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Pavić J, Krznar M, Čukljek S, Sedić B, Ozimec Vulinec Š, Kovačević I. The Association between Healthcare Satisfaction and Social Support and Stress, Depression, and Life Satisfaction in Female Caregivers: The Moderating Role of Dependence of a Sick Child. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1245. [PMID: 39338128 PMCID: PMC11431563 DOI: 10.3390/ijerph21091245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 09/16/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024]
Abstract
The caregivers of children suffering from rare diseases face numerous emotional, social, economic, organizational, and other difficulties, which can significantly impair their quality of life and mental health. Therefore, among other things, it is important to understand the factors which can influence psychosocial well-being. This research aimed to explore the association between healthcare satisfaction and social support and stress, depression, and life satisfaction in caregivers, with a moderating role of the ill child's dependence on their caregiver. METHODS A cross-sectional study was conducted among 185 female caregivers of children with rare diseases. The data were analysed by using hierarchical regression analysis to examine the moderating effect of the child's dependence. RESULTS Lower dependence of the child moderated the association between a higher level of healthcare satisfaction and reduced stress and a higher level of life satisfaction. Furthermore, lower child dependence moderated the association between a higher level of social support and a reduction in depression. In contrast, this association was absent in female caregivers with highly dependent children. On the other hand, the research confirmed that a higher level of social support led to stress reduction and increased life satisfaction in all respondents, regardless of the child's dependence. Furthermore, the research confirmed that higher levels of healthcare satisfaction are associated with a reduction in depression in caregivers, regardless of the child's dependence level. CONCLUSION This research highlights the importance of providing adequate social support and high-quality healthcare in order to improve the psychosocial well-being of caregivers of children with rare diseases. Interventions to increase this support can reduce stress and depression and increase caregivers' life satisfaction. Thus, future research should focus on the development and evaluation of specific interventions that support these factors.
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Affiliation(s)
- Jadranka Pavić
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia
- Department of Nursing, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Mateja Krznar
- DEBRA, Croatian Epidermolysis Bullosa Association, 10000 Zagreb, Croatia
| | - Snježana Čukljek
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia
- Department of Nursing, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Biserka Sedić
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia
| | | | - Irena Kovačević
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia
- Department of Nursing, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
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Stefanescu C, Nechita A, Iacob CI. Brief acceptance and commitment therapy for children and adolescents with type 1 diabetes. Front Psychol 2024; 15:1382509. [PMID: 38988396 PMCID: PMC11234476 DOI: 10.3389/fpsyg.2024.1382509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/14/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Children and adolescents with diabetes face challenges that can significantly impact their quality of life. Investigating psychological interventions for stress management can equip them with the skills needed to cope with type 1 diabetes. This study investigated the impact of a brief Acceptance and Commitment Therapy (ACT) intervention on stress management, diabetes acceptance, psychological flexibility, and patient-doctor relationships among this population. Methods A total of 55 children, and adolescents from Romania participated in a four-session ACT intervention for type 1 diabetes. The evaluation instruments used were the Perceived Stress Scale for Children (PSS-C), Acceptance and Action Diabetes Questionnaire (AADQ), Children's Psychological Flexibility Questionnaire (CPFQ), and Patient-Doctor Relationship Questionnaire (PDRQ-9). Results The participants (mean age = 14.14, SD = 2.26; 67% girls) reported lower stress levels, increased acceptance of diabetes, and greater psychological flexibility after the intervention. Additionally, the patient-doctor relationship was enhanced, potentially improving patient adherence to treatment. Positive qualitative feedback mirrored previous ACT research in the paediatric population, highlighting the beneficial role of experiential activities and metaphors when working with this target group. Discussion This study adds to the growing body of evidence supporting the effectiveness of ACT in enhancing healthy coping strategies among children and adolescents with chronic illnesses.
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Affiliation(s)
- Cristina Stefanescu
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania
| | - Aurel Nechita
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania
| | - Claudia Iuliana Iacob
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
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Ryan H, Burgess A, Jackson C, Hewson-Ravenscroft A, Meiser-Stedman R. High prevalence of depression in parents of children with Type 1 diabetes in a meta-analysis of data from five continents. Acta Paediatr 2024; 113:1145-1155. [PMID: 38140731 DOI: 10.1111/apa.17059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
AIM This meta-analysis identified the prevalence of depression in parents of children with Type 1 diabetes. METHODS MEDLINE, PsycINFO and CINAHL databases were searched for papers published in English from 1980 to May 2022, yielding 18 studies (N = 2044 participants). The prevalence of parental depression was pooled across the studies. RESULTS The prevalence of depression among parents of children with Type 1 diabetes was high. Random-effects meta-analyses estimated the prevalence of moderate depression and above in the total sample as 18.4% (95% CI 12.8-24.6; k = 17, N = 2044), with rates of 17.3% in mothers (95% CI 12.7-22.5; k = 12, N = 1106) and 9% in fathers (95% CI 4.3-15.1; k = 6, N = 199). The estimated prevalence of mild depression and above in the total sample was 32.7% (95% CI 20.3-46.6; k = 8, N = 797), with rates of 29.4% in mothers (95% CI 17.8-42.6; k = 4 N = 330) and 13.6% in fathers (95% CI 5.2-25.2; k = 2 N = 44). All results were characterised by high levels of heterogeneity. The risk of publication bias was low. CONCLUSION More than 1 in 6 parents of children with Type 1 diabetes had depression in the moderate plus category. The limitations and implications of these results are discussed.
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Affiliation(s)
- Hayley Ryan
- Central Norfolk Stroke Services, Norwich Community Health and Care NHS Trust, Norwich Community Hospital, Norwich, Norfolk, UK
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Aaron Burgess
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Clare Jackson
- Department of Psychological Medicine, Cambridgeshire and Peterborough Foundation Trust, Cambridge, UK
- Addenbrookes Hospital, Cambridge, UK
| | - Alyssa Hewson-Ravenscroft
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
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Sousa FAMDR, Andrade MDLMS, de Oliveira CMGS. Transition from parents to caregivers of a child with type 1 Diabetes Mellitus: a scoping review. Rev Bras Enferm 2023; 76:e20220201. [PMID: 36722648 PMCID: PMC9885367 DOI: 10.1590/0034-7167-2022-0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/09/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES to map and summarize the existing scientific evidence on parents' transition experience to exercise the caregiver role of a child with 1DM, identifying gaps in knowledge of this experience. METHODS a scoping review was carried out based on JBI methodology, in two databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. RESULTS we included 31 articles. From the studies, constitutive elements of parents' transition experience to caregiver role of a child with 1DM were found, which focused on the nature of the experience, the feelings and emotions experienced, the hindering conditions, the facilitating conditions, the strategies used by parents and the results or effects obtained. FINAL CONSIDERATIONS the transition process' characterizing elements were identified, but not a theoretical explanation of it. Additional research should be carried out in order to allow a deeper understanding of this process.
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Sousa FAMDR, Andrade MDLMS, Oliveira CMGSD. Transição de pais para cuidadores de um filho com Diabetes Mellitus tipo 1: scoping review. Rev Bras Enferm 2023. [DOI: 10.1590/0034-7167-2022-0201pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RESUMO Objetivos: mapear e resumir a evidência científica existente sobre a experiência de transição dos pais para o exercício do papel de cuidador de um filho com DM1, identificando lacunas existentes no conhecimento dessa experiência. Métodos: efetuada revisão scoping baseada na metodologia do JBI, em duas bases de dados, seguindo a checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Resultados: foram incluídos 31 artigos. A partir dos estudos, foram encontrados elementos constitutivos da experiência de transição dos pais para o papel de cuidador de um filho com DM1, que se centraram na natureza da experiência, nos sentimentos e emoções experimentadas, nas condições dificultadoras, nas condições facilitadoras, nas estratégias utilizadas pelos pais e nos resultados ou efeitos obtidos. Considerações finais: identificaram-se elementos caracterizadores do processo de transição, mas não uma explicação teórica do mesmo. Investigação adicional deverá ser realizada, a fim de permitir compreender aprofundadamente este processo.
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Lukács A, Bettina Zagraj V, Bartkóné Kovács A, Soós A, Török A, Barkai L. Health-related quality of life of preschool-aged children with type 1 diabetes in the context of family and maternal functioning. J Child Health Care 2022; 26:31-41. [PMID: 33599524 DOI: 10.1177/1367493521995320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In this study, generic health-related quality of life (HRQoL) of young children with type 1 diabetes (T1D) was compared to healthy peers taken in consideration of family functioning and psychological well-being of mothers. A total of 113 mothers provided data (28 mothers had a preschool-aged child with T1D). There were no significant differences in background parameters of two investigated groups. No significant differences between children with and without T1D were detected either in HRQoL or in family functioning. Moreover, mothers of children with diabetes reported lower levels of resilience and more depressive symptoms than mothers of healthy peers. In the regression analysis, mothers' depressive symptoms and the family functioning significantly affected children's HRQoL regardless of the presence of diabetes. These results suggest that parents of children with T1D handle the burden of diabetes well and integrate into the daily activities of the families. Mothers experience distress, presumably because diabetes management is burdensome; however, the family can function well and the young children can live in a similar way to their healthy peers.
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Affiliation(s)
- Andrea Lukács
- Faculty of Healthcare, Institute of Theoretical Health Sciences, 547530University of Miskolc, Hungary
| | - Veronika Bettina Zagraj
- Faculty of Healthcare, Institute of Applied Health Sciences, 547530University of Miskolc, Miskolc, Hungary
| | - Anett Bartkóné Kovács
- 125749Borsod-Abaúj-Zemplén County Central and University Teaching Hospital, Miskolc, Hungary
| | - Andrea Soós
- 125749Borsod-Abaúj-Zemplén County Central and University Teaching Hospital, Miskolc, Hungary
| | - András Török
- 125749Borsod-Abaúj-Zemplén County Central and University Teaching Hospital, Miskolc, Hungary
| | - László Barkai
- Faculty of Healthcare, Institute of Theoretical Health Sciences, 547530University of Miskolc, Hungary.,Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, 37862Pavol Jozef Šafárik University, Kosice, Slovakia
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Gallegos E, Harmon KB, Lee G, Qi Y, Jewell VD. A Descriptive Study of the Quality of Life and Burden of Mothers of Children and Adolescents with Type 1 Diabetes. Occup Ther Health Care 2022; 37:296-312. [PMID: 35189069 DOI: 10.1080/07380577.2022.2038401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this cross-sectional survey was to examine the quality of life and level of burden experienced by mothers of children and adolescents with type 1 diabetes (n = 199). Data was collected using a sociodemographic questionnaire, the Zarit Burden Interview Scale (ZBIS), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instruments. A simple descriptive analysis was conducted, and the Pearson's correlation coefficient was utilized to determine the correlation among variables. Most respondents (68.9%) reported moderate to severe burden on the ZBIS. Across age groups, statistically significant, negative correlations were found between burden and physical health (r = -0.371, p < 0.001), social relationships (r = -0.389, p < 0.001), psychological health (r = -0.445, p < 0.001) and environment (r = -0.438, p < 0.001). Mothers of children and adolescents with type 1 diabetes reported an inverse relationship between burden and quality of life influenced by the occupation of caregiving. Occupational therapy practitioners can address strategies to reduce caregiver burden and improve mothers' quality of life.
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Affiliation(s)
- Erica Gallegos
- Occupational Therapy Department, Regis-Creighton University Pathway, Denver, CO, USA
| | - Kasey B Harmon
- Occupational Therapy Department, Regis-Creighton University Pathway, Denver, CO, USA
| | - Gilliane Lee
- Occupational Therapy Department, Regis-Creighton University Pathway, Denver, CO, USA
| | - Yongyue Qi
- Occupational Therapy Department, Creighton University, Omaha, NE, USA
| | - Vanessa D Jewell
- Occupational Therapy Department, Creighton University, Omaha, NE, USA
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O’Donnell NR, Satherley RM, John M, Cooke D, Hale LS, Stewart R, Jones CJ. Development and Theoretical Underpinnings of the PRIORITY Intervention: A Parenting Intervention to Prevent Disordered Eating in Children and Young People With Type 1 Diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:822233. [PMID: 36992722 PMCID: PMC10012129 DOI: 10.3389/fcdhc.2022.822233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022]
Abstract
Children and young people (CYP) with type 1 diabetes (T1D) are twice as likely to develop disordered eating (T1DE) and clinical eating disorders than those without. This has significant implications for physical and mental health, with some eating disorders associated with repeated diabetic ketoacidosis and higher HbA1c levels, both of which are life threatening. There is currently limited psychological support for CYP and families with T1D but increasingly, policy and practice are suggesting disordered eating in T1D may be effectively prevented through psychological intervention. We describe the development and theoretical underpinnings of a preventative psychological intervention for parents of CYP aged 11-14, with T1D. The intervention was informed by psychological theory, notably the Information Motivation Behaviour Skills model and Behaviour Change Technique Taxonomy. The intervention was co-developed with an expert advisory group of clinicians, and families with T1D. The manualised intervention includes two online group workshops, and supplementary online materials. The intervention continues to evolve, and feasibility findings will inform how best to align the intervention with routine care in NHS diabetes teams. Early detection and intervention are crucial in preventing T1DE, and it is hoped that the current intervention can contribute to improving the psychological and physical wellbeing of young people and families managing T1D.
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Affiliation(s)
| | | | - Mary John
- School of Psychology, University of Surrey, Guildford, United Kingdom
- Research and Development Department, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton & Hove, United Kingdom
| | - Debbie Cooke
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Lucy S. Hale
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Rose Stewart
- Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, United Kingdom
| | - Christina J. Jones
- School of Psychology, University of Surrey, Guildford, United Kingdom
- *Correspondence: Christina J. Jones,
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Aasen L, Johannessen AK, Ruud Knutsen I, Werner A. The work of nurses to provide good and safe services to children receiving hospital-at-home: A qualitative interview study from the perspectives of hospital nurses and physicians. J Clin Nurs 2021; 31:2495-2506. [PMID: 34570945 DOI: 10.1111/jocn.16062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
AIM To explore and describe the work performed by the nurses providing hospital-at-home care to children and their families from the perspectives of hospital nurses and physicians. BACKGROUND To reduce capacity pressure on hospitals, various ambulatory services combining hospital and home treatment have emerged. Studies have shown that children and their families are satisfied with hospital-at-home when the parents experienced the professionals possessed the necessary competences. Knowledge is limited about nurses and physicians' perspectives on the work performed and competence needed when children receive hospital treatment in the family's home. DESIGN A qualitative descriptive design with semi-structured interviews was used. Sixteen nurses and physicians from two hospitals in Norway working in hospital-at-home for children were recruited to interview. Data were analysed using systematic text condensation. In preparing the manuscript, we applied the COREQ guidelines. The theory on 'expert nursing' supported the discussion of results. RESULTS We identified three categories through analysis; building a trustful relationship with the family and the sick child; performing essential skills in paediatric nursing care in hospital-at-home; and nurses serving as the 'hub' between the different parties. CONCLUSION The results demonstrate the complexity of the work performed by hospital nurses when children received hospital-at-home. Building a trustful relationship and alliance with the child and the family formed the cornerstone of accomplishing good and safe paediatric care. The nurses became a coordinating and collaborating 'hub' for actors involved, taking care of patient safety on a daily basis. RELEVANCE TO CLINICAL PRACTICE The way the nurses approached the children and their families, was the core element of the paediatric nursing expertise and important for the service quality and patient safety. The importance of building a trustful relationship needs to be more acknowledged, and the services would benefit to organise this through continuity of care.
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Affiliation(s)
- Line Aasen
- Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Anne-Kari Johannessen
- Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Ingrid Ruud Knutsen
- Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Anne Werner
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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McCarroll Z, Townson J, Pickles T, Gregory JW, Playle R, Robling M, Hughes DA. Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trial. BMJ Open 2021; 11:e043523. [PMID: 34011587 PMCID: PMC8137197 DOI: 10.1136/bmjopen-2020-043523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this economic evaluation was to assess whether home management could represent a cost-effective strategy in the patient pathway of type 1 diabetes (T1D). This is based on the Delivering Early Care In Diabetes Evaluation trial (ISRCTN78114042), which compared home versus hospital management from diagnosis in childhood diabetes and found no statistically significant difference in glycaemic control at 24 months. DESIGN Cost-effectiveness analysis alongside a randomised controlled trial. SETTING Eight paediatric diabetes centres in England, Wales and Northern Ireland. PARTICIPANTS 203 clinically well children aged under 17 years, with newly diagnosed T1D and their carers. OUTCOME MEASURES The base-case analysis adopted n National Health Service (NHS) perspective. A scenario analysis assessed costs from a broader societal perspective. The incremental cost-effectiveness ratio (ICER), expressed as cost per mmol/mol reduction in glycated haemoglobin (HbA1c), was based on the mean difference in costs between the home and hospital groups, divided by mean differences in effectiveness (HbA1c). Uncertainty was considered in terms of the probability of cost-effectiveness. RESULTS At 24 months postintervention, the base-case analysis showed a difference in costs between home and hospital, in favour of home management (mean difference -£2,217; 95% CI -£2825 to -£1,609; p<0.001). Home care dominated, with an ICER of £7434 (saved) per mmol/mol reduction of HbA1c. The results of the scenario analysis also favoured home management. The greatest driver of cost differences was hospitalisation during the initiation period. CONCLUSIONS Home management from diagnosis of children with T1D who are medically stable represents a less costly approach for the NHS in the UK, without impacting clinical effectiveness. TRIAL REGISTRATION NUMBER ISRCTN78114042.
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Affiliation(s)
| | - Julia Townson
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Timothy Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Rebecca Playle
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Michael Robling
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
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Tully C, Clary L, Monaghan M, Levy W, Hilliard ME, Streisand R. Implementation and Preliminary Feasibility of an Individualized, Supportive Approach to Behavioral Care for Parents of Young Children Newly Diagnosed With Type 1 Diabetes. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:293-308. [PMID: 34025105 PMCID: PMC8136148 DOI: 10.1016/j.cbpra.2020.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There are significant stressors related to parenting a young child with newly diagnosed type 1 diabetes (T1D). Despite these challenges, there are not yet clearly defined interventions to help promote psychological health and adherence for families with young children with T1D. First STEPS is a tailored stepped care design intervention to positively impact parents' emotional functioning and children's glycemic control in young children newly diagnosed with T1D. The First STEPS intervention is derived from a combination of Cognitive Behavioral Theory and Social Cognitive Theory to support family adjustment to T1D, promote parental mastery over T1D tasks, increase coping skills to manage stressors associated with T1D, and build on the strengths of families newly diagnosed with T1D to help them achieve positive health and wellbeing outcomes. We present details about the intervention and describe two pilot participants as case studies. Results indicated that the treatment and delivery model were acceptable to the pilot participants, as evidenced by treatment completion and satisfaction ratings. Future directions for this work include testing the efficacy of this new treatment in a randomized controlled trial.
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Affiliation(s)
- Carrie Tully
- Children's National Health System and George Washington University
| | - Lauren Clary
- Children's National Health System and George Washington University
| | - Maureen Monaghan
- Children's National Health System and George Washington University
| | - Wendy Levy
- Texas Children's Hospital and Baylor College of Medicine
| | | | - Randi Streisand
- Children's National Health System and George Washington University
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McConville A, Noser AE, Nelson EL, Clements MA, Majidi S, Patton SR. Depression as a predictor of hypoglycemia worry in parents of youth with recent-onset type 1 diabetes. Pediatr Diabetes 2020; 21:909-916. [PMID: 32410305 PMCID: PMC7435327 DOI: 10.1111/pedi.13039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/10/2020] [Accepted: 05/11/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND During the recent-onset period of type 1 diabetes (T1D), parents may be at increased risk for depression, stress, and hypoglycemia fear; however, current studies have not examined the parental psychological experience and anxiety from hypoglycemia fear (ie, hypoglycemia worry) over time. This study examined the trajectory of parental hypoglycemia worry (Hypoglycemia Fear Survey-Worry [HFS-Worry]) in families of children with recent-onset T1D and the effects of baseline parental depression on parents' trajectory of HFS-Worry. METHODS We enrolled 128 families of children ages 5- to 9-years-old with recent onset T1D in this study. At baseline, 125 parents completed measures of depression and HFS-Worry, followed by 111 at 6-month follow-up, 113 at 12-month follow-up, and 107 at 18-month follow-up. We used multilevel modeling to examine the 18-month trajectories of HFS-Worry and to examine if parental depression modified these trajectories. RESULTS We found that parents HFS-Worry scores increased over time for parents with and without elevated depressive symptoms. Parents' baseline report of depression appeared to modify their trajectory of HFS-Worry over time such that parents with elevated depressive symptoms reported significantly higher levels of worry when compared to parents without depressive symptoms across the 18-month study period (P < .05). CONCLUSIONS Parents of children with recent-onset T1D, who reported elevated depressive symptoms, reported higher HFS-Worry across the study period. Our findings suggest clinics should consider screening for parent depression and hypoglycemia worry following a T1D diagnosis. Integrating psychological screening for parents could help clinics to provide relevant treatment resources and tailor diabetes education for parents. Trial Registration NCT03698708.
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Affiliation(s)
- Andrew McConville
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas,Center for Children’s Healthy Lifestyles and Nutrition, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Amy E. Noser
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas,Center for Children’s Healthy Lifestyles and Nutrition, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Eve-Lynn Nelson
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark A. Clements
- Center for Children’s Healthy Lifestyles and Nutrition, Children’s Mercy Kansas City, Kansas City, Missouri,Division of Endocrinology & Diabetes, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Shideh Majidi
- Division of Endocrinology, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado
| | - Susana R. Patton
- Nemours’ Center for Healthcare Delivery Science, Jacksonville, Florida
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Arabiat D, Al Jabery M, Whitehead L. A concept analysis of psychological distress in parents related to diabetes management in children and adolescents. J SPEC PEDIATR NURS 2020; 25:e12287. [PMID: 31971657 DOI: 10.1111/jspn.12287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To report a concept analysis of parents' psychological distress in the context of diabetes management among children and adolescents. A clear understanding of the possible impact of diabetes management on parents will help to inform how nurses can work with parents to support glycaemic control in children and adolescents. DESIGN AND METHOD Concept analysis using Walker and Avant's eight-stage approach was used as a guiding framework. PubMed, OVID (CINAHL, Medline, PsychInfo), the Cochrane library and the Joanna Briggs library were searched for the past 50 years. RESULTS Thirty-three studies provided data for the concept analysis. Attributes included difficulty coping, changes in emotional status and manifestations of mental health problems. PRACTICE IMPLICATION Based on the literature synthesis, we suggest all facets of distress related to diabetes can in principle be inferred through the proposed relationship between distress and other interactions of individual coping, caring burden and family relational functioning. The proposed conceptual model linking antecedents' factors and individual characteristics of parents to the concepts of psychological distress may assist researchers to design interventions for supporting diabetes management in children and adolescents.
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Affiliation(s)
- Diana Arabiat
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, western Australia, Australia.,Faculty of Nursing, Maternal and Child Nursing Department, The University of Jordan, Amman, Jordan
| | - Mohammad Al Jabery
- Faculty of Education, Department of Special Education, The University of Jordan, Amman, Jordan
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, western Australia, Australia.,Postgraduate Centre for Nursing Studies, University of Otago, Christchursch, New Zealand
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Allan A, Rowlands S. What do parents believe are the causes of their Type 1 diabetic child's condition? HEALTH EDUCATION 2020. [DOI: 10.1108/he-12-2019-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper aims to investigate parents' beliefs about the causes of their child's Type 1 diabetes to understand if this affects the way diagnosis is processed and if this impacts on sibling parenting.Design/methodology/approachOnline, semi-structured qualitative interviews with nine parents of children with Type 1 diabetes who have at least one non-diabetic child. The results were analysed using interpretative phenomenological analysis (IPA).FindingsTwo interlinked themes were identified: “What ifs”: parents postulated underlying genetic reasons for their child's diabetes and had working theories about the triggers of diabetes that included stress, infection, vaccination or a virus. Developing a personal aetiology of their child's condition allowed some a feeling of control, while others focused on practical ways to manage diabetes. “Having something to blame”: narratives dwelt on the relationship between beliefs about causes and self-blame. Some believed that acting on an identified trigger reduced personal guilt.Research limitations/implicationsAlthough internet access is widespread in the UK, a limitation of this research is that it excluded those without internet access.Practical implicationsThe findings of this research may provide greater depth and a more holistic perspective to the health promoter to better support parents of Type 1 diabetics.Social implicationsThe analysis of illness narratives that this research provides may offer a greater understanding of the social context in which health and illness develop. This research found some examples of parental confidence about the causes and triggers of their child's diabetes being positively associated with a sense of control. This might indicate the value of a more comprehensive larger-scale study to establish whether parents who are supported to develop a personalised conception of the aetiology of their child's diabetes develop a greater sense of coherence and well-being regarding their child's condition.Originality/valueThere is very limited literature focusing on the beliefs of sufferers and their families about Type 1 diabetes causality. Of that which does exist, some research is heterogenous in its sampling of Types 1 and 2 diabetes sufferers. This study offers a rare, focused insight into the beliefs of parents about the background causes and more proximal triggers of their child's Type 1 diabetes.
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15
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Parental stress, anxiety and trait mindfulness: associations with parent-child mealtime interactions in children with type 1 diabetes. J Behav Med 2020; 43:448-459. [PMID: 32124139 DOI: 10.1007/s10865-020-00144-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/25/2020] [Indexed: 12/26/2022]
Abstract
Introduction This study examined how maternal and paternal stress, anxiety, and trait mindfulness, and child glycemic control are related to real-life parent-child interactions in families confronted with type 1 diabetes (T1D). Methods Parents reported on trait mindfulness, illness-related parenting stress, general stress, and state anxiety. Parent-child mealtime interactions were videotaped and scored in 33 families (31 mothers and 20 fathers) of children with T1D (5-12y., mean HbA1c = 7.22%). Results Parental stress and anxiety were related to more maladaptive and less adaptive parent-child interactions. For mothers, mindfulness was related to less observed discomfort of the child during injection. For fathers, more emotional involvement was related to better child glycemic control. Discussion Results indicate that parental stress and anxiety may be risk factors for maladaptive parent-child interactions.
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16
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Gregory JW, Townson J, Channon S, Cohen D, Longo M, Davies J, Harman N, Hood K, Pickles T, Playle R, Randell T, Robling M, Touray M, Trevelyan N, Warner J, Lowes L. Effectiveness of home or hospital initiation of treatment at diagnosis for children with type 1 diabetes (DECIDE trial): a multicentre individually randomised controlled trial. BMJ Open 2019; 9:e032317. [PMID: 31796486 PMCID: PMC6924753 DOI: 10.1136/bmjopen-2019-032317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine whether, in children with newly diagnosed type 1 diabetes who were not acutely unwell, management at home for initiation of insulin treatment and education of the child and family, would result in improved clinical and psychological outcomes at 2 years postdiagnosis. DESIGN A multicentre randomised controlled trial (January 2008/October 2013). SETTING Eight paediatric diabetes centres in England, Wales and Northern Ireland. PARTICIPANTS 203 clinically well children aged under 17 years, with newly diagnosed type 1 diabetes and their carers. INTERVENTION Management of the initiation period from diagnosis at home, for a minimum of 3 days, to include at least six supervised injections and delivery of pragmatic educational care. MAIN OUTCOME MEASURES Primary outcome was glycosylated haemoglobin (HbA1c) concentration at 24 months postdiagnosis. Secondary outcomes included coping, anxiety, quality of life and use of NHS resources. RESULTS 203 children, newly diagnosed, were randomised to commence management at home (n=101) or in hospital (n=102). At the 24 month primary end point, there was one withdrawal and a follow-up rate of 194/202 (96%). Mean HbA1c in the home treatment arm was 72.1 mmol/mol and in the hospital treated arm 72.6 mmol/mol. There was a negligible difference between the mean HbA1c levels in the two arms adjusted for baseline (1.01, 95% CI 0.93 to 1.09). There were mostly no differences in secondary outcomes at 24 months, apart from better child self-esteem in the home-arm. No home-arm children were admitted to hospital during initiation and there were no adverse events at that time. The number of investigations was higher in hospital patients during the follow-up period. There were no differences in insulin regimens between the two arms. CONCLUSIONS There is no evidence of a difference between home-based and hospital-based initiation of care in children newly diagnosed with type 1 diabetes across relevant outcomes. TRIAL REGISTRATION NUMBER ISRCTN78114042.
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Affiliation(s)
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - David Cohen
- Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK
| | - Mirella Longo
- Marie Curie Palliative Care Research Centre, Cardiff University, School of Medicine, Cardiff, UK
| | - Justin Davies
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola Harman
- University of Liverpool, Institute of Translational Medicine, Liverpool, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tabitha Randell
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Morro Touray
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Nicola Trevelyan
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Justin Warner
- Department of Child Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Lesley Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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17
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Zhao X, Ai Z, Chen Y, Wang J, Zou S, Zheng S. The Effectiveness of Parenting Interventions on Psychosocial Adjustment in Parents of Children and Adolescents with Type 1 Diabetes: A Meta‐Analysis. Worldviews Evid Based Nurs 2019; 16:462-469. [PMID: 31647190 DOI: 10.1111/wvn.12399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/09/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Xiaolei Zhao
- The Affiliated Hospital of Southwest Medical University Luzhou China
| | - Zhongping Ai
- The Affiliated Hospital of Southwest Medical University Luzhou China
| | - Yanhua Chen
- The Affiliated Hospital of Southwest Medical University Luzhou China
| | - Jiaxiang Wang
- The Affiliated Hospital of Southwest Medical University Luzhou China
| | - Shufang Zou
- The Affiliated Hospital of Southwest Medical University Luzhou China
| | - Silin Zheng
- The Affiliated Hospital of Southwest Medical University Luzhou China
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18
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Reed P, Giles A, White S, Osborne LA. Actual and perceived speedy diagnoses are associated with mothers' unresolved reactions to a diagnosis of autism spectrum disorder for a child. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1843-1852. [PMID: 30859844 DOI: 10.1177/1362361319833676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reaction to a child's diagnosis can strongly affect the parent, but little is known about the aspects of the diagnostic process associated with such reactions. The pre-diagnostic levels of anxiety, depression, and parenting stress of 67 volunteer mothers of children subsequently diagnosed with autism spectrum disorder were assessed, along with the children's functioning. The speed and number of professionals involved in the diagnosis were recorded, and mothers completed a post-diagnosis assessment of their perceptions of the process. Longer actual and perceived diagnosis speeds predicted resolved reactions to diagnosis. Mothers' psychological states pre-diagnosis did not predict reactions to diagnosis. Providing a measured diagnostic process, and strong relationship with mothers, rather than aiming for speed alone, may well be more productive for the parent and child.
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19
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Hospital-based home care for young children newly diagnosed with type 1 diabetes: Assessing expectations and obstacles in families and general practitioners. Arch Pediatr 2019; 26:324-329. [PMID: 31500922 DOI: 10.1016/j.arcped.2019.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/19/2019] [Accepted: 08/02/2019] [Indexed: 11/21/2022]
Abstract
AIMS This study aimed to evaluate whether hospital-based home care was desired by the parents of children diagnosed with type 1 diabetes (T1D) under the age of 5 years and their general practitioners, and to identify the main expectations and obstacles to its implementation. METHODS This descriptive bicentric study in France was performed between November 2016 and November 2017. Data were collected by interviewing 57 families of children diagnosed with diabetes before the age of 5 years and the corresponding 30 general practitioners. The primary endpoint was the families' or general practitioners' acceptance of home-based care after diagnosis. RESULTS A high proportion of families and physicians (86% and 93%, respectively) expressed a wish for hospital-based home care, most of whom considered it essential (79% and 87%, respectively). Low-income families were less likely to accept this care pathway (P<0.001). The families' expectations regarding home care were help with social care, the management of emergencies, and return to school. The physicians' main request was improved interprofessional collaboration. CONCLUSION Hospital-based home care seems to be an acceptable transition after conventional care for children just diagnosed with T1D. Multidisciplinary support, personalized social care, and access to welfare benefits may improve acceptance rates, especially among low-income families.
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20
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Khandan M, Tirgari B, Abazari F, Cheraghi MA. Mothers' Experiences of Maze Path of Type 1 Diabetes Diagnosis in Children. Ethiop J Health Sci 2019; 28:635-644. [PMID: 30607079 PMCID: PMC6308784 DOI: 10.4314/ejhs.v28i5.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Incidence of diabetes Type 1 in children with non-classic symptoms is one of the reasons for the delay in their follow-up. Failure in its diagnosis by the health professional exposes the mothers to many challenges. This study was conducted to explore mothers' experiences in the diagnosis pathway of diabetes Type 1 in children. Methods Semi-structured qualitative interviews were conducted with fifteen mothers of children with Type 1 diabetes. they were selected by the purposefull sampling method. Their child had a medical file in diabetes centers in Kerman, Iran, at least one year has passed of diabetes diagnosis in their child and the maximum age of the child is 14 years. Data were analyzed using content analysis. Three themes and nine sub-themes emerged during data analysis. Results The extracted themes included “presence in the maze path to the child's disease”, “facing the reality of the child's disease”, and “to grin and bear with new conditions”. Conclusions According to the finding, these mothers experienced various challenges. Therefore, identification of these challenges by health professionals to prevent and decrease of Them, is necessary.
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Affiliation(s)
- Maryam Khandan
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Batool Tirgari
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Farokh Abazari
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Ali Cheraghi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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21
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Noser AE, Dai H, Marker AM, Raymond JK, Majidi S, Clements MA, Stanek KR, Patton SR. Parental depression and diabetes-specific distress after the onset of type 1 diabetes in children. Health Psychol 2018; 38:103-112. [PMID: 30570283 DOI: 10.1037/hea0000699] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine trajectories of two types of type 1 diabetes (T1D) specific distress (i.e., daily T1D management and worries about the future and long-term complications) and the moderating role of parental depression in parents of children newly diagnosed with T1D. METHOD A total of 126 families of 5- to 9-year-olds with new-onset T1D enrolled in the study. One-hundred twenty-five families completed study measures at baseline, 102 at 6-month follow-up, and 89 at 12-month follow-up. Parents completed measures of depression and T1D-specific distress concerning daily T1D management and worries about the future and long-term complications at baseline and at 6- and 12-month follow-ups. We used multilevel modeling to examine 12-month trajectories of daily and long-term T1D-specific distress and to examine if parental depression modified these trajectories. RESULTS Results showed a significant reduction in daily T1D-specific distress from baseline to 6-month follow-up and maintenance of daily T1D-specific distress from 6- to 12-month follow-up. The significant interaction of baseline parental depression and time indicated that parents with depressive symptoms had a smaller reduction in daily T1D-specific distress from baseline to 6-month follow-up compared to parents without depressive symptoms. Findings for long-term T1D-specific distress indicated that parents with depressive symptoms reported higher distress across all assessment points, with peak long-term T1D-specific distress for parents with depressive symptoms occurring at 6-month follow-up. CONCLUSION Many parents experienced significant T1D-specific distress for a period of time following their child's initial diagnosis and this distress appears to be exacerbated by parental depressive symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Amy E Noser
- Clinical Child Psychology Program, University of Kansas
| | - Hongying Dai
- Health Services and Outcomes Research, Children's Mercy-Kansas City
| | | | - Jennifer K Raymond
- The Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles
| | - Shideh Majidi
- Division of Endocrinology, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine
| | - Mark A Clements
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center
| | - Kelly R Stanek
- Division of Endocrinology, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine
| | - Susana R Patton
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, and Children's Mercy-Kansas City
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22
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Adolfsson P, Rentoul D, Klinkenbijl B, Parkin CG. Hypoglycaemia Remains the Key Obstacle to Optimal Glycaemic Control - Continuous Glucose Monitoring is the Solution. EUROPEAN ENDOCRINOLOGY 2018; 14:50-56. [PMID: 30349594 PMCID: PMC6182923 DOI: 10.17925/ee.2018.14.2.50] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/17/2018] [Indexed: 12/14/2022]
Abstract
We queried PubMed and other internet databases to identify studies, meta-analyses, review articles and other data sources regarding hypoglycaemia incidence/costs/impacts and continuous glucose monitoring (CGM) use. Our analysis of the evidence showed that hypoglycaemia remains a significant health concern and a primary obstacle to optimal adherence to prescribed diabetes treatment. In addition to its adverse clinical consequences, hypoglycaemia negatively impacts quality of life and places additional financial burdens on patients, patient families, employers and healthcare payers. Clinical trials have shown that the use of CGM can reduce the incidence and duration of hypoglycaemic episodes. This article reviews relevant CGM studies, discusses the prevalence and clinical/financial implications of hypoglycaemia, and explores the strengths and limitations of current CGM systems in minimising the burden of hypoglycaemia.
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Affiliation(s)
- Peter Adolfsson
- Department of Pediatrics, Kungsbacka Hospital, Sweden.,Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden
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23
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Rodgers BL, Jacelon CS, Knafl KA. Concept Analysis and the Advance of Nursing Knowledge: State of the Science. J Nurs Scholarsh 2018; 50:451-459. [DOI: 10.1111/jnu.12386] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Beth L. Rodgers
- Gamma Omega , Chair, Adult Health and Nursing Systems Department, Nursing Alumni Endowed Professor; Virginia Commonwealth University; Richmond VA USA
| | - Cynthia S. Jacelon
- Beta Zeta , Professor, College of Nursing; University of Massachusetts Amherst; Amherst MA USA
| | - Kathleen A. Knafl
- Frances Hill Fox Distinguished Professor, School of Nursing; University of North Carolina at Chapel Hill; Chapel Hill NC USA
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24
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Parenting a Child with Phenylketonuria (PKU): an Interpretative Phenomenological Analysis (IPA) of the Experience of Parents. J Genet Couns 2018; 27:1074-1086. [PMID: 29468336 PMCID: PMC6132571 DOI: 10.1007/s10897-018-0227-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/29/2018] [Indexed: 11/01/2022]
Abstract
Phenylketonuria (PKU) is a rare inherited metabolic disorder which can cause neurological damage if left untreated. PKU is identified through newborn screening in developed countries, and treatment begins immediately to prevent these severe consequences. When a child is diagnosed, parents must assume immediate responsibility for the management of PKU and prevention of neurological damage. Quantitative studies have identified significant psychosocial stressors for parents, but little is known about how the parents experience this process. This study aimed to explore the experiences of parents of children with PKU under the age of two. It is the first study to examine these experiences in this way. Seven parents were interviewed about their experiences, and interpretative phenomenological analysis was used to analyse the data. Three main themes were identified: control, striving for normality and acceptance of PKU as a continuum. Links between the themes and processes underpinning the results were explored with relation to existing literature and theories from a clinical psychology perspective. The role of acceptance of PKU was central to the parent's experiences. Clinical implications and suggestions for further research are discussed.
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25
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Laffel LM, Aleppo G, Buckingham BA, Forlenza GP, Rasbach LE, Tsalikian E, Weinzimer SA, Harris DR. A Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System to Manage Children and Adolescents With Diabetes. J Endocr Soc 2017; 1:1461-1476. [PMID: 29344578 PMCID: PMC5760209 DOI: 10.1210/js.2017-00389] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/03/2017] [Indexed: 01/15/2023] Open
Abstract
After assessing previously published methods, we developed a practical approach to adjusting insulin doses using rtCGM trend arrows in pediatric patients with diabetes.
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Affiliation(s)
- Lori M Laffel
- Pediatric, Adolescent and Young Adult Programs, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611
| | - Bruce A Buckingham
- Department of Pediatric Endocrinology, Stanford University, Stanford, California 94305
| | - Gregory P Forlenza
- Barbara Davis Center, University of Colorado Denver, Aurora, Colorado 80045
| | - Lisa E Rasbach
- Division of Pediatric Endocrinology, Johns Hopkins Children's Center, Baltimore, Maryland 21287
| | - Eva Tsalikian
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06510
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26
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Clapin H, Hop L, Ritchie E, Jayabalan R, Evans M, Browne-Cooper K, Peter S, Vine J, Jones TW, Davis EA. Home-based vs inpatient education for children newly diagnosed with type 1 diabetes. Pediatr Diabetes 2017; 18:579-587. [PMID: 27807908 DOI: 10.1111/pedi.12466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/30/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Initial management of children diagnosed with type 1 diabetes (T1D) varies worldwide with sparse high quality evidence regarding the impact of different models of care. AIM To compare the inpatient model of care with a hybrid home-based alternative, examining metabolic and psychosocial outcomes, diabetes knowledge, length of stay, and patient satisfaction. SUBJECTS AND METHODS The study design was a randomized-controlled trial. Inclusion criteria were: newly diagnosed T1D, aged 3 to 16 years, living within approximately 1 hour of the hospital, English-speaking, access to transport, absence of significant medical or psychosocial comorbidity. Patients were randomized to standard care with a 5 to 6 day initial inpatient stay or discharge after 2 days for home-based management. All patients received practical skills training in the first 48 hours. The intervention group was visited twice/day by a nurse for 2 days to assist with injections, then a multi-disciplinary team made 3 home visits over 2 weeks to complete education. Patients were followed up for 12 months. Clinical outcomes included HbA1c, hypoglycemia, and diabetes-related readmissions. Surveys measured patient satisfaction, diabetes knowledge, family impact, and quality of life. RESULTS Fifty patients were recruited, 25 to each group. There were no differences in medical or psychosocial outcomes or diabetes knowledge. Average length of admission was 1.9 days shorter for the intervention group. Families indicated that with hindsight, most would choose home- over hospital-based management. CONCLUSIONS With adequate support, children newly diagnosed with T1D can be safely managed at home following practical skills training.
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Affiliation(s)
- H Clapin
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - L Hop
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - E Ritchie
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - R Jayabalan
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - M Evans
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - K Browne-Cooper
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - S Peter
- Hospital in the Home, Princess Margaret Hospital for Children, Perth, Australia
| | - J Vine
- Hospital in the Home, Princess Margaret Hospital for Children, Perth, Australia
| | - T W Jones
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - E A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
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27
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Thorsteinsson EB, Loi NM, Rayner K. Self-efficacy, relationship satisfaction, and social support: the quality of life of maternal caregivers of children with type 1 diabetes. PeerJ 2017; 5:e3961. [PMID: 29085757 PMCID: PMC5657414 DOI: 10.7717/peerj.3961] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/05/2017] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To examine maternal functioning and wellbeing as important aspects of a family's adaptation to chronic paediatric conditions, in particular, children with diabetes. METHOD This cross-sectional study investigated the difference between the perceived quality of life of mothers of children with diabetes (n = 63) and mothers of children without diabetes (n = 114). The study also examined the role of self-efficacy, relationship satisfaction, number of social support providers, and satisfaction with social support in predicting quality of life. RESULTS Mothers who had a child with diabetes had lower quality of life measured by general health, vitality, social functioning, role-emotional, and mental health than mothers that did not have a child with diabetes. Self-efficacy, relationship satisfaction, and social support were significant predictors of quality of life (mental health domain). CONCLUSION In order to enhance their psychological wellbeing, mothers of children with diabetes require adequate psychosocial support. Other implications for research and potential interventions are discussed.
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Affiliation(s)
| | - Natasha M Loi
- Department of Psychology, University of New England, Armidale, Australia
| | - Kylie Rayner
- Department of Psychology, University of New England, Armidale, Australia
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28
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McIntosh B, Khatchadourian K, Amed S. British Columbian Healthcare Providers' Perspectives on Facilitators and Barriers to Adhering to Pediatric Diabetes Treatment Guidelines. Can J Diabetes 2017; 41:224-240. [DOI: 10.1016/j.jcjd.2016.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 01/09/2023]
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Tiberg I, Lindgren B, Carlsson A, Hallström I. Cost-effectiveness and cost-utility analyses of hospital-based home care compared to hospital-based care for children diagnosed with type 1 diabetes; a randomised controlled trial; results after two years' follow-up. BMC Pediatr 2016; 16:94. [PMID: 27421262 PMCID: PMC4947351 DOI: 10.1186/s12887-016-0632-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/08/2016] [Indexed: 12/31/2022] Open
Abstract
Background Practices regarding hospitalisation of children at diagnosis of type 1 diabetes vary both within countries and internationally, and high-quality evidence of best practice is scarce. The objective of this study was to close some of the gaps in evidence by comparing two alternative regimens for children diagnosed with type 1 diabetes: hospital-based care and hospital-based home care (HBHC), referring to specialist care in a home-based setting. Methods A randomised controlled trial, including 60 children aged 3–15 years, took place at a university hospital in Sweden. When the children were medically stable, they were randomised to either the traditional, hospital-based care or to HBHC. Results Two years after diagnosis there were no differences in HbA1c (p = 0.777), in episodes of severe hypoglycaemia (p = 0.167), or in insulin U/kg/24 h (p = 0.269). Over 24 months, there were no statistically significant differences between groups in how parents’ reported the impact of paediatric chronic health condition on family (p = 0.138) or in parents’ self-reported health-related quality of life (p = 0.067). However, there was a statistically significant difference regarding healthcare satisfaction, favouring HBHC (p = 0.002). In total, healthcare costs (direct costs) were significantly lower in the HBHC group but no statistically significant difference between the two groups in estimated lost production (indirect costs) for the family as a whole. Whereas mothers had a significantly lower value of lost production, when their children were treated within the HBHC regime, fathers had a higher, but not a significantly higher value. The results indicate that HBHC might be a cost-effective strategy in a healthcare sector perspective. When using the wider societal perspective, no difference in cost effectiveness or cost utility was found. Conclusions Overall, there are only a few, well-designed and controlled studies that compare hospital care to different models of home care. The results of this study provide empirical support for the safety and feasibility of HBHC when a child is diagnosed with type 1 diabetes. Our results further indicate that the model of care may have an impact on families’ daily living, not only during the initial period of care but for a longer period of time. Trial registration ClinicalTrials.gov with identity number NCT00804232, December 2008.
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Affiliation(s)
- Irén Tiberg
- Department of Health Sciences, Lund University, SE-221 00, Lund, Sweden.
| | - Björn Lindgren
- Department of Health Sciences, Lund Universit, Lund, Sweden.,National Bureau of Economic Research (NBER), Cambridge, MA, USA
| | - Annelie Carlsson
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden
| | - Inger Hallström
- Department of Health Sciences, Lund University, Lund, Sweden
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Vogel TK, Kleib M, Davidson SJ, Scott SD. Parental Evaluation of a Nurse Practitioner-Developed Pediatric Neurosurgery Website. JMIR Res Protoc 2016; 5:e55. [PMID: 27072930 PMCID: PMC4846784 DOI: 10.2196/resprot.5156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/22/2015] [Accepted: 01/17/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Parents often turn to the Internet to seek health information about their child's diagnosis and condition. Information, support, and resources regarding pediatric neurosurgery are scarce, hard to find, and difficult to comprehend. To address this gap, a pediatric nurse practitioner designed a website called the Neurosurgery Kids Fund (NKF). Analyzing the legitimacy of the NKF website for parents seeking health information and fulfilling their social and resource needs is critical to the website's future development and success. OBJECTIVE To explore parental usage of the NKF website, track visitor behavior, evaluate usability and design, establish ways to improve user experience, and identify ways to redesign the website. The aim of this study was to assess and evaluate whether a custom-designed health website could meet parents' health information, support, and resource needs. METHODS A multimethod approach was used. Google Analytic usage reports were collected and analyzed for the period of April 23, 2013, to November 30, 2013. Fifty-two online questionnaires that targeted the website's usability were collected between June 18, 2014, and July 30, 2014. Finally, a focus group was conducted on August 20, 2014, to explore parents' perceptions and user experiences. Findings were analyzed using an inductive content analysis approach. RESULTS There were a total of 2998 sessions and 8818 page views, with 2.94 pages viewed per session, a 56.20% bounce rate, an average session duration of 2 minutes 24 seconds, and a 56.24% new sessions rate. Results from 52 eligible surveys included that the majority of NKF users were Caucasian (90%), females (92%), aged 36-45 years (48%), with a university or college degree or diploma (69%). Half plan to use the health information. Over half reported turning to the Internet for health information and spending 2 to 4 hours a day online. The most common reasons for using the NKF website were to (1) gather information about the 2 summer camps, (2) explore the Media Center tab, and (3) stay abreast of news and events supported by NKF. Parents were unanimous in reporting that the NKF website was pleasing in color and design, very easy to use and navigate, useful, and that they would continue to access it regularly. CONCLUSIONS Parents perceive the NKF website to be useful and easy-to-use in meeting their health information needs, finding social support, and learning about resources relevant to their child. A custom-designed website can be used to augment parents' health information needs by reinforcing, supplementing, and improving their understanding of their child's medical needs.
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Abstract
Purpose The purpose of this study was to explore the feasibility of using human patient simulation (HPS) to teach type 1 diabetes (T1DM) management to grandparents of grandchildren with T1DM. Methods Thirty grandparents (11 male, 19 female) of young grandchildren (aged 12 and under) with T1DM were recruited from an urban medical center. Experimental group (n = 14) grandparents received hands-on visual T1DM management education using an HPS intervention, and control group (n = 16) grandparents received similar education using a non-HPS intervention. Findings This study demonstrated the feasibility of recruiting and retaining grandparents into a clinical trial using HPS to teach T1DM management. Post intervention, all grandparent scores for T1DM knowledge, confidence, and fear showed significant improvement from time 1 to time 2, with HPS group grandparent scores showing consistently larger improvement. Conclusions The consistency of larger HPS-taught grandparent score improvement is suggestive of a benefit for the HPS teaching method. Early multimethod Certified Diabetes Educator (CDE)–provided T1DM education is an important point of entry for inducting grandparent members onto the grandchild’s diabetes care team.
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Curtis-Tyler K, Arai L, Stephenson T, Roberts H. What makes for a 'good' or 'bad' paediatric diabetes service from the viewpoint of children, young people, carers and clinicians? A synthesis of qualitative findings. Arch Dis Child 2015; 100:826-33. [PMID: 25791842 PMCID: PMC4552916 DOI: 10.1136/archdischild-2014-307517] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is mounting evidence that experience of care is a crucial part of the pathway for successful management of long-term conditions. DESIGN AND OBJECTIVES To carry out (1) a systematic mapping of qualitative evidence to inform selection of studies for the second stage of the review; and (2) a narrative synthesis addressing the question, What makes for a 'good' or a 'bad' paediatric diabetes service from the viewpoint of children, young people, carers and clinicians? RESULTS The initial mapping identified 38 papers. From these, the findings of 20 diabetes-focused papers on the views on care of ≥650 children, parents and clinicians were synthesised. Only five studies included children under 11 years. Children and young people across all age groups valued positive, non-judgemental and relationship-based care that engaged with their social, as well as physical, health. Parents valued provision responsive to the circumstances of family life and coordinated across services. Clinicians wanting to engage with families beyond a child's immediate physical health described finding this hard to achieve in practice. LIMITATIONS Socioeconomic status and ethnicity were poorly reported in the included studies. CONCLUSIONS In dealing with diabetes, and engaging with social health in a way valued by children, parents and clinicians, not only structural change, such as more time for consultation, but new skills for reworking relations in the consultation may be required.
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Affiliation(s)
| | - Lisa Arai
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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Lawton J, Waugh N, Barnard KD, Noyes K, Harden J, Stephen J, McDowell J, Rankin D. Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents' experiences and views. Diabet Med 2015; 32:1063-70. [PMID: 25472898 DOI: 10.1111/dme.12660] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 12/19/2022]
Abstract
AIMS To explore the difficulties parents encounter in trying to achieve clinically recommended blood glucose levels and how they could be better supported to optimize their child's glycaemic control. METHODS In-depth interviews were conducted with 54 parents of children with Type 1 diabetes (≤ 12 years). Data were analysed thematically. RESULTS Parents described being reluctant and finding it difficult to keep their child's blood glucose levels consistently within clinically recommended ranges. As well as worrying about their child's ability to detect/report hypoglycaemia, parents highlighted a multitude of factors that had an impact on their child's blood glucose levels and over which they could exercise little control. These included: leaving their child with other caregivers who could not be trusted to detect hypoglycaemia; difficulties remotely monitoring and regulating their child's food consumption and activity; and physical and social changes accompanying childhood development. Most parents used two sets of blood glucose targets, with clinically recommended targets employed when their child was in their immediate care and higher targets when in the care of others. Parents described health professionals as lacking understanding of the difficulties they encountered keeping blood glucose within target ranges and needing more empathetic, tailored and realistic advice. CONCLUSION It is not parents' fear of hypoglycaemia in isolation that leads to decisions to raise their child's blood glucose but, rather, parental fear in conjunction with other factors and considerations. Hence, to improve diabetes management in children, these factors may need to be addressed; for instance, by training others in diabetes management and using new technologies. Changes to consultations are also recommended.
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Affiliation(s)
- J Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh
| | - N Waugh
- Health Sciences, Division of Health Sciences Warwick Medical School, University of Warwick, Coventry
| | - K D Barnard
- Human Development and Health, University of Southampton, Southampton General Hospital, Southampton
| | - K Noyes
- Royal Hospital for Sick Children, Edinburgh
| | - J Harden
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh
| | - J Stephen
- Child Health Department, Borders General Hospital, Melrose
| | - J McDowell
- Nursing and Health Care School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - D Rankin
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh
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Tiberg I, Hallström I, Jönsson L, Carlsson A. Comparison of hospital-based and hospital-based home care at diabetes onset in children. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lowes L, Eddy D, Channon S, McNamara R, Robling M, Gregory JW. The experience of living with type 1 diabetes and attending clinic from the perception of children, adolescents and carers: analysis of qualitative data from the DEPICTED study. J Pediatr Nurs 2015; 30:54-62. [PMID: 25308399 DOI: 10.1016/j.pedn.2014.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/06/2014] [Accepted: 09/22/2014] [Indexed: 11/29/2022]
Abstract
Type 1 diabetes (T1D) is a complex, invasive childhood condition. Optimal glycemic control, essential to minimize risk of life-changing complications, is difficult to achieve. The DEPICTED trial evaluated a training program in consultation skills for pediatric diabetes teams. Qualitative descriptive analysis of questionnaire free-text comments from children, adolescents and carers participating in DEPICTED identified the emotional impact of living with T1D and how health professionals' communication skills in clinic influence the patient/carer experience. Healthcare professionals caring for children/adolescents with T1D and carers need training in patient-centered communication skills. Emotional needs of patients/carers need to be systematically assessed and addressed.
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Affiliation(s)
- Lesley Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales.
| | - Danielle Eddy
- School of Medicine, Cardiff University, Cardiff, Wales
| | - Sue Channon
- Cardiff and Vale University Health Board, The School of Psychology, Cardiff, Wales
| | - Rachel McNamara
- South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, Wales
| | - Michael Robling
- South East Wales Trials Unit (SEWTU), Institute of Translation, Innovation, Methodology & Engagement, School of Medicine, Cardiff University, Cardiff, Wales
| | - John W Gregory
- Institute of Molecular and Experimental Medicine, Cardiff University, Wales School of Medicine, Cardiff, Wales
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Brown O, Fouché P, Coetzee M. Bouncing forward: families living with a type I diabetic child. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2010.10874044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Rankin D, Harden J, Waugh N, Noyes K, Barnard KD, Lawton J. Parents' information and support needs when their child is diagnosed with type 1 diabetes: a qualitative study. Health Expect 2014; 19:580-91. [PMID: 25074412 PMCID: PMC5055234 DOI: 10.1111/hex.12244] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM AND OBJECTIVE The aim of this study was to describe and explore parents' information and support needs when their child is diagnosed with type 1 diabetes, including their views about the timing and chronology of current support provision. Our objective was to identify ways in which parents could be better supported in the future. DESIGN AND PARTICIPANTS Semi-structured interviews were conducted with 54 parents of children with type 1 diabetes in four paediatric diabetes clinics in Scotland. Data were analysed using an inductive, thematic approach. FINDINGS Parents described needing more reassurance after their child was diagnosed before being given complex information about diabetes management, so they would be better placed psychologically and emotionally to absorb this information. Parents also highlighted a need for more emotional and practical support from health professionals when they first began to implement diabetes regimens at home, tailored to their personal and domestic circumstances. However, some felt unable to ask for help or believed that health professionals were unable to offer empathetic support. Whilst some parents highlighted a need for support delivered by peer parents, others who had received peer support conveyed ambivalent views about the input and advice they had received. CONCLUSIONS Our findings suggest that professionals should consider the timing and chronology of support provision to ensure that parents' emotional and informational needs are addressed when their child is diagnosed and that practical advice and further emotional support are provided thereafter, which takes account of their day-to-day experiences of caring for their child.
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Affiliation(s)
- David Rankin
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jeni Harden
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Norman Waugh
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Qualitative observation instrument to measure the quality of parent-child interactions in young children with type 1 diabetes mellitus. BMC Pediatr 2014; 14:145. [PMID: 24915962 PMCID: PMC4086281 DOI: 10.1186/1471-2431-14-145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 05/01/2014] [Indexed: 01/08/2023] Open
Abstract
Background In young children with type 1 diabetes mellitus (T1DM), parents have complete responsibility for the diabetes-management. In toddlers and (pre)schoolers, the tasks needed to achieve optimal blood glucose control may interfere with normal developmental processes and could negatively affect the quality of parent–child interaction. Several observational instruments are available to measure the quality of the parent–child interaction. However, no observational instrument for diabetes-specific situations is available. Therefore, the aim of the present study was to develop a qualitative observation instrument, to be able to assess parent–child interaction during diabetes-specific situations. Methods First, in a pilot study (n = 15), the observation instrument was developed in four steps: (a) defining relevant diabetes-specific situations; (b) videotaping these situations; (c) describing all behaviors in a qualitative observation instrument; (d) evaluating usability and reliability. Next, we examined preliminary validity (total n = 77) by testing hypotheses about correlations between the observation instrument for diabetes-specific situations, a generic observation instrument and a behavioral questionnaire. Results The observation instrument to assess parent–child interaction during diabetes-specific situations, which consists of ten domains: “emotional involvement”, “limit setting”, “respect for autonomy”, “quality of instruction”, “negative behavior”, “avoidance”, “cooperative behavior”, “child’s response to injection”, “emphasis on diabetes”, and “mealtime structure”, was developed for use during a mealtime situation (including glucose monitoring and insulin administration). Conclusions The present study showed encouraging indications for the usability and inter-rater reliability (weighted kappa was 0.73) of the qualitative observation instrument. Furthermore, promising indications for the preliminary validity of the observation instrument for diabetes-specific situations were found (r ranged between |.24| and |.45| for significant correlations and between |.10| and |.23| for non-significant trends). This observation instrument could be used in future research to (a) test whether parent–child interactions are associated with outcomes (like HbA1c levels and psychosocial functioning), and (b) evaluate interventions, aimed at optimizing the quality of parent–child interactions in families with a young child with T1DM.
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Jönsson L, Lundqvist P, Tiberg I, Hallström I. Type 1 diabetes - impact on children and parents at diagnosis and 1 year subsequent to the child's diagnosis. Scand J Caring Sci 2014; 29:126-35. [DOI: 10.1111/scs.12140] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Lisbeth Jönsson
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Pia Lundqvist
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Irén Tiberg
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Inger Hallström
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
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Noyes JP, Lowes L, Whitaker R, Allen D, Carter C, Edwards RT, Rycroft-Malone J, Sharp J, Edwards D, Spencer LH, Sylvestre Y, Yeo ST, Gregory JW. Developing and evaluating a child-centred intervention for diabetes medicine management using mixed methods and a multicentre randomised controlled trial. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AimTo develop and evaluate an individually tailored age-appropriate diabetes diary and information pack for children and young people aged 6–18 years with type 1 diabetes to support decision-making and self-care with a specific focus on insulin management and blood glucose monitoring, compared with available resources in routine clinical practice.DesignFour-stage study following the Medical Research Council framework for designing and evaluating complex interventions. Stage 1: context – brief review of reviews and mixed-method systematic review; updating of database of children’s diabetes information; children’s diabetes information quality assessment and diabetes guideline analysis; and critical discourse analysis. Stage 2: intervention development – working with expert clinical advisory group; contextual qualitative interviews and focus groups with children and young people to ascertain their information preferences and self-care practices; ongoing consultation with children; development of intervention programme theory. Stage 3: randomised controlled trial (RCT) to evaluate the diabetes diaries and information packs in routine practice. Stage 4: process evaluation.FindingsThe RCT achieved 100% recruitment, was adequately powered and showed that the Evidence into Practice Information Counts (EPIC) packs and diabetes diaries were no more effective than receiving diabetes information in an ad hoc way. The cost per unit of producing the EPIC packs and diabetes diaries was low. Compared with treatment as usual information, the EPIC packs fulfilled all NHS policy imperatives that children and young people should receive high-quality, accurate and age-appropriate information about their condition, self-management and wider lifestyle and well-being issues. Diabetes guidelines recommend the use of a daily diabetes diary and EPIC diaries fill a gap in current provision. Irrespective of allocation, children and young people had a range of recorded glycated haemoglobin (HbA1c) levels, which showed that as a group their diabetes self-management would generally need to improve to achieve the HbA1clevels recommended in National Institute for Health and Care Excellence guidance. The process evaluation showed that promotion of the EPIC packs and diaries by diabetes professionals at randomisation did not happen as intended; the dominant ‘normalisation’ theory underpinning children’s diabetes information may be counterproductive; risk and long-term complications did not feature highly in children’s diabetes information; and children and young people engaged in risky behaviour and appeared not to care, and most did not use a diabetes diary or did not use the information to titrate their insulin as intended.LimitationsRecruitment of ‘hard to reach’ children and young people living away from their families was not successful. The findings are therefore more relevant to diabetes management within a family context.ConclusionsThe findings indicate a need to rethink context and the hierarchical relationships between children, young people, parents and diabetes professionals with regard to ‘partnership and participation’ in diabetes decision-making, self-care and self-management. Additional research, implementation strategies and service redesign are needed to translate available information into optimal self-management knowledge and subsequent optimal diabetes self-management action, including to better understand the disconnection between children’s diabetes texts and context; develop age-appropriate Apps/e-records for recording blood glucose measurements and insulin management; develop interventions to reduce risk-taking behaviour by children and young people in relation to their diabetes management; reconsider what could work to optimise children’s self-management of diabetes; understand how best to reorganise current diabetes services for children to optimise child-centred delivery of children’s diabetes information.Study registrationCurrent Controlled Trials ISRCTN17551624.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jane P Noyes
- Centre for Health-Related Research, Bangor University, Bangor, UK
| | - Lesley Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Rhiannon Whitaker
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Cynthia Carter
- Cardiff School of Journalism, Media and Cultural Studies, Cardiff University, Cardiff, UK
| | - Rhiannon T Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Janice Sharp
- Media Resources Centre, University Hospital of Wales, Cardiff, UK
| | - Deborah Edwards
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Yvonne Sylvestre
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - John W Gregory
- Department of Child Health, Wales School of Medicine, Cardiff University, Cardiff, UK
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Holtslander L, Kornder N, Letourneau N, Turner H, Paterson B. Finding straight answers: identifying the needs of parents and service providers of adolescents with type 1 diabetes to aid in the creation of an online support intervention. J Clin Nurs 2012; 21:2419-28. [PMID: 22889443 DOI: 10.1111/j.1365-2702.2012.04182.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the needs and preferences of parents and service providers of adolescents with type 1 diabetes in an online support intervention. BACKGROUND Parents experience stress during this time of transition as adolescent conflict is common and the consequences of risk-taking behaviour in combination with type 1 diabetes can be severe. Parents are in need of social support and desired an online intervention. Online support interventions have not been previously designed from the perspective of the users of these interventions. METHODS Participatory, qualitative design. Fourteen group interviews across Canada (n=60). RESULTS Participants identified four main themes (Finding straight answers, Making transitions, Struggling with parenting and Connecting with others) within the context of accessibility. Parents described their needs for credible Canadian information, support from other parents, fostering positive family dynamics while shifting parenting roles during adolescence. Connecting with others included finding a social support system and venue to share stories and resources. DISCUSSION These findings are innovative as these experienced participants desired a blend of professional information and peer informal knowledge and support in an accessible, online format. CONCLUSION The results of this study will form the foundation of an online support intervention while providing unique insight into the experiences of parents of adolescents with type 1 diabetes. RELEVANCE TO CLINICAL PRACTICE Parents and service providers indicate the need for information that is trusted, accurate and on a wide range of topics, within a preferred online environment. Supporting parents during this difficult time includes directing them to appropriate and accessible resources, facilitating a positive, healthy process of transition to interdependence, in their parenting of adolescents with type 1 diabetes.
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Tiberg I, Carlsson KS, Carlsson A, Hallström I. Metabolic control, healthcare satisfaction and costs 1 month after diagnosis of type 1 diabetes: a randomised controlled trial of hospital-based care vs. hospital-based home care. Pediatr Diabetes 2012; 13:625-31. [PMID: 22759218 DOI: 10.1111/j.1399-5448.2012.00879.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/30/2012] [Accepted: 04/12/2012] [Indexed: 11/28/2022] Open
Abstract
Procedures for the initial management of children newly diagnosed with diabetes vary greatly worldwide and the evidence available is insufficient for conclusively determining the best process regarding hospital-based or home-based care. The aim of the study was to compare two different regimens for children with newly diagnosed type 1 diabetes; hospital-based care and hospital-based home care (HBHC), defined as specialist care in a home-based setting. A randomised controlled trial, including 60 children, took place at a university hospital in Sweden during the period of March 2008 to September 2011. After 2-3 d with hospital-based care, children from 3 to 15 yr of age were randomised to either continued hospital-based care for a total of 1-2 wk or to HBHC. This article presents results 1 month after diagnosis. No differences were shown in the daily mean glucose level or in its variability when the children received care but, after discharge, children who received HBHC showed lower mean plasma glucose values and lower variability compared to children who received hospital-based care. Children in HBHC had fewer episodes of hypoglycaemia during the first month after diagnosis. In the HBHC group, parents were more satisfied with the healthcare received and healthcare costs for the first month were 30% lower as compared to hospital-based care. The results 1 month after diagnosis support the HBHC programme as being a safe and cost-effective way of providing care. A follow-up will continue for 2 yr to evaluate which process was best for the majority of families over time.
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Affiliation(s)
- Irén Tiberg
- Division of Nursing, Department of Health Sciences, Lund University, Lund, Sweden.
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Tiberg I, Katarina SC, Carlsson A, Hallström I. Children diagnosed with type 1 diabetes: a randomized controlled trial comparing hospital versus home-based care. Acta Paediatr 2012; 101:1069-73. [PMID: 22759081 DOI: 10.1111/j.1651-2227.2012.02775.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To compare two different regimens for children diagnosed with type 1 diabetes: hospital-based care or hospital-based home care (HBHC), referring to specialist care in a home-based setting. METHOD The trial took place in Sweden with a randomized controlled design and included 60 children, aged 3-15 years. After 2-3 days with hospital-based care, children were randomized to either continued hospital-based care or to HBHC for 6 days. The primary outcome was the child's metabolic control after 2 years. Secondary outcomes were set to evaluate the family and child situation as well as the healthcare services. This article presents data 6 months after diagnosis. RESULTS Results showed equivalence between groups in terms of metabolic control, insulin dose, parents' employment and working hours as well as parents' and significant others' absence from work related to the child's diabetes. Parents in the HBHC were more satisfied with the received health care and showed less subsequent healthcare resource use. The level of risk for the family's psychosocial distress assessed at diagnosis was associated with the subsequent use of resources, but not with metabolic control. CONCLUSION HBHC was found to be an equally safe and effective way of providing care as hospital-based care at the onset of type 1 diabetes for children who are medically stable.
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Affiliation(s)
- Irén Tiberg
- Department of Health Sciences and The Swedish Institute for Health Sciences, Lund University, Lund, Sweden.
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Whittemore R, Jaser S, Chao A, Jang M, Grey M. Psychological experience of parents of children with type 1 diabetes: a systematic mixed-studies review. DIABETES EDUCATOR 2012; 38:562-79. [PMID: 22581804 DOI: 10.1177/0145721712445216] [Citation(s) in RCA: 251] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this review is to describe the prevalence of psychological distress in parents of children with type 1 diabetes (T1DM), the relationship between parental psychological distress and health outcomes, and parents' psychological experience of having a child with T1DM. Clinical and research implications are presented. METHOD A systematic mixed-studies review was undertaken to review the quantitative and qualitative research on the parental experience of having a child with T1DM. A total of 34 articles met the inclusion criteria and were included in the review. RESULTS The prevalence of parental psychological distress across all studies ranged from 10% to 74%, with an average of 33.5% of parents reporting distress at diagnosis and 19% of parents reporting distress 1 to 4 years after diagnosis. Parental psychological distress in parents of children with T1DM, regardless of how it was defined, was associated with higher child self-report of stress and depressive symptoms, more problematic child behavior, and lower child self-report of quality of life. Parental psychological distress also had negative effects on diabetes management. Themes of the qualitative synthesis indicated that parents perceived T1DM as a difficult diagnosis that contributed to significant family disruption. Adjustment occurred over time; however, ongoing stress was experienced. CONCLUSIONS Screening for psychological distress in parents of children with T1DM is indicated, and preventive interventions are needed.
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Affiliation(s)
| | - Sarah Jaser
- Yale School of Nursing, New Haven, Connecticut
| | - Ariana Chao
- Yale School of Nursing, New Haven, Connecticut
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Smaldone A, Ritholz MD. Perceptions of parenting children with type 1 diabetes diagnosed in early childhood. J Pediatr Health Care 2011; 25:87-95. [PMID: 21320680 PMCID: PMC3053084 DOI: 10.1016/j.pedhc.2009.09.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 08/31/2009] [Accepted: 09/12/2009] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The purpose of this study was to explore perceptions of psychosocial adaptations in parenting young children with type 1 diabetes (T1DM) from diagnosis through childhood. METHOD Fourteen parents of 11 children with T1DM who were diagnosed at age five years or younger participated in semi-structured interviews. Data were analyzed using content analysis. RESULTS Three significant themes were identified. In the theme "Diagnostic Experiences: Frustrations, Fears, and Doubts," parents described inadequate diagnostic experiences with pediatricians where concerns were minimized and diagnosis was sometimes delayed. Although hospitalization occurred abruptly, communication with specialists was more satisfactory. In the theme "Adapting to Diabetes," parents described isolation in caring for their child's T1DM. Family and friends had minimal understanding of T1DM care. Support groups lessened mothers' isolation, but fathers were less positive about this experience. Parental adaptation was more effective when responsibility for diabetes decision making was shared. All parents reported never mastering diabetes management. The theme "Negotiating Developmental Transitions" revealed that normative childhood events were stressful, requiring that parents balance concerns to foster their child's participation. CONCLUSIONS Pediatric providers can improve diagnostic and treatment experiences for parents of children with T1DM by recognizing feelings of isolation and lack of mastery, providing attentive communication, encouraging parental teamwork, and offering ongoing anticipatory guidance.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, 617W168th St, New York, NY 10032, USA.
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Townson JK, Gregory JW, Cohen D, Channon S, Harman N, Davies JH, Warner J, Trevelyan N, Playle R, Robling M, Hood K, Lowes L. Delivering early care in diabetes evaluation (DECIDE): a protocol for a randomised controlled trial to assess hospital versus home management at diagnosis in childhood diabetes. BMC Pediatr 2011; 11:7. [PMID: 21247461 PMCID: PMC3031193 DOI: 10.1186/1471-2431-11-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 01/19/2011] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is increased incidence of new cases of type 1 diabetes in children younger than 15 years. The debate concerning where best to manage newly diagnosed children continues. Some units routinely admit children to hospital whilst others routinely manage children at home. A Cochrane review identified the need for a large well-designed randomised controlled trial to investigate any significant differences in comprehensive short and long-term outcomes between the two approaches. The DECIDE study will address these knowledge gaps, providing high quality evidence to inform national and international policy and practice. METHODS/DESIGN This is a multi-centre randomised controlled trial across eight UK paediatric diabetes centres. The study aims to recruit 240 children newly diagnosed with type 1 diabetes and their parents/carers. Eligible patients (aged 0-17 years) will be remotely randomised to either 'hospital' or 'home' management. Parents/carers of patients will also be recruited. Nursing management of participants and data collection will be co-ordinated by a project nurse at each centre. Data will be collected for 24 months after diagnosis; at follow up appointments at 3, 12 and 24 months and every 3-4 months at routine clinic visits.The primary outcome measure is patients' glycosylated haemoglobin (HbA1c) at 24 months after diagnosis. Additional measurements of HbA1c will be made at diagnosis and 3 and 12 months later. HbA1c concentrations will be analysed at a central laboratory.Secondary outcome measures include length of stay at diagnosis, growth, adverse events, quality of life, anxiety, coping with diabetes, diabetes knowledge, home/clinic visits, self-care activity, satisfaction and time off school/work. Questionnaires will be sent to participants at 1, 12 and 24 months and will include a questionnaire, developed and validated to measure impact of the diagnosis on social activity and independence. Additional qualitative outcome measures include the experience of both approaches by a subgroup of participants (n = 30) and health professionals. Total health service costs will be evaluated. A cost effectiveness analysis will assess direct and indirect health service costs against the primary outcome (HbA1c). DISCUSSION This will be the first randomised controlled trial to evaluate hospital and home management of children newly diagnosed with type 1 diabetes and the findings should provide important evidence to inform practice and national guidelines. TRIAL REGISTRATION NUMBER ISRCTN: ISRCTN78114042.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Clinical Protocols
- Cost of Illness
- Cost-Benefit Analysis
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/nursing
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Disease Management
- Early Diagnosis
- Glycated Hemoglobin/analysis
- Health Knowledge, Attitudes, Practice
- Home Nursing
- Hospitalization
- Humans
- Infant
- Length of Stay
- Outcome Assessment, Health Care
- Quality of Life
- United Kingdom
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Affiliation(s)
- Julia K Townson
- South East Wales Trials Unit (SEWTU), Department of Primary Care & Public Health, School of Medicine, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - John W Gregory
- Department of Child Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - David Cohen
- Health Economics and Policy Research Unit, University of Glamorgan, Pontypridd, CF37 1DL, UK
| | - Sue Channon
- Paediatric Psychology Department, Children's Centre, St David's Hospital, Cardiff, CF11 9XB, UK
| | - Nicola Harman
- Medicines for Children Research Network Clinical Trials Unit, University of Liverpool, Liverpool, L12 2AP, UK
| | - Justin H Davies
- Child Health Directorate, Southampton University Hospital Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Justin Warner
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - Nicola Trevelyan
- Child Health Directorate, Southampton University Hospital Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Rebecca Playle
- South East Wales Trials Unit (SEWTU), Department of Primary Care & Public Health, School of Medicine, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Michael Robling
- South East Wales Trials Unit (SEWTU), Department of Primary Care & Public Health, School of Medicine, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), Department of Primary Care & Public Health, School of Medicine, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Lesley Lowes
- School of Nursing and Midwifery Studies, Cardiff University, Cardiff, CF24 0AB, UK
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Jönsson L, Hallström I, Lundqvist A. A multi-disciplinary education process related to the discharging of children from hospital when the child has been diagnosed with type 1 diabetes--a qualitative study. BMC Pediatr 2010; 10:36. [PMID: 20507611 PMCID: PMC2889941 DOI: 10.1186/1471-2431-10-36] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 05/27/2010] [Indexed: 11/24/2022] Open
Abstract
Background Worldwide, insulin-dependent type 1 diabetes is one of the most frequently diagnosed long-term endocrine disorders found in children and the incidences of this diseased is still increasing. In Sweden the routines are, according to national guidelines, when the child is diagnosed with type 1 diabetes, the child and its family remains at the hospital for about two weeks. There is limited knowledge about how a diabetes team handles a child and its family from admission to discharge, therefore the purpose of this study was to seek a deeper understanding of how the diabetes team's parent/child education process works, from admission to discharge, among families with a child newly diagnosed with type 1 diabetes. Methods Qualitative data collection was used. Four focus-group interviews, with a sample of three diabetes teams from different paediatric hospitals in the south western part of Sweden, were conducted and the data recorded on tape and then analysed using qualitative content analysis. Results The results indicate that achieving a status of self-care on the part of the patient is the goal of the diabetes education programme. Part of the programme is aimed at guiding the child and its parents towards self-help through the means of providing them with knowledge of the disease and its treatment to enable the whole family to understand the need for cooperation in the process. To do this requires an understanding, by the diabetes team, of the individualities of the family in order to gain an overall picture. Conclusion The results of this study show that the diabetes education programme is specifically designed for each family using the internationally recommended clinical practice guidelines with its specific aims and objectives. Achieving the families' willingness to assist in the self-care of the child care is the goal of the parent education process. To achieve this, the paediatric diabetes specialist nurse and the diabetes specialist paediatrician immediately and deliberately start the process of educating the family using a programme designed to give them the necessary knowledge and skills they will need to manage their child's type 1 diabetes at home.
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Affiliation(s)
- Lisbeth Jönsson
- Division of Nursing, Department of Health Sciences, Lund University, Lund, Sweden.
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Bowes S, Lowes L, Warner J, Gregory JW. Chronic sorrow in parents of children with type 1 diabetes. J Adv Nurs 2009; 65:992-1000. [PMID: 19399973 DOI: 10.1111/j.1365-2648.2009.04963.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This paper reports on a study exploring parents' longer-term experiences of having a child with type 1 diabetes. BACKGROUND Parents of children with type 1 diabetes may experience a grief reaction at diagnosis similar to that normally associated with bereavement, but little is known about their long-term emotional adaptation. Chronic sorrow, a sustained but intermittent grief reaction, is identified in adults with diabetes but has not previously been explored in relation to parents. METHODOLOGY In-depth interviews were conducted in 2007 with a convenience sample of 17 parents of children with type 1 diabetes 7-10 years after diagnosis. Data were explored within a theoretical framework of grief, loss, adaptation, and change. FINDINGS Parents had adapted to the needs of diabetes management but most had not 'come to terms' with the diagnosis. They experienced a resurgence of grief at critical times during their child's development and some, particularly mothers, became upset during their interviews, even though these took place 7-10 years after their child's diagnosis. Mothers elaborated more on their emotions than fathers, but continuing feelings associated with grief, such as anger and guilt, were expressed by both fathers and mothers. CONCLUSION Greater understanding of parents' long-term emotional responses and recognition that grief may never resolve in these parents may enable healthcare professionals to provide appropriate and timely support at critical times.
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Marshall M, Carter B, Rose K, Brotherton A. Living with type 1 diabetes: perceptions of children and their parents. J Clin Nurs 2009; 18:1703-10. [DOI: 10.1111/j.1365-2702.2008.02737.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Paterson B, Brewer J. Needs for social support among parents of adolescents with diabetes. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1752-9824.2009.01019.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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