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Crossen SS, Wagner DV. Narrowing the Divide: The Role of Telehealth in Type 1 Diabetes Care for Marginalized Communities. J Diabetes Sci Technol 2023; 17:901-908. [PMID: 36896887 PMCID: PMC10348000 DOI: 10.1177/19322968231157367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Widespread uptake of telehealth in response to the COVID-19 pandemic has highlighted geographic, demographic, and economic disparities in access to virtual care. However, research studies and clinical programs that predate the pandemic demonstrate the potential for telehealth-based interventions to improve access to and outcomes of type 1 diabetes (T1D) care for individuals in geographically or socially marginalized communities. In this expert commentary, we discuss telehealth-based care models that have been successful in improving care for marginalized T1D populations. We also outline the policy changes needed to expand access to such interventions to reduce established disparities in T1D care and promote better health equity among people living with T1D.
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Affiliation(s)
- Stephanie S. Crossen
- Division of Pediatric Endocrinology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - David V. Wagner
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
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2
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Morone JF, Teitelman AM, Cronholm PF, Hawkes CP, Lipman TH. Influence of social determinants of health barriers to family management of type 1 diabetes in Black single parent families: A mixed methods study. Pediatr Diabetes 2021; 22:1150-1161. [PMID: 34713537 DOI: 10.1111/pedi.13276] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/07/2021] [Accepted: 10/23/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE US disparities in pediatric type 1 diabetes treatment and outcomes are increasing disproportionately among Black youth and compounded for youth from single parent homes. Despite worsened outcomes, Black youth from single parent homes and their caregivers are underrepresented in pediatric type 1 diabetes research. The purpose of this study was to understand the social determinants of health (SDOH) barriers that may contribute to health disparities and family management in Black youth with type 1 diabetes from single parent homes. RESEARCH DESIGN AND METHODS A three-phase mixed methods study with self-identified Black single parents of youth with type 1 diabetes from an urban US pediatric diabetes center was conducted. Focus groups and interviews informed development of a parent-generated survey of SDOH barriers to diabetes management. Survey results are presented. RESULTS A resulting 71 item parent-generated survey was administered to 105 parents. Among all items, most problematic SDOH barriers included lack of social support, managing parent/child diabetes-related stress, difficulties accessing diabetes supplies, pain management, cost of food and diabetes camp, need to take time off from work, lack of skilled school staff, school absences and unsafe neighborhoods. Structural racism related to child welfare reporting, and police targeting were also notable concerns. CONCLUSIONS There is a critical need for clinical, community, and policy-related research and interventions, designed to reduce type 1 diabetes racial health disparities by addressing the impacts of SDOH as drivers of family management outcomes among Black youth from single parent families.
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Affiliation(s)
- Jennifer F Morone
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, Veterans Health Administration, New Haven, Connecticut, USA
| | - Anne M Teitelman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Terri H Lipman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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3
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Papadakis JL, Shapiro JB, Evans M, Feldman MA, Weil LEG, Vesco AT, Thompson LG, Garza K, Weissberg-Benchell J. Psychometric properties of the diabetes skills checklist for adolescents with type 1 diabetes and their parents. Pediatr Diabetes 2021; 22:924-932. [PMID: 34173308 DOI: 10.1111/pedi.13241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Among adolescents with type 1 diabetes, research has found that their perception of their diabetes management is an important predictor of actual diabetes management. There is a need for measures that assess adolescents' perception of their ability to independently complete daily diabetes self-care tasks. The current study examined the psychometric properties of the Diabetes Skills Checklist Teen-Report (DSC-T) and DSC Parent of Teen-Report (DSC-PT), which assess perceived independence in diabetes self-care skills. RESEARCH DESIGN AND METHODS Data were from 1450 adolescents aged 12 to 18 years and their parents who participated in the Diabetes Camp Matters Study. Families completed the DSC as well as other questionnaires online assessing demographic and diabetes-related information, diabetes strengths, and diabetes-specific emotional distress. RESULTS Exploratory factor analysis revealed a 14-item DSC-T and 12-item DSC-PT, both with excellent internal consistency and concurrent validity. Both the DSC-T and DSC-PT were found to be positively correlated with diabetes strengths and negatively correlated with HbA1c, and the DSC-PT was significantly correlated with parent-reported diabetes distress. Adolescents who used insulin pumps and continuous glucose monitoring reported higher perceived independence in diabetes self-care skills compared to adolescents who used insulin pens/syringes or blood glucose meters. No differences were found based on demographic characteristics. CONCLUSIONS The DSC-T and DSC-PT have strong potential to be used during diabetes clinic visits to spark discussion regarding adolescents' self-care, which would allow for a more successful transfer of diabetes care from parent to adolescent, and eventually, the transition from pediatric to adult healthcare.
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Affiliation(s)
- Jaclyn Lennon Papadakis
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jenna B Shapiro
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Meredyth Evans
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marissa A Feldman
- Child Development and Rehabilitation Center, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Lindsey E G Weil
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anthony T Vesco
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laurie Gayes Thompson
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kimberly Garza
- Department of Anthropology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jill Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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4
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Dimentstein K, Valenzuela JM. JPP Student Journal Club Commentary: Predictors of HbA1c Trajectories in Predominantly Black Adolescents With Type 1 Diabetes. J Pediatr Psychol 2021; 46:251-253. [PMID: 33706366 DOI: 10.1093/jpepsy/jsab024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karen Dimentstein
- Department of Clinical and School Psychology, Nova Southeastern University
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5
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Hershey JA, Morone J, Lipman TH, Hawkes CP. Social Determinants of Health, Goals and Outcomes in High-Risk Children With Type 1 Diabetes. Can J Diabetes 2021; 45:444-450.e1. [PMID: 33863638 DOI: 10.1016/j.jcjd.2021.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Despite advances in technology and type 1 diabetes (T1D) care, children from low-income families continue to have suboptimal outcomes and increased health-care utilization. In this study, we describe social determinants of health (SDOH) in high-risk children with T1D, as well as their SDOH-related priority goals, and assess the correlation between SDOH, glycemic control and health-care utilization. METHODS Caregivers of children aged 4 to 18 years with a diagnosis of T1D of >1 year, poor glycemic control (glycated hemoglobin [A1C] ≥9.5%) or high health-care utilization (≥2 diabetes-related hospitalizations, emergency department attendances or missed outpatient appointments in the previous year) were included. Primary caregiver health-related quality of life (HRQOL), self-efficacy (Maternal Self-Efficacy in Diabetes [MSED] scale) and SDOH were assessed. Goals were identified after assessment by a community health worker. RESULTS Fifty-three families were included, most (n=48, 91%) of whom had government insurance. Children had a median age of 13.4 (interquartile range [IQR], 12 to 15.3) years and a median A1C of 11.1% (IQR, 10% to 13%). Almost half of the families (n=24, 45%) reported at least 1 adverse SDOH. One or more adverse SDOH was associated with significantly lower total HRQOL scores (56.6 [IQR, 38.5 to 70.7] vs 77.8 [IQR, 60.8 to 92.4], p=0.004), but not associated with A1C (p=0.3), emergency department visits (p=0.9) or MSED (p=0.5). CONCLUSIONS Screening for adverse SDOH and addressing these barriers to glycemic control is not part of routine T1D care. In children with poorly controlled T1D and high health-care utilization, we have demonstrated a high prevalence of adverse SDOH, which may represent a modifiable factor to improve outcomes in this patient population.
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Affiliation(s)
- Jennifer A Hershey
- Department of Social Work, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Jennifer Morone
- Yale University School of Medicine, New Haven, Connecticut, United States; Veterans Affairs Office of Academic Affiliations, West Haven, Connecticut, United States
| | - Terri H Lipman
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States; Department of Pediatrics and Child Health, University College Cork, Cork, Ireland.
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6
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Uhm JY, Kim MS. Predicting Quality of Life among Mothers in an Online Health Community for Children with Type 1 Diabetes. CHILDREN (BASEL, SWITZERLAND) 2020; 7:children7110235. [PMID: 33218148 PMCID: PMC7698800 DOI: 10.3390/children7110235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 12/29/2022]
Abstract
Quality of life of parents of children with chronic disease is important for disease self-management. This study aimed to identify predictors of quality of life among mothers of children with type 1 diabetes. A cross-sectional study was conducted. A total of 208 mothers of children with type 1 diabetes were recruited from an online health community. Online health community collective empowerment and social support, diabetes self-efficacy, diabetes-related burden, and quality of life were measured. A multiple regression analysis was conducted to determine predictive factors for quality of life. Multiple regression analysis showed that diabetes-related burden and the child’s age were predictors of quality of life, and total variance explained by the model was 64.1% using two factors. In mothers of younger children, it is important to reduce the diabetes-related burden. Factors that increase the diabetes-related burden should be identified, and strategies to reduce the diabetes-related burden must be established.
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7
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Novak LL, Baum HBA, Gray MH, Unertl KM, Tippey KG, Simpson CL, Uskavitch JR, Anders SH. Everyday objects and spaces: How they afford resilience in diabetes routines. APPLIED ERGONOMICS 2020; 88:103185. [PMID: 32678790 DOI: 10.1016/j.apergo.2020.103185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/11/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
Thirty million Americans currently have diabetes, and a substantial portion do not reach the goals of clinical treatment. This is in part due to the complex barriers to effective self-care faced by people with diabetes. This study uses a patient work perspective, focusing on the everyday, lived experience of managing diabetes. Our primary research goal was to explore how the work of self-care is embedded in the other routines of everyday living. We found that everyday objects and spaces were instrumental in the incorporation of diabetes work into daily routines. Objects anchored diabetes tasks by linking illness-specific artifacts to space and time (e.g. a morning routine), and by enabling the performance on diabetes tasks while on the move in either planned or unplanned ways.
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Affiliation(s)
- Laurie Lovett Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, United States.
| | - Howard B A Baum
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, United States
| | - Margaret H Gray
- Department of Medicine, University of Washington School of Medicine, United States
| | - Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, United States
| | - Kathryn G Tippey
- Lineberger Comprehensive Cancer Center - CHAI Core, University of North Carolina, Chapel Hill, United States
| | - Christopher L Simpson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, United States
| | | | - Shilo H Anders
- Department of Anesthesiology and Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, United States
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8
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Fried L, Chetty T, Cross D, Breen L, Davis E, Roby H, Jackiewicz T, Nicholas J, Jones T. The Challenges of Being Physically Active: A Qualitative Study of Young People With Type 1 Diabetes and Their Parents. Can J Diabetes 2020; 45:421-427. [PMID: 33223421 DOI: 10.1016/j.jcjd.2020.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Benefits of physical activity are well recognized for youth with type 1 diabetes mellitus (T1DM), but being active is challenging. In this study, we aimed to investigate the challenges experienced by adolescents, their parents and young adults with T1DM when they are physically active. METHODS Six focus groups involving adolescents (13 to 18 years old, n=14) and young adults (19 to 25 years old, n=7) and 4 focus groups with parents (n=14) of the adolescents (13 to 18 years) were established. Data were analyzed using content analysis. RESULTS Adolescents and young adults with T1DM identified challenges of unpredictability, knowledge, trust and stigma when they were physically active. Parent challenges were specifically unpredictability and trust. CONCLUSIONS Interventions are needed that provide adolescents and young adults with T1DM and parents of adolescents with T1DM more in-depth information about managing physical activity in a manner that enhances their perceived competence and builds autonomy. Interventions can also target peer and community support.
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Affiliation(s)
- Leanne Fried
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia.
| | - Tarini Chetty
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Donna Cross
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Lauren Breen
- Curtin University, Bentley, Western Australia, Australia
| | - Elizabeth Davis
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Heather Roby
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Tanyana Jackiewicz
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | | | - Tim Jones
- Perth Children's Hospital, Nedlands, Western Australia, Australia
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9
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Ibrahim SA, ElHajj M, Zidan A, Owusu Y, Awaisu A. Barriers to Diabetes Adherence: Translation and Cultural Adaptation of the Instrument Into Arabic Context. Value Health Reg Issues 2020; 22:49-53. [PMID: 32795934 DOI: 10.1016/j.vhri.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/15/2020] [Accepted: 03/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Barriers to Diabetes Adherence (BDA) instrument is a measure developed in English to assess barriers to adherence in adolescents with type 1 diabetes (T1DM). The main objectives of the present study were to translate and culturally adapt the BDA tool into Arabic for the assessment of barriers to adherence in adolescents with T1DM in Arabic-speaking populations. METHODS The International Society for Pharmacoeconomics and Outcomes Research guidelines for the translation and cultural adaptation of patient-reported outcome measures were used for the process. Permission to use the instrument was obtained from the developers. This was followed by 2 forward translations of the tool into Arabic. The 2 Arabic versions were combined into a reconciled Arabic version that was then back-translated into English. This was then tested against the original tool. The resultant Arabic version underwent a cognitive debriefing process to assess its comprehension and appropriateness among potential users, and this resulted in further refinements, leading to the final Arabic version of the tool. RESULTS The translation and cognitive debriefing processes revealed issues related to the cultural or conceptual equivalence of the tool that were addressed and resolved by rewording, restructuring, or addition or elimination of words or phrases that in certain circumstances necessitated communications with the developers for further clarifications of the intended meaning of relevant items. This process generated an easy, comprehensive, clear, and culturally acceptable tool as proven by the cognitive debriefing and clinical review processes. CONCLUSION A culturally acceptable Arabic translation of the BDA tool was developed to be used in adolescent Arabic population with T1DM.
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Affiliation(s)
| | - Maguy ElHajj
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Amani Zidan
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Yaw Owusu
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar.
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10
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A Resilience Framework for Addressing Self-Management in High Risk Adolescents with Diabetes. J Pediatr Nurs 2020; 52:103-105. [PMID: 32204985 DOI: 10.1016/j.pedn.2020.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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11
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Ellis DA, Carcone AI, Naar-King S, Rajkumar D, Palmisano G, Moltz K. Adaptation of an Evidence-Based Diabetes Management Intervention for Delivery in Community Settings: Findings From a Pilot Randomized Effectiveness Trial. J Pediatr Psychol 2020; 44:110-125. [PMID: 29186562 DOI: 10.1093/jpepsy/jsx144] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/09/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To adapt an evidence-based intervention targeting diabetes management in adolescents with poorly controlled type 1 diabetes for use in a community setting by community health workers (CHWs) and to conduct pilot testing of the new intervention, REACH for Control (RFC). The study was conducted as a collaboration between university researchers and a federally qualified health center. Methods In a pilot effectiveness trial, feasibility and acceptability of RFC were evaluated based on participant enrollment, treatment dose, and consumer satisfaction. RFC effects on adolescent adherence, health outcomes, and quality of life were also assessed. The trial used a parallel group design. Families were randomized to 6 months of RFC plus standard medical care (n = 26) or standard care (SC) only (n = 24). Data were collected at baseline and 7-month posttest. A mixed-methods approach was used to analyze data. Results Qualitative analyses suggested that caregivers viewed RFC and delivery of a home-based intervention by CHWs positively. Furthermore, adolescents who received RFC had statistically significant (p = .05) and clinically meaningful improvements in hemoglobin A1c (HbA1c) (0.7%) and reported significant improvements in quality of life from baseline to follow-up (p = .001). No significant changes were found for adolescents in standard medical care. However, while dose of primary intervention session delivered was acceptable, dose of follow-up sessions used for skills practice was low. Conclusions Results provide preliminary support for RFC's acceptability and effectiveness to improve health status and quality of life when used in community settings serving high-risk, low-income families. Additional testing in a full-scale effectiveness trial appears warranted.
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Affiliation(s)
- Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University
| | | | - Sylvie Naar-King
- Center for Translational Behavioral Research, Florida State University
| | - Dixy Rajkumar
- Department of Family Medicine and Public Health Sciences, Wayne State University
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12
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Where are the family caregivers? Finding family caregiver-related content in foundational nursing documents. J Prof Nurs 2020; 36:76-84. [DOI: 10.1016/j.profnurs.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 05/13/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022]
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13
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Weatherly J, Kishnani S, Aye T. Challenges with Patient Adoption of Automated Integration of Blood Glucose Meter Data in the Electronic Health Record. Diabetes Technol Ther 2019; 21:671-674. [PMID: 31335195 PMCID: PMC6812727 DOI: 10.1089/dia.2019.0178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Providers often encourage patients with type 1 diabetes (T1D) to contact them with blood glucose (BG) values between visits. However, patients and families find it cumbersome to share their BG values with clinical providers, creating a barrier to communication. Although many phone applications exist to help patients track BG values, most do not integrate with the electronic health record (EHR). Recent advances in technology can integrate the glucose meter (GM) data into the EHR. This pilot and feasibility study aimed to understand how an automated integration system of GM data into the EHR and remote monitoring by health care providers would impact patient-provider communication. Patients or parents of patients with T1D (n = 32, average hemoglobin A1c [HgbA1c]: 8.5%, SD: 1.7, average age: 13.9 years, SD: 3.8) who owned an Apple iPod® or iPhone® (5s or higher) participated, and their number of contacts through telephone calls or MyChart™ messages between clinic visits was recorded during each of the three phases: run-in, intervention, and learned. Twenty-eight families completed all phases, and despite guided review of BG trends and automated integration of BG values, the number of patient-initiated calls (P = 0.23) and HgbA1c values (P = 0.08) did not improve, nor was there a clinically significant change in the number of BG checks per day. Barriers to adoption and effectiveness of this technology exist, and patient motivation is still needed.
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Affiliation(s)
- Jake Weatherly
- Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California
| | - Saniya Kishnani
- Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California
| | - Tandy Aye
- Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California
- Address correspondence to: Tandy Aye, MD, Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, 300 Pasteur Drive G313, Stanford, CA 94305
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14
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Messer LH, Sousa K, Cook PF. Applying two minds theory to self-management of Type 1 diabetes. Res Nurs Health 2019; 42:500-508. [PMID: 31587327 DOI: 10.1002/nur.21983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022]
Abstract
Two minds theory (TMT) offers a new approach to changing health behavior. Here, TMT is applied to self-management of Type 1 diabetes. TMT can be conceptualized as a cycle where a stimulus produces an immediate Intuitive system response leading to health behavior, followed by a conscious narrative system response that is temporally delayed. Narrative responses do not produce behaviors directly but instead lead to conscious beliefs about past events and behavioral intentions for the future, both of which become part of the material considered by the intuitive system in selecting future behaviors. Because of the temporal delay between intuitive behavior and narrative interpretation, and the nonconscious nature of intuitive thought, there is often a gap between intentions and behaviors. This has implications for nursing practice. First, nurses should consider that patient-reported impressions of the past or future are fundamentally narrative system responses and understand that these may be less predictive of behavior than biopsychosocial measures that are more temporally immediate. Second, nurses can use TMT to inform new strategies for behavior change interventions. For diabetes self-management, nurses can encourage individuals to leverage environmental cues to prompt self-management (tricking the intuitive system), provide rewards for self-management (training the intuitive system), or engage the narrative system via planning, reframing, or attention practices for healthier future decisions. Overall, the TMT addresses the gap between intentions and behavior and should be further developed to inform behavioral health interventions.
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Affiliation(s)
- Laurel H Messer
- College of Nursing, University of Colorado Anschutz, Aurora, Colorado
| | - Karen Sousa
- College of Nursing, University of Colorado Anschutz, Aurora, Colorado
| | - Paul F Cook
- College of Nursing, University of Colorado Anschutz, Aurora, Colorado
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Agustini N, Nurhaeni N, Pujasari H, Abidin E, Lestari AW, Kurniawati A. Family Support towards Resilience in Adolescents with Type I Diabetes: A Preliminary Study in Indonesia. Asian Pac Isl Nurs J 2019; 4:66-71. [PMID: 31259231 PMCID: PMC6571917 DOI: 10.31372/20190402.1028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The prevalence of diabetes has increased in adolescents. Diabetic adolescents need ongoing support from their families, and the family plays an important role in the management of the disorder. This study aimed to identify the relationship between family support and resilience in adolescents with Type 1 Diabetes Mellitus (T1DM). Quantitative data analysis was conducted using simple logistic regression. Meanwhile, qualitative data were analyzed using content analysis. The results show that the median duration of a T1DM diagnosis was 4 years, which was dominated by early adolescents in the study group (41.9%); the mean resilience score was 67.95 (range 0-100) with 53.5% of the participants had low resilience, and 55.8% of the respondents received a high level of family support. Logistic regression test results indicate that significant family support is associated with resilience.
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16
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Fonte D, Colson S, Côté J, Lagouanelle-Simeoni MC, Apostolidis T. 'Adolescents are reckless': Representations at stake in the construction of the relationship of trust in paediatric diabetology. J Health Psychol 2018; 26:270-282. [PMID: 30426776 DOI: 10.1177/1359105318809861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A total of 10 focus groups were held with adolescents living with diabetes, their parents and health professionals in order to explore their needs in therapeutic education. The analysis showed that the relationship of trust was a central concern for a number of participants. Several adults were divided between a feeling of confidence inspired by the need to empower adolescents to cope with the chronic condition and a sense of distrust inspired by the idea of carelessness and irresponsibility thought to characterize adolescence. Adolescents, for their part, seemed relatively clear-sighted about how they can be perceived, and blamed adults for not trusting them. These findings emphasize the importance of considering the representations at stake in the dynamics of the therapeutic relationship in order to better understand the construction of the relational climate.
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Affiliation(s)
- David Fonte
- Aix Marseille Univ, LPS, Aix-en-Provence, France
| | - Sébastien Colson
- Aix Marseille Univ, UFR Sciences médicales et paramédicales, Ecole des Sciences Infirmières, CEReSS, Marseille, France
| | - José Côté
- Université de Montréal, Faculté des Sciences Infirmières, Montréal, Canada.,CRCHUM, Chaire de recherche sur les nouvelles pratiques de soins infirmiers, Montréal, Canada
| | - Marie-Claude Lagouanelle-Simeoni
- Aix Marseille Univ, LPS, Aix-en-Provence, France.,APHM, Hôpital Conception, Service d'évaluation médicale, 13385, Marseille, France
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Bratina N, Forsander G, Annan F, Wysocki T, Pierce J, Calliari LE, Pacaud D, Adolfsson P, Dovč K, Middlehurst A, Goss P, Goss J, Janson S, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Management and support of children and adolescents with type 1 diabetes in school. Pediatr Diabetes 2018; 19 Suppl 27:287-301. [PMID: 30084519 DOI: 10.1111/pedi.12743] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/27/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Natasa Bratina
- Department of Endocrinology, Diabetes & Metabolism, University Children's Hospital, Ljubljana, Slovenia
| | - Gun Forsander
- The Queen Silvia Children's Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children Health System, Orlando, Florida
| | - Jessica Pierce
- Center for Healthcare Delivery Science, Nemours Children Health System, Orlando, Florida
| | - Luis E Calliari
- Department of Pediatrics, Santa Casa de Sao Paulo School of Medical Sciences, Brazil
| | - Danièle Pacaud
- Division of Diabetes and Endocrinology, Alberta Children's Hospital, Department of Paediatrics, University of Calgary, Calgary, Canada
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Klemen Dovč
- Department of Endocrinology, Diabetes & Metabolism, University Children's Hospital, Ljubljana, Slovenia
| | - Angie Middlehurst
- International Diabetes Federation Life for a Child Program, Sydney, Australia
| | - Peter Goss
- Team Diabetes, Geelong, Victoria, Australia
| | | | - Staffan Janson
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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Patel NJ, Datye KA, Jaser SS. Importance of Patient-Provider Communication to Adherence in Adolescents with Type 1 Diabetes. Healthcare (Basel) 2018; 6:E30. [PMID: 29597246 PMCID: PMC6023481 DOI: 10.3390/healthcare6020030] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 01/15/2023] Open
Abstract
Effective communication between pediatric diabetes patients and their providers has the potential to enhance patient satisfaction and health outcomes, as well as improve diabetes-related self-management. In this review, we highlight the importance of communication between patients and providers, focusing on the effect of communication on adherence in the high-risk population of adolescents with type 1 diabetes. We synthesize the literature describing patient-provider communication in pediatric populations and provide implications for practice that focus on the most relevant, modifiable factors for improving self-management in adolescents with type 1 diabetes.
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Affiliation(s)
- Niral J Patel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Karishma A Datye
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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19
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Chen YC, Chang LC, Liu CY, Ho YF, Weng SC, Tsai TI. The Roles of Social Support and Health Literacy in Self-Management Among Patients With Chronic Kidney Disease. J Nurs Scholarsh 2018; 50:265-275. [DOI: 10.1111/jnu.12377] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Yu-Chi Chen
- Lambda Beta-at-Large , Associate Professor, Institute of Clinical Nursing, School of Nursing; National Yang-Ming University; Taipei Taiwan ROC
| | - Li-Chun Chang
- Lambda Beta-at-Large , Associate Professor, School of Nursing; Chang Gung University of Science and Technology; Tao-Yuan Taiwan ROC
| | - Chieh-Yu Liu
- Associate Professor, Department of Midwifery and Women Health Care; National Taipei University of Nursing and Health Sciences; Taipei City Taiwan ROC
| | - Ya-Fang Ho
- Lambda Beta-at-Large , PhD Candidate, Department of Nursing, School of Nursing; National Yang-Ming University; Taiwan ROC
| | - Shuo-Chun Weng
- PhD Candidate, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, and Attending Physician, Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine; Taichung Veterans General Hospital; Taichung Taiwan ROC
| | - Tzu-I Tsai
- Professor, Department of Nursing, School of Nursing; National Yang-Ming University; Taiwan ROC
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20
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Noser AE, Huffhines L, Clements MA, Patton SR. Diabetes conflict outstrips the positive impact of self-efficacy on youth adherence and glycemic control in type 1 diabetes. Pediatr Diabetes 2017; 18:614-618. [PMID: 27859979 PMCID: PMC6233994 DOI: 10.1111/pedi.12471] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To examine whether self-efficacy buffers the deleterious consequences of diabetes-specific family conflict on self-monitoring blood glucose (SMBG) and glycated hemoglobin (HbA1c) in youth with type 1 diabetes mellitus (T1DM). METHODS A total of 129 youth with T1DM (aged 10-16 years) completed measures of diabetes-specific family conflict and self-efficacy for diabetes management, and their blood glucose meter data and HbA1c were extracted from the electronic medical record. We preformed moderation analyses to examine whether self-efficacy moderated the association that diabetes-specific family conflict had with SMBG and HbA1c. We used simple slopes analyses to probe significant interactions. RESULTS Our results indicated that self-efficacy moderated the association that diabetes-specific family conflict had with SMBG and HbA1c. The pattern of these findings showed that high self-efficacy buffered the negative impact of diabetes conflict on HbA1c. However, benefits of high self-efficacy for more frequent SMBG was only apparent in the context of low diabetes-specific family conflict. CONCLUSIONS Study findings highlight the interactive relationship between diabetes-specific family conflict and self-efficacy in relation to SMBG and glycemic control. These findings suggest that family functioning and youth's self-efficacy are promising intervention targets for families having trouble with SMBG and HbA1c.
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Affiliation(s)
- Amy E. Noser
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045
| | - Lindsay Huffhines
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045
| | - Mark A. Clements
- Division of Endocrinology & Diabetes, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri 64108
| | - Susana R. Patton
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas 66103
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Wolkers PCB, Yakuwa MS, Pancieri L, Mendes-Rodrigues C, Furtado MCDC, Mello DFD. Children with type 1 Diabetes Mellitus: access to special immunobiological and child care. Rev Esc Enferm USP 2017; 51:e03249. [PMID: 29019528 DOI: 10.1590/s1980-220x2016049103249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/11/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Identifying the use of child care situations, the vaccination situation and the reasons for non-vaccination, and characterizing whether mothers/guardians demonstrate notions about the right to special vaccines for children with type 1 Diabetes Mellitus. METHOD A descriptive, cross-sectional study with analysis of quantitative data based on interviews with mothers/guardians, particularly regarding access to childcare and vaccination against influenza and pneumococcal 23-valent (PPSV). RESULTS 47 mothers/guardians participated in the study. The participants reported using more specialized services to follow child health, and only a few used the child care of the basic health care regularly. There were incomplete vaccination schedules, delayed annual follow-ups, missing vaccination cards at the consultations, misinformation about the special character of the vaccination, as well as emphasis on the need of presenting a specific form to obtain the vaccination, resulting in discontinuation of health actions and missed opportunities for vaccination. CONCLUSION Fragilities in child care and immunization actions require an increase of primary health care and of the care network, based on knowledge and the right to health in order to expand the evidence-based practice, access and comprehensiveness.
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Affiliation(s)
| | - Marina Sayuri Yakuwa
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Letícia Pancieri
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brazil
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Wolkers PCB, Macedo JCB, Rodrigues CM, Furtado MCDC, Mello DFD. Atenção primária à criança com diabetes mellitus tipo 1: perspectiva de cuidadores. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo: Avaliar e comparar a qualidade da atenção primária ofertada às crianças com diabetes mellitus tipo 1 entre os tipos de serviços públicos de atenção à saúde na experiência dos seus principais cuidadores. Métodos: Estudo transversal, fundamentado em avaliação em saúde, a partir de entrevistas com 55 cuidadores de crianças com diabetes mellitus tipo 1, com base no instrumento de avaliação Primary Care Assessment Tool-versão criança. Resultados: Grande parte dos atributos da atenção primária à saúde apresentou escores considerados insatisfatórios, inclusive os escores Geral e Essencial. Foi encontrado maior vínculo com o serviço especializado (ambulatórios de endocrinologia pediátrica). Apesar dos escores Geral e Essencial não terem alcançado valores satisfatórios, os serviços especializados apresentaram melhores resultados que os serviços de atenção primária à saúde, mostrando, na percepção dos usuários, diferenças relevantes entre os serviços. Os serviços especializados foram percebidos como fontes regulares de atenção e melhores fornecedores de práticas de atenção primária à saúde. Tal apontamento pode estar relacionado ao maior contato dos participantes com os profissionais dos serviços especializados e prontidão desses serviços na atenção às crianças com diabetes mellitus tipo 1, sugerindo fragilidades nos serviços de atenção primária à saúde. Conclusão: A atenção à saúde das crianças com diabetes mellitus tipo 1 no município estudado apresenta pouca presença e extensão dos atributos da atenção primária, com ações fragmentadas e desarticuladas, levam a prejuízos na integração e ampliação dos cuidados em rede.
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Colson S, Côté J, Collombier M, Debout C, Bonnel G, Reynaud R, Lagouanelle-Simeoni MC. Adaptation transculturelle et tests psychométriques d’outils de mesure de l’efficacité personnelle et de l’adhésion thérapeutique pour une population d’adolescents diabétiques de type 1 français. Rech Soins Infirm 2017:16-27. [DOI: 10.3917/rsi.127.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Green NS, Manwani D, Qureshi M, Ireland K, Sinha A, Smaldone AM. Decreased fetal hemoglobin over time among youth with sickle cell disease on hydroxyurea is associated with higher urgent hospital use. Pediatr Blood Cancer 2016; 63:2146-2153. [PMID: 27573582 PMCID: PMC5072999 DOI: 10.1002/pbc.26161] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hydroxyurea (HU) induces dose-dependent increased fetal hemoglobin (HbF) for sickle cell disease (SCD). Large deviation from historical personal best (PBest) HbF, a clinic-based version of maximum dose, may identify a subset with suboptimal HU adherence over time. PROCEDURE Retrospective clinical data from youth ages 10-18 years prescribed HU at two centers were extracted from medical records at three time points: pre-HU initiation, PBest and a recent assessment. Decrease from PBest HbF of 20% or more at recent assessment despite stable dosing was designated as high deviation from PBest. Acute hospital use was compared between 1-year periods, pre-HU and ±6 months for PBest and recent assessment. Groups were compared using descriptive and bivariate nonparametric statistics. RESULTS Seventy-five youth, mean HU duration 5.9 years, met eligibility criteria. Mean ages of HU initiation, PBest and recent assessment were 8.0, 10.9 and 13.9 years, respectively. Despite stable dosing, average HbF of 19.5% at PBest overall declined by 31.8% at recent assessment. PBest HbF declined by 11.7 and 40.1% in two groups, the latter comprised 70.7% of the sample, had lower pre-HU and recent HbF and higher dosing. They experienced more urgent hospital use during the year framing recent assessment than during PBest; these findings were supported by sensitivity analysis. CONCLUSIONS Decline from PBest HbF is a novel approach to assess HU effectiveness, is common among youth and may represent suboptimal adherence. Larger prospective studies using additional adherence measures are needed to confirm our approach of tracking HbF deviation over time and to define an appropriate cutoff.
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Affiliation(s)
- Nancy S. Green
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Deepa Manwani
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Albert Einstein Medical School and Montefiore Hospital, New York, New York
| | - Mahvish Qureshi
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Karen Ireland
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Albert Einstein Medical School and Montefiore Hospital, New York, New York
| | - Arpan Sinha
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Albert Einstein Medical School and Montefiore Hospital, New York, New York
| | - Arlene M. Smaldone
- School of Nursing, Columbia University Medical Center, New York, New York,College of Dental Medicine, CUMC
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Abstract
Type 1 diabetes is a chronic disease that can lead to severe complications if poorly controlled. Adolescents are particularly vulnerable to worsening diabetes control due to changes in physiology, family dynamics, and social interactions. Good diabetes control requires following a regimen of frequent blood glucose checks, accurate carbohydrate counts, and compliance with insulin administration. Patients who are challenged in controlling their diabetes do tend to respond to behavioral interventions; however, the effect of the intervention wanes over time. Using technology to provide interventions has shown promise in terms of improving compliance. Positive family support and adequate knowledge of the developmental stages is important to ensure a successful transition from childhood to adolescence. Providers should also incorporate a structured transition from adolescent to adult diabetes care. [Pediatr Ann. 2016;45(9):e327-e331.].
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Stuckey HL, Mullan-Jensen C, Kalra S, Reading J, Wens J, Vallis M, Kokoszka A, Malek R, Kovacs Burns K, Piana N, Skovlund SE, Peyrot M. Living with an adult who has diabetes: Qualitative insights from the second Diabetes Attitudes, Wishes and Needs (DAWN2) study. Diabetes Res Clin Pract 2016; 116:270-8. [PMID: 27321345 DOI: 10.1016/j.diabres.2016.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/10/2016] [Accepted: 04/16/2016] [Indexed: 12/18/2022]
Abstract
AIMS The second Diabetes Attitudes, Wishes and Needs (DAWN2) study identified the experiences of family members who support adults living with diabetes. METHODS Participants were 2057 adult family members living with the person with diabetes from 17 countries. Qualitative data were responses to open-ended survey questions about how living with a person with diabetes has impacted family members and the ways they choose to be involved in the diabetes care for the person with whom they live. Emergent coding with input from multinational collaborators identified thematic content about psychosocial aspects. RESULTS Family members wanted to do what was best for the person with diabetes and help in whatever way possible. Four themes branched from that principle: (1) family members worry about day-to-day struggles of the person with diabetes, such as hypoglycemia and employment stability; (2) diabetes negatively affects the person with diabetes-family member relationship, creating an emotional strain and shift in relationship; (3) family members have some support resources to deal with the burdens and lifestyle changes of diabetes, but would like more; and (4) the person with diabetes has provided inspiration to the family member, and helped the family member make positive life changes in eating healthier. CONCLUSIONS These data provide insight into the ways that family members experience living with diabetes, including their challenges, motivations and intentions in supporting their person with diabetes. Family members speak eloquently and with emotion about their role in a family with diabetes.
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Affiliation(s)
- Heather L Stuckey
- Department of Medicine, College of Medicine, Pennsylvania State University, Hershey, PA, USA.
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital & B.R.I.D.E., Karnal, India
| | - Jean Reading
- Department of Medicine, College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Johan Wens
- Department of Medicine and Health Sciences, Primary and Interdisciplinary Care Antwerp, University of Antwerp, Antwerp, Belgium
| | - Michael Vallis
- Departments of Family Medicine and Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Rachid Malek
- Department of Internal Medicine, Setif University Hospital, Algeria
| | - Katharina Kovacs Burns
- Interdisciplinary Health Research Academy, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Natalia Piana
- Healthy Lifestyle Institute, (C.U.R.I.A.MO.: Centro Universitario di Ricerca Interdipartimentale Attività Motoria), University of Perugia, Perugia, Italy
| | | | - Mark Peyrot
- Department of Sociology, Loyola University Maryland, Baltimore, MD, USA
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27
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Two Days With Diabetes. TOP CLIN NUTR 2016. [DOI: 10.1097/tin.0000000000000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Corathers SD, Schoettker PJ, Clements MA, List BA, Mullen D, Ohmer A, Shah A, Lee J. Health-system-based interventions to improve care in pediatric and adolescent type 1 diabetes. Curr Diab Rep 2015; 15:91. [PMID: 26374568 DOI: 10.1007/s11892-015-0664-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite significant advances in pharmacology and technology, glycemic targets are difficult to achieve for patients with type 1 diabetes (T1D) and management remains burdensome for patients and their families. Quality improvement (QI) science offers a methodology to identify an aim, evaluate complex contributors to the goal, and test potential interventions to achieve outcomes of interest. Day-to-day management of diabetes is often an iterative process but interventions exist at all care levels: individual patient and family, clinic, and larger population and health system. This article reviews current literature and proposes novel QI interventions for enhancing health outcomes, with attention to essential determinants or drivers of improved glycemic control and patient experience for pediatric T1D in the context of the Chronic Care Model. In-depth consideration of key drivers of successful T1D care, including self-management and integration of technology, are explored, and examples of larger health systems with improved outcomes, including Learning Health Systems are highlighted.
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Affiliation(s)
- Sarah D Corathers
- Divisions of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Pamela J Schoettker
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.
| | - Mark A Clements
- Pediatric Clinical Research Unit, Endocrine Clinical Research, University of Missouri-Kansas City, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Betsy A List
- Xavier University, 3800 Victory Parkway, Cincinnati, OH, 45207-7351, USA.
| | - Deborah Mullen
- International Diabetes Center, 3800 Park Nicollet Blvd, IDC 6N, St. Louis Park, MN, 55416, USA.
| | - Amy Ohmer
- Naturally Sweet Sisters, 9573 Tree Top Court, Pinckney, MI, 48169, USA.
| | - Avni Shah
- Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, G-313 Medical Center, MC 5208, Stanford, CA, 94305-5208, USA.
| | - Joyce Lee
- Pediatric Endocrinology, Child Health Evaluation and Research Unit, University of Michigan, 300 NIB, Room 6E14, Campus Box 5456, Ann Arbor, MI, 48109-5456, USA.
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