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Smudja M, Milenković T, Minaković I, Zdravković V, Javorac J, Milutinović D. Self-care activities in pediatric patients with type 1 diabetes mellitus. PLoS One 2024; 19:e0300055. [PMID: 38442115 PMCID: PMC10914259 DOI: 10.1371/journal.pone.0300055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Effective diabetes self-management and collaborative responsibility sharing with parents are imperative for pediatric patients with type 1 diabetes mellitus, particularly as they gradually assume more self-care responsibilities. The primary goal of this study was to assess differences in adherence to self-care activities regarding sociodemographics and clinical characteristics in pediatric patients with type 1 diabetes. The secondary goal of this study was to understand the level of parental involvement in diabetes management and to assess the pediatric patients' behaviors (independent or dependent on disease self-management) that relate to sociodemographic and clinical characteristics. METHODS This was a comparative cross-sectional and correlational study. The study sample included 182 children and adolescents who had been diagnosed with type 1 diabetes at least 3 months prior. Data collection instruments included a sociodemographic and questionnaire about Adherence to self-care activities and parental involvement in diabetes self-management, as well as a documentation sheet for recording clinical data. RESULTS A majority of participants (71%) exhibited non-adherence to self-care tasks, despite 78.0% asserting their independence in diabetes self-management. Notably, insufficient parental involvement in administering insulin therapy significantly predicted severe hypoglycemic episodes. CONCLUSIONS Pediatric patients dealing with type 1 diabetes demonstrate a substantial degree of autonomy in managing their condition, paradoxically coupled with self-reported non-adherence to critical self-care responsibilities. Notably, children (aged 8-12) rely more heavily on parental support, especially concerning insulin therapy administration. The study underscores the crucial role of parental engagement in insulin therapy, as its deficiency significantly predicts the likelihood of severe hypoglycemic episodes.
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Affiliation(s)
- Mirjana Smudja
- Department of Higher Medical School, Academy for Applied Studies Belgrade, Belgrade, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Tatjana Milenković
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Ivana Minaković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Health Center Novi Sad, Novi Sad, Serbia
| | - Vera Zdravković
- University Children’s Hospital Belgrade, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovan Javorac
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Dragana Milutinović
- Department of Nursing, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Leocadio P, Kelleher C, Fernández E, Hawkes CP. Adolescents' Experiences of Transition to Self-Management of Type 1 Diabetes: Systematic Review and Future Directions. Sci Diabetes Self Manag Care 2023; 49:477-492. [PMID: 37927049 PMCID: PMC10666500 DOI: 10.1177/26350106231206779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE The purpose of this systematic literature review was to explore studies that report the experiences of adolescents, their families, and health care professionals of adolescents' transition to self-management of type 1 diabetes (T1DM). METHODS SocINDEX, PsycInfo, APA PsycArticles, and MEDLINE electronic databases were searched. Studies reporting on experiences of transition to self-management of T1DM for adolescents, their parents, siblings, and health care professionals published between January 2010 amd December 2021 were included. The Mixed Methods Appraisal Tool guided trustworthiness and relevance of selected studies. RESULTS A total of 29 studies met the inclusion criteria. Findings indicate that adolescents' experiences of transitioning to self-management of T1DM are interconnected with the supports provided by others (eg, family, teachers, friends). Considering interdependence and collective lived experiences is essential to developing effective and personalized family, peer, and social interventions to facilitate transition and to avoid negative outcomes in later life. The renegotiation of roles within the network of supports that impact adolescents' transition and adolescents' self-negotiation have been neglected. CONCLUSION Transition to self-management of T1DM is a dynamic and iterative process comprising of continuous shifts between interdependence and independence, making it challenging for all involved. A number of research gaps and avenues for future research are outlined.
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Affiliation(s)
- Paula Leocadio
- Department of Management and Marketing, University College Cork, Cork, Ireland
| | - Carol Kelleher
- Department of Management and Marketing, University College Cork, Cork, Ireland
| | - Eluska Fernández
- School of Applied Social Studies, University College Cork, Cork, Ireland
| | - Colin P. Hawkes
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Yamaguchi M, Honda J, Fukui M. Effects of Parental Involvement on Glycemic Control in Adolescents With Type 1 Diabetes Mellitus: A Scoping Review. JOURNAL OF FAMILY NURSING 2023; 29:382-394. [PMID: 37211777 DOI: 10.1177/10748407231171842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is typically diagnosed in pediatric patients. Transitioning from supported management in childhood to self-management in adolescence is an important step. Parental psychosocial influence is a possible factor in adolescents' disease control. This review summarized the effects of parental involvement on glycemic control in adolescents with T1DM by focusing on hemoglobin A1c (HgbAIc). A scoping review per the Guidance for Systematic Scoping Reviews was conducted with the following inclusion criteria: (a) studies in English, (b) focused on adolescents with T1DM, (c) outcomes included HgbAIc, and (d) focused on parental influence of children with T1DM. Of 476 articles, 14 were included. The study outcomes were classified based on direct or indirect influence. "Parental support for adherence" and "parental conflict" significantly affected HgbAIc control. This study provides current evidence on parental influence on glycemic control in adolescents.
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Affiliation(s)
| | | | - Minae Fukui
- Mukogawa Women's University, Nishinomiya, Japan
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Schweizer R, Lösch-Binder M, Hayn C, Friz S, Uber J, Ziegler J, Liebrich F, Neu A. Transition From Childhood to Adult Care in Patients with Type 1 Diabetes: 20 Years of Experience From the Tübinger Transition Study. Exp Clin Endocrinol Diabetes 2023; 131:532-538. [PMID: 37467782 DOI: 10.1055/a-2132-9585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
AIMS Transition from pediatric to adult care is difficult for patients with chronic diseases. In this study, factors associated with metabolic control in childhood-onset type 1 diabetes (T1D) after transfer to adult care were analyzed. METHODS Overall, 224 persons with T1D were contacted yearly from 1998 to 2019. They voluntarily answered a questionnaire about their current hemoglobin A1c (HbA1c) levels, diabetes-associated complications, kind of care, living conditions, and family situation. Then, mixed longitudinal-cross-sectional analyses were carried out. RESULTS Overall, 190 patients answered at least once (mean age: 26.6 years). Diabetes complications were mentioned by 10 patients (5 microalbuminuria, 5 retinopathy). Most patients (92.6%) were in diabetes-specific care during the first year after transfer, with a trend to leave diabetes-specific care during the observation period. Patients in diabetes-specific care displayed lower HbA1c levels (%/mmol/mol) (7.1/54 vs. 7.5/58). An important predictor for HbA1c after transfer was HbA1c during the year before transfer (r=0.67, p <0.001). Patients living alone showed no difference in HbA1c levels from those living with their parents. Married patients had lower HbA1c levels (7.0/53 vs. 7.3/56, p<0.05) than unmarried ones. Patients with children (15.8%) presented lower HbA1c levels (6.9/52 vs. 7.3/56, p <0.01) than those without. CONCLUSIONS Good metabolic results are favored in patients followed-up in specialized care, are married, and are parents. We recommend transfer to a diabetologist with experience in T1D at an individual age.
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Affiliation(s)
- Roland Schweizer
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | | | - Clara Hayn
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | - Silas Friz
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | - Julia Uber
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | - Julian Ziegler
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | - Franziska Liebrich
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | - Andreas Neu
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
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Zeiler M, Wittek T, Graf T, Bozic I, Nitsch M, Waldherr K, Karwautz A, Wagner G, Berger G. Psychosocial impact of the COVID-19 pandemic for adolescents with type-1-diabetes: a qualitative interview study involving adolescents and parents. Behav Med 2023; 49:412-422. [PMID: 35816425 DOI: 10.1080/08964289.2022.2084358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 12/23/2022]
Abstract
This study aims to investigate the psychosocial impact of the COVID-19 pandemic on adolescents with type-1-diabetes (T1D). We conducted 18 semi-structured interviews including adolescents with T1D (n = 10, 50% female, 15-18 years) and their parents (n = 8, 88% mothers). The main topics addressed were experiences during confinement regarding everyday life, lifestyle behaviors, diabetes management and treatment. We applied thematic analysis to identify common patterns of meanings. Being aware of belonging to a potential COVID-19 risk group caused worries especially in parents which resulted in strict adherence to preventive measures. Information from trustworthy sources regarding the actual risk mitigated the concerns. Digital diabetes treatment was well accepted and experienced as highly usable. The pandemic situation either facilitated or hindered the transition from parental control to diabetes self-management. While some patients managed to improve healthy lifestyle behaviors as their everyday lives seemed more predictable, others had difficulties in adapting to changed daily routines resulting in increased sedentary behavior and snacking. The perceived level of stress was directly associated with blood glucose levels. In conclusion, the implementation of psychological interventions (both for adolescents with T1D and their parents) addressing mental health literacy and media literacy seems to be important to promote positive coping skills for dealing with the pandemic situation.
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Affiliation(s)
- Michael Zeiler
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Tanja Wittek
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Theres Graf
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Ina Bozic
- Diabetes Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna
| | - Martina Nitsch
- Ferdinand Porsche FernFH - Distance Learning University of Applied Sciences
| | - Karin Waldherr
- Ferdinand Porsche FernFH - Distance Learning University of Applied Sciences
| | - Andreas Karwautz
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Gudrun Wagner
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Gabriele Berger
- Diabetes Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna
- Pediatric Diabetes Outpatient Clinic, Health Care Centre Vienna Floridsdorf
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Nightingale R, Kirk S, Swallow V, McHugh GA. Supporting the parent-to-child transfer of self-management responsibility for chronic kidney disease: A qualitative study. Health Expect 2023; 26:683-692. [PMID: 36562551 PMCID: PMC10010075 DOI: 10.1111/hex.13693] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION As children with long-term conditions (LTCs) mature, they are usually expected to assume responsibility from their parents for self-management of their condition. Little is known about what supports families with this handover of responsibility, including the role of healthcare professionals (HCPs). This study aimed to explore what supports young people with chronic kidney disease (CKD) to assume self-management responsibility and parents to relinquish control. METHODS A qualitative study, using a grounded theory approach was conducted. Individual and dyadic interviews and focus groups were carried out with 16 young people aged 13-17 years old with CKD, 13 parents, and 20 HCPs. Participants were recruited from two UK children's renal units. FINDINGS Building and maintaining trust, fostering positivity, learning from mistakes, forming partnerships and individualized support, facilitated the transfer of self-management responsibility. However, HCPs' focus on developing partnerships with young people meant some parents felt excluded, highlighting uncertainty around whether support should be child- or family-centred. Although tailored support was identified as critical, aspects of local service provision appeared to impact on HCPs' capacity to implement individualized approaches. CONCLUSION This study has identified what supports the handover of responsibility, and, importantly, HCPs' current, and potential role in helping young people to assume responsibility for managing their LTC. Further research is needed to explore how HCPs' involvement balances child- and family-centred care, and how HCPs can adopt personalized, strengths-based approaches to help ensure the support that families receive is tailored to their individual needs. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery.
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Affiliation(s)
- Ruth Nightingale
- Language and Cognition Department, UCL Division of Psychology and Language Science, University College London, London, UK
| | - Sue Kirk
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Gretl A McHugh
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Tuohy E, Gallagher P, Rawdon C, Murphy N, Swallow V, Lambert V. Adolescent perspectives on negotiating self-management responsibilities for type 1 diabetes with their parents. PATIENT EDUCATION AND COUNSELING 2023; 109:107629. [PMID: 36641999 DOI: 10.1016/j.pec.2023.107629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/24/2022] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The overall purpose of this study was to explore adolescent perspectives on communicating about self-management of type 1 diabetes (T1D) and negotiating responsibilities for self-management with parents. METHODS Semi-structured interviews were conducted with 28 adolescents aged 11-17 years living with T1D. Interviews were audio-recorded, transcribed verbatim and thematically analysed. RESULTS Two themes and five subthemes were identified. The first theme, 'changing levels of involvement in self-management' describes the division of responsibility for self-management within the family and adolescents collaborating and sharing responsibilities with parents for self-management. The second theme, 'talking about self-management with parents' describes changes in patterns of parent-adolescent communication about T1D over time, adolescents' seeking parental feedback and advice and the factors that contribute to the promotion of self-management communication between adolescents and parents. CONCLUSION This study identified that how adolescents perceive communication with their parents contributes to negotiation of responsibilities for self-management during adolescence. The findings provide a nuanced understanding of adolescent perspectives on communication with parents about T1D self-management and how parent-adolescent communication can be framed in ways that promote positive adolescent engagement with T1D self-management. PRACTICE IMPLICATIONS Targeting parent-adolescent communication strategies may result in more optimal sharing of responsibilities and improved self-management.
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Affiliation(s)
- Ella Tuohy
- School of Psychology, Dublin City University, Dublin, Ireland
| | | | - Caroline Rawdon
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Nuala Murphy
- Diabetes and Endocrine Unit, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Veronica Swallow
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland.
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Eysenbach G, Lin YK, Chhabra M, Henschke A, Brown E, Pedley L, Pedley E, Hannan K, Brown K, Wright K, Phillips C, Tricoli A, Nolan CJ, Suominen H, Desborough J. Toward Diabetes Device Development That Is Mindful to the Needs of Young People Living With Type 1 Diabetes: A Data- and Theory-Driven Qualitative Study. JMIR Diabetes 2023; 8:e43377. [PMID: 36696176 PMCID: PMC9947809 DOI: 10.2196/43377] [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: 10/11/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND An important strategy to understand young people's needs regarding technologies for type 1 diabetes mellitus (T1DM) management is to examine their day-to-day experiences with these technologies. OBJECTIVE This study aimed to examine young people's and their caregivers' experiences with diabetes technologies in an exploratory way and relate the findings to the existing technology acceptance and technology design theories. On the basis of this procedure, we aimed to develop device characteristics that meet young people's needs. METHODS Overall, 16 in-person and web-based face-to-face interviews were conducted with 7 female and 9 male young people with T1DM (aged between 12 and 17 years) and their parents between December 2019 and July 2020. The participants were recruited through a pediatric diabetes clinic based at Canberra Hospital. Data-driven thematic analysis was performed before theory-driven analysis to incorporate empirical data results into the unified theory of acceptance and use of technology (UTAUT) and value-sensitive design (VSD). We used the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist for reporting our research procedure and findings. In this paper, we summarize the key device characteristics that meet young people's needs. RESULTS Summarized interview themes from the data-driven analysis included aspects of self-management, device use, technological characteristics, and feelings associated with device types. In the subsequent theory-driven analysis, the interview themes aligned with all UTAUT and VSD factors except for one (privacy). Privacy concerns or related aspects were not reported throughout the interviews, and none of the participants made any mention of data privacy. Discussions around ideal device characteristics focused on reliability, flexibility, and automated closed loop systems that enable young people with T1DM to lead an independent life and alleviate parental anxiety. However, in line with a previous systematic review by Brew-Sam et al, the analysis showed that reality deviated from these expectations, with inaccuracy problems reported in continuous glucose monitoring devices and technical failures occurring in both continuous glucose monitoring devices and insulin pumps. CONCLUSIONS Our research highlights the benefits of the transdisciplinary use of exploratory and theory-informed methods for designing improved technologies. Technologies for diabetes self-management require continual advancement to meet the needs and expectations of young people with T1DM and their caregivers. The UTAUT and VSD approaches were found useful as a combined foundation for structuring the findings of our study.
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Affiliation(s)
| | | | - Madhur Chhabra
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Adam Henschke
- Philosophy Section, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands
| | - Ellen Brown
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Lachlan Pedley
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Elizabeth Pedley
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia.,The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australia
| | - Kristal Hannan
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Karen Brown
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia.,The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australia
| | - Kristine Wright
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia.,The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australia
| | - Christine Phillips
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Antonio Tricoli
- Nanotechnology Research Laboratory, Faculty of Engineering, The University of Sydney, Sydney, Australia.,Nanotechnology Research Laboratory, Research School of Chemistry, College of Science, The Australian National University, Canberra, Australia
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia.,The John Curtin School of Medical Research, College of Health and Medicine, The Australian National University, Canberra, Australia.,Department of Endocrinology and Diabetes, Canberra Health Services, Canberra, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering, Computing and Cybernetics, The Australian National University, Canberra, Australia.,Department of Computing, University of Turku, Turku, Finland
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
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Hatzir L, Tuval-Mashiach R, Pinhas-Hamiel O, Silberg T. Good Health Practices and Well-Being among Adolescents with Type-1 Diabetes: A Cross-Sectional Study Examining the Role of Satisfaction and Frustration of Basic Psychological Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1688. [PMID: 36767047 PMCID: PMC9914057 DOI: 10.3390/ijerph20031688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
Type 1 diabetes (T1D) is a chronic disease requiring medical adherence. However, among adolescents, non-adherence rates may reach up to 75%. Satisfaction or frustration with psychological needs is a crucial factor in the motivation and management of health-related behaviors. This study aimed to examine the differences in good health practices and psychological and physical well-being among adolescents with and without T1D and the mediating role of satisfaction and frustration of psychological needs on the association between good health practices and well-being in this population. A total of 94 adolescents (42 with T1D, 52 healthy controls, mean age 14.83 ± 1.82 years) completed questionnaires assessing good health practices, satisfaction or frustration of psychological needs, and well-being. Adolescents with T1D reported lower levels of physical well-being compared to healthy controls. Satisfaction or frustration of psychological needs had an effect on good health practices and psychological and physical well-being among healthy controls. Among adolescents with T1D, satisfaction or frustration of psychological needs was related to psychological well-being and partially related to physical well-being, but not to good health practices. The results demonstrate that the satisfaction or frustration of psychological needs has a unique effect on health behaviors and well-being among adolescents with T1D. This calls for further examination of the underlying mechanisms involved in health-related behaviors and well-being among adolescents with T1D.
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Affiliation(s)
- Lika Hatzir
- Department of Psychology, Bar-Ilan University, Ramat-Gan 52900, Israel
| | | | - Orit Pinhas-Hamiel
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv 69978, Israel
| | - Tamar Silberg
- Department of Psychology, Bar-Ilan University, Ramat-Gan 52900, Israel
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan 52621, Israel
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Koerner R, Rechenberg K. Psychosocial Outcomes in Adolescents With Type 1 Diabetes: Associations With Grade Level and Disease Duration. J Pediatr Health Care 2023; 37:25-29. [PMID: 36163117 DOI: 10.1016/j.pedhc.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/15/2022] [Accepted: 09/03/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The purpose of this study was to examine anxiety and depressive symptoms in adolescents with type 1 diabetes (T1D) to determine differences based on grade level and disease duration. METHOD We conducted a secondary data analysis of adolescents with T1D, which included demographic characteristics, general anxiety symptoms, and depressive symptoms. RESULTS Of the 147 adolescents included in the analysis, 32% (n=47) were in middle school and 68% (n=100) were in high school. Most had been diagnosed with diabetes for less than 3 years (67.3%, n=99). When controlling for covariates, middle schoolers were more likely to report clinically significant depressive symptoms compared to their high school peers (β = 0.83, p = 0.008). DISCUSSION Younger adolescents may be at a higher risk of a clinically significant symptom burden from depression and should be screened regularly. Future research should include tailoring psychosocial interventions specifically to an adolescent's age and disease duration.
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Affiliation(s)
- Rebecca Koerner
- Rebecca Koerner, Graduate Student, College of Nursing, University of South Florida, Tampa, FL.
| | - Kaitlyn Rechenberg
- Kaitlyn Rechenberg, Assistant Professor, College of Nursing, University of South Florida, Tampa, FL
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Rawdon C, Kilcullen SM, Murphy N, Swallow V, Gallagher P, Lambert V. Parents' perspectives of factors affecting parent-adolescent communication about type 1 diabetes and negotiation of self-management responsibilities. J Child Health Care 2022:13674935221146009. [PMID: 36529483 DOI: 10.1177/13674935221146009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Adolescence is an important time in which young people take on type 1 diabetes (T1D) self-management responsibility. Parents are key facilitators of this process. Little is known about parents' experiences of communicating with their children about T1D during adolescence. Semi-structured interviews were conducted with 32 parents (24 mothers and 8 fathers) of adolescents (11-17 years) living with T1D to explore how parents communicate about T1D and self-management with their adolescent children. Parents were recruited through two national child and adolescent diabetes and endocrine clinics and online advertisement through a national diabetes advocacy organisation. Interviews were transcribed verbatim and thematically analysed. Six themes were identified: parent factors, quality of the parent-adolescent relationship, communication strategies, adolescent factors, communication triggers and family/system factors. Understanding factors that impact communication about self-management between parents and adolescents will enable healthcare professionals to provide support and targeted interventions as parent and adolescent roles change over time.
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Affiliation(s)
| | | | - Nuala Murphy
- 11457Children's Health Ireland at Temple Street, Dublin, Ireland
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12
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Dalmer S, Caulfield S, Murdoch F, Urschel S. Patient and care provider inclusion in the development of an educational graphic novel for heart transplanted teenagers. Pediatr Transplant 2022; 26:e14396. [PMID: 36124747 DOI: 10.1111/petr.14396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Teenagers experience high rates of rejection and organ failure after heart transplantation due to non-adherence to medications, poor transition into adult care, and difficulties communicating with adults including healthcare providers. This project aimed to creatively bridge this gap-including teenage patients, their parents, and healthcare providers in the development of a new resource meant to motivate teenage heart-transplant-patients to take interest and ownership of their long-term health. METHODS Four teenage heart-transplanted patients, four parents, and three healthcare providers provided insight into relevant content for an educational resource through semi-standardized questionnaires and interviews. Their input guided the style and substance of the resource developed under the supervision of Fine Arts professors and the pediatric heart transplant team. RESULTS Parents and healthcare providers were concerned about teenagers' health choices and lack of perspective while patients were more bothered by parental nagging and being careful about infections than worrying about post-transplant risks. The resource that was developed therefore used subtlety within a narrative medium: a graphic novel that involved mutant worms, secret plots, and daring escapes, to address identified medical concerns and encouragements without triggering teenage resistance to instruction. CONCLUSION The discrepancies between the priorities of healthcare providers, parents, and teenage heart-transplant-patients illustrate the significance of basing resource-development on input from the target population. We developed the first graphic novel written for teenage heart-transplant-patients with patient input and interdisciplinary cooperation, using the subtlety of a narrative medium as a model for integrating medical content within an appealing, motivational, patient-centered, and age-appropriate resource.
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Affiliation(s)
- Stephanie Dalmer
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sean Caulfield
- Department of Art and Design, University of Alberta, Edmonton, Alberta, Canada
| | - Faye Murdoch
- Division of Pediatric Cardiology, Departments of Pediatrics, University of Alberta/Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Simon Urschel
- Division of Pediatric Cardiology, Departments of Pediatrics, University of Alberta/Stollery Children's Hospital, Edmonton, Alberta, Canada.,Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada.,Alberta Transplant Institute, University of Alberta, Li Ka Shing Centre For Health Research, Edmonton, Alberta, Canada
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13
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Nsamba J, Nabirye G, Hense S, Drenos F, Mathews E. Lived Experiences of Newly Diagnosed Type 1 Diabetes Mellitus Children and Adolescents in Uganda. J Multidiscip Healthc 2022; 15:2647-2665. [DOI: 10.2147/jmdh.s389265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
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14
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Kołota A, Głąbska D. Analysis of Association between Adolescents' Food Habits and Body Mass Change in a Population-Based Sample: Diet and Activity of Youth during COVID-19 (DAY-19) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811772. [PMID: 36142043 PMCID: PMC9517231 DOI: 10.3390/ijerph191811772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic may have contributed to food habit changes, including some negative ones that may increase the risk of overweight and obesity. The aim of the study was to analyze the association between adolescents' food habits, body mass change, as well as physical activity level in a population-based sample within the Diet and Activity of Youth during COVID-19 (DAY-19) Study. The DAY-19 Study was conducted in a cohort of 1333 students (aged 10-16 years) recruited in schools after stratified random quota sampling of primary schools (sampling counties within voivodeships and schools within counties) in June 2020. The food habits were assessed for the period of the COVID-19 pandemic and the period before the COVID-19 pandemic while using Adolescent Food Habits Checklist (AFHC). The body mass changes were assessed based on body weight and height for the period of the COVID-19 pandemic and the period before the COVID-19 pandemic while using Polish growth reference values. The physical activity changes were assessed based on the subjective assessment of adolescents. It was stated that for female adolescents declaring body mass gain during the COVID-19 pandemic the highest AFHC purchase scores (healthy purchase habits) (p < 0.0001) were accompanied by the lowest AFHC consumption score (unhealthy consumption habits) (p < 0.0001), as well as for female adolescents declaring physical activity decrease during the COVID-19 pandemic the highest AFHC purchase scores (healthy purchase habits) were observed (p = 0.0333). It was stated that for male adolescents declaring physical activity increased during the COVID-19 pandemic, the highest AFHC consumption scores (healthy consumption habits) were observed (p = 0.0003). In the case of a majority of participants, the general food habits were unchanged, which was observed mainly for food habits associated with food preparation. More food habits changes associated with the COVID-19 pandemic resulting in body mass changes were observed in females than in male adolescents. Body mass gain during the COVID-19 pandemic in adolescents may have resulted from unhealthy consumption habits, accompanied by decreased physical activity, in spite of the fact that this sub-group presented healthy purchase habits, which was observed especially for female adolescents.
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15
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Pembroke S, Cody D, Roche EF, Sleath B, Hilliard C, Brenner M, Coyne I. Encouraging adolescents' participation during paediatric diabetes clinic visits: Design and development of a question prompt list intervention. Diabetes Res Clin Pract 2022; 190:109985. [PMID: 35809690 DOI: 10.1016/j.diabres.2022.109985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
AIMS To investigate adolescents' communication with healthcare providers (HCPs) and co- design a question prompt list as one part of an intervention to increase patient participation and communication at diabetes clinic visits. METHODS Using an adolescent-led co-design approach we conducted interviews and focus groups with adolescents, parents, and healthcare providers (HCPs) and held workshops with both a Youth Advisory Group (YAG) and a Parent Advisory Group (PAG). RESULTS Adolescents and parents identified challenges categorised into four themes: negative experience communicating with HCPs, lacking patient education leading to disinterest, low self-confidence out of fear of being wrong and forgetting to ask question(s). Adolescents identified that a Question Prompt List (QPL) could help them to ask questions, be more confident and participate more. The design process was an iterative development that engaged all stakeholders. Parents and HCPs assumed adolescents had greater knowledge about diabetes than they had in reality. CONCLUSIONS Divergence in perceptions between adults and adolescents regarding patient knowledge of diabetes care demonstrates the importance of encouraging adolescents to ask the questions that matter to them. The QPL could be a useful means of supporting adolescents to actively participate in clinic encounters with healthcare providers.
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Affiliation(s)
- Sinead Pembroke
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland.
| | - Declan Cody
- Children's Health Ireland Crumlin, Cooley Road, Dublin 12, Ireland
| | - Edna F Roche
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland and Children's Health Ireland, Tallaght, Tallaght, Dublin 24, Ireland
| | - Betsy Sleath
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carol Hilliard
- Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
| | - Maria Brenner
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Imelda Coyne
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland.
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16
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Nightingale R, McHugh GA, Swallow V, Kirk S. Shifting responsibilities: A qualitative study of how young people assume responsibility from their parents for self-management of their chronic kidney disease. Health Expect 2022; 25:1919-1929. [PMID: 35770677 PMCID: PMC9327865 DOI: 10.1111/hex.13549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The responsibility for managing a long-term condition (LTC) such as chronic kidney disease (CKD) typically transfers from parent to child, as children become older. However, children can find it challenging to become independent at managing their LTC, and evidence for how healthcare professionals (HCPs) support transfer of responsibility is limited. This study aimed to explore how young people with CKD assume responsibility for managing their condition and the HCP's role during this process. METHODS Sampling, qualitative data collection and analysis were guided by a constructivist grounded theory approach. Individual and dyadic interviews, and focus groups, were conducted with 16 young people aged 13-17 years with CKD, 13 parents and 20 HCPs. FINDINGS A grounded theory, shifting responsibilities, was developed that provides new insights into how young people's, parents' and HCPs' constructions of the transfer of responsibility differed. These diverse constructions contributed to multiple uncertainties around the role of HCPs, when the process started and was completed and whether the endpoint of the process was young people's self-management or young person-parent shared management. CONCLUSION Families would benefit from HCP support over a longer timeframe that integrates assuming self-management responsibility with gaining independence in other areas of their lives and focuses on young people 'doing' self-management. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery.
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Affiliation(s)
- Ruth Nightingale
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Gretl A McHugh
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Sue Kirk
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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17
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Pasquini S, Rinaldi E, Da Prato G, Csermely A, Indelicato L, Zaffani S, Santi L, Sabbion A, Maffeis C, Bonora E, Trombetta M. Growing up with type 1 diabetes mellitus: Data from the Verona Diabetes Transition Project. Diabet Med 2022; 39:e14719. [PMID: 34657317 DOI: 10.1111/dme.14719] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 10/13/2021] [Indexed: 12/20/2022]
Abstract
AIM Transition from paediatric to adult care is a critical step in life of emerging adults with type 1 diabetes. We assessed, according to indicators established by panel of experts, clinical, socio-demographic and psychosocial factors in young adults with type 1 diabetes throughout structured transition to investigate the associations, if any, with HbA1c value at time of transition. METHODS The "Verona Diabetes Transition Project" started in January 2009: a structured transition program, shared between paediatric and adult clinic, was organised with a multi-disciplinary team. All young adults underwent a semi-structured interview by a psychologist, before transition. Minimum age for transition was 18 years. RESULTS 222 (M/F = 113/109) young adults moved to adult care from January 2009 to March 2020. The mean time between the last paediatric visit and the first adult visit ranged from 13.6 ± 6.1 months at the beginning of the project to 3.6 ± 11.5 months over the following years. At first adult clinic attendance, women showed higher HbA1c values (70 ± 11 mmol/mol vs. 65 ± 7 mmol/mol or 8.57% ± 1.51% vs. 8.14% ± 0.98%, p = 0.01), higher frequency of disorders of eating behaviours (15.6% vs. 0%, p < 0.001) and poor diabetes acceptance (23.9% vs. 9.7%, p < 0.001) than men. Mediation analyses showed a significant mediating role of glucose control 2 years before transition in the relationship between poor diabetes acceptance and glucose control at transition. CONCLUSIONS This study demonstrated a delay reduction in establishing care with an adult provider and suggested the potential role of low diabetes acceptance on glycemic control at transition. Further studies are needed to confirm and expand these data.
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Affiliation(s)
- Silvia Pasquini
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Elisabetta Rinaldi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Giuliana Da Prato
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Csermely
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Liliana Indelicato
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Silvana Zaffani
- Division of Pediatrics, Department of Medicine, University of Verona, Verona, Italy
| | - Lorenza Santi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Alberto Sabbion
- Division of Pediatrics, Department of Medicine, University of Verona, Verona, Italy
| | - Claudio Maffeis
- Division of Pediatrics, Department of Medicine, University of Verona, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Maddalena Trombetta
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
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18
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Gardener L, Desha L, Bourke-Taylor H, Ziviani J. Responsibility sharing for adolescents with type 1 diabetes: A scoping review. Chronic Illn 2022; 18:6-21. [PMID: 32998528 DOI: 10.1177/1742395320959406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The term 'Responsibility Sharing', albeit poorly defined, has emerged from the diabetes literature, to describe a distinct mechanism for comprehensively managing the characteristic shift in responsibility that underpins the transition to self-management for adolescents. METHODS A scoping review, following the PRISMA-ScR guidelines, distilled the literature from seven databases to answer the questions: What is responsibility sharing? Who are the key stakeholders? What factors affect responsibility transaction? What are its recognized outcomes? How is responsibility shared? RESULTS Responsibility sharing is a transactional arrangement between youth and their caregiver/s that functions to repeatedly and flexibly apply ownership to the management of diabetes care tasks, across the course of adolescence. In the main, responsibility sharing was associated with better metabolic and/or psychosocial outcomes. Effective responsibility sharing was seen as being responsive to adolescent capacity and driven by autonomy supportive, sustained communication patterns that enable mutually agreeable responsibility assumption by all stakeholders. CONCLUSION Different perspectives on responsibility sharing for adolescents with Type 1 diabetes, and the lack of a universal definition, have led to discordance within the literature about its operationalization and measurement. This paper proposes a definition of responsibility sharing for future researchers to apply.
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Affiliation(s)
- Lisa Gardener
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Laura Desha
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Helen Bourke-Taylor
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Australia
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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19
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Sattoe J, Peeters M, Bronner M, van Staa A. Transfer in care and diabetes distress in young adults with type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2021; 9:9/2/e002603. [PMID: 34969691 PMCID: PMC8719139 DOI: 10.1136/bmjdrc-2021-002603] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/23/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Diabetes distress (DD) is a serious problem in many people with diabetes and is associated with unfavorable clinical and psychosocial outcomes in children and adults. Little is known about DD in young adults (YAs) with type 1 diabetes mellitus (T1DM) who transferred to adult care. This study aimed to explore the differences between YAs with/without DD regarding transfer experiences, self-management and health-related quality of life (HRQoL). RESEARCH DESIGN AND METHODS Cross-sectional online questionnaire completed by YAs with T1DM after transfer. DD was measured with the short-form Problem Areas in Diabetes scale. Descriptive analyses were followed by t-tests and χ2 tests to explore differences between the groups with/without DD. Effect sizes were calculated. RESULTS Of 164 respondents with mean age 22.7 (±1.56) years, 60.7% was female. The total sample scored low on DD (6.52±4.67; range: 0-17), but 57 (34.8%) had a score ≥8, indicating DD. YAs with DD felt less ready to transfer to adult care than those without DD and scored lower on alliance between pediatric and adult care and reception in adult care. They also reported poorer self-management skills and lower HRQoL in all domains of functioning. CONCLUSIONS More than one-third YAs experienced DD after transfer; this was associated with less favorable transition, self-management and psychosocial outcomes. Transfer in care seems to be a source of DD. Systematic screening on DD and attention for YAs' worries is recommended in both pediatric and adult care.
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Affiliation(s)
- Jane Sattoe
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Mariëlle Peeters
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Madelon Bronner
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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20
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Pembroke S, Roche EF, Sleath B, Brenner M, Hilliard C, Cody D, Coyne I. Developing a video intervention to improve youth question-asking and provider education during paediatric diabetes clinic encounters: The Promoting Adolescents Communication and Engagement study. PATIENT EDUCATION AND COUNSELING 2021; 104:2170-2176. [PMID: 33640232 DOI: 10.1016/j.pec.2021.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/27/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Research on long-term health conditions indicates that adolescents are not actively involved during their medical visits. Active involvement is essential because this can help adolescents learn how to self-manage their treatment plan. OBJECTIVE To co-design a video intervention to improve youth question-asking and provider education during paediatric diabetes visits. PATIENT INVOLVEMENT A participatory-led approach was used to co-design the video, through a combination of interviews/ focus groups and the establishment of a Youth Advisory Group. METHODS First, focus groups and one-to-one interviews were held with adolescents, parents and healthcare providers. Second, two workshops were held with the Youth Advisory Group, Parent Advisory Group and stakeholders on script design. Finally, an iterative development of the video took place between the research team, videographer, both advisory groups and the steering committee. There were three rounds of feedback before the video was finalised. RESULTS Adolescents' content preferences included: 1) message of empowerment; 2) managing your diabetes so you can get on with the fun stuff in life; 3) Promoting independence; 4) Reasons for not speaking at clinic visits and reassurance; 5) Becoming comfortable to speak and ask questions at clinic visits; 6) Practical advice on how to ask questions. Formatting preferences included that the video should be short, divided into segments, with adolescents with diabetes acting in it, and speaking directly to the camera. DISCUSSION Identifying and reflecting adolescents' needs and preferences for engagement with healthcare providers was critical in the development process. Adolescents' participation in the co-design process was pivotal to the acceptability of the intervention for adolescents with diabetes. PRACTICAL VALUE The intervention may increase adolescents' participation in communication and interactions with healthcare providers, which may help them to be more active in the self-management of their condition.
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Affiliation(s)
- Sinead Pembroke
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland.
| | - Edna F Roche
- Department of Endocrinology and Diabetes, Children's Health Ireland, Tallaght, Dublin 24, Ireland; School of Medicine, Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Betsy Sleath
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland
| | - Carol Hilliard
- Department of Diabetes and Endocrinology, Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland; School of Medicine, Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Declan Cody
- Department of Diabetes and Endocrinology, Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland
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21
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Betz CL, Mannino JE, Disabato JA. Survey of US pediatric nurses' role in health care transition planning: Focus on assessment of self-management abilities of youth and young adults with long-term conditions. J Child Health Care 2021; 25:468-480. [PMID: 32870717 DOI: 10.1177/1367493520953649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The survival rates of youth and young adults (YYAs) diagnosed with long-term conditions have improved considerably as 90% now enter adulthood; health care transition planning (HCTP) has emerged as a nursing practice priority. The aim of this national online survey was to investigate the extent to which nurses, recruited from two major United States pediatric nursing organizations are involved with HCTP including assessing YYA self-management abilities (SMA). Findings of a 9-item assessment of self-management abilities subscale of the nurses' role in HTCP tool are reported. The nurse respondents (n = 1269), identified the most frequently assessed SMA was the YYAs' ability to understand and speak about their condition and its treatment (M = 2.3, SD = .89). The least frequently assessed was the YYAs' ability to identify community advocates to help them become more independent (M =1.5, SD = .90). Regression analysis identified significant predictors of the frequency nurses assess YYA for SMA included nurses' level of knowledge, perceived level of importance, HCTP and skills identified in job description, and caring for YYA. Findings indicate HCTP care advancements will necessitate HCTP training and development of nurse-led service efforts to facilitate optimal outcomes for YYA.
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Affiliation(s)
- Cecily L Betz
- Department of Pediatrics, Keck School of Medicine, University of Southern California, CA, USA
| | - Jennifer E Mannino
- Barbara H. Hagan School of Nursing, and Health Sciences 6957Molloy College, NY, USA
| | - Jennifer A Disabato
- College of Nursing and School of Medicine, 296427University of Colorado Anschutz Medical Campus, CO, USA
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22
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Schulman-Green D, Feder SL, Montano AR, Batten J, Tan H, Hoang K, Grey M. Use of the self- and family management framework and implications for further development. Nurs Outlook 2021; 69:991-1020. [PMID: 34183187 DOI: 10.1016/j.outlook.2021.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/20/2021] [Accepted: 05/02/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Self- and Family Management Framework (SFMF) was created in 2006 and revised in 2015 to guide research on self- and family management of chronic conditions. There has been no review of use of the SFMF. PURPOSE We reviewed articles citing the SFMF to identify the frequency and nature of use. METHOD We conducted a citation analysis, searching Web of Science, Scopus, and Google Scholar databases and extracted key data from identified articles. FINDINGS Of 126 articles, 84(66%) cited the 2006 SFMF, 37(29%) cited the 2015 SFMF, and 6(5%) cited both. The SFMF was used most to inform study design. Users noted strengths (e.g., considers family context) and limitations (e.g., non-specification of patient- family caregiver synergies) of the framework. DISCUSSION The SFMF has been used broadly to guide research on self- and family management of chronic conditions. Findings will inform development of a third version of the SFMF.
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Affiliation(s)
| | | | | | | | - Hui Tan
- Yale New Haven Health Bridgeport Hospital, Bridgeport, CT
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23
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Kao YC, Coster W, Cohn ES, Orsmond GI. Preparation for Adulthood: Shifting Responsibility for Management of Daily Tasks From Parents to Their Children. Am J Occup Ther 2021; 75:7502205050p1-7502205050p11. [PMID: 33657347 PMCID: PMC7929602 DOI: 10.5014/ajot.2020.041723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Importance: Limited research has described the timing of acquisition of the broad range of skills required for the transition to adulthood. Objective: To describe the timing of the shift of responsibility for daily tasks from parent to child. Design: This study used an existing data set of parent responses to 49 items in the Responsibility domain of the Pediatric Evaluation of Disability Inventory Computer Adaptive Tests. Participants: A U.S. nationally representative sample of 2,205 typically developing children and youth ages 0 to 20 yr. Outcomes and Measures: Descriptive analyses focused on two ages: (1) starting age (when >50% of parents reported their child was taking at least some responsibility for a task) and (2) full responsibility age (when >50% of parents reported their child was taking full responsibility for the task). Results: The process of shifting responsibility for daily life tasks from parent to child typically occurred over a long period. Many task items had an interval of 5 yr from starting age to full responsibility age; the longest interval was 15 yr. Youth began assuming responsibility for more complex tasks and tasks that involved more risk at ages 10 to 15. Conclusions and Relevance: Results can serve as a reference for the timing of the transition to greater self-management of daily life tasks across childhood and adolescence. Timing of responsibility shifts may reflect a combination of development of underlying capacities and social transitions. Executive functioning may be especially relevant for management of the more complex tasks required in daily life in adulthood. What This Article Adds: The transfer of responsibility for managing tasks of daily life from parents to children often extends over a period of many years. Clinicians may find the results helpful when discussing the future with parents of young people with disabilities and other chronic conditions and the tasks that their children must learn to manage for independent living as an adult.
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Affiliation(s)
- Ying-Chia Kao
- Ying-Chia Kao, ScD, OTR, is Assistant Professor, Department of Occupational Therapy, Asia University, Taichung, Taiwan;
| | - Wendy Coster
- Wendy Coster, PhD, OTR, FAOTA, is Professor, Department of Occupational Therapy, Boston University, Boston, MA
| | - Ellen S Cohn
- Ellen S. Cohn, ScD, OTR, FAOTA, is Clinical Professor Emerita, Department of Occupational Therapy, Boston University, Boston, MA
| | - Gael I Orsmond
- Gael I. Orsmond, PhD, is Professor, Department of Occupational Therapy, Boston University, Boston, MA
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Jacobs JKD, Basson WD, Basson MJ. Perceptual systems of the self-management of students living with diabetes mellitus: an IQA approach. JOURNAL OF ENDOCRINOLOGY, METABOLISM AND DIABETES OF SOUTH AFRICA 2020. [DOI: 10.1080/16089677.2020.1817281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- JKD Jacobs
- Medicine Usage in South Africa, North-West University, Potchefstroom, South Africa
| | - WD Basson
- Medicine Usage in South Africa, North-West University, Potchefstroom, South Africa
| | - MJ Basson
- Medicine Usage in South Africa, North-West University, Potchefstroom, South Africa
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Hung LC, Huang CY, Lo FS, Cheng SF. The Self-Management Experiences of Adolescents with Type 1 Diabetes: A Descriptive Phenomenology Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145132. [PMID: 32708617 PMCID: PMC7400392 DOI: 10.3390/ijerph17145132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/11/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
Many adolescents with type 1 diabetes experience challenges in achieving good glycemic control and have insufficient understanding in executing interventions for glycemic control. This study aimed to understand self-management experiences of adolescents with type 1 diabetes in Taiwan. In this descriptive phenomenological study, we conducted in-depth interviews with 18 adolescents with type 1 diabetes from the pediatric outpatient clinic of a medical center. Data were analyzed using the Colaizzi's method. Four themes were identified: (1) misconception regarding self-management of blood glucose; (2) conflict between depending on and breaking away from parental assistance for glycemic control; (3) encounter with disruptions in glycemic control regimen due to the presence of schedule changes; and (4) lack of motivation to achieve good glycemic control. The findings indicated that the misconceptions of adolescents with type 1 diabetes about managing glycemic levels resulted from an insufficient understanding of self-management of diabetes. In Taiwan, the heavy emphasis of academic achievement and changes of schedules during breaks tended to disrupt the regimen for glycemic control. Healthcare professionals are encouraged to provide individualized education focusing on the adolescents' misconceptions regarding self-management of diabetes.
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Affiliation(s)
- Li-Chen Hung
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan;
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
| | - Chu-Yu Huang
- School of Nursing, Cedarville University, Cedarville, OH 45314, USA;
| | - Fu-Sung Lo
- Division of Endocrinology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan;
| | - Su-Fen Cheng
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
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Sezgin E, Weiler M, Weiler A, Lin S, Hart L. It Is a Life Journey: A Roadmap of Teens With Chronic Diseases in Transitioning to Independence. J Pediatr Health Care 2020; 34:346-355. [PMID: 32171611 DOI: 10.1016/j.pedhc.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Adolescents with chronic diseases have to cope with a number of challenges in their transition to independence and need to learn self-management. The purpose of this study was to understand the life journey of adolescents and their caregivers. METHOD Face-to-face interviews were conducted with 13 adolescents with chronic diseases (e.g., type 1 diabetes, cystic fibrosis, attention deficit hyperactivity disorder, epilepsy) and 13 caregivers (N = 26). Verbal methods were complemented with visual materials. Behavioral models and grounded theory principles guided the analysis of the data. RESULTS Participants were grouped according to an "archetype" based on the strategy they adopted to manage their chronic diseases. A life journey map was developed having the stages of transition. DISCUSSION This study proposed a new perspective to the life journey, transition stages, and personal archetypes from a patient-centered approach. We argued the need of a multidimensional approach and outlined the differences of archetypes and transition stages.
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Silva K, Miller VA. Does Self-Efficacy Mediate the Link Between Impulse Control and Diabetes Adherence? J Pediatr Psychol 2020; 45:445-453. [PMID: 32106299 DOI: 10.1093/jpepsy/jsaa007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The goal of this study was to test the hypothesis that diabetes self-efficacy mediates the relationship between impulse control and type 1 diabetes (T1D) management from ages 8 to 18 years, using multilevel modeling. METHODS Participants included 117 youth with T1D and their parents. Youth (aged 8-16 years at baseline) and parents were assessed 5 times over 2 years. Using a cohort sequential design, we first estimated the growth trajectory of adherence from age 8 to 18 years, then specified a multilevel mediation model using impulse control as the main predictor, diabetes self-efficacy as the mediator, and changes in adherence (both within- and between-individuals) as the outcome. RESULTS According to youth-reported adherence only, self-efficacy partially mediated the within-person effect of impulse control on adherence. On occasions when youth reported increases in impulse control, they tended to report higher adherence, and this was, in part, due to increases in youths' perceived self-efficacy. Self-efficacy accounted for approximately 21% of the within-person relationship between impulse control and youth-reported adherence. There was no association between impulse control and adherence between-individuals. Impulse control and self-efficacy were not related to parent-reported adherence. CONCLUSION Environments that enrich youth with confidence in their own diabetes-related abilities may benefit self-care behaviors in youth with T1D, but such increases in youths' perceived competence do not fully account for, or override, the behavioral benefits of impulse control. Efforts to improve adherence in youth with T1D will benefit from consideration of both impulse control and self-efficacy.
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Affiliation(s)
- Karol Silva
- Department of Pediatrics, Children's Hospital of Philadelphia
| | - Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia.,Perelman School of Medicine, University of Pennsylvania
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Perceptions of HIV Self-Management Roles and Challenges in Adolescents, Caregivers, and Health Care Providers. J Assoc Nurses AIDS Care 2020; 30:415-427. [PMID: 31241506 DOI: 10.1097/jnc.0000000000000011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Self-management of HIV is a desirable goal for the millions of adolescent persons living with HIV (PLWH). Adolescent PLWH continue to experience poor HIV care outcomes, primarily due to poor rates of medication adherence and retention in care, highlighting a need to develop adolescent self-management skills. The aim of our study was to examine adolescent, caregiver, and health care provider perceptions of adolescent PLWH self-management roles, barriers, and facilitators. Swendeman et al.'s self-management framework for chronic diseases guided the analyses. Participant narratives highlighted perceptions of their responsibilities and related challenges with regard to self-management of HIV by adolescents. Our findings highlighted the complexity of HIV self-management for adolescents and underscored the need for multifaceted programs to strengthen adolescent-caregiver-health care provider partnerships in order to improve adolescent PLWH health and wellbeing.
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Rakhshan M, Mirshekari F, Dehghanrad F. The Relationship between Illness Perception and Self-Care Behaviors among Hemodialysis Patients. IRANIAN JOURNAL OF PSYCHIATRY 2020; 15:150-158. [PMID: 32426011 PMCID: PMC7215252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective: Illness perception and self-care behaviors can result in higher levels of health behavior among hemodialysis patients. The present study aimed to assess the relationship between illness perception and self-care behaviors among hemodialysis patients who referred to the hospitals affiliated to Shiraz University of Medical Sciences in 2017. Method : In this descriptive cross sectional study, 216 hemodialysis patients who referred to the hemodialysis wards of the hospitals affiliated to Shiraz University of Medical Sciences were selected via convenience sampling. The study data were collected using a demographic information form, Brief Illness Perception Questionnaire (9 items), and a 15-item Self-care Behavior of Hemodialysis Patients Questionnaire. Then, the data were analyzed using independent t test and one-way ANOVA. Also, significance level was set at P < 0.05. Results: The mean age of the study participants was 30.15+6.65 years. Also, most of the participants were female (n = 125, 58%). The results revealed a significant relationship between illness perception and self-care behaviors among hemodialysis patients. A significant relationship was observed between the following items: daily weight control and perception of consequences (r = 0.200, p = 0.001), between contacting the physician at the time of shortness of breath and consequences (r = 0.209, p = 0.001), between weight control according to the physician's order and consequences (r = 0.763, p = 0.001), and between adherence to fluids restriction and identity(r = 0.149, p < 0.05). Conclusion: Considering the relationship between illness perception and self-care, beliefs as illness perception have to be incorporated into self-care programs designed for hemodialysis patients so as to promote their self-care behaviors. These findings can be used for planning and implementing care for hemodialysis patients.
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Affiliation(s)
- Mahnaz Rakhshan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.,Corresponding Author: Address: School of Nursing and Midwifery, Shiraz University of Medical Sciences, Zand Boulvard, Namazi Square, Shiraz, Iran, Postal Code: 7193613119. Tel & Fax: 98-713 6474254,
| | - Fatemeh Mirshekari
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Dehghanrad
- Nursing Department, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Sherr JL, Buckingham BA, Forlenza GP, Galderisi A, Ekhlaspour L, Wadwa RP, Carria L, Hsu L, Berget C, Peyser TA, Lee JB, O'Connor J, Dumais B, Huyett LM, Layne JE, Ly TT. Safety and Performance of the Omnipod Hybrid Closed-Loop System in Adults, Adolescents, and Children with Type 1 Diabetes Over 5 Days Under Free-Living Conditions. Diabetes Technol Ther 2020; 22:174-184. [PMID: 31596130 PMCID: PMC7047109 DOI: 10.1089/dia.2019.0286] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: The objective of this study was to assess the safety and performance of the Omnipod® personalized model predictive control (MPC) algorithm in adults, adolescents, and children aged ≥6 years with type 1 diabetes (T1D) under free-living conditions using an investigational device. Materials and Methods: A 96-h hybrid closed-loop (HCL) study was conducted in a supervised hotel/rental home setting following a 7-day outpatient standard therapy (ST) phase. Eligible participants were aged 6-65 years with A1C <10.0% using insulin pump therapy or multiple daily injections. Meals during HCL were unrestricted, with boluses administered per usual routine. There was daily physical activity. The primary endpoints were percentage of time with sensor glucose <70 and ≥250 mg/dL. Results: Participants were 11 adults, 10 adolescents, and 15 children aged (mean ± standard deviation) 28.8 ± 7.9, 14.3 ± 1.3, and 9.9 ± 1.0 years, respectively. Percentage time ≥250 mg/dL during HCL was 4.5% ± 4.2%, 3.5% ± 5.0%, and 8.6% ± 8.8% per respective age group, a 1.6-, 3.4-, and 2.0-fold reduction compared to ST (P = 0.1, P = 0.02, and P = 0.03). Percentage time <70 mg/dL during HCL was 1.9% ± 1.3%, 2.5% ± 2.0%, and 2.2% ± 1.9%, a statistically significant decrease in adults when compared to ST (P = 0.005, P = 0.3, and P = 0.3). Percentage time 70-180 mg/dL increased during HCL compared to ST, reaching significance for adolescents and children: HCL 73.7% ± 7.5% vs. ST 68.0% ± 15.6% for adults (P = 0.08), HCL 79.0% ± 12.6% vs. ST 60.6% ± 13.4% for adolescents (P = 0.01), and HCL 69.2% ± 13.5% vs. ST 54.9% ± 12.9% for children (P = 0.003). Conclusions: The Omnipod personalized MPC algorithm was safe and performed well over 5 days and 4 nights of use by a cohort of participants ranging from youth aged ≥6 years to adults with T1D under supervised free-living conditions with challenges, including daily physical activity and unrestricted meals.
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Affiliation(s)
- Jennifer L. Sherr
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, New Haven, Connecticut
- Address correspondence to: Jennifer L. Sherr, MD, PhD, Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, One Long Wharf Drive Suite 503, New Haven, CT 06511
| | - Bruce A. Buckingham
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | - Gregory P. Forlenza
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Alfonso Galderisi
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Laya Ekhlaspour
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | - R. Paul Wadwa
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lori Carria
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Liana Hsu
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | - Cari Berget
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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31
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Tuohy E, Rawdon C, Gallagher P, Glacken M, Murphy N, Swallow V, Lambert V. Children and young people's experiences and perceptions of self-management of type 1 diabetes: A qualitative meta-synthesis. Health Psychol Open 2019; 6:2055102919877105. [PMID: 31555459 PMCID: PMC6751535 DOI: 10.1177/2055102919877105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The aim of this review was to conduct a meta-synthesis of the experiences and perceptions of self-management of type 1 diabetes of children and young people living with type 1 diabetes (CYPDs). Six databases were systematically searched for studies with qualitative findings relevant to CYPDs' (aged 8-18 years) experiences of self-management. A thematic synthesis approach was used to combine articles and identify analytical themes. Forty articles met the inclusion criteria. Two analytical themes important to CYPDs' experiences and perceptions of self-management were identified: (1) negotiating independence and (2) feeling in control. The synthesis contributes to knowledge on contextual factors underpinning self-management and what facilitates or impedes transition towards autonomous self-management for CYPDs.
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Affiliation(s)
| | | | | | | | - Nuala Murphy
- Children's Health Ireland at Temple Street, Ireland
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32
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Lerch MF, Thrane SE. Adolescents with chronic illness and the transition to self-management: A systematic review. J Adolesc 2019; 72:152-161. [PMID: 30903932 DOI: 10.1016/j.adolescence.2019.02.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 02/11/2019] [Accepted: 02/24/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Chronic illness effects one in ten adolescents worldwide. Adolescence involves a desire for autonomy from parental control and the necessity to transition care from parent to child. This review investigates the transition to adolescent self-management of chronic illness treatment behaviors in the context of parent-adolescent relationships. METHODS A systematic search of PubMed, CINAHL, and Web of Science was conducted from earliest database records to early June 2017. Articles were included if they focused on adolescents, addressed illness self-management, discussed the parent-adolescent relationship, and were published in English. Articles were excluded if the chronic illness was a mental health condition, included children younger than 10 years of age, or lacked peer review. RESULTS Nine studies met inclusion criteria. Outcomes included challenges to adolescent self-management, nature of the parent-adolescent relationship, illness representation, perceptions of adolescent self-efficacy in compliance, medical decision making, laboratory measures, and adolescent self-management competence. Across diagnoses, parents who were available to monitor, be a resource, collaborate with their adolescent, and engage in ongoing dialogue were key in the successful transition to autonomous illness management. CONCLUSIONS There is a paucity of research addressing the experiences of adolescents in becoming experts in their own care.
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Affiliation(s)
- Matthew F Lerch
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Susan E Thrane
- College of Nursing, The Ohio State University, 322 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, United States.
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33
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Nightingale R, McHugh G, Kirk S, Swallow V. Supporting children and young people to assume responsibility from their parents for the self-management of their long-term condition: An integrative review. Child Care Health Dev 2019; 45:175-188. [PMID: 30690751 DOI: 10.1111/cch.12645] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/21/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Children and young people with long-term conditions (LTCs) are usually dependent on, or share management with, their families and are expected to develop self-management skills as they mature. However, during adolescence, young people can find it challenging to follow prescribed treatment regimens resulting in poor clinical outcomes. Though reviews have looked at children's and parents' experiences of self-management, none have explicitly examined the parent-to-child transfer of self-management responsibility. METHODS An integrative review was conducted with the aim of exploring the parent-to-child transfer of LTC self-management responsibility, through addressing two questions: (a) How do children assume responsibility from their parents for self-management of their LTC? (b) What influences the parent-to-child transfer of this responsibility? Eight databases were searched for papers published from 1995 to 2017. Methodological quality was assessed; included papers were synthesized to identify themes. RESULTS Twenty-nine papers were identified. Most papers used qualitative designs and focused on children with diabetes. Participants were predominantly children and/or parents; only two studies included health professionals. Assuming self-management responsibility was viewed as part of normal development but was rarely explored within the context of the child gaining independence in other areas of their life. Children and parents adopted strategies to help the transfer, but there was limited evidence around health professionals' roles and ambivalence around what was helpful. There was a lack of clarity over whether children and parents were aiming for shared management, or self-management, and whether this was a realistic or desired goal for families. Multiple factors such as the child, family, social networks, health professional, and LTC influenced how a child assumed responsibility. CONCLUSIONS Evidence suggests that the parent-to-child transfer of self-management responsibility is a complex, individualized process. Further research across childhood LTCs is needed to explore children's, parents', and professionals' views on this process and what support families require as responsibilities change.
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Affiliation(s)
- Ruth Nightingale
- Great Ormond Street for Hospital NHS Foundation Trust, London, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - Gretl McHugh
- School of Healthcare, University of Leeds, Leeds, UK
| | - Susan Kirk
- School of Health Sciences, University of Manchester, Manchester, UK
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Trudeau B, Trudeau C, Polfuss ML, Sullivan-Bolyai S. A Developmental Milestones Map of Type 1 Diabetes Self-Management Transition From Parents to Adolescents. Diabetes Spectr 2019; 32:21-29. [PMID: 30853761 PMCID: PMC6380240 DOI: 10.2337/ds18-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Transitional diabetes self-management (DSM) for children and their families is complicated. This article was undertaken to provide an exemplar of DSM strategies used by one family that were based on developmental milestones from preschool through college age. Two brothers who were both diagnosed with type 1 diabetes before the age of 2 years reflected on how their parents began a DSM navigation process during their early preschool years. Personal strategies and recommendations successfully resulted in both youths transitioning to college. With the parents serving as DSM coaches to the boys, an interdependent relationship was built. Key recommendations include 1) starting early, 2) being consistent and flexible, 3) using "invisible actions" and "what ifs," 4) incorporating technology and community resources into DSM, and 5) building confidence with shared problem-solving.
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Affiliation(s)
- Bobby Trudeau
- Undergraduate student, Rensselaer Polytechnic Institute, Troy, NY
| | - Cameron Trudeau
- Undergraduate student, University of Massachusetts Amherst, Amherst, MA
| | - Michele Lynn Polfuss
- University of Wisconsin–Milwaukee College of Nursing, Milwaukee, WI
- Children’s Hospital of Wisconsin, Wauwatosa, WI
| | - Susan Sullivan-Bolyai
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA
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35
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Lee S, Chen B, Wong S, Chang S, Tsai M, Wang R. Psychometric testing of the short‐form Chinese version of the self‐management for adolescents with type 1 diabetes scale. Res Nurs Health 2018; 41:563-571. [DOI: 10.1002/nur.21910] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 08/25/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Shu‐Li Lee
- College of NursingKaohsiung Medical UniversityKaohsiungTaiwan
| | - Bai‐Hsiun Chen
- Department of PediatricsKaohsiung Medical University HospitalKaohsiungTaiwan
| | - Siew‐Lee Wong
- Department of PediatricsChia‐Yi Christian HospitalChia‐YiTaiwan
| | - Shu‐Chen Chang
- Department of Nursing, Changhua Christian Hospital, and Assistant ProfessorCollege of Nursing and Health SciencesDayeh UniversityChanghuaTaiwan
| | - Meng‐Che Tsai
- Division of Genetics Metabolism and EndocrinologyDepartment of PediatricsNational Cheng Kung University Hospital, and Clinical Assistant ProfessorCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Ruey‐Hsia Wang
- College of NursingKaohsiung Medical UniversityKaohsiungTaiwan
- Department of Medical ResearchKaohsiung Medical University HospitalKaohsiungTaiwan
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36
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Delamater AM, de Wit M, McDarby V, Malik JA, Hilliard ME, Northam E, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19 Suppl 27:237-249. [PMID: 30058247 DOI: 10.1111/pedi.12736] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 01/09/2023] Open
MESH Headings
- Adaptation, Psychological/physiology
- Adolescent
- Burnout, Psychological/psychology
- Burnout, Psychological/therapy
- Child
- Consensus
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Endocrinology/organization & administration
- Endocrinology/standards
- Humans
- International Cooperation
- Neurodevelopmental Disorders/therapy
- Pediatrics/organization & administration
- Pediatrics/standards
- Practice Patterns, Physicians'/standards
- Psychotherapy/methods
- Psychotherapy/standards
- Quality of Life/psychology
- Resilience, Psychological
- Societies, Medical/organization & administration
- Societies, Medical/standards
- Stress, Psychological/etiology
- Stress, Psychological/therapy
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Affiliation(s)
- Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Maartje de Wit
- Department of Medical Psychology, EMGO Institute for Health & Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Vincent McDarby
- National Children's Research Centre and Our Lady's Children's Hospital, Dublin, Ireland
| | - Jamil A Malik
- Center of Excellence, National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | | | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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37
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Strand M, Broström A, Haugstvedt A. Adolescents’ perceptions of the transition process from parental management to self‐management of type 1 diabetes. Scand J Caring Sci 2018; 33:128-135. [DOI: 10.1111/scs.12611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/15/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Marianne Strand
- Department of Pediatrics Ålesund Hospital Ålesund Norway
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Bergen Norway
| | - Anders Broström
- Department of Nursing School of Health and Welfare Jönköping University Jönköping Sweden
- Department of Clinical Neurophysiology Linköping University Hospital Linköping Sweden
| | - Anne Haugstvedt
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Bergen Norway
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38
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Rising Holmström M, Häggström M, Audulv Å, Junehag L, Coyne I, Söderberg S. To integrate and manage diabetes in school: Youth’s experiences of living with Type 1 diabetes in relation to school – a qualitative study. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/20573316.2017.1375599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Marie Häggström
- Department of Nursing Science, Mid Sweden University, SE-851 70 Sundsvall, Sweden
| | - Åsa Audulv
- Department of Nursing Science, Mid Sweden University, SE-851 70 Sundsvall, Sweden
| | - Lena Junehag
- Department of Nursing Science, Mid Sweden University Sundsvall, SE-83125 Östersund, Sweden
| | - Imelda Coyne
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier street, Dublin 2, Ireland
| | - Siv Söderberg
- Department of Nursing Science, Mid Sweden University Sundsvall, SE-83125 Östersund, Sweden
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Huyett LM, Ly TT, Forlenza GP, Reuschel-DiVirgilio S, Messer LH, Wadwa RP, Gondhalekar R, Doyle FJ, Pinsker JE, Maahs DM, Buckingham BA, Dassau E. Outpatient Closed-Loop Control with Unannounced Moderate Exercise in Adolescents Using Zone Model Predictive Control. Diabetes Technol Ther 2017; 19:331-339. [PMID: 28459617 PMCID: PMC5510043 DOI: 10.1089/dia.2016.0399] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The artificial pancreas (AP) has the potential to improve glycemic control in adolescents. This article presents the first evaluation in adolescents of the Zone Model Predictive Control and Health Monitoring System (ZMPC+HMS) AP algorithms, and their first evaluation in a supervised outpatient setting with frequent exercise. MATERIALS AND METHODS Adolescents with type 1 diabetes underwent 3 days of closed-loop control (CLC) in a hotel setting with the ZMPC+HMS algorithms on the Diabetes Assistant platform. Subjects engaged in twice-daily exercise, including soccer, tennis, and bicycling. Meal size (unrestricted) was estimated and entered into the system by subjects to trigger a bolus, but exercise was not announced. RESULTS Ten adolescents (11.9-17.7 years) completed 72 h of CLC, with data on 95 ± 14 h of sensor-augmented pump (SAP) therapy before CLC as a comparison to usual therapy. The percentage of time with continuous glucose monitor (CGM) 70-180 mg/dL was 71% ± 10% during CLC, compared to 57% ± 16% during SAP (P = 0.012). Nocturnal control during CLC was safe, with 0% (0%, 0.6%) of time with CGM <70 mg/dL compared to 1.1% (0.0%, 14%) during SAP. Despite large meals (estimated up to 120 g carbohydrate), only 8.0% ± 6.9% of time during CLC was spent with CGM >250 mg/dL (16% ± 14% during SAP). The system remained connected in CLC for 97% ± 2% of the total study time. No adverse events or severe hypoglycemia occurred. CONCLUSIONS The use of the ZMPC+HMS algorithms is feasible in the adolescent outpatient environment and achieved significantly more time in the desired glycemic range than SAP in the face of unannounced exercise and large announced meal challenges.
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Affiliation(s)
- Lauren M. Huyett
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
- William Sansum Diabetes Center, Santa Barbara, California
| | - Trang T. Ly
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California
| | - Gregory P. Forlenza
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Suzette Reuschel-DiVirgilio
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California
| | - Laurel H. Messer
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - R. Paul Wadwa
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ravi Gondhalekar
- William Sansum Diabetes Center, Santa Barbara, California
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Francis J. Doyle
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
- William Sansum Diabetes Center, Santa Barbara, California
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | | | - David M. Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Bruce A. Buckingham
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California
| | - Eyal Dassau
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
- William Sansum Diabetes Center, Santa Barbara, California
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
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Ersig AL, Tsalikian E, Coffey J, Williams JK. Stressors in Teens with Type 1 Diabetes and Their Parents: Immediate and Long-Term Implications for Transition to Self-Management. J Pediatr Nurs 2016; 31:390-6. [PMID: 26831378 DOI: 10.1016/j.pedn.2015.12.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 01/21/2023]
Abstract
UNLABELLED Teens with Type 1 diabetes and their parents experience every day and illness-related stress; however, understanding of how these stressors relate to the transition to adulthood is limited. The purpose of this study was to identify stressors of teens with Type 1 diabetes (T1DM) and their parents related to the impending transition to adulthood. DESIGN AND METHODS This study used open-ended questions to identify every day and illness-related stressors among 15 teens with T1DM and 25 parents seen in one pediatric diabetes clinic. Qualitative descriptive analysis identified themes in interview transcripts. RESULTS The primary teen stressor related to impending transition centered on ineffective self-management, often when they were taking over responsibility for T1DM management. Parents' concerns included immediate and long-term negative outcomes of teen self-management as well as financial resources and health insurance for the teen. Teens and parents both expressed specific concerns about outcomes and prevention of nocturnal hypoglycemia, and identified uncertainties related to teen health and diabetes-focused health care when no longer living in the parent's home. CONCLUSIONS Teens with Type 1 diabetes and their parents understand that independent teen self-management is a component of transition to adulthood, but worry about teen self-management outcomes. Concerns specific to health care transition included health insurance, T1DM resources, and teens' abilities to handle new situations. PRACTICE IMPLICATIONS Identifying current and future self-management concerns of individuals and families can facilitate targeted education and interventions to support successful transition to adulthood.
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Affiliation(s)
- Anne L Ersig
- College of Nursing, The University of Iowa, Iowa City, IA.
| | - Eva Tsalikian
- University of Iowa Carver College of Medicine, Stead Family Department of Pediatrics, Iowa City, IA
| | - Julie Coffey
- University of Iowa Carver College of Medicine, Stead Family Department of Pediatrics, Iowa City, IA
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41
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Christian BJ. Translational Research--Addressing the Challenge of Healthcare Transitions for Adolescents With Special Health Care Needs. J Pediatr Nurs 2015; 30:797-801. [PMID: 26293903 DOI: 10.1016/j.pedn.2015.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 07/29/2015] [Indexed: 11/27/2022]
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