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Allen V, Mahieu A, Kasireddy E, Shouman W, Pourrahmat MM, Collet JP, Cherkas A. Humanistic burden of pediatric type 1 diabetes on children and informal caregivers: systematic literature reviews. Diabetol Metab Syndr 2024; 16:73. [PMID: 38515123 PMCID: PMC10956250 DOI: 10.1186/s13098-024-01310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Diagnosis of children with type 1 diabetes (T1D) imposes an unprecedented burden on children and their caregivers. OBJECTIVE To assess the burden of T1D on children and their informal caregivers, both after a recent diagnosis or after a longer duration of disease. METHODS A series of systematic literature reviews were performed to explore the burden of T1D on children with the disease and their primary informal caregivers, based on the time of diagnosis. After the extraction of the qualitative and quantitative data from the included studies, two literature-based conceptual frameworks were developed: on the burden of pediatric T1D on children, and on informal caregivers. A third conceptual framework on the shared burden of pediatric T1D on both children and informal caregivers as part of the same family unit was also developed. RESULTS The review of literature has identified a series of factors that affect the quality of life of children with T1D and their informal caregivers, with a direct impact on physical, emotional, and social outcomes. Generally, female patients and older adolescents experience more worry and stress that affects their quality of life. Other categories of factors affecting the child's and caregiver's burden include social, emotional, and physical factors, treatment-related and disease-related factors, as well as their coping abilities. Anxiety, depression, stress, and worry were commonly found among children and caregivers, starting with the diagnosis of T1D and continuing over time in relation to new challenges pertaining to aging or the disease duration. CONCLUSION T1D causes a significant burden to affected children and their caregivers, both independently and through transactional interaction within the family unit. Disease burden can be reduced by strengthening individuals for the benefit of the whole family.
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Affiliation(s)
| | | | | | - Walid Shouman
- Evidinno Outcomes Research Inc., Vancouver, BC, Canada
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2
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Gardener L, Desha L, Bourke-Taylor H, Ziviani J. Responsibility sharing for adolescents with type 1 diabetes: A scoping review. Chronic Illn 2022; 18:6-21. [PMID: 32998528 DOI: 10.1177/1742395320959406] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The term 'Responsibility Sharing', albeit poorly defined, has emerged from the diabetes literature, to describe a distinct mechanism for comprehensively managing the characteristic shift in responsibility that underpins the transition to self-management for adolescents. METHODS A scoping review, following the PRISMA-ScR guidelines, distilled the literature from seven databases to answer the questions: What is responsibility sharing? Who are the key stakeholders? What factors affect responsibility transaction? What are its recognized outcomes? How is responsibility shared? RESULTS Responsibility sharing is a transactional arrangement between youth and their caregiver/s that functions to repeatedly and flexibly apply ownership to the management of diabetes care tasks, across the course of adolescence. In the main, responsibility sharing was associated with better metabolic and/or psychosocial outcomes. Effective responsibility sharing was seen as being responsive to adolescent capacity and driven by autonomy supportive, sustained communication patterns that enable mutually agreeable responsibility assumption by all stakeholders. CONCLUSION Different perspectives on responsibility sharing for adolescents with Type 1 diabetes, and the lack of a universal definition, have led to discordance within the literature about its operationalization and measurement. This paper proposes a definition of responsibility sharing for future researchers to apply.
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Affiliation(s)
- Lisa Gardener
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Laura Desha
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Helen Bourke-Taylor
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Australia
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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3
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Supervising Without Controlling: A New Authority intervention for Adolescents with Type 1 Diabetes. JOURNAL OF CHILD AND FAMILY STUDIES 2022. [DOI: 10.1007/s10826-021-02186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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4
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Understanding the meaning of trauma-informed care for burns health care professionals in a pediatric hospital: A qualitative study using interpretive phenomenological analysis. Burns 2021; 48:1462-1471. [PMID: 34922784 DOI: 10.1016/j.burns.2021.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/02/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Trauma-informed care includes a range of practices that build a culture of safety, empowerment, and healing. Limited information is available regarding the lived experience of trauma-informed care by healthcare professionals treating burns in a multidisciplinary setting. OBJECTIVE The primary aim of this study was to understand what 'trauma-informed care' means to staff and students working in burns at a tertiary pediatric hospital. METHODS Semi-structured interviews and focus group were conducted with healthcare professionals (medical, nursing, allied health, pre-graduate students) working in paediatric burn care (or their line manager). Analysis of the dataset was undertaken using qualitative methods (interpretive phenomenological approach and qualitative content analysis). RESULTS Eleven interviews and one focus group were completed and transcribed verbatim. Three superordinate themes were applicable across the five cohorts: 'what does trauma-informed care mean?', 'being able to deliver trauma-informed care' (agency) and 'impact of the setting'. Eleven components of trauma-informed care practice (for example, everyday interactions with patients and colleagues, screening and assessment) and service-level approaches (for example, service provider training) were described by participants. CONCLUSIONS Healthcare professionals' experiences of delivering trauma-informed care in a burns centre highlighted the need to clarify the concept of 'trauma-informed care' as a first step. Enabling the workforce to understand trauma-informed care and apply it in everyday interactions with patients and colleagues, and a strategic commitment to practice change needs to be actioned more systematically to support implementation of a trauma-informed care approach in pediatric health services.
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Stephens SB, Raphael JL, Zimmerman CT, Garland BH, de Guzman MM, Walsh SM, Hergenroeder AC, Wiemann CM. The Utility of Self-Determination Theory in Predicting Transition Readiness in Adolescents With Special Healthcare Needs. J Adolesc Health 2021; 69:653-659. [PMID: 34059429 DOI: 10.1016/j.jadohealth.2021.04.004] [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: 11/19/2020] [Revised: 03/10/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Adolescents and young adults with chronic health conditions must learn skills to successfully manage their health as they prepare to transition into adult-based care. Self-determination theory (SDT), an empirically based theory of human motivation, posits that competence (feeling effective), autonomy (volition to perform behaviors), and relatedness (support for autonomy from others) influence behavioral change. This study evaluates the utility of SDT constructs in predicting transition readiness among adolescents and young adults recruited into an intervention to promote successful healthcare transition. METHODS Baseline assessments were completed by 137 patients aged 17-23 years recruited from pediatric renal, gastroenterology, or rheumatology clinical services. Surveys measured transition readiness (Transition Readiness Assessment Questionnaire) as well as SDT constructs, including competence (Patient Activation Measure); provider relatedness and parent autonomy support (Health Care Climate Questionnaire); and health care-related autonomy (Treatment Self-Regulation Questionnaire). Relationships between SDT constructs and transition readiness were evaluated using linear regression. RESULTS Between 44 and 48 participants were recruited from each service. Bivariate correlation coefficients between transition readiness and SDT constructs were competence (r = .44), autonomous autonomy (r = .34), controlled autonomy (r = .27), provider relatedness (r = .46), and parental autonomy support (r = .35) (p < .01). Age positively correlated with transition readiness (r = .47, p < .001). After controlling for age, gender, and clinical service, competence (p < .001) and provider relatedness (p = .008) successfully predicted transition readiness (R2 = .423; F change; p < .001). CONCLUSIONS Findings from this cross-sectional study support the utility of SDT constructs in promoting transition readiness among adolescents and young adults with chronic conditions, underscoring the importance of building competence and provider support for autonomy during this critical period.
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Affiliation(s)
- Sara B Stephens
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Jean L Raphael
- Center for Child Health Policy and Advocacy, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Cortney T Zimmerman
- Section of Psychology, Renal Service, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Beth H Garland
- Sections of Adolescent Medicine & Sports Medicine and Psychology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Marietta M de Guzman
- Section of Rheumatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Seema M Walsh
- Section of Gastroenterology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Albert C Hergenroeder
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Constance M Wiemann
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
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6
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Bérubé S, Ogez D, Aramideh J, Amesse C, Bourque CJ, Longpré C, Muise L, Levesque A, Sultan S. It's difficult to say no: Development of a parenting booklet about physical activity restrictions and recommendations in pediatric hemophilia. Health Psychol Open 2021; 8:20551029211039920. [PMID: 34881045 PMCID: PMC8647236 DOI: 10.1177/20551029211039920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Physical activity restrictions can be particularly difficult for children with hemophilia and their parents, as most children want to engage in the same activities as their friends or siblings. This study aimed to assess parents' need for a booklet on how to manage physical activity restrictions based on the self-determination theory and gather their suggestions for the booklet's improvement in a focus group. Data were analyzed using thematic analyses to highlight to what extent the needs of parents were met by the booklet, as well as their suggestions for improvement. A discussion on the methodology of the booklet's creation is also presented.
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Affiliation(s)
- Sarah Bérubé
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Sainte-Justine UHC, Montreal, QC, Canada
| | - David Ogez
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Sainte-Justine UHC, Montreal, QC, Canada
- Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Jennifer Aramideh
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Sainte-Justine UHC, Montreal, QC, Canada
| | | | - Claude J Bourque
- Sainte-Justine UHC, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | | | | | - Ariane Levesque
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Sainte-Justine UHC, Montreal, QC, Canada
| | - Serge Sultan
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Sainte-Justine UHC, Montreal, QC, Canada
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7
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Klostermann S, Iskander J, Enlow P, Delamater AM, Dolan L, Pendley JS. Predicting healthcare utilization in youth with type 1 diabetes: The importance of family level variables. Pediatr Diabetes 2021; 22:294-302. [PMID: 33169899 DOI: 10.1111/pedi.13146] [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: 03/23/2020] [Revised: 10/29/2020] [Accepted: 11/06/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Little is known about how family factors impacting treatment adherence in type 1 diabetes are directly associated with unplanned healthcare utilization (e.g., emergency room visits and hospital admissions). Given the substantial financial burden of diabetes, understanding predictors of healthcare utilization in particular is important to inform behavioral interventions aimed toward improving adherence. RESEARCH DESIGN AND METHODS The current study examined the relationship between family-level variables and healthcare utilization in a sample of 239 youth with type 1 diabetes and their parents. Healthcare utilization was determined via parent report and chart review. Parent- and youth-reports regarding levels of family conflict, youth autonomy, and parent support related to diabetes management were obtained via questionnaire, and negative reciprocity was obtained by coding observations of parent and youth interactions. Generalized Estimating Equations were used to examine the longitudinal association between healthcare utilization and family-level factors. RESULTS Higher levels of observed negative reciprocity were associated with more frequent hospital admissions, while higher levels of youth-reported parent involvement in diabetes management were associated with fewer hospital admissions and ED visits. CONCLUSIONS These findings highlight how family-level factors are directly related to healthcare utilization and point to the continued importance of integrating family-focused behavioral interventions in routine medical care for improving type 1 diabetes outcomes and reducing healthcare costs.
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Affiliation(s)
- Susan Klostermann
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Paul Enlow
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lawrence Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Shroff Pendley
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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8
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Perlberg M, Katz I, Loewenthal N, Kahil N, Haim A, Chechik T, Hershkovitz E. The role of autonomy-supportive parenting in the competence, adherence and glycemic control of adolescents with type 1 diabetes. Diabetes Res Clin Pract 2021; 173:108679. [PMID: 33516781 DOI: 10.1016/j.diabres.2021.108679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/11/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To examine the relationships between autonomy support provided to adolescents with Type 1 Diabetes by their parents, and adolescents' competence, adherence to treatment, and glycemic control indicators. METHOD Thirty-seven adolescents, along with one of their parents, completed a set of questionnaires on the level of autonomy support provided by their parents. Adolescents' self-treatment competence and their level of adherence to treatment were also measured. A recent blood test assessing the adolescents' 3-month average glycemic level (HbA1c) was retrieved from their medical records as a glycemic control indicator. RESULTS Structural Equation Modeling suggested that parental autonomy support as reported by parents and adolescents was associated with higher adolescent self-treatment competence and higher adherence to treatment. These in turn were associated with better glycemic control. CONCLUSION Parental autonomy support is crucial and may contribute to the competence, adherence, and physical wellbeing of adolescents with Type 1 Diabetes. Parents should be instructed on ways to better support autonomy but still be involved in their child's life.
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Affiliation(s)
- Maya Perlberg
- Department of Education, Ben-Gurion University of the Negev, Israel
| | - Idit Katz
- Department of Education, Ben-Gurion University of the Negev, Israel.
| | - Netta Loewenthal
- Pediatric Endocrinology and Metabolism Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
| | - Nurit Kahil
- Pediatric Endocrinology and Metabolism Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
| | - Alon Haim
- Pediatric Endocrinology and Metabolism Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
| | - Tzilla Chechik
- Pediatric Endocrinology and Metabolism Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
| | - Eli Hershkovitz
- Pediatric Endocrinology and Metabolism Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
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Chen CY, Lo FS, Wang RH. Roles of Emotional Autonomy, Problem-Solving Ability and Parent-Adolescent Relationships on Self-Management of Adolescents with Type 1 Diabetes in Taiwan. J Pediatr Nurs 2020; 55:e263-e269. [PMID: 32493633 DOI: 10.1016/j.pedn.2020.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND High emotional autonomy has a negative association, whereas good problem-solving ability and parent-adolescent relationships have positive association with self-management in adolescents with type 1 diabetes (T1D). Exploring roles of these variables is crucial to design specific interventions to improve self-management in such afflicted adolescents. PURPOSE To explore the roles of emotional autonomy, problem-solving ability and parent-adolescent relationships on self-management in adolescents with T1D. DESIGN AND METHODS Cross-sectional design was used in this study. A total of 242 adolescents with T1D were recruited from an outpatient clinic of a medical center by convenience sampling in Taiwan. Self-reported questionnaires were used to collect personal characteristics, self-management, emotional autonomy, problem-solving ability, and parent-adolescent relationships. RESULTS Hierarchical multiple regressions indicated that body mass index, problem-solving ability, father-adolescent relationship, and emotional autonomy were significant factors associated with self-management. The interactions of emotional autonomy with problem-solving ability and with parent-adolescents relationship were not significantly associated with self-management. The overall model explained 47.5% variance of self-management. CONCLUSIONS High emotional autonomy was significantly associated with poor self-management. Problem-solving ability and father-adolescent relationships could not moderate, but were independently and significantly associated with self-management in adolescents with T1D. PRACTICE IMPLICATION Healthcare providers should evaluate emotional autonomy earlier and provide more timely help to reduce any negative impact on self-management in adolescents with T1D. Improving problem-solving ability and encouraging fathers to develop optimal father-adolescents relationship might be promising strategies to enhance self-management in adolescents with T1D.
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Affiliation(s)
- Chia-Ying Chen
- Administration Center of Research and Education, Ditmanson Medical Foundation Chai-Yi Christian Hospital, Taiwan.
| | - Fu-Sung Lo
- Division of Endocrinology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chung Gung University, Taiwan.
| | - Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Taiwan.
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10
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Simons M, De Young A, McPhail SM, Harvey G, Kenardy J, Kularatna S, Kimble R, Tyack Z. A web-based educational intervention to implement trauma-informed care in a paediatric healthcare setting: protocol for a feasibility study using pre-post mixed methods design. Pilot Feasibility Stud 2020; 6:118. [PMID: 32832097 PMCID: PMC7436985 DOI: 10.1186/s40814-020-00636-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022] Open
Abstract
Background Adoption of responsive trauma-informed practices by staff in hospital-based paediatric care may help mitigate downstream costs associated with treatment delivery due to reduced pain and distress for children and care providers, improved health-related quality of life and increased satisfaction with care. A web-based education intervention (termed Responsive CARE) was developed to build self-efficacy of staff in a paediatric medical setting. This protocol paper describes a feasibility study (including preliminary effectiveness) of the implementation of Responsive CARE in a tertiary, outpatient burn clinical setting. Methods A pre-post, mixed methods design will be employed. Children and caregivers attending hospital for change of burn wound dressings or burn scar management during the 3-month control or 3-month intervention period will be eligible, with follow-up to 6-months post-baseline. All children and caregiver/s will receive “standard care” including burn interventions focused on wound healing, scar management, itch management (both pharmacological and non-pharmacological), counselling, age-appropriate procedural support and burn rehabilitation. Health professional participants will be those involved in the management of children with burns during the study period or their senior managers. Health professional participants who attend a weekly educational clinical meeting will be invited to complete the intervention during a 1-month timeframe between the control and intervention period (or upon their commencement in burn outpatients during the intervention period) using an individualised log-in process. A purposive sample of caregivers and health professionals will be sought for participation in semi-structured interviews. Qualitative data will be analysed using Framework analysis. Feasibility will be evaluated via interviews, digital records of intervention usage and technical assistance logs. The primary outcome measures of effectiveness (pain, itch and distress) will be measured using self-report or behavioural observation. Quantitative data will primarily be analysed descriptively and using generalised linear models. Discussion This study will provide insights into factors that impact upon the feasibility of a web-based trauma-informed care education intervention in a clinical practice setting. This knowledge may support other education approaches within healthcare settings related to improving and supporting patients to reduce the risk of healthcare interactions that result in paediatric medical traumatic stress.
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Affiliation(s)
- Megan Simons
- Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Queensland 4101 Australia.,Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia
| | - Alexandra De Young
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia.,School of Psychology, The University of Queensland, St Lucia, Queensland 4072 Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059 Australia.,Clinical Informatics Directorate, Metro South Health, 199 Ipswich Road, Woolloongabba, Queensland 4102 Australia
| | - Gillian Harvey
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059 Australia
| | - Justin Kenardy
- School of Psychology, The University of Queensland, St Lucia, Queensland 4072 Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059 Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia
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Ayar D, Gürkan KP, Bektas M, Böber E, Abaci A. Psychometric properties of a Turkish version of the Collaborative Parent Involvement Scale for youths with type 1 diabetes. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-00868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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12
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Hung LC, Huang CY, Lo FS, Cheng SF. The Self-Management Experiences of Adolescents with Type 1 Diabetes: A Descriptive Phenomenology Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145132. [PMID: 32708617 PMCID: PMC7400392 DOI: 10.3390/ijerph17145132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/11/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
Many adolescents with type 1 diabetes experience challenges in achieving good glycemic control and have insufficient understanding in executing interventions for glycemic control. This study aimed to understand self-management experiences of adolescents with type 1 diabetes in Taiwan. In this descriptive phenomenological study, we conducted in-depth interviews with 18 adolescents with type 1 diabetes from the pediatric outpatient clinic of a medical center. Data were analyzed using the Colaizzi's method. Four themes were identified: (1) misconception regarding self-management of blood glucose; (2) conflict between depending on and breaking away from parental assistance for glycemic control; (3) encounter with disruptions in glycemic control regimen due to the presence of schedule changes; and (4) lack of motivation to achieve good glycemic control. The findings indicated that the misconceptions of adolescents with type 1 diabetes about managing glycemic levels resulted from an insufficient understanding of self-management of diabetes. In Taiwan, the heavy emphasis of academic achievement and changes of schedules during breaks tended to disrupt the regimen for glycemic control. Healthcare professionals are encouraged to provide individualized education focusing on the adolescents' misconceptions regarding self-management of diabetes.
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Affiliation(s)
- Li-Chen Hung
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan;
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
| | - Chu-Yu Huang
- School of Nursing, Cedarville University, Cedarville, OH 45314, USA;
| | - Fu-Sung Lo
- Division of Endocrinology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan;
| | - Su-Fen Cheng
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
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13
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Nicholl MC, Valenzuela JM, Lit K, DeLucia C, Shoulberg AM, Rohan JM, Shroff Pendley J, Dolan L, Delamater AM. Featured Article: Comparison of Diabetes Management Trajectories in Hispanic versus White Non-Hispanic Youth with Type 1 Diabetes across Early Adolescence. J Pediatr Psychol 2020; 44:631-641. [PMID: 30916748 DOI: 10.1093/jpepsy/jsz011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Ethnic minority youth with type 1 diabetes (T1D) often have poorer glycemic control and lower rates of adherence compared to White Non-Hispanic (WNH) youth. Variables such as family conflict, autonomy support, and youth regimen responsibility have been shown to change over adolescence and impact diabetes management. However, these factors have been investigated in predominantly White samples. Few studies have examined potential differences in these variables and their trajectories for Hispanic youth over early adolescence. METHODS Youth with T1D (178 WNH and 33 Hispanic youth participants), as well as their maternal caregivers (174 WNH and 32 Hispanic maternal caregivers), completed measures of diabetes-specific autonomy support, diabetes-related family conflict, regimen responsibility, and blood glucose monitoring frequency at 4 timepoints over a 3-year period. RESULTS At baseline, Hispanic youth had significantly poorer glycemic control, more family conflict, and fewer blood glucose checks on average compared to WNH youth. Similar to WNH youth, Hispanic youth have increasing independence for regimen tasks and decreasing parent autonomy support during this developmental period. However, while Hispanic youth had worsening diabetes management during early adolescence (as did WNH youth), Hispanic parents reported a more gradual change in youth's diabetes management over early adolescence. CONCLUSIONS This study presents an important contribution to the existing literature on youth with T1D. Findings suggest potential strengths and targets for Hispanic youth navigating diabetes management during the adolescent period. It is important to continue to investigate the trajectories of ethnic minority youth with diabetes.
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Affiliation(s)
- Meg C Nicholl
- Department of Pediatrics, Kennedy Krieger Institute/Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jessica M Valenzuela
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Keith Lit
- Department of Psychology, Jackson Health System, Miami, FL, USA
| | - Christian DeLucia
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Amanda M Shoulberg
- Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer M Rohan
- Division of Hematology and Oncology, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Jennifer Shroff Pendley
- Division of Behavioral Health, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Lawrence Dolan
- Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Endocrinology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alan M Delamater
- Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
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14
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Miller VA, Jawad AF. Decision-Making Involvement and Prediction of Adherence in Youth With Type 1 Diabetes: A Cohort Sequential Study. J Pediatr Psychol 2020; 44:61-71. [PMID: 29788441 DOI: 10.1093/jpepsy/jsy032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/26/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To assess developmental trajectories of decision-making involvement (DMI), defined as the ways in which parents and children engage each other in decision-making about illness management, in youth with type 1 diabetes (T1D) and examine the effects of DMI on levels of and changes in adherence with age. Methods Participants included 117 youth with T1D, enrolled at ages 8-16 years and assessed five times over 2 years. The cohort sequential design allowed for the approximation of the longitudinal curve from age 8 to 19 from overlapping cohort segments. Children and parents completed the Decision-Making Involvement Scale, which yields subscales for different aspects of DMI, and a self-report adherence questionnaire. Mixed-effects growth curve modeling was used for analysis, with longitudinal measures nested within participant and participants nested within cohort. Results Most aspects of DMI (Parent Express, Parent Seek, Child Express, and Joint) increased with child age; scores on some child report subscales (Parent Express, Child Seek, and Joint) decreased after age 12-14 years. After accounting for age, Child Seek, Child Express, and Joint were associated with overall higher levels of adherence in both child (estimates = 0.08-0.13, p < .001) and parent (estimates = 0.07- 0.13, p < .01) report models, but they did not predict changes in adherence with age. Conclusion These data suggest that helping children to be more proactive in T1D discussions, by encouraging them to express their opinions, share information, and solicit guidance from parents, is a potential target for interventions to enhance effective self-management.
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Affiliation(s)
- Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania
| | - Abbas F Jawad
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania
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15
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Psihogios AM, Fellmeth H, Schwartz LA, Barakat LP. Family Functioning and Medical Adherence Across Children and Adolescents With Chronic Health Conditions: A Meta-Analysis. J Pediatr Psychol 2020; 44:84-97. [PMID: 29982694 DOI: 10.1093/jpepsy/jsy044] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/03/2018] [Indexed: 12/16/2022] Open
Abstract
Objectives A meta-analysis examined family functioning and medical adherence in children and adolescents with chronic health conditions. Family functioning was evaluated at the level of the family unit, as well as parent-child interactions. Methods We conducted literature searches using PubMed, PsycINFO, SCOPUS, Web of Science, and Cochrane. After reviewing 764 articles, 62 studies met eligibility criteria. Pearson's r correlations were the effect size of interest. We conducted both omnibus and domain-specific (e.g., family conflict, cohesion) meta-analyses. Meta-regressions examined whether relevant covariates related to the magnitude of the effect. Results The omnibus meta-analysis showed that family functioning was significantly related to medical adherence across a variety of pediatric chronic health conditions. Lower family conflict, greater family cohesion, greater family flexibility, more positive communication, and better family problem-solving were each associated with better adherence. There were no significant differences in the magnitude of the omnibus effect based on child age, measurement features (subjective vs. objective or bioassay adherence; family unit vs. parent-child interactions), or study quality. Conclusions Consistent with social-ecological frameworks, findings supported links between family functioning and medical adherence. This study highlights several limitations of the extant research, including absence of a guiding theoretical framework and several methodological weaknesses. We offer clinical and research recommendations for enhancing scientific understanding and promotion of adherence within the family context.
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Affiliation(s)
| | | | - Lisa A Schwartz
- The Children's Hospital of Philadelphia.,Perelman School of Medicine of the University of Pennsylvania
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia.,Perelman School of Medicine of the University of Pennsylvania
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16
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Van Gampelaere C, Luyckx K, van der Straaten S, Laridaen J, Goethals ER, Casteels K, Vanbesien J, den Brinker M, Depoorter S, Klink D, Cools M, Goubert L. Families with pediatric type 1 diabetes: A comparison with the general population on child well-being, parental distress, and parenting behavior. Pediatr Diabetes 2020; 21:395-408. [PMID: 31697435 DOI: 10.1111/pedi.12942] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/18/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS The aim of this study was to compare families with a child (2-12 years) with type 1 diabetes (T1D) to families which are not confronted with chronic illness, with regard to children's well-being, parental distress, and parenting behavior. In addition, differences were explored between families whose child has optimal vs suboptimal glycemic control. METHODS Mothers, fathers, and children of 105 families with pediatric T1D completed questionnaires assessing child well-being, parental distress, and parenting. The control group consisted of 414 families without chronic illness. RESULTS With regard to child well-being, children with T1D had more adjustment difficulties (as reported by mothers) and lower quality of life (QoL) (as reported by mothers and fathers), whereas children themselves (8-12 years) reported higher QoL compared to controls. In terms of parental distress, mothers, but not fathers, of children with T1D reported more stress, anxiety symptoms, and depressive symptoms than controls. With regard to parenting behavior, parent reports revealed less protectiveness in fathers and less autonomy support and responsiveness in both parents as compared to controls. No differences were found in parent-reported psychological control between parents of children with and without T1D, but children with T1D perceived lowered parental psychological control. Lastly, secondary analyses indicated that especially families with suboptimal child glycemic control showed more maternal distress and worse child well-being (according to parents). CONCLUSIONS Families confronted with pediatric T1D differ from families without chronic illness: childhood T1D impacts parental perceptions of child well-being and differentially affects mothers' and fathers' distress levels and behaviors.
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Affiliation(s)
- Cynthia Van Gampelaere
- Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Koen Luyckx
- Department of School Psychology and Development in Context, University of Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Saskia van der Straaten
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Jolien Laridaen
- Department of Medical Child and Adolescent Psychology, Ghent University Hospital, Ghent, Belgium
| | - Eveline R Goethals
- Department of School Psychology and Development in Context, University of Leuven, Leuven, Belgium.,Department of Pediatric Diabetes, University Hospital Leuven, Leuven, Belgium.,Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Kristina Casteels
- Department of Pediatric Diabetes, University Hospital Leuven, Leuven, Belgium.,Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Jesse Vanbesien
- Department of Pediatrics, University Hospital Brussels, Brussel, Belgium
| | - Marieke den Brinker
- Department of Pediatrics Division of Pediatric Endocrinology and Diabetology, University Hospital Antwerp, Edegem, Belgium
| | - Sylvia Depoorter
- Department of Child Endocrinology, General Hospital Sint-Jan Bruges-Ostend, Bruges, Belgium
| | - Daniel Klink
- Department of Child Endocrinology, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Martine Cools
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Liesbet Goubert
- Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium
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17
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Spaans EAJM, Kleefstra N, Groenier KH, Bilo HJG, Brand PLP. Adherence to insulin pump treatment declines with increasing age in adolescents with type 1 diabetes mellitus. Acta Paediatr 2020; 109:134-139. [PMID: 31292993 DOI: 10.1111/apa.14931] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/23/2019] [Accepted: 07/05/2019] [Indexed: 01/05/2023]
Abstract
AIM This study assessed the impact of illness perceptions, emotional responses to the disease and its management, and patient characteristics on the adherence to optimal insulin pump management in adolescents with type 1 diabetes mellitus. METHODS From May to December 2013 and May 2015 to September 2016, we investigated 90 adolescents (50% boys), 12-18 years with type 1 diabetes. We analysed the association of optimal adherence to insulin pump therapy to age, gender, diabetes duration, results of questionnaires relating to fear and problems of self-testing, illness perceptions, emotional distress and family conflicts. Optimal adherence was defined as bolusing insulin on average ≥2.5/3 main meals/d. RESULTS Adolescents with suboptimal adherence were on average 1.8 years older (95% Confidence Interval 1.09-2.50 years, P < .001) than those with optimal adherence. After adjustment for age, no other patient or parent factors were related to optimal adherence. CONCLUSION Adherence to insulin pump self-management in adolescents with type 1 diabetes declined with increasing age, illustrating the challenges of transition of self-management from parents to the adolescent patient themselves.
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Affiliation(s)
- Engelina A. J. M. Spaans
- Diabetes Centre Isala Zwolle the Netherlands
- Princess Amalia Children's Centre Isala Zwolle the Netherlands
| | - Nanno Kleefstra
- Medical Research Group Langerhans Ommen the Netherlands
- GGZ Drenthe Mental Health Institute High Intensive Care Assen the Netherlands
- Department of Internal Medicine University Medical Center Groningen, University of Groningen Groningen the Netherlands
| | | | - Henk J. G. Bilo
- Diabetes Centre Isala Zwolle the Netherlands
- Department of Internal Medicine University Medical Center Groningen, University of Groningen Groningen the Netherlands
| | - Paul L. P. Brand
- Princess Amalia Children's Centre Isala Zwolle the Netherlands
- UMCG Postgraduate School of Medicine, University Medical Center University of Groningen Groningen the Netherlands
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18
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Psihogios AM, Daniel LC, Tarazi R, Smith-Whitley K, Patterson CA, Barakat LP. Family Functioning, Medical Self-Management, and Health Outcomes Among School-Aged Children With Sickle Cell Disease: A Mediation Model. J Pediatr Psychol 2019; 43:423-433. [PMID: 29048590 DOI: 10.1093/jpepsy/jsx120] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/05/2017] [Indexed: 12/29/2022] Open
Abstract
Background Informed by the Pediatric Self-Management Model, the present study tested relationships between parent and family functioning, sickle cell disease (SCD) self-management, and health outcomes for children with SCD. Method 83 children with SCD and a parent completed baseline data as part of a larger investigation of a family-based, problem-solving intervention for children with SCD (M age = 8.47). Youth and parents completed a measure of child health-related quality of life (HRQOL), and parents completed measures of family efficacy, parenting stress, and SCD self-management. SCD pain episodes and urgent health utilization information over the past year were obtained via medical chart review. Results SCD self-management mediated the relationship between parent-reported family efficacy and parent proxy HRQOL, as well as the relationship between parenting stress and child and parent proxy HRQOL. Mediation models were nonsignificant for outcomes beyond HRQOL, including SCD pain episodes and urgent health utilization. Conclusion Fostering family efficacy and reducing parenting stress may be meaningful intervention targets for improving SCD self-management and child HRQOL among school-aged children. Although findings were consistent with the Pediatric Self-Management Model in terms of HRQOL, the model was not supported for pain episodes or urgent health utilization, highlighting the need for multi-method, longitudinal research on the SCD self-management behaviors that are linked to preventable health outcomes.
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Affiliation(s)
| | - Lauren C Daniel
- The Children's Hospital of Philadelphia.,Rutgers University, Camden
| | - Reem Tarazi
- Drexel University College of Medicine.,St. Christopher's Hospital for Children
| | - Kim Smith-Whitley
- The Children's Hospital of Philadelphia.,Perelman School of Medicine of the University of Pennsylvania
| | - Chavis A Patterson
- The Children's Hospital of Philadelphia.,Perelman School of Medicine of the University of Pennsylvania
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia.,Perelman School of Medicine of the University of Pennsylvania
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19
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LaBarbera B, Dvorak J, Zhang Y, Jeter K, Talsania M, Beck J. Diabetes-related events in adolescents and young adults: opportunities for psychosocial interventions. PSYCHOL HEALTH MED 2019; 24:1148-1157. [PMID: 30971099 DOI: 10.1080/13548506.2019.1597976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study was conducted to evaluate predictive factors of diabetes-related emergency room (ER) visits and hospitalizations among adolescents and young adults (AYA) with type 1 diabetes (T1D). Baseline demographic, medical, and psychosocial variables were collected for 177 AYA with T1D. Medical records were reviewed to identify ER visits and hospitalizations related to diabetes. Those with diabetes-related events had significantly higher hemoglobin A1c (A1c) values at baseline (p = 0.0001) and during an average 3.36 years of follow-up (p < 0.0001). Participants with events were more likely to have Medicaid or no insurance vs. private insurance (p = 0.0006) and were more likely to be on multiple daily injections vs. insulin pumps (p = 0.0159). Participants with events reported greater diabetes impact on their lives and their parents reported less autonomy in AYA with events (p = 0.0435). These results suggest that when participants were transferring from pediatric to adult care services, factors such as A1c, insurance status and diabetes treatment are associated with diabetes-related events. Further research is needed to elucidate a causative relationship and develop focused interventions to reduce diabetes-related events during this high-risk time. Autonomy should be further explored to determine its role in diabetes-related events during this transition period.
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Affiliation(s)
- Brenton LaBarbera
- a University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Justin Dvorak
- a University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Ying Zhang
- a University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Kathryn Jeter
- a University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Mitali Talsania
- a University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Joni Beck
- a University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
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20
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Chalew S, Gomez R, Vargas A, Kamps J, Jurgen B, Scribner R, Hempe J. Hemoglobin A1c, frequency of glucose testing and social disadvantage: Metrics of racial health disparity in youth with type 1 diabetes. J Diabetes Complications 2018; 32:1085-1090. [PMID: 30318164 DOI: 10.1016/j.jdiacomp.2018.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Black youth with type 1 diabetes (T1D) have higher HbA1c than whites. To understand HbA1c differences, we examined the relationship of psycho-social factors and glucose testing with HbA1c. METHODS Glucose tests per day (BGs/d) and mean blood glucose (MBG) were calculated from meter data of youth self-identified as black (n = 33) or white (n = 53) with T1D. HbA1c, family income, insurance status, concentrated disadvantage (CDI), psychological depression (DSC), mother educational attainment (MEA), and insulin delivery method (IDM) data was were analyzed. RESULTS Black patients had significantly higher HbA1c, MBG and disadvantage measures compared to whites. BGs/d correlated with HbA1c, MBG, age and CDI. Race (p < 0.0158), age (p < 0.0001) and IDM (p < 0.0036) accounted for 50% of the variability (R2 = 0.5, p < 0.0001) in BGs/d. Regardless of age, black patients had lower BGs/d than whites. MBG (p < 0.0001) and BGs/d (p < 0.0001) accounted for 61% of the variance in HbA1c (p < 0.0001). CONCLUSIONS BGs/d is easily assessed and closely associated with HbA1c racial disparity. BGs/d is intricately linked with greater social disadvantage. Innovative management approaches are needed to overcome obstacles to optimal outcomes.
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Affiliation(s)
- Stuart Chalew
- Division of Endocrinology and Diabetes, Children's Hospital of New Orleans and The Louisiana State University Health Sciences Center, 200 Henry Clay Ave, New Orleans, LA 70118, USA.
| | - Ricardo Gomez
- Division of Endocrinology and Diabetes, Children's Hospital of New Orleans and The Louisiana State University Health Sciences Center, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - Alfonso Vargas
- Division of Endocrinology and Diabetes, Children's Hospital of New Orleans and The Louisiana State University Health Sciences Center, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - Jodi Kamps
- Department of Psychology, Children's Hospital of New Orleans, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - Brittney Jurgen
- Department of Psychology, Children's Hospital of New Orleans, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - Richard Scribner
- School of Public Health, The Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA 70112, USA
| | - James Hempe
- Research Institute for Children, Children's Hospital of New Orleans and The Louisiana State University Health Sciences Center, 200 Henry Clay Ave, New Orleans, LA 70118, USA
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21
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Kelly CS, Berg CA. Close relationships and diabetes management across the lifespan: The good, the bad, and autonomy. J Health Psychol 2018; 26:226-237. [PMID: 30318922 DOI: 10.1177/1359105318805815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Relationships are linked with positive and negative self-management and illness outcomes for individuals with type 1 diabetes. Explanations for these mixed associations have remained separated in psychosocial research in type 1 diabetes by relationship type (e.g. parent vs spouse) and individual's age (e.g. adolescence vs older adulthood). In this conceptual review, we present a novel perspective that close relationships across the lifespan may be beneficial for illness self-management when they support individuals' sense of autonomy, defined from a Basic Psychological Needs perspective. Processes of autonomy support are crucial for promoting illness management across all ages and relationship types.
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22
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Bratina N, Forsander G, Annan F, Wysocki T, Pierce J, Calliari LE, Pacaud D, Adolfsson P, Dovč K, Middlehurst A, Goss P, Goss J, Janson S, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Management and support of children and adolescents with type 1 diabetes in school. Pediatr Diabetes 2018; 19 Suppl 27:287-301. [PMID: 30084519 DOI: 10.1111/pedi.12743] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/27/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Natasa Bratina
- Department of Endocrinology, Diabetes & Metabolism, University Children's Hospital, Ljubljana, Slovenia
| | - Gun Forsander
- The Queen Silvia Children's Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children Health System, Orlando, Florida
| | - Jessica Pierce
- Center for Healthcare Delivery Science, Nemours Children Health System, Orlando, Florida
| | - Luis E Calliari
- Department of Pediatrics, Santa Casa de Sao Paulo School of Medical Sciences, Brazil
| | - Danièle Pacaud
- Division of Diabetes and Endocrinology, Alberta Children's Hospital, Department of Paediatrics, University of Calgary, Calgary, Canada
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Klemen Dovč
- Department of Endocrinology, Diabetes & Metabolism, University Children's Hospital, Ljubljana, Slovenia
| | - Angie Middlehurst
- International Diabetes Federation Life for a Child Program, Sydney, Australia
| | - Peter Goss
- Team Diabetes, Geelong, Victoria, Australia
| | | | - Staffan Janson
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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23
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Crandell JL, Sandelowski M, Leeman J, Havill NL, Knafl K. Parenting behaviors and the well-being of children with a chronic physical condition. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2018; 36:45-61. [PMID: 29172624 PMCID: PMC5880719 DOI: 10.1037/fsh0000305] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Numerous studies have identified the importance of parenting behaviors to the well-being of children with chronic physical conditions. Synthesizing the findings of these studies has potential to identify which parenting behaviors are associated with specific aspects of child well-being. METHOD We retrieved research reports addressing the relationship between parenting behaviors and well-being in children with chronic physical conditions, and categorized parenting behaviors based on Skinner, Johnson, and Snyder's (2005) core dimensions of parenting (warmth, rejection, structure, chaos, autonomy support, and coercion) Through meta-analysis, we examined relationships between parenting dimension and child well-being variables. RESULTS Fifty-four reports from 47 unique studies met inclusion criteria. Parent warmth was associated with less child depression, better quality of life, better physical functioning, and fewer externalizing behavior problems. Parent rejection was associated with more child depression, internalizing/externalizing behavior problems, and poorer physical functioning. Parent structure was associated with better child physical functioning. Parent chaos was associated with poorer child physical functioning. Parent autonomy support was associated with better quality of life and fewer externalizing behavior problems. Parent coercion was associated with more child depression, poorer quality of life, poorer physical function, and more internalizing behavior problems. CONCLUSION The results identify multiple, potentially modifiable parenting dimensions associated with well-being in children with a chronic condition, which could be targeted in developing family-focused interventions. They also provide evidence that research using Skinner's core dimensions could lead to conceptualization and study of parenting behaviors in ways that would enable comparison of parenting in a variety of health and sociocultural contexts. (PsycINFO Database Record
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Affiliation(s)
| | | | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill
| | - Nancy L Havill
- School of Nursing, University of North Carolina at Chapel Hill
| | - Kathleen Knafl
- School of Nursing, University of North Carolina at Chapel Hill
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24
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Dumrisilp T, Supornsilchai V, Wacharasindhu S, Aroonparkmongkol S, Sahakitrungruang T. Factors associated with glycemic control in children and adolescents with type 1 diabetes mellitus at a tertiary-care center in Thailand: a retrospective observational study. ASIAN BIOMED 2017. [DOI: 10.1515/abm-2018-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Children and adolescents with type 1 diabetes mellitus (T1D), even those with intensive insulin treatment regimens, often have higher glycated hemoglobin (HbA1c) levels than adults.
Objective
To delineate the medical and psychosocial factors associated with glycemic control in an unselected pediatric population with T1D.
Methods
We included a cross-section of 58 adolescents (28 boys and 30 girls) aged 13.6 ± 4.0 years with T1D ≥1 year attending a well-established pediatric diabetes clinic in Thailand. Median diabetes duration was 4.1 years (range 1–18 years). Participants were divided into 2 subgroups according to their average HbA1c level over the past year. Those with good control (HbA1c <8%) (n = 13) were compared with those with poor control (HbA1c ≥8%) (n = 45). Data collected from self-report standardized questionnaires and medical records were used to compare variables between groups.
Results
Adolescents with good control used significantly less daily insulin and had higher family income, higher scores for family support, and quality of life (QoL) than those in the group with poor control (P < 0.05). Age, sex, puberty, duration of diabetes, insulin regimen, frequency of blood glucose monitoring, and self-report adherence did not differ between groups. By univariate logistic regression, the only factor associated significantly with poor glycemic control was a QoL score <25.
Conclusion
Adolescents with T1D may be at a higher risk of poor glycemic control if they have poor QoL, impaired family functioning, poor coping skills, and lower socioeconomic status, suggesting that psychosocial interventions could potentially improve glycemic control in this population.
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Affiliation(s)
- Termpong Dumrisilp
- Department of Pediatrics , Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Vichit Supornsilchai
- Department of Pediatrics , Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Suttipong Wacharasindhu
- Department of Pediatrics , Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Suphab Aroonparkmongkol
- Department of Pediatrics , Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Taninee Sahakitrungruang
- Department of Pediatrics , Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
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25
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Wu YP, Stenehjem DD, Linder LA, Yu B, Parsons BG, Mooney R, Fluchel MN. Adherence to Oral Medications During Maintenance Therapy Among Children and Adolescents With Acute Lymphoblastic Leukemia: A Medication Refill Analysis. J Pediatr Oncol Nurs 2017; 35:86-93. [PMID: 29188741 DOI: 10.1177/1043454217741877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Adherence to oral medications during maintenance therapy is essential for pediatric patients with acute lymphoblastic leukemia. Self-reported or electronic monitoring of adherence indicate suboptimal adherence, particularly among particular sociodemographic groups. This study used medication refill records to examine adherence among a national sample of pediatric patients with acute lymphoblastic leukemia. Patients in a national claims database, aged 0 to 21 years with a diagnosis of acute lymphoblastic leukemia and in the maintenance phase of treatment, were included. Medication possession ratios were used as measures of adherence. Overall adherence and adherence by sociodemographic groups were examined. Adherence rates were 85% for 6-mercaptopurine and 81% for methotrexate. Adherence was poorer among patients 12 years and older. Oral medication adherence rates were suboptimal and similar to or lower than previously documented rates using other methods of assessing adherence. Refill records offer a promising avenue for monitoring adherence. Additional work to identify groups most at-risk for poor adherence is needed. Nurses are well positioned to routinely monitor for medication adherence and to collaborate with the multidisciplinary team to address barriers to adherence.
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Affiliation(s)
- Yelena P Wu
- 1 University of Utah, Salt Lake City, UT, USA
| | - David D Stenehjem
- 1 University of Utah, Salt Lake City, UT, USA.,3 Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth, MN, USA
| | - Lauri A Linder
- 1 University of Utah, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Bin Yu
- 1 University of Utah, Salt Lake City, UT, USA
| | | | - Ryan Mooney
- 1 University of Utah, Salt Lake City, UT, USA
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26
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Visekruna S, McGillis Hall L, Parry M, Spalding K. Intersecting Health Policy and the Social Determinants of Health in Pediatric Type 1 Diabetes Management and Care. J Pediatr Nurs 2017; 37:62-69. [PMID: 28683888 DOI: 10.1016/j.pedn.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 06/03/2017] [Indexed: 12/20/2022]
Abstract
THEORETICAL PRINCIPLES Type 1 diabetes health technologies are evolving. This is an expensive chronic condition to manage, hence a combination of public and private healthcare funding sources, as well as out-of-pocket payments support disease management. The aim of this paper is to describe two conceptual underpinnings, which can appropriately position the health policy and clinical context of pediatric type 1 diabetes management and care. PHENOMENA ADDRESSED: "The Main Determinants of Health" framework is used to position pediatric T1D management and care within the model's four interconnected layers: the structural environment, social and material conditions, support systems and individual health behaviors. A health policy in Ontario, Canada, the Assistive Devices Program for insulin pump therapy is also discussed relative to the model's outermost layer: the structural environment. Four dimensions of control, which characterize the "street-level bureaucrat" role including "distributing benefits and sanctions; structuring the context; teaching the client role; and, psychological benefits and sanctions" then position the policy context of the diabetes nurse educator role relative to the Assistive Devices Program policy. RESEARCH LINKAGES These conceptual underpinnings could extend beyond the pediatric T1D landscape to position global research in other nursing practice areas, as well as with other patient populations and professional disciplines such as social work and medicine.
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Affiliation(s)
- Sanja Visekruna
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Linda McGillis Hall
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Karen Spalding
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada.
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McDonough RJ, Clements MA, DeLurgio SA, Patton SR. Sleep duration and its impact on adherence in adolescents with type 1 diabetes mellitus. Pediatr Diabetes 2017; 18:262-270. [PMID: 27028035 PMCID: PMC6941140 DOI: 10.1111/pedi.12381] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/21/2016] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adherence to the type 1 diabetes (T1D) regimen, while predictive of glycemic control, decreases during adolescence. For adolescents, attaining adequate sleep is an additional challenge. This study evaluates the impact of sleep on adherence in teens with T1D. SUBJECTS Forty-five adolescents aged 12-18 yr, with T1D for at least 6 months while on insulin pump therapy. METHODS Adolescents logged their sleep on a written diary for 2 wk. Corresponding insulin pump/glucometer downloads as well as sleep habit questionnaires were also obtained. RESULTS Data from 20 girls and 25 boys, with a mean age of 15 ± 1.6 yr and mean glycated hemoglobin of 8.7 ± 1.1% (72 mmol/mol), were analyzed. Overall, average sleep was 8.6 ± 0.9 h per night. Sleep durations were compared to the next day's frequency of self-monitored blood glucose (SMBG) and total daily insulin bolus frequency. Associations were found between sleep duration and youths' SMBG and insulin bolus frequencies (p < 0.03 and p < 0.001, respectively). Specifically, a 15- and 20-min increase in sleep was associated with one additional SMBG check and one additional insulin bolus, respectively. CONCLUSION Analyses suggest an associated increase in T1D self-management behaviors in youths with increased sleep duration. These findings highlight the importance of assessing sleep in clinical practice, and encourage further research to examine effective strategies to address sleep hygiene as part of routine diabetes management.
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Affiliation(s)
- Ryan J. McDonough
- Department of Pediatrics, Division of Endocrinology/Diabetes, Children’s Mercy – Kansas City, Kansas City, MO, USA, 64111
| | - Mark A. Clements
- Department of Pediatrics, Division of Endocrinology/Diabetes, Children’s Mercy – Kansas City, Kansas City, MO, USA, 64111;,Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA, 66160;,Department of Pediatrics, University of Missouri Kansas City, Kansas City, MO, USA, 64108
| | - Stephen A. DeLurgio
- Center for Health Outcomes and Health Services Research, Children’s Mercy – Kanasas City, Kansas City, MO, USA, 64108
| | - Susana R. Patton
- Center for Children’s Healthy Lifestyles and Nutrition, Children’s Mercy – Kansas City, Kansas City, MO, USA 64108 & University of Kansas Medical Center, Kansas City, KS, USA, 66160;,Department of Pediatrics, Division of Behavioral Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA, 66160
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Pathways of emotional autonomy, self-care behaviors, and depressive symptoms on health adaptation in adolescents with type 1 diabetes. Nurs Outlook 2017; 65:68-76. [DOI: 10.1016/j.outlook.2016.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/18/2016] [Accepted: 07/30/2016] [Indexed: 12/13/2022]
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Abstract
The majority of people with type 1 diabetes have suboptimal glycemic control, increasing their complication risk. Technology to support diabetes self-care has advanced significantly and includes self-monitoring of blood glucose (SMBG), insulin pump therapy (IPT), continuous glucose monitoring (CGM), and sensor-augmented pump therapy (SAPT), which are stepping stones toward the "artificial pancreas" using closed-loop technology. Use of these technologies improves clinical outcomes for patients with the appropriate skills and motivation. This review addresses the psychosocial factors that influence both technology provision and clinical outcome and also how technology impacts on psychological outcomes. Optimal use of the various diabetes self-management technologies is influenced by previous self-care behaviors, demographic and psychological factors. Provision of IPT is also influenced by the same factors. Despite technology increasing the complexity of treatment, the lack of evidence for adverse psychological outcomes is reassuring. Treatment satisfaction is high, and discontinuation rates are low. However, technology will widen the health inequality gap if its use is limited to motivated patients who demonstrate good self-care behaviors. Pivotal to the success of the various technologies is provision of appropriate education at initiation of the technology, regular ongoing contact for treatment adjustments and trouble-shooting device issues plus access to psychological support when required. Additional support strategies may be required to help patients struggling with their diabetes to benefit from the available technology, recognizing that they may have most to gain.
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Affiliation(s)
- Victoria Franklin
- Raigmore Hospital, Inverness, Scotland, UK University of Aberdeen, Scotland, UK
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Landers SE, Friedrich EA, Jawad AF, Miller VA. Examining the interaction of parental involvement and parenting style in predicting adherence in youth with type 1 diabetes. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2016; 34:41-50. [PMID: 26866945 PMCID: PMC4786450 DOI: 10.1037/fsh0000183] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION This study examined whether aspects of parenting style (specifically, warmth, autonomy support, and coercion) moderated the association between parental involvement and adherence in youth with type 1 diabetes. METHODS Children ages 8 to 16 years with type 1 diabetes and a parent completed assessments of parental involvement, parenting style, and adherence. RESULTS Parent autonomy support and coercion were associated with adherence but warmth was not. Child report of more parental involvement was associated with better adherence. Warmth, autonomy support, and coercion were not moderators. DISCUSSION The findings underscore the importance of parental involvement, operationalized as responsibility for diabetes tasks, and parenting style, specifically coercion and autonomy support, for adherence in pediatric chronic illness management. Longitudinal research is needed to better understand how and why dimensions of involvement (e.g., responsibility, monitoring, support) vary over time and whether they impact outcomes differentially.
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Affiliation(s)
- Sara E Landers
- Department of Pediatrics, The Children's Hospital of Philadelphia
| | | | - Abbas F Jawad
- Department of Pediatrics, The Children's Hospital of Philadelphia
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Viau KS, Jones JL, Murtaugh MA, Gren LH, Stanford JB, Bilder DA. Phone-based motivational interviewing to increase self-efficacy in individuals with phenylketonuria. Mol Genet Metab Rep 2016; 6:27-33. [PMID: 27014576 PMCID: PMC4789343 DOI: 10.1016/j.ymgmr.2016.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/10/2016] [Accepted: 01/10/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To measure change in patient activation and self-efficacy in individuals with phenylketonuria (PKU) before and after a 6-month phone-based motivational interviewing (MI) intervention and determine the feasibility of implementing dietary counseling for PKU using an MI approach. METHODS Participants (n = 31) included preadolescents (7-12 years), adolescents (13-17 years), and adults (18-35 years) with early-treated PKU. Participants completed online questionnaires assessing self-reported stage of change (SOC), patient activation, and self-efficacy for PKU self-management behaviors. The intervention included monthly phone-based dietary counseling using MI during which participants set monthly goals. RESULTS Patient activation and self-efficacy were significantly different by age group (both p < 0.01) with higher scores in older participants. Self-efficacy significantly increased from baseline to month 6 among adolescents and adults (7.4 ± 1.9 and 8.6 ± 1.3, respectively, p = 0.002). Preadolescents did not have a significant change in self-efficacy (p = 0.79). There was no increase in patient activation for preadolescents or adolescents/adults (p = 0.19 and p = 0.24, respectively). Indicators of learning problems were not significantly associated with self-efficacy (p = 0.33) or patient activation (p = 0.83). CONCLUSION These results demonstrate the feasibility of implementing phone-based dietary counseling for PKU using MI. This study also supports further investigation of MI as an intervention approach to improving self-efficacy and self-management behaviors in adolescents and adults with PKU.
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Affiliation(s)
- Krista S. Viau
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
| | - Jessica L. Jones
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
| | - Maureen A. Murtaugh
- Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Lisa H. Gren
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
| | - Deborah A. Bilder
- Department of Psychiatry, University of Utah, 650 Komas Drive, Suite 200, Salt Lake City, UT 84108, USA
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Motivational techniques to improve self-care in hemophilia: the need to support autonomy in children. BMC Pediatr 2016; 16:4. [PMID: 26754457 PMCID: PMC4707725 DOI: 10.1186/s12887-016-0542-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/05/2016] [Indexed: 11/29/2022] Open
Abstract
Background In pediatric hemophilia, caregivers are facing unique challenges to adherence and self-care in children and adolescents with hemophilia. Hemophilia treatment requires adequate prophylaxis and on-demand treatment, as well as a clear behavioral strategy to limit risk-taking in terms of physical exercise and diet. Medication adherence rates of hemophilia patients have been reported to decrease during late childhood and adolescence. In the developing child, moving safely from parent-care to self-care is one of the greatest challenges of integrative care within this domain. There is a clear need for initiatives designed to increase an individual’s motivation for treatment and self-care activities. Discussion Among motivational approaches, the self-determination perspective offers a useful framework to explain how the transition to self-care can be facilitated. We discuss how motivation regarding hemophilia treatment may be increased through parental autonomy support and we offer examples of applied communication techniques to facilitate autonomy-supportive caregiving. Although it has not yet been tested in the context of hemophilia, these communication techniques could potentially help caregivers promote adherence and self-care in children. Summary Confronted by unique challenges to adherence and self-care, caregivers of children with hemophilia should move from an exclusive focus on illness-management education to an integrative strategy, including motivation-enhancing communication. The self-determination perspective provides important proximal objectives (e.g. autonomy support) to maintain optimal adherence in adolescents as they move from parent-care to self-care. Future research initiatives should address the practice of these communication techniques and evaluate them in the context of hemophilia.
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Abstract
PURPOSE OF REVIEW Adolescence is a well known, high-risk time period for all youth, and in patients with type 1 diabetes, glycemic control is at its worst. This manuscript will review updates in adolescent diabetes literature between February 2014 and February 2015. The article will highlight new research in the behavioural and psychosocial literature focused on type 1 diabetes in adolescents, including compliance with standards of care, quality of life, depression, psychological burden of type 1 diabetes, parental involvement, the parent-child relationship, self-management, socioeconomic status and transition and transfer of care. Recent behavioural interventions focusing on adolescents with type 1 diabetes will also be discussed. RECENT FINDINGS These literature updates have found that behavioural and psychosocial concerns remain prevalent in adolescents with type 1 diabetes, psychological needs in the population are not being met and current interventions have not been largely successful in impacting outcomes. SUMMARY Behavioural and psychosocial issues in adolescents with type 1 diabetes greatly impact their diabetes and general life outcomes. Additional research, specifically interventions successfully addressing the behavioural and psychosocial issues in this population, is desperately needed.
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Affiliation(s)
- Jennifer Raymond
- The Barbara Davis Center for Childhood Diabetes, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Colorado, USA
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Rohan JM, Huang B, Pendley JS, Delamater A, Dolan L, Reeves G, Drotar D. Predicting Health Resilience in Pediatric Type 1 Diabetes: A Test of the Resilience Model Framework. J Pediatr Psychol 2015; 40:956-67. [PMID: 26152400 DOI: 10.1093/jpepsy/jsv061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/31/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This research examined whether individual and family-level factors during the transition from late childhood to early adolescence protected individuals from an increased risk of poor glycemic control across time, which is a predictor of future diabetes-related complications (i.e., health resilience). METHODS This longitudinal, multisite study included 239 patients with type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c. Individual and family-level factors included: demographic variables, youth behavioral regulation, adherence (frequency of blood glucose monitoring), diabetes self-management, level of parental support for diabetes autonomy, level of youth mastery and responsibility for diabetes management, and diabetes-related family conflict. RESULTS Longitudinal mixed-effects logistic regression indicated that testing blood glucose more frequently, better self-management, and less diabetes-related family conflict were indicators of health resilience. CONCLUSIONS Multiple individual and family-level factors predicted risk for future health complications. Future research should develop interventions targeting specific individual and family-level factors to sustain glycemic control within recommended targets, which reduces the risk of developing future health complications during the transition to adolescence and adulthood.
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Affiliation(s)
- Jennifer M Rohan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Department of Psychology, University of Cincinnati,
| | - Bin Huang
- Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center
| | | | | | - Lawrence Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, and
| | - Grafton Reeves
- Division of Pediatric Endocrinology, Alfred I. duPont Hospital for Children
| | - Dennis Drotar
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Department of Psychology, University of Cincinnati
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Iskander JM, Rohan JM, Pendley JS, Delamater A, Drotar D. A 3-year prospective study of parent-child communication in early adolescents with type 1 diabetes: relationship to adherence and glycemic control. J Pediatr Psychol 2014; 40:109-20. [PMID: 24839292 DOI: 10.1093/jpepsy/jsu027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine changes in parent-child communication patterns and their relation to glycemic control and treatment adherence using observational data in a 3-year prospective multisite study of youth with type 1 diabetes aged 9-11 years at baseline and their families (n = 217). METHODS Adolescents and caregivers participated in a diabetes problem-solving discussion. Families were rated on negative and positive communication and interactions using the Interaction Behavior Code. RESULTS Maternal and paternal negative communication decreased over time, whereas adolescent and maternal positive communication and positive reciprocity increased. Baseline preadolescent youth and maternal positive communication predicted adherence 3 years later. Changes in family communication did not predict changes in glycemic control or adherence. CONCLUSIONS During the transition to adolescence, family communication changed in unexpected and positive ways. Additionally, the relationship of baseline family communication to subsequent adherence suggests the need to assess family communication concerning diabetes-related management during preadolescence.
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Affiliation(s)
- Jeannette M Iskander
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine
| | - Jennifer M Rohan
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine
| | - Jennifer Shroff Pendley
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine
| | - Alan Delamater
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine
| | - Dennis Drotar
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine
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