Gaff, C. (2008). Challenges in illness: A critique of the ‘stage’ ing education activity.
the genetic testing of children for famil- approach. Psychology & Health, 3, 93- The Pediatric Nursing Editorial Board
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Researching children’s experiences. Anthony J. Jannetti, Inc. is accredited as a
Shen, L., Wright, L., & Harris, T.M.
New York: Guilford Press. provider of continuing nursing education by the
(2009). Believing in both genetic deter-
Gallo, A.M., Angst, D., Knafl, K.A., Hadley, E., American Nurses Credentialing Center's Com-
minism and behavioral action. Public
& Smith, C. (2005). Parents sharing mission on Accreditation.
Understanding of Science, 18(6), 730-
746. information with their children about Anthony J. Jannetti, Inc. is a provider
Cunningham-Burley, S. (2006). Public knowl- genetic conditions. Journal of Pediatric approved by the California Board of Registered
edge and public trust. Community Health Care, 19(5), 267-275. Nursing, Provider Number, CEP 5387.
Genetics, 9, 204-210. Graneheim, U.H., & Lundman, B. (2004). Licenses in the state of California must
Dougherty, M.J. (2009). Closing the gap: Qualitative content analysis in nursing retain this certificate for four years after the CNE
Inverting the genetics curriculum to research: Concepts, procedures, and activity is completed.
ensure an informed public. The measures to achieve trustworthiness. This article was reviewed and formatted for
American Journal of Human Genetics, Nurse Education Today, 24, 105-112. contact hour credit by Hazel Dennison, DNP,
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