1
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Farthing P, Bally J, Rennie DC. Perceptions Related to Death in Adolescents and Their Parents During the Management of Type 1 Diabetes: A Thematic Analysis. J Pediatr Health Care 2024; 38:586-594. [PMID: 38661590 DOI: 10.1016/j.pedhc.2024.04.002] [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: 12/18/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Type 1 diabetes (T1D) is associated with an increased risk of premature death compared to those without T1D, yet perceptions of dying have not been well studied. The purpose of this secondary analysis of existing data was to explore the fears of adolescents with T1D and their parents related to the possibility of death due to T1D. METHOD A reflexive thematic analysis was used to examine data from interviews conducted with adolescents with T1D and their parents who participated in a primary grounded theory study of interdependence in T1D management. FINDINGS Three themes were generated from the data including: (1) Facing the Reality of Death, (2) Fearing Highs and Lows, and (3) Finding a Way through Fears. Participants indicated they see death as a consequence of failing to optimally manage T1D. CONCLUSION Additional investigation is needed to explore the fear of death in adolescents with T1D and any fear their parents may have of their adolescents' mortality.
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Affiliation(s)
- Pamela Farthing
- Pamela Farthing, Saskatchewan Polytechnic, School of Nursing, Saskatoon, Canada..
| | - Jill Bally
- Jill Bally, Associate Professor, College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Donna C Rennie
- Donna C. Rennie, Professor Emeritus, College of Nursing, University of Saskatchewan, Saskatoon, Canada
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2
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Wong JJ, Hanes SJ, Flores H, Ngo J, Hood KK. Satisfaction with diabetes involvement: Exploring parent and adolescent perspectives. Diabet Med 2024; 41:e15254. [PMID: 38010056 PMCID: PMC11021166 DOI: 10.1111/dme.15254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
AIMS Both parent and adolescent involvement in type 1 diabetes management are critical during adolescence. The current study sought to understand the factors associated with parent and adolescent satisfaction with their own and one another's involvement in diabetes management. METHODS Cross-sectional baseline data from 157 parent-adolescent dyads enrolled in an RCT were used. Adolescent ages ranged from 12 to 19 (Mage = 14.7, SD = 1.89) and were balanced by gender (50.3% male). Paired t-tests examined concordance between parent and adolescent satisfaction, bivariate correlations identified correlates, and regressions examined unique associations. RESULTS Roughly, 43% of adolescents and 29% of parents were very satisfied with adolescent involvement in diabetes management, whereas 71% of adolescents and 26.1% of parents were very satisfied with parent involvement. Indicators of better glycaemic health (via higher percent time-in-range and lower HbA1c and percent time in hyperglycaemia) and psychosocial functioning (less diabetes distress and depression) were correlated with higher satisfaction. Parent satisfaction with adolescent involvement was higher among older adolescents (R = 0.198, p = 0.013). Non-Hispanic white youth were more satisfied with their own involvement than youth of colour (t(149) = -2.783, p = 0.003). Both percent time-in-range and one's own diabetes distress uniquely related to parent and adolescent satisfaction with adolescent involvement. Conversely, parent satisfaction with their own involvement was only uniquely associated with parent diabetes distress. CONCLUSION Both adolescent and parents' satisfaction with adolescents' involvement in self-management are indicators of both glycaemic control and psychosocial well-being, whereas parents' self-evaluations are more closely tied to diabetes-specific distress.
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Affiliation(s)
- Jessie J Wong
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Sarah J Hanes
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Haley Flores
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Jessica Ngo
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Korey K Hood
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, California, USA
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3
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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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4
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Ersig AL, Young EE, Brown RL, Malecki K. Genetic Variation, Stress, and Physiological Stress Response in Adults With Food Allergy or Celiac Disease. Biol Res Nurs 2023; 25:300-309. [PMID: 36280595 DOI: 10.1177/10998004221134826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persistently high chronic stress can lead to maladaptive psychological, behavioral, and physiological stress responses and poor mental and physical health, highlighting the importance of identifying individuals at increased risk. Chronic health condition diagnosis and genetics are 2 characteristics that can influence stress, stress response, and health outcomes. PURPOSE Food allergy (FA) and celiac disease (CD) require constant vigilance in daily life and can lead to increased stress. The purpose of this exploratory analysis was to examine the association of variants in selected stress-related genes with stress exposures, stress, clinical measures of physiological stress response, and mental health symptoms in adults with and without FA or CD. METHODS We compared stress exposures, symptoms of PTSD, depression, anxiety, and stress, BMI, and waist-hip ratio between cases and controls. We analyzed the association of SNPs in genes with known or hypothesized associations with stress-related measures in 124 cases and 124 matched controls: CRHBP (rs7718461, rs10474485), CRHR1 (rs242940) and OXTR (rs2268490). For this exploratory study, p-values ≤ 0.10 were considered suggestive. RESULTS For cases and controls, rs7718461 was associated with stress symptoms, rs2268490 with symptoms of stress and PTSD, and rs242940 with symptoms of stress, PTSD, anxiety, and depression. Further analyses found that stress-related outcomes in individuals with FA or CD may be influenced by SNP genotype. CONCLUSIONS Given these suggestive findings, larger prospective studies should examine similar relationships in individuals with other chronic health conditions, incorporating factors such as environmental exposures, individual experiences, and epigenetic modifications.
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Affiliation(s)
- Anne L Ersig
- 5228University of Wisconsin-Madison, School of Nursing, Madison, WI, USA
| | - Erin E Young
- 12251University of Kansas School of Medicine, Kansas City, KS, USA
| | - Roger L Brown
- 5228University of Wisconsin-Madison, School of Nursing, Madison, WI, USA
| | - Kristen Malecki
- Division of Environmental and Occupational Health Sciences, School of Public Health, 14681University of Illinois Chicago, Chicago, IL, USA
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5
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Diaz JVR, Figueroa J, Felner EI. A pilot study of mealtime insulin administration and parental stress in youth with new-onset type 1 diabetes. Diabet Med 2023; 40:e15039. [PMID: 36617389 DOI: 10.1111/dme.15039] [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: 08/14/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
AIMS To compare the stress level in parents of children with new-onset type 1 diabetes receiving a fixed insulin dose for a fixed range of carbohydrates (CHOs) to parents of children receiving a precise insulin dose for a precise number of CHOs using an insulin-to-carbohydrate ratio (ICR). METHODS Twenty-four participants (8-14 years) were randomized to receive a fixed dose of insulin for a fixed range of CHOs (FD group) or a precise dose of insulin for a precise number of carbohydrates using an ICR (ICR group). The primary endpoint was parental stress measured with the parental stress survey (PSS) 1 to 4 months after diagnosis. Secondary endpoints included glycemic variability, glycated haemoglobin (HbA1C ) and safety. RESULTS Compared to parents of children in the ICR group, those from the FD group reported less stress during the first 4 months after diagnosis (p = 0.022). Glycemic variability and HbA1C were similar in both groups. None of the patients from either group required an emergency department visit or hospitalization. CONCLUSIONS In comparison to precise insulin dosing using an ICR, fixed insulin dosing for a fixed range of CHOs may be less stressful for parents to learn and employ when initially taught diabetes management skills for their child with new-onset type 1 diabetes.
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Affiliation(s)
- Jacqueline V Reyes Diaz
- Department of Pediatrics, Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, United States
- Children's Healthcare of Atlanta (CHOA), Atlanta, Georgia, United States
| | - Janet Figueroa
- Department of Pediatrics, Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Eric I Felner
- Department of Pediatrics, Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, United States
- Children's Healthcare of Atlanta (CHOA), Atlanta, Georgia, United States
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6
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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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7
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Rankin D, Kimbell B, Hovorka R, Lawton J. Adolescents' and their parents' experiences of using a closed-loop system to manage type 1 diabetes in everyday life: qualitative study. Chronic Illn 2022; 18:742-756. [PMID: 33472409 PMCID: PMC9643806 DOI: 10.1177/1742395320985924] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Type 1 diabetes can have life-shattering consequences for adolescents and parents. A closed-loop system is a cutting-edge technology which automatically regulates glucose to reduce the burden of diabetes management. We explored adolescents' and parents' experiences of using this technology to understand how it affects their biographies and everyday lives. METHODS In-depth interviews with 18 adolescents newly diagnosed with type 1 diabetes and 21 parents after ≥12 months experience using closed-loop technology. Data were analysed thematically. RESULTS Participants reported very few disruptions to their lives when using a closed-loop. Reports of family conflict were minimal as the closed-loop enabled dietary flexibility and glucose levels to be checked effortlessly. Adolescents described doing 'normal' activities without worrying about high/low glucose, and parents reported allowing them to do so unsupervised because the closed-loop would regulate their glucose and keep them safe. Some adolescents expressed concerns about the visibility of components and, to avoid stigma, described curtailing activities such as swimming. Participants described how the closed-loop enabled adolescents to be in control of, or create distance from, diabetes. DISCUSSION The closed-loop has life-enhancing consequences for both adolescents and parents and helps to reduce the biographical disruption of type 1 diabetes in this age group.
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Affiliation(s)
- D Rankin
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - B Kimbell
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - R Hovorka
- Wellcome Trust - Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - J Lawton
- Usher Institute, University of Edinburgh, Edinburgh, UK
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8
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Taraban L, Wasserman R, Cao VT, Eshtehardi SS, Anderson BJ, Thompson D, Marrero DG, Hilliard ME. Diabetes-Related Worries and Coping Among Youth and Young Adults With Type 1 Diabetes. J Pediatr Psychol 2022; 47:1145-1155. [PMID: 35773974 PMCID: PMC9582784 DOI: 10.1093/jpepsy/jsac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Although mood and anxiety symptoms are common in youth with type 1 diabetes (T1D), little research has described their worries across developmental stages or the strategies they use to cope with these worries. This secondary data analysis aimed to describe and characterize common T1D-related worries and coping strategies from middle childhood through young adulthood. METHODS Twenty-three youth (9 children, 7 adolescents, and 7 young adults) completed semistructured qualitative interviews about health-related quality of life. We coded interview transcripts using thematic analysis to generate common themes of diabetes-related worries and coping strategies. RESULTS Participants' worries fell into four major themes: Managing Blood Glucose, Self-Efficacy for Diabetes Management, Interpersonal Relationships, and Lifestyle Impact, and eight youth denied having diabetes-related worries. Coping strategies fell into the three major themes: Attempts to Change Source of Worry, Attempts to Change Reactions to Worry, and Attempts to Orient Away from the Worry. CONCLUSIONS Youths' worries about various aspects of living with and feeling able to self-manage diabetes are important to consider across pediatric development as they can impact youths' participation in daily activities and future plans. By adolescence, youth report longer-term worries about the health and lifestyle implications of diabetes. Youths' reported coping strategies are generally consistent with existing coping frameworks, though our data suggest some possible refinements. Social support emerged as an important coping strategy for all age groups. Thus, interventions supporting youth in building and strengthening their social networks may be particularly beneficial in helping youth cope with their diabetes-related worries across development.
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Affiliation(s)
- Lindsay Taraban
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, USA
| | - Rachel Wasserman
- Nemours Children’s Health and University of Central Florida College of Medicine, USA
| | - Viena T Cao
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, USA
| | - Sahar S Eshtehardi
- Department of Psychological Health and Learning Sciences, University of Houston, USA
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, USA
| | - Debbe Thompson
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, USA
| | | | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, USA
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9
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Yi-Frazier JP, Senturia K, Wright DR, Lind C, Malik FS. The clock is ticking: Parental stress around emerging adulthood for adolescents with type 1 diabetes. J Pediatr Nurs 2022; 62:164-170. [PMID: 34294485 PMCID: PMC9273159 DOI: 10.1016/j.pedn.2021.07.012] [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: 12/09/2020] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Our goal was to explore parental views on the challenges and stressors of transition to young adulthood for adolescents with type 1 diabetes and to describe specific strategies used to reduce parents' own stress during this time. DESIGN AND METHODS Focus groups with 39 parents of adolescents with type 1 diabetes were conducted in the greater Seattle area. Semi-structured prompts addressed adolescents' self-care tasks, parental assistance with care, challenges and barriers with self-care tasks, and stress/pressure around self-care. Data was analyzed using qualitative methods for emerging themes. RESULTS Parental stress was heightened when adolescents were approaching common developmental milestones such as driving, moving out, and engaging in risky behaviors that could be exacerbated by poor diabetes management. Thus, most parents reported providing assistance even late into adolescence. Parents shared strategies for guiding adolescents' transition from assisted to independent care with an emphasis on active behaviors parents could continue, thereby lowering their own stress. CONCLUSIONS Parents of adolescents with type 1 diabetes experienced significant stress around their children's transition to independent diabetes self-care management. PRACTICE IMPLICATIONS As part of overall preparation for transition, care providers should be encouraged to communicate with parents about these common stressors and promising avenues for nurturing a teen's independence.
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Affiliation(s)
- Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Kirsten Senturia
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Cara Lind
- Center for Child Health Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Faisal S Malik
- Center for Child Health Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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10
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Montali L, Zulato E, Cornara M, Ausili D, Luciani M. Barriers and facilitators of type 1 diabetes self-care in adolescents and young adults. J Pediatr Nurs 2022; 62:136-143. [PMID: 34561133 DOI: 10.1016/j.pedn.2021.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/12/2021] [Accepted: 09/12/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE This study explores the disease experience of adolescents and young adults with T1DM focusing on the barriers and facilitators that characterise their disease self-care. Self-care requires complex decision making and cooperation between patients, their families, the healthcare team, and the social support system. Personal and social factors affect self-care, and specific challenges impact adolescents and young adults, putting them at a higher risk of poor glycaemic control and more severe complications. DESIGN AND METHODS The study uses a qualitative description approach. Twenty-two people (15 women; 10-30 years old; 2-24 years from diagnosis) were purposefully recruited through snowballing techniques. Data were collected with semi-structured interviews and analysed inductively with semantic thematic analysis. RESULTS Four themes and nine subthemes conceptualise the patients' experience as a life-long journey that has its difficult beginning at the time of diagnosis and continues through the resolution of the initial crisis by integrating disease at the identity level and acquiring expertise. Technology and social environment act both as self-care barriers and facilitators. CONCLUSIONS Findings highlight the importance of designing and improving technology related to diabetes accounting for patients' experiences. Second, it is imperative to work towards a de-stigmatisation of diabetes. Finally, health professionals should work with people with T1DM on the psychological aspects of the disease and identity integration. PRACTICE IMPLICATIONS Diabetes-related technology should promote usability and acceptability while addressing visibility and device burden issues. Clinicians should pay particular attention during the transition from the paediatric to the adult centres and offer global assessments and treatment.
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Affiliation(s)
- Lorenzo Montali
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, Italy.
| | - Edoardo Zulato
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, Italy.
| | - Mattia Cornara
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, Italy.
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, Italy.
| | - Michela Luciani
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, Italy.
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11
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Clinical Measures of Allostatic Load in Children and Adolescents with Food Allergy, Depression, or Anxiety. J Pediatr Nurs 2021; 61:346-354. [PMID: 34555747 PMCID: PMC8665031 DOI: 10.1016/j.pedn.2021.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Sustained high stress exposure results in chronic activation of the stress response system, dysregulated stress responses, high allostatic load, and poor later-life health. Children and adolescents with chronic health conditions face stressors related to their condition in addition to those typical of childhood and adolescence, placing them at risk of high allostatic load. The purpose of this secondary analysis was to examine whether youth with chronic health conditions differ from controls on clinical measures of allostatic load. DESIGN AND METHODS A secondary analysis of two datasets, the electronic health record of a tertiary children's hospital and data from the Survey of the Health of Wisconsin, compared youth with chronic health conditions to controls on clinical measures of allostatic load. Additional analyses explored whether parental stress and mental health influenced these relationships. RESULTS Analyses identified differences in BMI, blood pressure, and waist circumference between youth with food allergy, anxiety, or depression, and controls. These relationships differed for males and females and for those with comorbid mental and physical conditions, and were influenced by parent stress and mental health. CONCLUSIONS Results support future studies exploring whether high stress in youth with chronic health conditions leads to increased allostatic load. Incorporating biomarkers as well as genetic and epigenetic factors will provide critical insights. PRACTICE IMPLICATIONS Youth with mental and physical CHCs may be at increased risk of high allostatic load, reflected in clinical measures of metabolism, and should have regular assessments of their metabolic health.
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12
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Papadakis JL, Shapiro JB, Evans M, Feldman MA, Weil LEG, Vesco AT, Thompson LG, Garza K, Weissberg-Benchell J. Psychometric properties of the diabetes skills checklist for adolescents with type 1 diabetes and their parents. Pediatr Diabetes 2021; 22:924-932. [PMID: 34173308 DOI: 10.1111/pedi.13241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Among adolescents with type 1 diabetes, research has found that their perception of their diabetes management is an important predictor of actual diabetes management. There is a need for measures that assess adolescents' perception of their ability to independently complete daily diabetes self-care tasks. The current study examined the psychometric properties of the Diabetes Skills Checklist Teen-Report (DSC-T) and DSC Parent of Teen-Report (DSC-PT), which assess perceived independence in diabetes self-care skills. RESEARCH DESIGN AND METHODS Data were from 1450 adolescents aged 12 to 18 years and their parents who participated in the Diabetes Camp Matters Study. Families completed the DSC as well as other questionnaires online assessing demographic and diabetes-related information, diabetes strengths, and diabetes-specific emotional distress. RESULTS Exploratory factor analysis revealed a 14-item DSC-T and 12-item DSC-PT, both with excellent internal consistency and concurrent validity. Both the DSC-T and DSC-PT were found to be positively correlated with diabetes strengths and negatively correlated with HbA1c, and the DSC-PT was significantly correlated with parent-reported diabetes distress. Adolescents who used insulin pumps and continuous glucose monitoring reported higher perceived independence in diabetes self-care skills compared to adolescents who used insulin pens/syringes or blood glucose meters. No differences were found based on demographic characteristics. CONCLUSIONS The DSC-T and DSC-PT have strong potential to be used during diabetes clinic visits to spark discussion regarding adolescents' self-care, which would allow for a more successful transfer of diabetes care from parent to adolescent, and eventually, the transition from pediatric to adult healthcare.
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Affiliation(s)
- Jaclyn Lennon Papadakis
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jenna B Shapiro
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Meredyth Evans
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marissa A Feldman
- Child Development and Rehabilitation Center, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Lindsey E G Weil
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anthony T Vesco
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laurie Gayes Thompson
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kimberly Garza
- Department of Anthropology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jill Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Shelat T, Mastrandrea LD, Majumdar I, Quattrin T. Perceptions of Diabetes Self-Efficacy and Glycemic Control in Youth With Type 1 Diabetes. Diabetes Spectr 2021; 34:313-320. [PMID: 34511859 PMCID: PMC8387614 DOI: 10.2337/ds20-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Chiang Y, Tsay P, Chen C, Hsu C, Yu H, Chang C, Lo F, Moons P. A Delphi Study on the Healthcare Needs of Patients with Type 1 Diabetes during the Transition from Adolescence to Adulthood: Consensus among Patients, Primary Caregivers, and Healthcare Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137149. [PMID: 34281086 PMCID: PMC8296953 DOI: 10.3390/ijerph18137149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Patients with type 1 diabetes mellitus at the age of 16-25 face the challenges of the deterioration of disease control and accelerated exacerbation. Providing interventions that meet patient's healthcare needs can reduce the impact and improve health outcome. The purpose of this study was to identify the healthcare needs of patients with type 1 diabetes during the adolescence to adulthood transition period from the perspectives of patients, parents and healthcare providers. A two-round Delphi study was conducted among 48 participants, and included 17 patients, 16 primary caregivers, and 15 healthcare providers. The central tendency and dispersion were computed to establish a consensus. Seventy-one healthcare needs were identified across five dimensions-technology, external support, internal support, management, and healthcare-and 56 were considered as important healthcare needs and with a moderate to high level of agreement. Meanwhile, patients, primary caregivers, and healthcare providers were found to display significantly different opinions (p < 0.05) for 23 healthcare needs. This study concluded the consensus of the healthcare needs of patients with type 1 diabetes mellitus during the adolescence to adulthood transition period from a systematic investigation. The findings can serve as reference for developing transitional intervention strategies.
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Affiliation(s)
- Yuehtao Chiang
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan 33302, Taiwan; (H.Y.); (C.C.)
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Correspondence: (Y.C.); (F.L.); Tel.: +886-3-2118800 (ext. 3866) (Y.C.); Tel.: +886-3-3281200 (ext. 8969) (F.L.)
| | - Peikwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang-Gung University, Taoyuan 33302, Taiwan;
| | - Chiwen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
| | - Chienlung Hsu
- Department of Information Management, Chang-Gung University, Taoyuan 33302, Taiwan;
- Graduate Institute of Business and Management, Chang Gung University, Taoyuan 33302, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Visual Communication Design, Ming Chi University of Technology, New Taipei 24301, Taiwan
- Department of Nursing, Taoyuan Chang Gung Memorial Hospital, Taoyuan 33044, Taiwan
| | - Hsingyi Yu
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan 33302, Taiwan; (H.Y.); (C.C.)
- Department of Nursing, Chang-Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chiwen Chang
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan 33302, Taiwan; (H.Y.); (C.C.)
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Fusung Lo
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan 33305, Taiwan
- College of Medicine, Chung-Gung University, Taoyuan 33302, Taiwan
- Correspondence: (Y.C.); (F.L.); Tel.: +886-3-2118800 (ext. 3866) (Y.C.); Tel.: +886-3-3281200 (ext. 8969) (F.L.)
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven-University of Leuven, 3000 Leuven, Belgium;
- Institute of Health and Care Sciences, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7701, South Africa
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Lawton J, Hart RI, Kimbell B, Allen JM, Besser REJ, Boughton C, Elleri D, Fuchs J, Ghatak A, Randell T, Thankamony A, Trevelyan N, Hovorka R, Rankin D. Data Sharing While Using a Closed-Loop System: Qualitative Study of Adolescents' and Parents' Experiences and Views. Diabetes Technol Ther 2021; 23:500-507. [PMID: 33605790 PMCID: PMC8252900 DOI: 10.1089/dia.2020.0637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective: To understand and explore data sharing practices among adolescents and their parents using a closed-loop system. Methods: Eighteen adolescents (aged 11-18 years) and 19 parents were interviewed after adolescents had ∼6 months experience of using a closed-loop system, which permitted them to share glucose and insulin data with parents/caregivers. Data were analyzed thematically. Results: There was considerable variability in how parent-child dyads perceived, valued, and undertook data sharing. Parents of early adolescents (11-13 years) reported making extensive use of "real time" data to remotely manage their child's diabetes and early adolescents described needing and wanting this input. Parents of middle adolescents (14-16 years) described making greater use of retrospective data. To avoid conflict and encourage and support their son/daughter's autonomy, these individuals reported practicing watchful waiting and only intervening after concerns about a pattern of problematic behavior or their child's safety arose. Middle adolescents indicated that data sharing had been done primarily for the benefit of their parents, although they also noted quality of life benefits for themselves. Among late adolescents (17+ years), parents were simply remote because their son/daughter had not permitted access to their data. Participants recommended clear ground rules be put in place about when, and how, data sharing should be used. Conclusions: To help parent-child dyads use data sharing in ways which minimize conflict and optimize constructive parental support, we recommend tailored input and support, which takes account of family dynamics, the young person's developmental maturity, and the different ways in which data are used across the adolescent age range.
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Affiliation(s)
- Julia Lawton
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, United Kingdom
- Address correspondence to: Julia Lawton, BA, PhD, Usher Institute, Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Ruth I. Hart
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Barbara Kimbell
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Janet M. Allen
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Elizabeth Jane Besser
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Charlotte Boughton
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Daniela Elleri
- Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Julia Fuchs
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Atrayee Ghatak
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- Children's Services, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Nicola Trevelyan
- Department of Child Health, Southampton Children's Hospital, Southampton, United Kingdom
| | - Roman Hovorka
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - David Rankin
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, United Kingdom
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16
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Teh KL, Hoh SF, Arkachaisri T. The Coming-of-Age Transition Care for Adolescents with Rheumatic Disease-Where Are We and What Have We Done in Asia? J Clin Med 2021; 10:jcm10040821. [PMID: 33671413 PMCID: PMC7923028 DOI: 10.3390/jcm10040821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022] Open
Abstract
The transition from pediatric to adult health care is a challenging yet important process in rheumatology as most childhood-onset rheumatic diseases persist into adulthood. Numerous reports on unmet needs as well as evidence of negative impact from poor transition have led to increased efforts to improve transition care, including international guidelines and recommendations. In line with these recommendations, transition programs along with transition readiness assessment tools have been established. Despite these efforts, there are still a lot of work to be done for transition care in rheumatology. This review article focuses on how transition care in rheumatology has developed in recent years and highlights the gaps in current practices.
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Affiliation(s)
- Kai Liang Teh
- Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
| | - Sook Fun Hoh
- Division of Nursing, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
| | - Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
- Pediatric Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Correspondence:
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The Development of Health Self-Management Among Adolescents With Chronic Conditions: An Application of Self-Determination Theory. J Adolesc Health 2021; 68:394-402. [PMID: 32713740 DOI: 10.1016/j.jadohealth.2020.05.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the study was to better understand the progressive development of health self-management among adolescents and emerging adults (AEAs) with chronic medical conditions in order to identify opportunities to prepare AEA for transition to adult-based care. METHODS Twenty-three AEA aged 17-20 years with renal, inflammatory bowel, or rheumatologic diseases, and their parents, completed individual semistructured interviews describing each AEA's health self-management. Self-Determination Theory was used to frame interview questions, including the constructs of competence, autonomy, and autonomy support. Transcripts were analyzed using directed content analysis. RESULTS Four themes emerged: Development of Competence in Self-Management; Autonomy: Motivations to Self-Manage; Ways Important Others Support or Hinder Independence; and Normal Adolescent Development. AEA's competency and autonomy increased as they progressed from lack of knowledge about self-management to having knowledge without doing tasks, and, ultimately, to independent completion of tasks. Motivations to self-manage included avoiding sickness/weakness and wanting to engage in activities. Parents and providers supported AEA's autonomy through teaching and transferring responsibility. Parental fear/lack of trust in AEA's ability to self-manage hindered development of AEA's autonomy, producing anxiety. Normal adolescent development impacted timing of self-management task mastery. CONCLUSIONS As AEA gain competence in increasingly complex self-management tasks, they assume greater responsibility for managing their health. Competence and autonomy are facilitated by a feedback loop: AEA successful self-management increased parent trust, enabling the parent to transfer responsibility for more complex tasks. Conversely, parents' fear of the AEA doing wrong hinders transfer of responsibility, limiting competence and autonomy. Health-care providers play an important role in fostering autonomy.
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18
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Chiang YT, Yu HY, Lo FS, Chen CW, Huang TT, Chang CW, Moons P. Emergence of a butterfly: the life experiences of type 1 diabetes Taiwanese patients during the 16-25 years old transition period. Int J Qual Stud Health Well-being 2021; 15:1748362. [PMID: 32292126 PMCID: PMC7178814 DOI: 10.1080/17482631.2020.1748362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: To explore the life experiences of patients with type 1 diabetes transition from adolescence into adulthood in Taiwan. Methods: Descriptive phenomenological design was used. Fourteen participants were individually interviewed using a semi-structured interview. Results: The life experiences of patients with type 1 diabetes transition from adolescence into adulthood experience a metamorphosis from awareness of responsibility to figuring out a way to care for themselves. Six themes emerged: (1) hibernation: awareness of responsibility; (2) emergence: attempts to take responsibility; (3) perseverance: encountering difficulties; (4) anxiety: multiple worries; (5) hesitation: back-and-forth,” and (6) exit: finding a way out.” Conclusions: During the transition phase, the participants experienced the trials of various situations. Regardless of whether they are able to independently bear the responsibilities of self-management, they all hope to turn around the challenges of disease control and take ownership of their disease. Like a butterfly that emerges from a cocoon, they hoped to overcome the dangers of taking flight through trial and error and navigating the world. The results of this study can serve as a reference for clinical care and developing localized intervention strategies targeted to the transition period between adolescence and young adulthood.
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Affiliation(s)
- Yueh-Tao Chiang
- School of Nursing, College of Medicine, Chang-Gung University, Tao-yuan, Taiwan.,Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Tao-yuan, Taiwan
| | - Hsing-Yi Yu
- School of Nursing, College of Medicine, Chang-Gung University, Tao-yuan, Taiwan.,Department of Nursing, Chang-Gung Memorial Hospital, Tao-yuan, Taiwan
| | - Fu-Sung Lo
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang- Gung Memorial Hospital, Tao-yuan, Taiwan.,College of Medicine, Chung-Gung University, Tao-yuan, Taiwan
| | - Chi-Wen Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Tzu-Ting Huang
- School of Nursing, College of Medicine, Chang-Gung University, Tao-yuan, Taiwan.,Department of Neurology (Dementia Center), Chang-Gung Memorial Hospital, Tao-yuan, Taiwan
| | - Chi-Wen Chang
- School of Nursing, College of Medicine, Chang-Gung University, Tao-yuan, Taiwan.,Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Tao-yuan, Taiwan
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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19
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Sanjari M, Peyrovi H, Mehrdad N. The Process of Managing the Children with Type 1 Diabetes in the Family: A Grounded Theory Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:25-33. [PMID: 33954095 PMCID: PMC8074732 DOI: 10.4103/ijnmr.ijnmr_5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/02/2020] [Accepted: 08/23/2020] [Indexed: 11/04/2022]
Abstract
Background: Diabetes is a disease that affects all family members. Parents of children with type 1 diabetes are always concerned about all aspects of children's life. The aim of this study was to elucidate the process of managing children with diabetes in the family. Materials and Methods: This is a qualitative grounded theory of a doctoral dissertation, which was done on 2016. The 18 participants were selected through purposive and theoretical sampling until data saturation. The main participants in this study included parents, siblings, and children with type 1 diabetes. The data was gathered by semi-structured interviews as well as field notes and memos. Data analysis was done concurrently with data collection in four levels, including data analysis for concept and contex, bringing the process into the analysis, and integration of categories according to Corbin and Struss (2008). Core category appeared at the end of integrated categories. Results: “The family with diabetes in the child's diabetes orbit” as a core category contains the process of managing children with diabetes within the family, which included three main subcategories, including “entering into the diabetes orbit”, “movement into the diabetes orbit”, and “living into the diabetes orbit”. Conclusions: The family through the concept of “The family with diabetes in the child's diabetes orbit “as a main concern of families with diabetes suffering diabetes attempt to select and practicing appropriate strategies and manage diabetes and children with diabetes.
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Affiliation(s)
- Mahnaz Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Peyrovi
- Department of Critical Care Nursing, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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20
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Pritlove C, Markowitz B, Mukerji G, Advani A, Parsons JA. Experiences and perspectives of the parents of emerging adults living with type 1 diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e001125. [PMID: 33004400 PMCID: PMC7534673 DOI: 10.1136/bmjdrc-2019-001125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Whereas it is widely recognized that emerging adulthood can be a difficult time in the life of an individual living with type 1 diabetes, relatively little is known about the experiences of their parents or guardians. These individuals once shouldered much of the burden for their child's diabetes 'self'-management, yet their contribution is often overlooked by the adult healthcare system. Here, we set out to gain an understanding of the perspectives of parents of emerging adults living with type 1 diabetes. RESEARCH DESIGN AND METHODS Semi-structured interviews were performed with a purposeful sample of parents of emerging adults with type 1 diabetes recruited from two urban young adult diabetes clinics and through a national diabetes charity. Thematic coding was derived using a constant comparative approach. RESULTS Analysis of interviews with 16 parents of emerging adults with type 1 diabetes identified three themes: parental experiences of the transition to adult care; negotiating parent-child roles, responsibilities and relationships; and new and evolving fears. Parents spoke in detail about the time surrounding their child's diagnosis of type 1 diabetes to emphasize the complexity of diabetes care and the need to establish a 'new normal' for the family. In turn, adolescence and emerging adulthood required a renegotiation of roles and responsibilities, with many parents continuing to play a role in high-level diabetes management. Several parents of emerging adults with type 1 diabetes (particularly those of young men) vocalized worries about their child's readiness to assume responsibility for their self-care, and some expressed frustration with the apparent dichotomy in the role expectations of parents between the pediatric and adult care settings. CONCLUSIONS Adult healthcare providers should recognize both the ongoing involvement of parents in the 'self'-management of emerging adults with type 1 diabetes and the unique aspects of the caregiver burden that they experience.
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Affiliation(s)
- Cheryl Pritlove
- Applied Health Research Centre, Li ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Benjamin Markowitz
- Applied Health Research Centre, Li ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Division of Endocrinology, Women's College Hospital, Toronto, Ontario, Canada
- WCH Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Andrew Advani
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Janet A Parsons
- Applied Health Research Centre, Li ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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21
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Ness MM, Saylor JL, Ji X, Bell A, Habermann B. Challenges Experienced by Parents of Emerging Young Adults With Type 1 Diabetes Mellitus During the Transition to College. DIABETES EDUCATOR 2020; 46:435-443. [PMID: 32734833 DOI: 10.1177/0145721720943120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study is to gain a deeper understanding of the challenges experienced by parents of emerging young adults (EYAs) with type 1 diabetes mellitus (T1DM) who completed their freshman or sophomore year of college. METHODS Using a descriptive, qualitative design, 16 parents participated in semistructured interviews that explored factors impacting the college transition for parents of college freshmen and sophomores with T1DM. Participants were recruited from local endocrinology clinics as well as the College Diabetes Network (CDN) Parent Facebook page, the CDN Facebook page, the CDN Twitter feed, and the Delaware Chapter of the JDRF (formerly Juvenile Diabetes Research Foundation). Researchers used a thematic analysis to analyze the data and develop categories. Interviews were conducted and recorded via video conferencing from July 2019 to September 2019. RESULTS Results represent data from 16 interviews comprising 15 (94%) mothers and 1 father. Thematic analysis resulted in the emergence of 3 themes: managing parental concerns, changes in the parental role, and identifying sources of parental support. Parents identified several challenges including the EYAs' ability to manage T1DM at college, communication with the EYA, and the availability of support for parents. CONCLUSION Parents experience several challenges during their EYA's transition to college with T1DM. Supporting the needs of parents and EYAs during this time may serve to reduce diabetes-related complications for EYAs and increase overall quality of life for both members of the dyad.
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Affiliation(s)
| | | | - Xiaopeng Ji
- School of Nursing, University of Delaware, Newark, Delaware
| | - Ann Bell
- School of Nursing, University of Delaware, Newark, Delaware
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22
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Otis M, Zhu J, Mustafa-Kutana SN, Bernier AV, Ma Shum J, Soros Dupre AA, Wang ML. Testing Usability and Feasibility of a Mobile Educator Tool for Pediatric Diabetes Self-Management: Mixed Methods Pilot Study. JMIR Form Res 2020; 4:e16262. [PMID: 32356773 PMCID: PMC7229529 DOI: 10.2196/16262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/02/2019] [Accepted: 02/10/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mobile interventions hold promise as an intervention modality to engage children in improving diabetes self-management education, attitudes, and behaviors. OBJECTIVE This pilot study aimed to explore the usability, acceptability, and feasibility of delivering a mobile diabetes educational tool to parent-child pairs in a clinical setting. METHODS This mixed methods pilot study comprised two concurrent phases with differing study participants. Phase 1 used user testing interviews to collect qualitative data on the usability and acceptability of the tool. Phase 2 used a single-arm pre- and poststudy design to quantitatively evaluate the feasibility and preliminary efficacy of the intervention. Study participants (English-speaking families with youth aged 5-14 years with insulin-dependent diabetes) were recruited from an urban hospital in Massachusetts, United States. In phase 1, parent-child pairs were invited to complete the intervention together and participate in 90-min user testing interviews assessing the tool's usability and acceptability. Interview transcripts were analyzed using a directed content analysis approach. In phase 2, parent-child pairs were invited to complete the intervention together in the clinical setting. Measures included parental and child knowledge, attitudes, and behaviors related to diabetes management (self-report surveys) and child hemoglobin A1c levels (medical record extractions); data were collected at baseline and 1-month follow-up. Pre- and postoutcomes were compared using paired t tests and the Fisher exact test. RESULTS A total of 11 parent-child pairs (N=22) participated in phase 1 of the study, and 10 parent-child pairs (N=20) participated in phase 2 of the study. Participants viewed the mobile educational tool as acceptable (high engagement and satisfaction with the layout, activities, and videos) and identified the areas of improvement for tool usability (duration, directions, and animation). CONCLUSIONS The findings from this pilot study suggest that the mobile educational tool is an informative, engaging, and feasible way to deliver diabetes self-management education to parents and children in an urban hospital setting. Data will inform future iterations of this mobile diabetes educational intervention to improve usability and test intervention efficacy.
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Affiliation(s)
- Marisa Otis
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Jack Zhu
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Suleiman N Mustafa-Kutana
- Division of Pediatric Endocrinology and Metabolism, Boston Medical Center, Boston, MA, United States
| | - Angelina V Bernier
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL, United States
| | - Julio Ma Shum
- Division of Pediatric Endocrinology and Metabolism, Boston Medical Center, Boston, MA, United States
| | - Arlette A Soros Dupre
- Division of Pediatric Endocrinology and Metabolism, Boston Medical Center, Boston, MA, United States
| | - Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
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23
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Whittemore R, Coleman J, Delvy R, Zincavage R, Ambrosoli JA, Shi L, Kato B, Marceau L. An eHealth Program for Parents of Adolescents With T1DM Improves Parenting Stress: A Randomized Control Trial. DIABETES EDUCATOR 2019; 46:62-72. [PMID: 31808376 DOI: 10.1177/0145721719890372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the short-term effects of the Type 1 Teamwork program for parents of adolescents with type 1 diabetes mellitus (T1DM) on the primary outcome of psychosocial stress. METHODS The study was a randomized wait-list control trial evaluating an eHealth program to reduce parenting stress around T1DM management during adolescence through interactive sessions on the safe transfer of responsibility, positive communication, and stress management. The primary outcome was psychosocial stress (parenting stress specific to child illness and general stress). Secondary outcomes included depressive and anxiety symptoms, parent support for adolescent autonomy, family conflict, and adolescent metabolic control (A1C). Data were collected at baseline, 3 months, and 6 months online. Mixed-model analyses were conducted, using intent-to-treat procedures. RESULTS Parents (n = 162) had a mean age of 45.6 (±5.3) years, were 98% female, 91% white, 91% married/partnered, 51% of high income, and geographically dispersed around the United States. Parents reported that adolescents had a mean A1C of 7.9% (±1.2%) and T1DM duration of 5.08 (±3.62) years. At 6 months, parents in the Type 1 Teamwork group demonstrated less parenting stress compared with the control group. There were no differences between groups on general stress or secondary outcomes. Attrition at 6 months was 32% in the treatment group and 11% in the control group. CONCLUSIONS An eHealth program for parents of adolescents with T1DM improves parenting stress in a sample of parents from across the United States.
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Affiliation(s)
| | | | | | | | | | - Ling Shi
- HealthCore, Inc, Watertown, Massachusetts
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24
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Luo D, Xu JJ, Cai X, Zhu M, Wang H, Yan D, Li MZ. The effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes. J Clin Nurs 2019; 28:4478-4487. [PMID: 31410916 DOI: 10.1111/jocn.15033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/24/2019] [Accepted: 08/03/2019] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To examine the effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes and to determine whether resilience mediates the effects of family functioning on self-management and glycaemic control. BACKGROUND Poor self-management and glycaemic control are common in youth with type 1 diabetes. Family functioning and resilience are known to be important psychosocial factors that contribute to individual health and development. However, no studies have explored the effects of family functioning and resilience on self-management and glycaemic control among youths with type 1 diabetes in mainland China. DESIGN This study was conducted using a survey with a convenience sample following the STROBE guidelines. METHODS A total of 204 Chinese youth who had been diagnosed with type 1 diabetes for at least 6 months were recruited. Family functioning, resilience, self-management and diabetes distress were measured using self-reports and standard measurement tools. Glycaemic control was assessed by glycated haemoglobin (HbA1C ) levels. A structural equation model was used to test the hypothesised model. RESULTS The final model accounted for 52.1% and 19.5% of the total variance of self-management and HbA1C level, respectively. Resilience had a direct effect on self-management and an indirect effect on control of HbA1C . Family functioning had an indirect effect on both self-management and control of HbA1C through resilience. The model remained invariant across the mild-distress and severe-distress groups. CONCLUSION In Chinese youth with type 1 diabetes, resilience positively affected self-management and ultimately optimised glycaemic control, even in the presence of diabetes distress. Family functioning positively affected self-management and glycaemic control by promoting resilience. RELEVANCE TO CLINICAL PRACTICE This study found that family functioning and resilience had positive effects on self-management and glycaemic control in youth. This study confirms the importance of incorporating resilience assessments and family-based resilience interventions into clinical nursing practice with youth with type 1 diabetes.
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Affiliation(s)
- Dan Luo
- School of Nursing, Peking University, Beijing, China
| | - Jing-Jing Xu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Min Zhu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dan Yan
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming-Zi Li
- School of Nursing, Peking University, Beijing, China
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Ness MM, Saylor J, Selekman J. Barriers and Facilitators Influencing Parental Transition of College-Bound Youth with Type 1 Diabetes Mellitus: An Integrative Review. Curr Diab Rep 2019; 19:57. [PMID: 31302793 DOI: 10.1007/s11892-019-1179-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review was to synthesize current research about potential barriers impacting parents as they transition their college-bound youth with type 1 diabetes mellitus (T1DM) to college. RECENT FINDINGS Seven studies, 5 qualitative and 2 quantitative, met the qualifications for inclusion in this study by focusing on parents and were included in this review. Three potential barriers impacting the parental experience during the transition of their youth with T1DM to college were identified: developing and promoting autonomy, evolving relationships and roles in the parent/youth dyad, and distress. Parents consistently indicated concern about their youth's ability to self-manage their T1DM and lack of support for their own transition. This review indicates that several barriers may influence parents of adolescents with T1DM as they transition to becoming the parent of a college-bound youth with T1DM. The parental transition of launching their youth to college is more complex and unique for parents of youth with T1DM parents of youth without chronic conditions. Additional research focusing on the identification of desired supports for parents and the development of specific interventions to assist parents as they transition with their college-bound youth with T1DM is recommended.
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Affiliation(s)
- Michelle M Ness
- University of Delaware, McDowell Hall, Newark, DE, 19716, USA.
| | - Jennifer Saylor
- University of Delaware, McDowell Hall, Newark, DE, 19716, USA
| | - Janice Selekman
- University of Delaware, McDowell Hall, Newark, DE, 19716, USA
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Ersig AL. An Exploratory Study: Transition to Adulthood for College Students with Type 1 Diabetes and Their Parents. J Pediatr Nurs 2019; 46:12-17. [PMID: 30811974 DOI: 10.1016/j.pedn.2019.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/13/2019] [Accepted: 01/13/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE The transition to college and adulthood can be challenging for young adults with chronic health conditions and their parents. Few studies have simultaneously explored the experiences of college students and their parents during the transition to college. The purpose of this study was to explore the transition to adulthood for college students with type 1 diabetes (T1D) and their parents. DESIGN AND METHODS A descriptive exploratory study was conducted with college students with T1D and their parents. Data were collected online using quantitative surveys and open-ended questions. Descriptive statistics were generated for quantitative measures. Analysis of responses to open-ended questions used qualitative description. RESULTS College students (18-24 years) and parents described challenges with life-stage stress, diabetes management worries, and concern about T1D-related long-term complications. Respondents also described the critical role of the college peer network for support and help in case of crisis situations. Students reported stress related to uncertainty in diabetes management, while parents described constant worry about their child's diabetes. CONCLUSIONS Findings support the importance of assessing anticipated and current stressors of college students with T1D and other chronic health conditions and their parents during and after transition to college. PRACTICE IMPLICATIONS Nurses can support students and parents by providing anticipatory guidance about the transition to college. Assistance identifying established sources of support on college campuses, as well as planning for potential crisis situations, may help reduce stress experienced by students and parents.
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Affiliation(s)
- Anne L Ersig
- The University of Wisconsin-Madison, School of Nursing, Madison, WI, United States of America..
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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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Saylor J, Hanna KM, Calamaro CJ. Experiences of College Students Who Are Newly Diagnosed With Type 1 Diabetes Mellitus. J Pediatr Nurs 2019; 44:74-80. [PMID: 30683284 DOI: 10.1016/j.pedn.2018.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE To gain insight and understanding of emerging adult experiences after a diagnosed with type 1 diabetes mellitus (T1DM) and prior to or during college life experiences. DESIGN AND METHODS A qualitative research design using a focus group was conducted with 12 college students recently diagnosed with T1DM during emerging adulthood. The focus group took place during a College Diabetes Network retreat. Using Braun and Clarke's six phase process, two researchers independently conducted a thematic analysis from the transcribed, verbatim audiotaped narratives. RESULTS The 12 participants attended colleges in 11 different states. The mean age was 21 years (SD = 6.3) and the majority were female (n = 7). Qualitative analysis revealed four themes: 1) diabetes affects all aspects of life and complicates college living; 2) college environment affects diabetes management; 3) diabetes diagnosis facilitates growth and maturity; and 4) strategies used for diabetes management in college. CONCLUSION T1DM is complex to manage in the college environment. However, these emerging adults newly diagnosed with T1DM highlight strategies for diabetes management while in college and the pivotal role of pediatric providers play in the successful management of T1DM. PRACTICE IMPLICATIONS Diabetes education for emerging adults in college requires an adaptive focus that supports the developmental needs of this population. Nurses should focus on teaching healthy, modifiable behaviors of sleep, physical activity, and nutrition to improve glycemic control as well as adapting to the college life choices.
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Affiliation(s)
| | - Kathleen M Hanna
- University of Nebraska Medical Center, College of Nursing, NE, USA
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Sheng N, Ma J, Ding W, Zhang Y. Family management affecting transition readiness and quality of life of Chinese children and young people with chronic diseases. J Child Health Care 2018; 22:470-485. [PMID: 29361839 DOI: 10.1177/1367493517753712] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transition from pediatric to adult health care is a key milestone for children and young people (CYP) with chronic conditions. Family management (FM) and self-management are two important concepts during the process. This study aimed to explore the relationships between FM, self-management and transition readiness, and quality of life (QoL), and identify the potential CYP or family factors influencing the relationships. Data about FM, self-management and transition readiness, QoL, and various contextual factors were collected from 268 caregiver-child pairs. Structural equation modeling was used to examine the relationships between all variables. Results revealed that the easy aspects of FM mediated the relationships between the challenging aspects of FM, self-management and transition readiness, and QoL of CYP. Self-management and transition readiness mediated the relationship between the easy aspects of FM and QoL. Contextual factors indirectly influenced CYP's transition readiness and QoL through different aspects of FM. The results imply that to ensure the smooth transition from pediatric to adult health care and improve the CYP's QoL, strengthening CYP's independence and self-management competencies, combined with the support of the easy aspects of FM, seem to be useful strategies to increase CYP's readiness for transfer.
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Affiliation(s)
- Nan Sheng
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jiali Ma
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Wenwen Ding
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
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Ersig AL, Williams JK. Student and Parent Perspectives on Severe Food Allergies at College. J Pediatr Health Care 2018; 32:445-454. [PMID: 29903523 DOI: 10.1016/j.pedhc.2018.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/18/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Constant vigilance to manage severe food allergies (FAs) can lead to high stress. Additional stress may develop during life-course transitions, such as the transition to college. However, few studies have evaluated everyday and FA-related stress in college students with FA and their parents. This analysis examined experiences of 26 college students with FA and their parents. METHODS Students and parents completed online surveys in a mixed-methods exploratory study of everyday and FA-related stressors, potential contributing factors, and FA management. RESULTS FA affected nearly all areas of students' lives. Management required constant vigilance because of issues of trust in others. However, nearly 40% of students did not consistently carry emergency medication to counteract reactions. Parents worried from a distance while learning to trust their child's FA management capabilities. DISCUSSION Additional preparation and support for college students with severe FA and their parents may help improve stress and FA management.
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Douma M, Scholten L, Maurice-Stam H, Grootenhuis MA. Online cognitive-behavioral based group interventions for adolescents with chronic illness and parents: study protocol of two multicenter randomized controlled trials. BMC Pediatr 2018; 18:235. [PMID: 30021540 PMCID: PMC6052594 DOI: 10.1186/s12887-018-1216-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/09/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adolescents with chronic illness (CI) and parents of a child with CI are at risk for psychosocial problems. Psychosocial group interventions may prevent these problems. With the use of cognitive-behavioral therapy, active coping strategies can be learned. Offering an intervention online eliminates logistic barriers (travel time and distance) and improves accessibility for participants. Aim of this study is to examine the effectiveness of two cognitive-behavioral based online group interventions, one for adolescents and one for parents: Op Koers Online. The approach is generic, which makes it easier for patients with rare illnesses to participate. METHODS/DESIGN This study conducts two separate multicenter randomized controlled trials. Participants are adolescents (12 to 18 years of age) with CI and parents of children (0 to 18 years of age) with CI. Participants are randomly allocated to the intervention group or the waitlist control group. Outcomes are measured with standardized questionnaires at baseline, after 8 (adolescents) or 6 (parents) weeks of treatment, and at 6- and 12-month follow-up period. Primary outcomes are psychosocial functioning (emotional and behavioral problems) and disease-related coping skills. Secondary outcomes for adolescents are self-esteem and quality of life. Secondary outcomes for parents are impact of the illness on family functioning, parental distress, social involvement and illness cognitions. The analyses will be performed according to the intention-to-treat principle. Primary and secondary outcomes will be assessed with linear mixed model analyses using SPSS. DISCUSSION These randomized controlled trials evaluate the effectiveness of two online group interventions improving psychosocial functioning in adolescents with CI and parents of children with CI. If proven effective, the intervention will be optimized and implemented in clinical practice. TRIAL REGISTRATION ISRCTN ISRCTN83623452 . Registered 30 November 2017. Retrospectively registered.
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Affiliation(s)
- Miriam Douma
- Psychosocial Department, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Linde Scholten
- Psychosocial Department, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Heleen Maurice-Stam
- Psychosocial Department, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martha A. Grootenhuis
- Psychosocial Department, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Maxima Center for Pediatric Oncology, University Medical Center, Lundlaan 6, Postbus 85090, 3508 AB Utrecht, the Netherlands
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Holtz BE, Murray KM, Hershey DD, Richman J, Dunneback JK, Vyas A, Wood MA. The design and development of MyT1DHero: A mobile app for adolescents with type 1 diabetes and their parents. J Telemed Telecare 2017; 25:172-180. [PMID: 29228854 DOI: 10.1177/1357633x17745470] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Type 1 diabetes impacts approximately 1.25 m Americans, many of them young children. As a child grows, there is a transition towards independence and they must learn to manage their diabetes independently. The objective of this study was to design, develop and conduct a prototype test to assess the satisfaction and feasibility of a mobile app for adolescents with type 1 diabetes and their parents to aid in this transition. METHODS Ten parent/adolescent groups used MyT1DHero for four weeks. They were given a pre-test/post-test survey regarding family conflict with three tasks of diabetes management and the general tone of family communication. At post-test they were asked questions regarding their satisfaction and perception of ease of use of the app. They also participated in short interviews regarding the app. Additionally, we used server data to examine actual app usage. RESULTS The parents' perceptions of conflict around the results of the blood sugar tests increased ( t(9) = 2.71, p = .02) as did perceptions of conflict around logging the blood sugar results ( t(9) = 3.67, p = .005). The adolescents perceived increased conflict surrounding the results around logging the blood sugars results ( t(9) = 3.09, p = .01).There was no change in the tone of general family communication. During the prototype testing, we discovered that the app crashed repeatedly and several of the functions were not working properly. In the interview data, three main themes emerged, app-crashing issues, problems with notifications and positive feedback. DISCUSSION Through this process, all of the reported issues were corrected and new features were planned for subsequent versions. A smartphone application has the potential to be a novel intervention for engaging adolescents and their parents in positive communication to support type 1 diabetes management.
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Affiliation(s)
- Bree E Holtz
- 1 Department of Advertising & Public Relations, Michigan State University, MI, USA
| | - Katharine M Murray
- 1 Department of Advertising & Public Relations, Michigan State University, MI, USA
| | | | - Joshua Richman
- 3 Department of Surgery, University of Alabama-Birmingham, MI, USA
| | - Julie K Dunneback
- 4 Department of Paediatric Endocrinology, Sparrow Health System, MI, USA
| | - Arpita Vyas
- 5 Department of Paediatrics, Texas Tech University, MI, USA
| | - Michael A Wood
- 6 Department of Paediatrics, University of Michigan, MI, USA
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Holtz BE, Murray KM, Hershey DD, Dunneback JK, Cotten SR, Holmstrom AJ, Vyas A, Kaiser MK, Wood MA. Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents. JMIR Mhealth Uhealth 2017; 5:e53. [PMID: 28428167 PMCID: PMC5415658 DOI: 10.2196/mhealth.6654] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 11/25/2022] Open
Abstract
Background Type 1 diabetes (T1D) afflicts approximately 154,000 people under 20 years of age. Three-quarters of adolescents are not achieving glycosylated hemoglobin (HbA1c) targets, which leads to negative health outcomes. Mobile health (mHealth), the use of technology in health, has been used successfully to improve health in many chronic conditions, including diabetes. Objective The purpose of this study was to use patient-centered research methods to inform and improve the design and functionality of our T1D app, MyT1DHero, and to provide insight for others who are designing a health app for adolescents and parents. Methods This study included data from focus groups with participants recruited from the Juvenile Diabetes Research Foundation (JDRF) southeast Michigan’s family network. All data collected during the sessions were audio-recorded, transcribed, and coded. Results Four key themes were identified: (1) diabetes is unpredictable, (2) negative and frustrated communication, (3) motivations to use an app, and (4) feedback specific to our app. Conclusions A patient-centered approach was used to assist in the development of an app for adolescents with T1D. Participants were satisfied with overall app design; customization, interactivity, and tangible rewards were identified as being necessary for continued use. Participants believed the app would help improve the communication between parents and adolescents. Many apps developed in the health context have not used a patient-centered design method or have seen vast improvements in health. This paper offers suggestions to others seeking to develop apps for adolescents and their parents.
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Affiliation(s)
- Bree E Holtz
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI, United States
| | - Katharine M Murray
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI, United States
| | - Denise D Hershey
- College of Nursing, Michigan State University, East Lansing, MI, United States
| | - Julie K Dunneback
- Sparrow Health System, Department of Pediatric Endocrinology, Lansing, MI, United States
| | - Shelia R Cotten
- Department of Media and Information, Michigan State University, East Lansing, MI, United States
| | - Amanda J Holmstrom
- Department of Communication, Michigan State University, East Lansing, MI, United States
| | - Arpita Vyas
- Department of Pediatrics, Texas Tech University, Lubbock, TX, United States
| | - Molly K Kaiser
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI, United States
| | - Michael A Wood
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
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Christian BJ. Translational Research - Balancing the Demands of Chronic Illness Caregiving and Self-Management for Children, Adolescents, and their Parents. J Pediatr Nurs 2016; 31:449-52. [PMID: 27321877 DOI: 10.1016/j.pedn.2016.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 11/16/2022]
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