1
|
Swartwout E, Hass EJ, Deyo P, El-Zein A, Lewis B, Rao-Gupta S. The Design and Testing of the Psychometric Properties of the Adolescent Capacity to Engage Index Instrument to Measure an Adolescent's Capacity to Engage in Healthcare. J Nurs Meas 2023; 31:458-469. [PMID: 36192123 DOI: 10.1891/jnm-2021-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Engagement in one's healthcare is paramount to improving health outcomes. As adolescents begin their journey into adulthood and increase involvement in their health-care decision-making, it is critical to understand their ability to be involved in their healthcare. The purpose of this instrumentation study was to develop and evaluate the psychometric properties and underlying factors of the Adolescent Capacity to Engage Index (ACEI) tool which measures the construct of an adolescent's capacity to engage in their healthcare. Methods: This study had a two-phase approach. Phase 1 consisted of the pilot and cognitive testing of the items developed based on the literature and content expertise. Phase 2 was the testing of the final 21 item revised instrument among 15- to 17-year-old online teen panel (n = 226). Results: Psychometric testing revealed a valid and reliable 21 item scale with a four-factor solution. The Cronbach's alpha for the total scale was .901. The four subscales and each subscale Cronbach's alpha were: (a) Active Participation In Healthcare with Psychosocial Support to Aid/Foster Good Healthcare Choices, (.826); (b) Transition Readiness to Self-Management with Family Support to Guide/Foster Health/Healthcare Decisions, (.825); (c) Proactivity and Empowerment to Have a Say in Health/Healthcare, (.747); and (d) Technology Use to Seek Health/Healthcare Information (.648). Conclusions: This study demonstrated the ACEI is a psychometrically sound instrument with good internal consistency for the overall scale and subscales. The ACEI can be implemented in clinical practice to measure adolescents' engagement capacity in their healthcare and identify appropriate interventions based on ACEI score. Further research to determine engagement capacity among teens of various populations is warranted.
Collapse
Affiliation(s)
- Ellen Swartwout
- Research Consultant, O'Neil Center, GetWellNetwork, Bethesda, MD, USA
| | - Edward J Hass
- Director, Consumer Insights & Market Research, Nemours Center for Health Delivery Innovation, Nemours Children's Health, Wilmington, DE, USA
| | - Patricia Deyo
- Nurse Research Consultant, O'Neil Center, GetWellNetwork, Bethesda, MD, USA
| | - Ashley El-Zein
- Research Consultant, O'Neil Center, GetWellNetwork, Bethesda, MD, USA
| | - Brennan Lewis
- Vice President, Nursing Excellence, Children's Health, Dallas, TX, USA
| | - Suma Rao-Gupta
- Director, Patient and Family Education, Clinical and Organizational Development, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| |
Collapse
|
2
|
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]
|
3
|
Short-Term Effects of COVID-19 Lockdown in Italian Children and Adolescents with Type 1 Diabetes Mellitus: The Role of Separation Anxiety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115549. [PMID: 34067365 PMCID: PMC8196957 DOI: 10.3390/ijerph18115549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022]
Abstract
In March 2020, the Italian Government imposed mandatory home confinement to limit the spread of COVID-19. Few studies assessed the psychophysical impact of COVID-19 on chronically ill children. This study examined these effects on children with Type 1 Diabetes Mellitus (T1D) and their caregivers. Seventy-one patients (7-13 years) with T1D and their caregivers were administered a survey created ad hoc and some standardized questionnaires, assessing psychological well-being and anxiety. Medical data (physical and biochemical characteristics) were recorded before (T0, January-February) and after (T1, May-June) the lockdown. Paired Student t-test, Spearman two-tailed correlations, and a linear regression model were used for statistical analysis. Children at T1 showed higher BMI (body mass index), daily total and basal insulin dose, and time spent in therapeutic range, and they showed lower HbA1c (glycated hemoglobin), time spent above the therapeutic range, and standard deviations of the mean glucose values than at T0. A total of 32.9% scored in the clinical range for separation anxiety. The increase in separation anxiety was predicted by younger age, female gender, more recent T1D diagnosis, less time spent in therapeutic range at T1, and higher perceived fear of COVID-19 infection. In a pandemic context, separation anxiety may be stronger in younger females, with more recent T1D diagnosis and poor metabolic control, thus affecting the parent's ability to manage diabetes and to support children's autonomy.
Collapse
|
4
|
Fried L, Chetty T, Cross D, Breen L, Davis E, Roby H, Jackiewicz T, Nicholas J, Jones T. The Challenges of Being Physically Active: A Qualitative Study of Young People With Type 1 Diabetes and Their Parents. Can J Diabetes 2020; 45:421-427. [PMID: 33223421 DOI: 10.1016/j.jcjd.2020.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Benefits of physical activity are well recognized for youth with type 1 diabetes mellitus (T1DM), but being active is challenging. In this study, we aimed to investigate the challenges experienced by adolescents, their parents and young adults with T1DM when they are physically active. METHODS Six focus groups involving adolescents (13 to 18 years old, n=14) and young adults (19 to 25 years old, n=7) and 4 focus groups with parents (n=14) of the adolescents (13 to 18 years) were established. Data were analyzed using content analysis. RESULTS Adolescents and young adults with T1DM identified challenges of unpredictability, knowledge, trust and stigma when they were physically active. Parent challenges were specifically unpredictability and trust. CONCLUSIONS Interventions are needed that provide adolescents and young adults with T1DM and parents of adolescents with T1DM more in-depth information about managing physical activity in a manner that enhances their perceived competence and builds autonomy. Interventions can also target peer and community support.
Collapse
Affiliation(s)
- Leanne Fried
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia.
| | - Tarini Chetty
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Donna Cross
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Lauren Breen
- Curtin University, Bentley, Western Australia, Australia
| | - Elizabeth Davis
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Heather Roby
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Tanyana Jackiewicz
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | | | - Tim Jones
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| |
Collapse
|
5
|
Di Riso D, Bassi G, Mancinelli E, Zaffani S, Salcuni S, Maffeis C. Mothers and Fathers Parenting Stress and Their Perception of Children's Psychosocial Functioning in Paediatric Diabetes: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134734. [PMID: 32630232 PMCID: PMC7369791 DOI: 10.3390/ijerph17134734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/26/2022]
Abstract
(1) Background: In the context of a child with Type 1 Diabetes Mellitus (T1DM), the rearrangement of the family’s lifestyle can account for an increased risk of experiencing psychosocial problems for both child and parents. Those few studies on pediatric diabetes, which focused on parents’ perception of children’s psychological strengths and weaknesses, reported significantly higher rates of children’s emotional and conduct problems associated with an imbalance in the Hemoglobin A1c (HbA1c). The main aim of this paper was to assess the role of parental perception of children’s psychosocial symptoms as a mediator of the perceived parenting stress, considering mother and father separately. (2) Methods: The study involved 12 parent couples (Mothers Mage = 40.25, SD = 6.58; Fathers Mage = 42.5, SD = 6.38) of children with T1DM aged between 7 and 11 years (Mage = 8.8, SD = 0.996). Parents completed questionnaires such as the Strengths and Difficulties Questionnaire for parents and their perspective of their child, and the Parenting Stress Index–Short Form. (3) Results: Mothers and fathers had significant differences in the perception of their child’s internalizing symptoms. Specifically, mothers present a greater perception of the mentioned symptoms compared to fathers. Mediation models showed that only for fathers’ perception of the child conduct problems has a significant role between the fathers’ perception of dysfunctional interaction with the child and the HbA1c. (4) Conclusions: The current study provides useful evidence also for clinical settings, suggesting that an interesting interplay between parenting stress, perception of children’s symptoms and glucometabolic control should be taken into consideration.
Collapse
Affiliation(s)
- Daniela Di Riso
- Department of Developmental Psychology and Socialization, University of Padova, 35122 Padova, Italy; (D.D.R.); (S.S.)
| | - Giulia Bassi
- Department of Developmental Psychology and Socialization, University of Padova, 35122 Padova, Italy; (D.D.R.); (S.S.)
- Fondazione Bruno Kessler, 38123 Trento, Italy
- Correspondence:
| | - Elisa Mancinelli
- Department of General Psychology, University of Padova, 35131 Padova, Italy;
| | - Silvana Zaffani
- Pediatric Diabetes and Metabolic Disorders Unit, Department of Surgery, Dentistry, Pediatrics and Gynaecology, University-Hospital of Verona, 37126 Verona, Italy; (S.Z.); (C.M.)
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padova, 35122 Padova, Italy; (D.D.R.); (S.S.)
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Department of Surgery, Dentistry, Pediatrics and Gynaecology, University-Hospital of Verona, 37126 Verona, Italy; (S.Z.); (C.M.)
| |
Collapse
|
6
|
Guo J, Yang J, Wiley J, Ou X, Zhou Z, Whittemore R. Perceived stress and self-efficacy are associated with diabetes self-management among adolescents with type 1 diabetes: A moderated mediation analysis. J Adv Nurs 2019; 75:3544-3553. [PMID: 31441523 DOI: 10.1111/jan.14179] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/15/2019] [Accepted: 08/03/2019] [Indexed: 02/06/2023]
Abstract
AIMS The aims of this study were to: (a) determine if self-efficacy mediates the relationship between perceived stress and diabetes self-management in adolescents with type 1 diabetes (T1D); and (b) explore whether perceived stress moderated the self-efficacy and diabetes self-management relationship. DESIGN Non-experimental, descriptive correlational design, conducted from January-December 2016. METHODS Guided by the Adaptation to Diabetes framework, data on demographic and clinical characteristics, perceived stress, self-efficacy and diabetes self-management were collected. Descriptive analyses and regression analyses were generated by SPSS Version 22. Structural equation modelling was implemented with the MPlus program. RESULTS There was no direct effect of perceived stress on diabetes self-management; however, self-efficacy mediated the relationship between perceived stress and diabetes self-management. Adolescents who had high self-efficacy and low perceived stress demonstrated better diabetes care activities and diabetes communication than would be predicted from the main effects of self-efficacy and perceived stress alone. CONCLUSIONS Decreasing perceived stress and improving self-efficacy are important strategies to improve diabetes self-management in adolescents with T1D. IMPACT Adolescents with T1D experience considerable stress with daily self-management demands. This study highlights the mediating role of self-efficacy on perceived stress and diabetes self-management. Assessment of perceived stress and self-efficacy in self-management tasks in adolescents with T1D may help nurses individualize self-management education and support. Incorporating strategies to promote stress management and self-efficacy in diabetes education may also improve diabetes self-management.
Collapse
Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Jundi Yang
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - James Wiley
- School of Nursing, University of California San Francisco, San Francisco, California
| | - Xiancai Ou
- School of Business, XingJian College of Science and Liberal Arts of Guangxi University, Nanning, Guangxi Province, China
| | - Zhiguang Zhou
- Diabetes Center, Institute of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, China
| | | |
Collapse
|
7
|
Matos-Melo AL, Cumba-Avilés E. Family Environment Scale Parental Ratings of Conflict among Latino Families of Depressed Adolescents with Type 1 Diabetes. PUERTO RICO HEALTH SCIENCES JOURNAL 2018; 37:200-207. [PMID: 30548055 PMCID: PMC6450648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Family conflict is related to depression, difficulties with treatment adherence and glycemic control, in adolescents with type 1 diabetes (T1D). We examined the psychometric properties of a parent-rated family conflict measure and the most frequent behaviors endorsed by caregivers of these youths. METHODS Participants were 51 caregivers (86.27% women) of adolescents (aged 12-17) with T1D, recruited during a psychotherapy study for youth depression. Both (caregivers and youths) completed questionnaires during the eligibility evaluation. Caregivers completed the Conflict subscale of the Family Environment Scale, considering to what extent its items described their whole family or its majority. RESULTS The most frequent indicators of conflict where becoming upset, displaying anger openly, believing that something can be achieved by speaking loudly, and criticizing and fighting, although not physically. Internal consistency for the subscale when rating conflict indicators in a dichotomous format was .69 and .76 when rated in an ordinal format. Conflict scores correlated moderately and significantly (p less than or equal .05) with other measures completed by youths and caregivers. Caregivers of youths with the worst glycemic control reported the highest levels of conflict. The subscale also showed a satisfactory sensitivity to change by reflecting a significant reduction in caregivers' reports of family conflict after adolescent group treatment. CONCLUSION Our results confirm the frequent occurrence of conflict (especially verbal conflict) in these families and document the psychometric properties of a measure for its assessment, which may be useful in studies that examine the impact of family conflict in both youth depression and diabetes.
Collapse
Affiliation(s)
- Anthony L Matos-Melo
- Institute for Psychological Research, University of Puerto Rico Río Piedras Campus, San Juan, PR
| | - Eduardo Cumba-Avilés
- Institute for Psychological Research, University of Puerto Rico Río Piedras Campus, San Juan, PR
| |
Collapse
|
8
|
Plevinsky JM, Greenley RN, Bugno L, Carreon S, Igler EC, Davies WH. Development and preliminary validation of a patient-reported measure of patient–provider communication about medication prescriptions for adolescents and young adults. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1531757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Jill M. Plevinsky
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Rachel N. Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Lindsey Bugno
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Samantha Carreon
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Eva C. Igler
- Department of Psychology, University of Wisconsin Milwaukee, Milwaukee, WI
| | - W. Hobart Davies
- Department of Psychology, University of Wisconsin Milwaukee, Milwaukee, WI
| |
Collapse
|
9
|
Iversen HH, Helland Y, Bjertnaes O, Skrivarhaug T. Parent experiences of diabetes care questionnaire (PEQ-DC): reliability and validity following a national survey in Norway. BMC Health Serv Res 2018; 18:774. [PMID: 30314486 PMCID: PMC6186125 DOI: 10.1186/s12913-018-3591-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/01/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patient experiences are acknowledged as an important aspect of health care quality but no validated instruments have been identified for the measurement of either parent or patient experiences with outpatient paediatric diabetes care. The aim of the current study was to assess the psychometric properties of a new instrument developed to measure parent experiences of paediatric diabetes care at hospital outpatient departments in Norway. METHODS The development of the questionnaire was based on a literature review of existing questionnaires, qualitative interviews with both parents and children/adolescents, expert-group consultations, pretesting of the questionnaire and a pilot study. The national pilot study included parents of 2606 children/adolescents aged 0-17 years with Type 1 Diabetes registered in The Norwegian Childhood Diabetes Registry, a nationwide, population-based registry. Levels of missing data, ceiling effects, factor structure, internal consistency, item discriminant validity and construct validity were assessed. RESULTS A total of 2606 patients were included in the survey, but 80 were excluded due to incorrect addresses. 1399 (55%) parents responded to the questionnaire. Low levels of missing or "not applicable" responses were found for 31 of the 35 items (< 10%), and 27 of 35 items were below the ceiling-effect criterion. Psychometric testing and theoretical considerations identified six scales: Consultation (six items), organisation (five items), equipment (three items), nurse contact (four items), doctor contact (four items) and outcome (five items). All six scales met the 0.7 criterion for Cronbach's alpha (range: 0.71-0.90). As expected, each item had a higher correlation with its hypothesised scale than with any of the other five scales. The construct validity of the Parent Experiences of Diabetes Care Questionnaire (PEQ-DC) was supported by 17 out of 18 associations with variables expected to be related to parent experiences. CONCLUSION The psychometric testing of the PEQ-DC showed good evidence for data quality, internal consistency and construct validity. The instrument includes important aspects of diabetes care at paediatric outpatient departments from the perspective of the parent. The content validity of the PEQ-DC was secured by a rigorous development process, and the instrument was tested following a national survey in Norway, securing generalisability across Norway.
Collapse
Affiliation(s)
| | - Ylva Helland
- Norwegian Directorate of Health, PO Box 7000, N-0130 Oslo, Norway
| | - Oyvind Bjertnaes
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, The Norwegian Childhood Diabetes Registry, Oslo University Hospital, PO Box 4956, Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, N-0318 Oslo, Norway
| |
Collapse
|
10
|
Jeong YM, Quinn L, Kim N, Martyn-Nemeth P. Health-Related Stigma in Young Adults With Type 1 Diabetes Mellitus. J Psychosoc Nurs Ment Health Serv 2018; 56:44-51. [DOI: 10.3928/02793695-20180503-01] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/19/2018] [Indexed: 11/20/2022]
|
11
|
Jones CM, Foli KJ. Maturity in Adolescents with Type 1 Diabetes Mellitus: A Concept Analysis. J Pediatr Nurs 2018; 42:73-80. [PMID: 30219302 DOI: 10.1016/j.pedn.2018.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022]
Abstract
THEORETICAL PRINCIPLES The transition from adolescence to adulthood can be a particularly challenging time for teenagers with type 1 diabetes mellitus (T1DM). Adolescents with T1DM must manage a treatment regimen which requires a high level of responsibility and self-care. Often the responsibilities of self-care are given to these teens without a clear assessment of their maturity, resulting in poor health outcomes. In order to accurately assess a youth's ability to assume self-management of T1DM, a clear understanding of the concept of maturity is needed. PHENOMENA ADDRESSED The purpose of this paper is to provide a theoretical definition of the concept of maturity in the context of adolescents with T1DM and support this definition based on a literature review. This discussion was developed utilizing the Walker and Avant approach to concept analysis. RESEARCH LINKAGES This concept analysis defined maturity in adolescents with T1DM as a multi-dimensional state of development that encompasses the physical, cognitive, psychological, and social dimensions of being. Maturity requires that an individual is capable of functioning with behavioral, cognitive, and emotional autonomy in self-care activities related to TIDM on a consistent basis. This explanation also emphasizes that the process of achieving maturity is gradual and dynamic in nature. Caregivers must understand that physical age alone does not indicate that an adolescent is adequately prepared to assume independent diabetes management. Nurses are in the unique position to assist youth with the transition from dependent diabetes care to independent self-management of the disease; thus, increasing the likelihood of positive outcomes.
Collapse
Affiliation(s)
| | - Karen J Foli
- Purdue University School of Nursing, West Lafayette, IN, USA.
| |
Collapse
|
12
|
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]
|
13
|
Plevinsky JM, Greenley RN, Fishman LN. Self-management in patients with inflammatory bowel disease: strategies, outcomes, and integration into clinical care. Clin Exp Gastroenterol 2016; 9:259-67. [PMID: 27601930 PMCID: PMC5003515 DOI: 10.2147/ceg.s106302] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Self-management, including medication adherence, is associated with improved health and outcomes for patients with inflammatory bowel disease. The concept of self-management is complex, but can be divided into those aspects that involve the individual patient, those that involve the provider–patient relationship, and those that encompass the social environment. At the individual level, enhancing problem-solving skills and self-efficacy have both been shown to improve self-management tasks, particularly adherence to treatment. However, it is critical to consider these domains from a lifespan perspective because these processes by which self-management can be improved are distinct for children, adolescents, young adults, and adults. A particular emphasis is placed on strategies to improve self-management of older adolescents and young adults as they transition from pediatric to adult providers. The review concludes with recommendations for providers, including rationale and techniques for assessing and promoting patient self-efficacy, encouraging the development of problem-solving skills, improving the patient–provider relationship, and enhancing social support. Providers are encouraged to utilize elements of problem-solving skills training, engage in collaborative relationships with their patients, and offer their patients recommendations for how to increase the quality of their social support networks as ways of increasing overall self-management.
Collapse
Affiliation(s)
- Jill M Plevinsky
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Rachel N Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Laurie N Fishman
- Department of Gastroenterology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
14
|
Helping Adolescents with Type 1 Diabetes "Figure It Out". J Pediatr Nurs 2016; 31:123-31. [PMID: 26586309 DOI: 10.1016/j.pedn.2015.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 09/11/2015] [Accepted: 10/12/2015] [Indexed: 01/08/2023]
Abstract
UNLABELLED The aim of this study was to gain an understanding of adolescent's experiences living with diabetes and build a theoretical paradigm for future interventions in adolescents with type 1 diabetes mellitus (T1DM). The adolescent's quest for independence, balancing blood sugars, and integrating diabetes led to increased conflict with parents which contributed to difficulty coping. One code in this study, "figuring it out", is the focus of this manuscript. METHODS Grounded theory with 15 in depth interviews were conducted with adolescents ages 11 to 15 with T1DM. RESULTS A theoretical model about the concept of "normalizing" was identified. Normalizing was defined as the ability to integrate diabetes into the background of one's daily life to make diabetes 'part of me'. The fifth phase of normalizing was "Figuring it out" which had 4 sub codes: (1) learning to accept diabetes, (2) believing it's possible to manage their diabetes, (3) showing responsibility, and (4) staying on track, and the normalizing task was "accepting the new normal". CONCLUSIONS Adolescents with T1DM develop the understanding that diabetes is their 'new normal'. The use of motivational interviewing, goal setting, and promotion of self-management may be important interventions in supporting adolescents with T1DM to normalize their life.
Collapse
|
15
|
Moving the Journey Towards Independence: Adolescents Transitioning to Successful Diabetes Self-Management. J Pediatr Nurs 2015; 30:648-60. [PMID: 26190456 PMCID: PMC5116197 DOI: 10.1016/j.pedn.2015.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/01/2015] [Accepted: 06/07/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To gain a greater understanding of adolescent's experiences living with Type 1 diabetes mellitus (T1DM) and create a theoretical paradigm. METHODS Grounded theory as described by Glaser was used. Fifteen in-depth interviews were conducted with adolescent's ages 11-15 with T1DM. Symbolic interactionism is the theoretical framework for grounded theory. Data were collected; transcribed, coded, and analyzed simultaneously using constant comparative analysis and findings were grounded in the words of participants. RESULTS A theoretical model was created with the concept of "normalizing". Normalizing was defined as the ability to integrate diabetes into one's daily life to make diabetes 'part of me'. Phase four of the model, and the focus of this manuscript was "Moving the Journey towards Independence" and included: 1) taking over care, 2) experiencing conflict with parents, and 3) realizing diabetes is hard. The major task for adolescents in this phase was separating from parents to independently manage diabetes. The normalizing task for this phase was: "taking on the burden of care". Adolescents described challenges with independent care and increased parental conflict including: fearing needles, forgetting insulin, feeling embarrassed and believing that diabetes was a burden in their life. Additionally, juggling the multiple responsibilities of home, school and work along with managing a chronic illness during adolescence is challenging. CONCLUSIONS Transitioning to diabetes self-management is a challenge for adolescents. This model advances understanding of the moving processes in adolescents transitioning; additionally, hypotheses are presented that may be used for developing interventions to promote success in self-management.
Collapse
|
16
|
Boogerd EA, Maas-van Schaaijk NM, Noordam C, Marks HJG, Verhaak CM. Parents' experiences, needs, and preferences in pediatric diabetes care: Suggestions for improvement of care and the possible role of the Internet. A qualitative study. J SPEC PEDIATR NURS 2015; 20:218-29. [PMID: 26076888 DOI: 10.1111/jspn.12118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/28/2015] [Accepted: 04/20/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the needs and preferences of parents of children with type 1 diabetes (T1D) concerning pediatric diabetes care and use of Internet in care. DESIGN AND METHODS Parents of 34 children, aged 2-12, with T1D participated in seven focus group interviews. RESULTS Analysis revealed provision of tailored care, disease information, peer support, and accessibility of healthcare professionals as major needs in parents. Internet could be used to satisfy these needs. PRACTICAL IMPLICATIONS According to parents, diabetes teams should focus on the impact of the disease, parents' experience, and the child's development, and provide online professional and peer support.
Collapse
Affiliation(s)
- Emiel A Boogerd
- Department of Medical Psychology, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Cees Noordam
- Department of Pediatrics, Radboud university medical center, Nijmegen, the Netherlands.,Children's Diabetes Center Nijmegen, Nijmegen, the Netherlands
| | - Hans J G Marks
- Department of Cultural Anthropology and Development Studies, Radboud University, Nijmegen, the Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Radboud university medical center, Nijmegen, the Netherlands
| |
Collapse
|
17
|
Pelicand J, Fournier C, Le Rhun A, Aujoulat I. Self-care support in paediatric patients with type 1 diabetes: bridging the gap between patient education and health promotion? A review. Health Expect 2015; 18:303-11. [PMID: 23311712 PMCID: PMC5060779 DOI: 10.1111/hex.12041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study examines how the term 'self-care' imported from health promotion has been used in the context of patient education interventions for paediatric patients with type 1 diabetes. METHODS Thirty articles over the last decade were analysed, using a qualitative method of thematic coding and categorizing. RESULTS The term 'self-care' has been mainly used as a synonym for self-management of one's condition and treatment. Indeed, the activities performed by paediatric patients independently or with the help of their parents under the term 'self-care' fail to explicitly take into account the general health and life dimensions of self-care, as defined in health promotion. Although such dimensions are implicitly present when it comes to define the parents' and health-care providers' roles in supporting the children's emerging self-care capacity, their importance is acknowledged as a way of strengthening the children's and their families' capacity to respond to illness demands, rather than in relation to their general well-being. CONCLUSION The discourse on self-care in the field of paediatric diabetes therefore appears to be oriented more towards disease and prevention, rather than health promotion. The psychosocial dimension of self-care should be particularly investigated, as young patients need to be supported in their efforts to gain autonomy not only in relation to the management of their condition, but in their lives in general.
Collapse
Affiliation(s)
- Julie Pelicand
- Pediatric DiabetologyHospital Necker‐Enfants MaladesParisFrance
| | | | | | - Isabelle Aujoulat
- Institute of Health & Society (IRSS), Université Catholique de LouvainBrusselsBelgium
| |
Collapse
|
18
|
Kaller T, Petersen I, Petermann F, Fischer L, Grabhorn E, Schulz KH. Family strain and its relation to psychosocial dysfunction in children and adolescents after liver transplantation. Pediatr Transplant 2014; 18:851-9. [PMID: 25307019 DOI: 10.1111/petr.12367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 12/01/2022]
Abstract
Parental functioning is essential to children's development. Therefore, this cross-sectional single-center study examined the prevalence of family strain in 181 parents and its associations to psychosocial functioning in their children after LT. Median age at LT was one yr. Mean time elapsed since LT was 5.8 yr. The IFS, and the SDQ were applied to parents. Family strain in the present sample was comparable to that in the German normative group of families with a chronically ill or disabled child, but families of LT recipients showed a significantly higher financial impact, impact on coping, and impact on siblings (p < 0.001). Younger age of patients at survey, a more severe clinical course, child's restrictions, and financial losses following LT were determined as significant predictors of family strain (R(2) = 0.42). Parents reported less family strain after living-related compared with deceased donation. Family strain was significantly correlated to psychosocial dysfunction in children post-LT. Present findings demonstrate a risk of maladjustment to the post-LT condition in families. They emphasize the importance of psychological assessment of parents and patients during transplant and follow-up to ensure the best achievable long-term outcome of patients.
Collapse
Affiliation(s)
- T Kaller
- Center of Clinical Psychology and Rehabilitation, University Bremen, Bremen, Germany
| | | | | | | | | | | |
Collapse
|
19
|
Abstract
OBJECTIVE To determine if 3 distinct self-management patterns (i.e., maladaptive, moderate/mixed, and adaptive) observed at baseline, 1 year, and 2 years in a sample of youth with type 1 diabetes and their caregivers predicted mean differences in adolescent's subsequent glycemic control. METHODS This study is a descriptive, multisite, prospective study that examined a sample of youth diagnosed with type 1 diabetes (ages 9-11 years at baseline). Youth and their maternal and paternal caregivers provided information about the youth's self-management patterns at baseline, 1 year, and 2 years using the Diabetes Self-Management Profile structured interview. Glycemic control (hemoglobin A1c: HbA1c) was examined at baseline and 6, 12, 18, and 24 months. RESULTS Three distinct self-management patterns were observed at 1 year and 2 years, which were conceptually consistent with previously reported baseline self-management patterns. Youth identified by their maternal caregivers as having adaptive self-management patterns at baseline had better glycemic control across 2 years compared with those in the maladaptive and mixed self-management groups. Similarly, maternal reports suggested that youth with less adaptive self-management patterns generally had worse glycemic control over time and HbA1c values above the American Diabetes Association recommendations. Youth and paternal caregiver reports yielded more variable findings. CONCLUSIONS Findings underscore the stability of self-management patterns in pediatric type 1 diabetes and the need for preventive interventions that are tailored to specific patterns of self-management associated with risk for problematic glycemic control.
Collapse
|
20
|
Dashiff C, Suzuki-Crumly J, Kracke B, Britton L, Moreland E. Cystic fibrosis-related diabetes in older adolescents: parental support and self-management. J SPEC PEDIATR NURS 2013; 18:42-53. [PMID: 23289454 DOI: 10.1111/jspn.12010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 07/20/2012] [Accepted: 10/06/2012] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to describe the experience of cystic fibrosis-related diabetes (CFRD), parental support of adolescent self-management, and the relationship of parental autonomy support with disease self-management. DESIGN AND METHODS Semi-structured interviews and questionnaires were employed in a study conducted with 10 adolescents and their parents. RESULTS Parents and adolescents lacked confidence to manage CFRD. Mothers' autonomy support was associated with adolescents' CFRD competence and cystic fibrosis self-care. Fathers' autonomy support was associated with mothers' reports of adolescent cystic fibrosis self-care. PRACTICE IMPLICATIONS Education about CFRD management and support of adolescent autonomy in disease management is needed.
Collapse
Affiliation(s)
- Carol Dashiff
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | | | | | | | | |
Collapse
|
21
|
Drotar D, Ittenbach R, Rohan JM, Gupta R, Pendley JS, Delamater A. Diabetes management and glycemic control in youth with type 1 diabetes: test of a predictive model. J Behav Med 2012; 36:234-45. [PMID: 22569775 DOI: 10.1007/s10865-012-9426-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 04/16/2012] [Indexed: 01/12/2023]
Abstract
The objective of this study was to test a comprehensive model of biologic (pubertal status), family (communication and conflict), and psychological influences (behavioral autonomy) on diabetes management and glycemic control in a sample of youth (N = 226) with type 1 diabetes recruited during late childhood/early adolescence (ages 9-11 years). The study design was a prospective, multisite, multi-method study involving prediction of diabetes management and glycemic control 1 year post-baseline. The primary outcome measures included diabetes management behaviors based on the Diabetes Self-Management Profile (DSMP) administered separately to mothers and youth and glycemic control measured by glycated hemoglobin (HbA1c) obtained by blood samples and analyzed by a central laboratory to ensure standardization. Our hypothesized predictive model received partial support based on structural equation modeling analyses. Family conflict predicted less adequate glycemic control 1 year later (p < 0.05). Higher conflict predicted less adequate diabetes management and less adequate glycemic control. More advanced pubertal status also predicted less adequate glycemic control, but behavioral autonomy did not. Family conflict is an important, potentially clinically significant influence on glycemic control that should be considered in primary and secondary prevention in the management of type 1 diabetes in youth.
Collapse
Affiliation(s)
- Dennis Drotar
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Lindsay S, Kingsnorth S, Hamdani Y. Barriers and facilitators of chronic illness self-management among adolescents: a review and future directions. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1752-9824.2011.01090.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|