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Kelleher J, LaQuaglia R, Heddings J, Ely B, Jones E, Shaffer T, Duncan CL. Transition readiness and coping styles in adolescents with type 1 diabetes. J Pediatr Nurs 2024; 78:e338-e345. [PMID: 39127590 DOI: 10.1016/j.pedn.2024.07.023] [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: 11/21/2023] [Revised: 06/06/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE Although promoting positive coping and reducing negative coping improves health, little research has examined how types of coping relate to transition readiness in adolescents with type 1 diabetes (T1D). This study aimed to clarify the direct and indirect relations between coping style and transition readiness. We first examined which coping styles predict transition readiness in adolescents with T1D and then explored whether diabetes distress mediates the relation between disengagement coping and transition readiness. DESIGN AND METHODS Using a cross-sectional observational design, 68 families with an adolescent with T1D were recruited during routine clinic appointments. Surveys on family demographics, coping styles, transition readiness, and diabetes distress were completed electronically. Medical information was extracted from electronic health records. RESULTS Neither primary control, secondary control, nor disengagement coping had a direct significant association with transition readiness after controlling for HbA1c. There was a significant indirect effect of disengagement coping on transition readiness through greater diabetes distress (adolescent report β = -0.13; 95% CI, LL = -0.27, UL = -0.02; parent report β = -0.12; 95% CI, LL = -0.26, UL = -0.02). CONCLUSIONS Coping style did not have a direct effect on transition readiness. However, disengagement coping was associated with diabetes distress, which in turn was significantly related to transition readiness. PRACTICE IMPLICATIONS Clinicians and researchers should consider incorporating coping strategies within transition readiness interventions to decrease distress and improve transition readiness. Disease-specific psychosocial screening may enhance routine diabetes transition education.
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Affiliation(s)
- Jennifer Kelleher
- West Virginia University, Department of Psychology, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV 26506-6040, USA.
| | - Rebecca LaQuaglia
- West Virginia University, Department of Psychology, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV 26506-6040, USA
| | - Janelle Heddings
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Brian Ely
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Evan Jones
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Tebony Shaffer
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Christina L Duncan
- West Virginia University, Department of Psychology, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV 26506-6040, USA; West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
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Pitts L, Patrician PA, Landier W, Kazmerski T, Fleming L, Ivankova N, Ladores S. Parental entrustment of healthcare responsibilities to youth with chronic conditions: A concept analysis. J Pediatr Nurs 2024; 76:1-15. [PMID: 38309191 DOI: 10.1016/j.pedn.2024.01.028] [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: 08/16/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Chronic health conditions impact nearly 40% of children in the United States, necessitating parents/caregivers to entrust healthcare responsibilities to youth aging into adulthood. Understanding the parental entrustment process may lead to tailored transition support; however, the concept lacks conceptual clarity, limiting its research and practical applications. DESIGN AND METHODS Rodgers' evolutionary concept analysis method was used to clarify the parental entrustment of healthcare responsibilities to youth with chronic health conditions. PubMed, CINAHL, and PsycINFO databases were searched without date restrictions, including full-text, English-language, primary source articles related to parent-child healthcare transition preparation. Following title, abstract, and full-text screenings, data were analyzed using a hybrid thematic approach to identify antecedents, attributes, and consequences. RESULTS Forty-three studies from August 1996 to September 2023 were identified. Antecedents encompass social cues and readiness factors, while attributes involve a) responsibility transfer, support, and facilitation, b) a dynamic process, c) balancing trust and fear, d) navigating conflict, and e) parental letting go. Consequences entail shifts in parental and adolescent roles. Parental entrustment is an iterative process wherein parents guide their maturing child through responsibility transfer via facilitation, support, conflict navigation, and trust building. CONCLUSION The clarified concept underscores the role of parents/caregivers in empowering youth to manage their health. Introducing a working definition and conceptual model contributes to understanding the processes families navigate in the larger landscape of healthcare transition. PRACTICE IMPLICATIONS This clarification holds implications for clinicians and policymakers, offering insights to enhance support and guidance for families navigating healthcare transition.
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Affiliation(s)
- Leslie Pitts
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Patricia A Patrician
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Wendy Landier
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama Heersink School of Medicine, Division of Pediatric Hematology/Oncology, 1600 7th Avenue South, Lowder 512, Birmingham, AL 35233, United States.
| | - Traci Kazmerski
- The University of Pittsburg Medical Center Children's Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University Center, 120 Lytton St.-Suite M060, Pittsburgh, PA 15213, United States.
| | - Louise Fleming
- The University of North Carolina at Chapel Hill, School of Nursing, 105 Carrington Hall, Chapel Hill, NC 37599, United States.
| | - Natalyia Ivankova
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama at Birmingham, School of Health Professions, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Sigrid Ladores
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
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Allemang B, Samuel S, Greer K, Schofield K, Pintson K, Patton M, Farias M, Sitter KC, Patten SB, Mackie AS, Dimitropoulos G. Transition readiness of youth with co-occurring chronic health and mental health conditions: A mixed methods study. Health Expect 2023; 26:2228-2244. [PMID: 37452518 PMCID: PMC10632650 DOI: 10.1111/hex.13821] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND A large proportion of youth with chronic conditions have mental health comorbidities. However, the effect of these comorbidities on paediatric-adult transition readiness, and the relevance of widely used tools for measuring transition readiness, are unknown. OBJECTIVE The objectives of this study were to describe and explore the transition readiness of youth with co-occurring chronic health and mental health conditions using a combination of quantitative data obtained from participants completing the Transition Readiness Assessment Questionnaire (TRAQ) and qualitative data. DESIGN AND PARTICIPANTS A three-phase sequential explanatory mixed methods design was employed, with the qualitative strand taking priority. First, the TRAQ scores (range 1-5) of youth with co-occurring conditions (n = 61) enroled in a multisite randomized controlled trial were measured, followed by qualitative interviews with a sample of youth (n = 9) to explain the quantitative results. Results from both strands were then integrated, yielding comprehensive insights. RESULTS Median TRAQ scores ranged from 2.86 on the appointment keeping subscale to 5.00 on the talking with providers subscale. The qualitative results uncovered the complexities faced by this group concerning the impact of a mental health comorbidity on transition readiness and self-management skills across TRAQ domains. The integrated findings identified a diverse and highly individualized set of strengths and challenges amongst this group that did not align with overarching patterns as measured by the TRAQ. CONCLUSIONS This mixed methods study generated novel understandings about how youth with co-occurring conditions develop competencies related to self-care, self-advocacy and self-management in preparation for paediatric-adult service transitions. Results demonstrated the assessment of transition readiness using a generic scale does not address the nuanced and complex needs of youth with co-occurring chronic health and mental health conditions. Our findings suggest tailoring transition readiness practices for this group based on youths' own goals, symptoms, coping mechanisms and resources. PATIENT OR PUBLIC INVOLVEMENT This study was conducted in collaboration with five young adult research partners (YARP) with lived experience transitioning from paediatric to adult health/mental health services. The YARP's contributions across study phases ensured the perspectives of young people were centred throughout data collection, analysis, interpretation and presentation of findings. All five YARP co-authored this manuscript.
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Affiliation(s)
- Brooke Allemang
- Department of Social WorkUniversity of CalgaryCalgaryAlbertaCanada
| | - Susan Samuel
- Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Katelyn Greer
- Department of Social WorkUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Karina Pintson
- Department of Social WorkUniversity of CalgaryCalgaryAlbertaCanada
| | - Megan Patton
- Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Marcela Farias
- Department of Social WorkUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Scott B. Patten
- Department of Psychiatry, Mathison Centre for Mental Health Research and EducationUniversity of CalgaryCalgaryAlbertaCanada
- Department of Psychiatry, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Andrew S. Mackie
- Department of PediatricsStollery Children's HospitalEdmontonAlbertaCanada
| | - Gina Dimitropoulos
- Department of Social WorkUniversity of CalgaryCalgaryAlbertaCanada
- Department of Psychiatry, Mathison Centre for Mental Health Research and EducationUniversity of CalgaryCalgaryAlbertaCanada
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Kokorelias KM, Lee TSJ, Bayley M, Seto E, Toulany A, Nelson MLA, Dimitropoulos G, Penner M, Simpson R, Munce SEP. "I Have Eight Different Files at Eight Different Places": Perspectives of Youths and Their Family Caregivers on Transitioning from Pediatric to Adult Rehabilitation and Community Services. J Clin Med 2023; 12:jcm12041693. [PMID: 36836228 PMCID: PMC9960001 DOI: 10.3390/jcm12041693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION The number of young adults (youth) living with childhood-onset disabilities, and requiring transitional support to adult community and rehabilitation services, is increasing. We explored facilitators and barriers to accessing and sustaining community and rehabilitation services during the transition from pediatric to adult care. METHODS A qualitative descriptive study was conducted in Ontario, Canada. Data were collected through interviews with youth (n = 11) and family caregivers (n = 7). The data were coded and analyzed using thematic analysis. RESULTS Youth and caregivers face many types of transitions from pediatric to adult community and rehabilitation services, e.g., those related to education, living arrangements, and employment. This transition is marked by feelings of isolation. Supportive social networks, continuity of care (i.e., same care providers), and advocacy all contribute to positive experiences. Lack of knowledge about resources, changing parental involvement without preparation, and a lack of system responses to evolving needs were barriers to positive transitions. Financial circumstances were described as either a barrier or facilitator to service access. CONCLUSIONS This study demonstrated that continuity of care, support from providers, and social networks all contribute markedly to the positive experience of transitioning from pediatric to adult services for individuals with childhood-onset disabilities and family caregivers. Future transitional interventions should incorporate these considerations.
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Affiliation(s)
- Kristina M. Kokorelias
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Department of Occupational Sciences and Occupational Therapy, Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Tin-Suet Joan Lee
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
| | - Mark Bayley
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Center for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Alene Toulany
- Department of Adolescent Medicine, the Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle L. A. Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Melanie Penner
- Department of Pediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
| | - Robert Simpson
- St. John’s Rehab Research Program at Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, North York, ON M2M 2G1, Canada
| | - Sarah E. P. Munce
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Department of Occupational Sciences and Occupational Therapy, Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Correspondence:
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