Dissimilarity in adolescent and maternal representations of Type 1 diabetes: exploration of relations to adolescent well-being

Individual and Family Management in Portuguese Adolescents with Type 1 Diabetes: a Path Analysis

BACKGROUND

This study evaluates the adequacy of the Revised Self and Family Management Framework (Grey et al., Nurs Outlook 63:162-170, 2015) in Portuguese adolescents with type 1 diabetes and analyzes the effect of parental coping, family support, and adherence in the association between illness representations, school support, metabolic control, quality of life, and family functioning.

METHOD

One hundred adolescents (aged 12-19) and their parents participated in a cross-sectional study. Adolescents were assessed on school support, adherence to self-care, family support, and quality of life. Parents were assessed on parental coping and family functioning. Both adolescents and parents were assessed on illness representations. Adolescent's metabolic control was evaluated through glycosylate hemoglobin.

RESULTS

Adolescents' and parents' illness representations were associated with metabolic control, quality of life and family functioning. Parental coping, family support and adherence had an indirect effect between illness representations and diabetes outcomes.

CONCLUSION

Findings showed the adequacy of Grey and colleagues' model (Nurs Outlook 63:162-170, 2015) in adolescents with type 1 diabetes and how family support, parental coping, and adherence contribute to diabetes management. Interventions to improve adolescents' and family's management of Type 1 diabetes should be designed to change adolescents' and family's representations and enhance their ability and skills in diabetes management.

A triadic perspective on control perceptions in youth with type 1 diabetes and their parents: Associations with treatment adherence and glycemic control

AIMS

A family approach was applied to examine youth, maternal, and paternal control perceptions in relation to type 1 diabetes outcomes in adolescents and emerging adults. Mean levels of personal and treatment control were compared among patients and parents. Their associations with diabetes outcomes were examined as well.

METHODS

The sample included 330 patient-mother-father triads. Patients' (48% male) mean age was 18.25 years (SD = 2.98). All respondents reported on their control perceptions and youth treatment adherence. Physicians provided HbA1c-values.

RESULTS

Paired-samples t-tests revealed higher personal control in patients compared to parents. Regression analyses examined if control perceptions predicted treatment adherence and HbA1c. Main effects for patient and maternal personal control and two-way interactions showed the best outcomes when both patients and mothers reported high personal control. Main effects of patient, maternal, and paternal treatment control and three-way interaction terms revealed better outcomes in case of high treatment control in patients and at least one parent, while the poorest outcomes were observed in case of low treatment control in all respondents.

CONCLUSIONS

The findings highlight the importance of parental control perceptions on top of patients' own perceptions. A family perspective on illness perceptions and their associations with diabetes outcomes is encouraged.

Measuring illness perceptions in the family context: psychometric properties of the IPQ-R adapted for adolescent-caregiver dyads

OBJECTIVES

Given the lack of validated measures assessing illness perceptions in families, the aim of our study was the development and psychometric testing of an adapted version of the Illness Perceptions Questionnaire-Revised (IPQ-R) allowing for Common Sense Model-based dyadic assessment of adolescents' and caregivers' perceptions of a chronic illness in adolescence.

METHODS

Using a cross-sectional survey design, factor structure, reliability and validity of the adapted measure You-IPQ-R were tested in a sample of adolescents with asthma (N = 155) and their primary caregivers (N = 132). Analysis included a dyadic methodology (dyadic confirmatory factor analyses) and examination of the suitability of the measure for different age groups.

RESULTS

Both the adolescent and the caregiver versions of the You-IPQ-R revealed good overall validity and reliability. For all Common Sense Model dimensions except for timeline cyclical in the caregiver version, unidimensional scales aligning with the original IPQ-R structure could be confirmed. Age-specific analyses revealed good to excellent measurement properties in adolescents aged 14 years or older, but considerably poorer indices in younger adolescents.

CONCLUSION

The dyadically validated You-IPQ-R will enable researchers and clinicians to compare illness perceptions in adolescent-caregiver dyads and to assess the effects of family illness perceptions' congruence upon medical, psychosocial and behavioural outcomes.

Association of Asthma Illness Representations and Reported Controller Medication Adherence Among School-Aged Children and Their Parents

This study examined the relationship between asthma illness representations and reported controller medication adherence of school-aged children (6-11 years) with persistent asthma and their parents. Thirty-four parent-child dyads independently reported on asthma controller medication adherence and asthma illness representations. Hierarchical regression analyses were used to test parent and child illness representation domain variables as predictors of reported medication adherence. Parent beliefs about medication necessity versus concerns was a significant predictor of parent-reported adherence (β = .55, p < .01), and child treatment control was also a significant predictor of parent-reported adherence (β = -.50, p < .01). Child beliefs about medication necessity versus concerns was a significant predictor of child-reported adherence (β = .50, p < .01), and no parent variables reached significance. Although there are similarities between parent and child asthma illness representations, findings indicate that school-aged children develop illness representations somewhat independently from their parents and, therefore, are critical participants in both asthma care and research.

Adolescent and parental perceptions about asthma and asthma management: a dyadic qualitative analysis

BACKGROUND

Considering that asthma management is a family affair - with specific challenges in adolescence - a better understanding of both adolescent and parental perspectives on asthma and its treatment are needed as these constructs may substantially account for variation in illness-related behaviour and functioning. The present study aimed to (1) explore adolescents' and caregivers' perceptions about asthma and asthma management and (2) examine congruence and dissimilarities within the adolescent-caregiver dyads.

METHODS

Data collection was conducted separately for adolescents and caregivers using a focus group approach for the adolescents and telephone interviews for parental data collection. In total, dyadic data from n = 15 adolescent patients with asthma (aged 11-17 years, M = 14.9) and their mothers (aged 37-55 years, M = 46.3) were considered in the study. The interviews were transcribed verbatim and analysed in a dyad-focused multistep qualitative content analysis procedure using the software.

RESULTS

The results demonstrated high complexity in the perceptions among adolescents and mothers and reflected 113 specific themes that could be assigned to four main topics: asthma beliefs, representations of asthma treatment, perceptions about individual asthma management and perceptions about family asthma management. Dyadic analyses revealed congruence in the adolescent-caregiver dyads in most of the themes. However, we also found issues where divergent perceptions became evident including, for example, perceptions of asthma's general impact on adolescents' life or the question of who takes the main responsibility in asthma management.

CONCLUSIONS

Adolescents' and caregivers' perceptions were found to reflect a great variety of beliefs regarding the adolescents' illness and illness-related behaviour on both the individual and the family level. The study adds to the illness perceptions literature by providing a systemic perspective that was rather rarely presented in prior research.

Congruence of Transition Perspectives Between Adolescents With Perinatally-Acquired HIV and Their Guardians: An Exploratory Qualitative Study

Youth with perinatally-acquired HIV infection (PHIV) routinely survive into adulthood requiring transition to adult care. Research underscores the importance of assessing transition perspective congruence between adolescents and guardians. Interviews focused on transition decisions were conducted with 18 adolescents with PHIV and their guardians recruited from a southeastern US pediatric infectious disease clinic. Transcribed responses were coded as congruent or divergent. Adolescents and guardians held congruent views that the transition process had not started. Fewer dyads agreed upon the level of adolescent and guardian involvement in transition decisions. Providers should assess congruence of adolescent and guardian perspectives regarding transition-related decisions.

The role of maternal illness perceptions in perceived asthma symptoms in school-aged children

OBJECTIVE

To examine the unique contribution of perceptions held by mothers about their children's asthma in relation to the symptoms as reported by their children.

METHODS

Families with a child diagnosed with asthma participating in a larger smoking prevention study were invited to participate. For all, 89 children (mean age 10.1 years) and 87 mothers questionnaire and lung function data during home visits were provided. The main outcome of this study involved asthma symptoms as measured by the Pediatric Quality of Life Inventory. Mothers' and children's reports of symptoms, as well as the lung function parameter of percentage of predicted Forced Expiratory Volume in one second (% of predicted FEV1), were analyzed in relation to maternal illness perceptions.

RESULTS

Mothers' perceptions of illness were not associated with % of predicted FEV(1.) However, while controlling for gender and children's baseline asthma symptoms, four out of eight mothers' perceptions of illness (i.e., identity, consequences, concern, and emotional influence) were associated with children's asthma symptoms. Additional analyses controlling for % of predicted FEV(1) in the models with subjective asthma symptoms reports of mother and child did not change the study findings.

CONCLUSIONS

This pilot study provides evidence that, in addition to children's lung function and baseline symptoms, maternal perception of illness contributes to symptom-related quality of life (QoL) of children. More research on underlying mechanisms, which addresses the linking of mothers' perceptions of concern and emotion to the QoL symptoms as reported by children is necessary.

The association between discrepancy in illness representations on distress in stroke patients and carers

BACKGROUND

To investigate the association between the illness representations of recently diagnosed stroke patients and their carers and distress in the months after stroke.

METHOD

Forty-two stroke survivors and their carers were assessed at 3 months and 32 couples returned data at 6 months after stroke. Patients and carers completed the Illness Perceptions Questionnaire-Revised, Barthel Index, Significant Others Scale and General Health Questionnaire. Analyses were conducted using the Actor-Partner Interdependence Model.

RESULTS

Carers were more pessimistic than patients about the symptoms, timeline and consequences of the stroke. Patient distress was associated with both patient and carer illness representations at Time 1, and their own illness representations and discrepancy in the illness representations of patients and carers at Time 2. Carer distress was associated with their own illness representations at Time 1, but not the patient's illness representations. Discrepant illness representations were associated with higher carer distress at Time 1 but not Time 2.

CONCLUSION

Illness representations of stroke patients and carers have implications for adjustment for both partners. It is important to understand couples' views of stroke, as discrepancy was as strongly associated with patient and carer distress as was physical disability.

Illness perceptions and glycaemic control in diabetes: a systematic review with meta-analysis

AIMS

The Illness Perception Questionnaire, the Revised Illness Perception Questionnaire and the Brief Illness Perception Questionnaire have been widely used to measure people's beliefs about diabetes. This review aimed to synthesize evidence on the relationship between the dimensions of the Illness Perception Questionnaire, the Revised Illness Perception Questionnaire and the Brief Illness Perception Questionnaire and HbA(1c) level in adults with diabetes.

METHODS

A systematic literature search was carried out in January 2010 to identify relevant studies. Random-effects model meta-analyses were conducted with cross-sectional data to quantify the relationship between Illness Perception Questionnaire dimensions and HbA(1c) across studies. Randomized controlled trials that targeted Illness Perception Questionnaire perceptions and included HbA(1c) as an outcome measure were discussed in a narrative review.

RESULTS

Nine cross-sectional studies and four randomized controlled trials were included. Stronger Identity (r+=0.14), Consequences (r+=0.14), Timeline Cyclical (r+ = 0.26) Concern (r+= 0.21), and Emotional Representations (r+=0.18) perceptions had significant positive associations with HbA(1c.) Greater Personal Control (r+=- 0.12) was negatively associated with HbA(1c) . For all relationships, heterogeneity tests were non-significant, suggesting little variability in effect size estimates. Two of the four randomized controlled trials successfully changed illness perceptions, with one also reporting an intervention group reduction in HbA(1c).

CONCLUSIONS

Some Illness Perception Questionnaire dimensions had small significant associations with HbA(1c) , although the direction of these associations remains unclear. There was also tentative evidence that illness perceptions can be positively changed through targeted intervention and that these changes may also impact on glycaemic control. Future research could benefit from tailoring intervention content to perceptions that are most highly associated with HbA(1c).

Illness perceptions among carer-survivor dyads are related to psychological distress among Oesophageal cancer survivors

OBJECTIVE

To examine the extent to which the illness perceptions of Oesophageal cancer survivors and the illness perceptions of their carers explain the survivors' levels of psychological distress (in terms of anxiety and depression symptoms) relative to demographic and biomedical variables and patients' coping strategies.

METHOD

Everyone registered with the Oesophageal Patients' Association in the UK was mailed a questionnaire booklet containing questions about medical and demographic variables, the Illness Perception Questionnaire-Revised, the Cancer Coping Questionnaire, and the Hospital Anxiety and Depression Scale. Patients were asked to pass a modified version of the Illness Perception Questionnaire-Revised to someone they identified as a carer. Complete responses were received from 317 dyads.

RESULTS

Regression models indicated that the variables measured could explain 56% of the variance in anxiety and 54% of the variance in depression. Patients' illness perceptions explained the majority of this variance. Positive focus coping strategies were also found to be important in explaining psychological well-being. Some of the carers' illness perceptions made a significant contribution to the explanation of the patients' levels of psychological distress, and in some instances, carer perceptions were found to moderate the relationship between patients' perceptions and psychological distress.

CONCLUSION

The findings suggest that cognition-based interventions could potentially be most effective in minimizing emotional distress among survivors of Oesophageal cancer. This study also shows that these interventions could usefully be delivered at the level of the patient-carer dyad.

Acceptance and well-being in adolescents and young adults with cystic fibrosis: a prospective study

OBJECTIVE

To prospectively investigate the role of acceptance in well-being in adolescents and young adults with cystic fibrosis (CF).

METHOD

A total of 40 adolescents and young adults with CF (ages 14-22 years) completed questionnaires assessing acceptance, anxiety and depressive symptoms, physical functioning, role functioning, emotional functioning, and social functioning. After 6 months, 28 of them completed the questionnaires on anxiety and depressive symptoms, physical functioning, role functioning, emotional functioning, and social functioning a second time.

RESULTS

More acceptance (Time 1) was related to less depressive symptoms (Time 1 and 2), and to better role, emotional, and social functioning (Time 1).

CONCLUSIONS

Results indicate that accepting the limitations imposed by chronic disease and readjusting life goals may have a positive effect upon well-being in adolescents and young adults with CF. Further research is needed to clarify whether acceptance-based interventions are useful in promoting well-being in adolescents and young adults with CF.

Understanding Type 2 Diabetes

Purpose

The purpose of this study was to examine the relationship between psychological and social factors and diabetes outcomes in people with type 2 diabetes and their family members.

Methods

A total of 153 patients with type 2 diabetes were assessed at a diabetes outpatient clinic and postal questionnaires were sent to nominated family members. The measures examined were diabetes knowledge, social support, well-being, and illness perceptions.

Results

When compared with those with diabetes, family members reported lower positive well-being and lower levels of satisfaction with support. They also perceived diabetes as a more cyclical illness, which was controlled more by treatment than by the individual. Family members also reported that the person with diabetes was more emotionally distressed and knew more about diabetes than the patient had actually reported himself or herself. There were no differences between the family members of those in good or poor glycaemic control.

Conclusions

This study reinforces the importance of understanding social context and illness beliefs in diabetes management. It also highlights the potential for including family members in discussions and education about diabetes management.

Finding the balance: adolescents with type 1 diabetes and their parents

INTRODUCTION

The purpose of this study was to describe the ways that parents and 11- to 15-year-old teens communicate and the recurrent themes and patterns of behavior that were revealed during brief interactions about issues related to diabetes management.

METHOD

A secondary qualitative analysis of data, based on a template for analysis developed from the literature, was completed on audiotaped interactions of 28 adolescents and their parents.

RESULTS

Themes identified were frustration, fear, normalizing, trusting, and discounting. Trusting the adolescent to manage diabetes was difficult for the parents and was associated with frustration, fear, and discounting communication.

DISCUSSION

Results support the need for clinicians to work with families to facilitate trust and positive parent-adolescent communication about diabetes management.

Illness representations among patients with type 2 diabetes and their partners: relationships with self-management behaviors

OBJECTIVE

There is accumulating evidence to indicate that the illness representations of significant others are important for understanding patients' responses to chronic disease. The aims of the present study were to (a) assess the illness representations of patients with type 2 diabetes and their partners, (b) determine the extent of agreement between patient and partner representations, and (c) examine whether partners' representations mediate the relationships between patients' representations and their prospective self-management behaviors.

METHODS

Patients' and partners' representations of diabetes were assessed with the Revised Illness Perception Questionnaire [Moss-Morris R, Weinman J, Petrie K, Horne R, Cameron LD, Buick, D. The revised illness perception questionnaire (IPQ-R). Psychol Health 2002;17:116] at baseline (n=164). Self-management behaviors were assessed 12 months later with self-report measures of physical activity, medication, and a food frequency questionnaire.

RESULTS

Patients scored lower on the illness coherence dimension, indicating that they reported a poorer understanding of the condition (t=-2.66, df=163, P=.009) relative to their partners. Patients demonstrated higher scores for personal control than their partners (t=2.01, df=163, P=.046). Mediational analyses indicated that partners' perceived timeline of diabetes partially mediated the relationship between patients' representations and their self-management behaviors including physical activity and dietary intake. In addition, partners' personal control representations partially mediated the relationship between patients' representations and physical activity.

CONCLUSION

It was demonstrated that patient-partner dyads generally share similar representations of type 2 diabetes and perceived control over the condition. Furthermore, there was evidence that partners' representations partially mediated the relationships between patients' representations and their prospective self-management behaviors.

Mother and adolescent representations of illness ownership and stressful events surrounding diabetes

OBJECTIVE

To assess the extent to which adolescents with diabetes and their mothers appraise diabetes as a shared entity across adolescence through (a) assessing appraisals of illness ownership and their relationship to joint responsibility for daily diabetes tasks, (b) exploring whether appraisals of shared illness ownership are associated with congruent views of what is stressful about diabetes, and (c) examining whether age-related declines occur in these shared appraisals across adolescence.

METHODS

One hundred twenty-seven adolescents (ages 10-15 years, M = 12.8) and their mothers completed an interview that probed appraisals of illness ownership, the most stressful events surrounding diabetes in the past week, and a questionnaire regarding who was responsible for performing diabetes-related tasks.

RESULTS

Dyads, most frequently, agreed that diabetes was a "shared" entity. Shared appraisals of illness ownership reflected the greater joint responsibility of mothers and children in daily diabetes tasks. Shared appraisals of illness ownership were not related to congruent reports of diabetes stressful events, and incongruence in appraisals of stressful events was common. With age adolescents reported less shared illness ownership and congruence regarding stressful events, age differences were not seen in mothers' reports.

CONCLUSIONS

Although diabetes is often appraised as a social entity, adolescents and their mothers experience different aspects of the disease as stressful, especially as adolescents age, and become more independent in performing diabetes-related tasks.

Informant Discrepancy in Perceptions of Sickle Cell Disease Severity

OBJECTIVES

To evaluate whether informants (children, caregivers, and physicians) differ in their perceptions of chronic disease severity and the extent to which these differences can be explained by objective indices of disease severity, and adjustment of the caregiver.

METHODS

Participants were 58 children and adolescents between the ages of 8 and 18 years diagnosed with sickle cell disease. Information on perceptions of disease severity, caregiver adjustment, and biological markers of disease severity was obtained at a routine clinic follow-up appointment.

RESULTS

Analyses indicated significant differences in perceptions of disease severity. Psychological adjustment of the caregiver and biological indices of disease severity were significant predictors of these differences.

CONCLUSION

Implications for the association between chronic disease and adjustment are discussed.