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Kelleher J, LaQuaglia R, Heddings J, Ely B, Jones E, Shaffer T, Duncan CL. Transition readiness and coping styles in adolescents with type 1 diabetes. J Pediatr Nurs 2024; 78:e338-e345. [PMID: 39127590 DOI: 10.1016/j.pedn.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 06/06/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE Although promoting positive coping and reducing negative coping improves health, little research has examined how types of coping relate to transition readiness in adolescents with type 1 diabetes (T1D). This study aimed to clarify the direct and indirect relations between coping style and transition readiness. We first examined which coping styles predict transition readiness in adolescents with T1D and then explored whether diabetes distress mediates the relation between disengagement coping and transition readiness. DESIGN AND METHODS Using a cross-sectional observational design, 68 families with an adolescent with T1D were recruited during routine clinic appointments. Surveys on family demographics, coping styles, transition readiness, and diabetes distress were completed electronically. Medical information was extracted from electronic health records. RESULTS Neither primary control, secondary control, nor disengagement coping had a direct significant association with transition readiness after controlling for HbA1c. There was a significant indirect effect of disengagement coping on transition readiness through greater diabetes distress (adolescent report β = -0.13; 95% CI, LL = -0.27, UL = -0.02; parent report β = -0.12; 95% CI, LL = -0.26, UL = -0.02). CONCLUSIONS Coping style did not have a direct effect on transition readiness. However, disengagement coping was associated with diabetes distress, which in turn was significantly related to transition readiness. PRACTICE IMPLICATIONS Clinicians and researchers should consider incorporating coping strategies within transition readiness interventions to decrease distress and improve transition readiness. Disease-specific psychosocial screening may enhance routine diabetes transition education.
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Affiliation(s)
- Jennifer Kelleher
- West Virginia University, Department of Psychology, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV 26506-6040, USA.
| | - Rebecca LaQuaglia
- West Virginia University, Department of Psychology, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV 26506-6040, USA
| | - Janelle Heddings
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Brian Ely
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Evan Jones
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Tebony Shaffer
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Christina L Duncan
- West Virginia University, Department of Psychology, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV 26506-6040, USA; West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
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2
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Luo D, Cai X, Wang H, Xu J, Wang Y, Li M. An ecological resilience model for adolescents with type 1 diabetes: a cross-sectional study. BMC Psychiatry 2024; 24:263. [PMID: 38594663 PMCID: PMC11003067 DOI: 10.1186/s12888-024-05634-1] [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: 08/29/2023] [Accepted: 02/23/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Highly resilient adolescents with type 1 diabetes have been proved to achieve within-target glycemic outcomes and experience high quality of life. The ecological resilience model for adolescents with type 1 diabetes was developed in this study. It aims to increase our understanding of how resilience is both positively and negatively affected by internal and environmental ecological factors. METHODS This cross-sectional study surveyed 460 adolescents with type 1 diabetes from 36 cities in 11 provinces, China. Participants completed self-report questionnaires on resilience, family functioning, peer support, peer stress, coping style, and demographics. Standard glycated hemoglobin tests were performed on the adolescents. Structural equation modeling was applied to analyze the data. RESULTS The ecological resilience model for adolescents with type 1 diabetes was a good model with a high level of variance in resilience (62%). Family functioning was the most important predictor of resilience, followed by peer support, positive coping, and peer stress. Moreover, positive coping was the mediator of the relationship between family functioning and resilience. Positive coping and peer stress co-mediated the association between peer support and resilience. CONCLUSIONS Family functioning, peer relationships, and positive coping are interrelated, which may jointly influence resilience. The findings provide a theoretical basis for developing resilience-promotion interventions for adolescents with type 1 diabetes, which may lead to health improvements during a vulnerable developmental period.
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Affiliation(s)
- Dan Luo
- School of Nursing, Nanjing University of Chinese Medicine, Jiangsu, China.
| | - Xue Cai
- Department of Respiratory, Department of Nursing, School of Medicine, Zhongda Hospital, Southeast University, Jiangsu, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Jingjing Xu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China.
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China.
| | - Yubing Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Jiangsu, China.
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
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Leocadio P, Kelleher C, Fernández E, Hawkes CP. Adolescents' Experiences of Transition to Self-Management of Type 1 Diabetes: Systematic Review and Future Directions. Sci Diabetes Self Manag Care 2023; 49:477-492. [PMID: 37927049 PMCID: PMC10666500 DOI: 10.1177/26350106231206779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE The purpose of this systematic literature review was to explore studies that report the experiences of adolescents, their families, and health care professionals of adolescents' transition to self-management of type 1 diabetes (T1DM). METHODS SocINDEX, PsycInfo, APA PsycArticles, and MEDLINE electronic databases were searched. Studies reporting on experiences of transition to self-management of T1DM for adolescents, their parents, siblings, and health care professionals published between January 2010 amd December 2021 were included. The Mixed Methods Appraisal Tool guided trustworthiness and relevance of selected studies. RESULTS A total of 29 studies met the inclusion criteria. Findings indicate that adolescents' experiences of transitioning to self-management of T1DM are interconnected with the supports provided by others (eg, family, teachers, friends). Considering interdependence and collective lived experiences is essential to developing effective and personalized family, peer, and social interventions to facilitate transition and to avoid negative outcomes in later life. The renegotiation of roles within the network of supports that impact adolescents' transition and adolescents' self-negotiation have been neglected. CONCLUSION Transition to self-management of T1DM is a dynamic and iterative process comprising of continuous shifts between interdependence and independence, making it challenging for all involved. A number of research gaps and avenues for future research are outlined.
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Affiliation(s)
- Paula Leocadio
- Department of Management and Marketing, University College Cork, Cork, Ireland
| | - Carol Kelleher
- Department of Management and Marketing, University College Cork, Cork, Ireland
| | - Eluska Fernández
- School of Applied Social Studies, University College Cork, Cork, Ireland
| | - Colin P. Hawkes
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Sari SA, Agadayi E, Celik N, Karahan S, Komurluoglu Tan A, Doger E. The Turkish version of the problem areas in diabetes-parents of teens (P-PAID-T): Cross-cultural adaptation, reliability, and validity. J Pediatr Nurs 2023; 73:e146-e153. [PMID: 37573154 DOI: 10.1016/j.pedn.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To examine the Turkish validity and reliability of the Problem Areas in Diabetes- Parents of Teens (P-PAID-T) scale and its psychometric properties for determining the parents' diabetes-related distress. METHODS The study included the parents of 200 adolescents with T1DM for at least a year. P-PAID-T and a demographic data form were used for data collection. Davis technique was used for the content validity of the scale. The scale's reliability was tested using test-retest, and its internal reliability was analyzed with Cronbach's alpha test. Exploratory Factor Analysis (EFA) was used to analyze the factor structure. Confirmatory Factor Analysis (CFA) was used to evaluate the fit of the scale. RESULTS 69.5% (n = 139) of the participants were mothers. Compared to the fathers, the mothers' mean P-PAID-T score was significantly higher. Parents of sons, who used insulin injections for their children, and had a college degree or higher education level had higher P-PAID-T scores. The test-retest correlation coefficient of the scale was 0.977. The Cronbach α value of the scale was 0.901. The results of confirmatory factor analysis were x2/df = 2.931, GFI = 0.736, CFI = 0.711, NFI = 0.628, NNFI = 0.660, RMSEA = 0.141. CONCLUSION The Turkish version of P-PAID-T was a valid and reliable screening tool for measuring diabetes stress in parents of adolescents with T1DM. PRACTICE IMPLICATIONS Nurses could use the Turkish version of P-PAID-T to monitor parental diabetes distress and organize interventions; also Turkish P-PAID-T could facilitate research on diabetes distress for parents of adolescents with T1DM.
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Affiliation(s)
- Seda Aybuke Sari
- Department of Child and Adolescent Psychiatry, Hatay Mustafa Kemal University Faculty of Medicine Hatay/Turkey (prev: Department of Child and Adolescent Psychiatry, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
| | - Ezgi Agadayi
- Department of Medical Education, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Nurullah Celik
- Department of Pediatric Endocrinology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Seher Karahan
- Department of Medical Education, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Ayça Komurluoglu Tan
- Department of Pediatrics, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Esra Doger
- Department of Pediatric Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
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Owusu BA, Ofori-Boateng P, Doku DT. Coping and adaptation strategies among young persons living with type 1 diabetes and their caregivers: textual and photovoice analyses. BMC Public Health 2023; 23:1684. [PMID: 37653475 PMCID: PMC10472693 DOI: 10.1186/s12889-023-16573-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Management of type 1 diabetes (T1D) is complex and demanding. It requires patients and their caregivers, particularly those in low-resource settings to adopt productive coping strategies to achieve ideal glycaemic control. Coping and adaptation strategies have far-reaching implications on their behavioural and health outcomes. Yet, it is uncertain how young people living with T1D and their caregivers in low-resource settings cope and adapt to the challenges of T1D management. This study analysed textual and photo evidence on the coping and adaptation strategies employed by young persons living with T1D (warriors) and their caregivers in Ghana. METHODS Qualitative data were collected from 28 warriors, 12 caregivers, 6 healthcare providers and other stakeholders in southern Ghana using semi-structured interview guides. Participants were identified at T1D support group centres, hospitals, and their places of residence, and recruited into the study using maximum variation and snowball sampling approaches. Data were collected via face-to-face interviews, photovoice, telephone interviews and videoconferencing and were thematically analysed using QSR NVivo 11. RESULTS Four superordinate themes which are productive coping, non-productive coping, keeping T1D a secret, and coping with costs of care were identified. Productive coping entailed condition acceptance, planning ahead, seeking social support, borrowing insulin, and overcoming the barriers of insulin storage. On the other hand, avoidance, disengagement, and re-use of syringes were the common non-productive coping approaches. Due to stigma and discrimination, the warriors shrouded their condition in secrecy. As a response to the financial burden of T1D care, caregivers/patients borrowed money, took loans, and sold household items. CONCLUSION Young persons living with T1D and their caregivers adopted coping strategies which both promoted and compromised their T1D management. There was an occasional co-existence of diverse coping strategies (productive and non-productive), and these reflects the personal and contextual stressors they faced. The results call for the need to eliminate barriers of T1D management and equip patients and their caregivers with ongoing T1D coping competencies.
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Affiliation(s)
| | - Prince Ofori-Boateng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Cape Coast Teaching Hospital, Central Region, Cape Coast, Ghana
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Teela L, Verhagen LE, van Oers HA, Kramer EEW, Daams JG, Gruppen MP, Santana MJ, Grootenhuis MA, Haverman L. Pediatric patient engagement in clinical care, research and intervention development: a scoping review. J Patient Rep Outcomes 2023; 7:32. [PMID: 36988738 DOI: 10.1186/s41687-023-00566-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/21/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND In the last decades, pediatric patient engagement has received growing attention and its importance is increasingly acknowledged. Pediatric patient engagement in health care can be defined as the involvement of children and adolescents in the decision-making of daily clinical care, research and intervention development. Although more attention is paid to pediatric patient engagement, a comprehensive overview of the activities that have been done regarding pediatric patient engagement and the changes over time is lacking. Therefore, the aim of this study is to provide an overview of the literature about pediatric patient engagement. METHODS The methodological framework of Arksey & O'Malley was used to conduct this scoping review. The bibliographic databases Medline, Embase, and PsycINFO were searched for eligible articles. All retrieved articles were screened by at least two researchers in two steps. Articles were included if they focused on pediatric patient engagement, were carried out in the context of clinical care in pediatrics, and were published as full text original article in English or Dutch. Data (year of publication, country in which the study was conducted, disease group of the participants, setting of pediatric patient engagement, used methods, and age of participants) were extracted, synthesized, and tabulated. RESULTS A total of 288 articles out of the 10,714 initial hits met the inclusion criteria. Over the years, there has been an increase in the number of studies that engage pediatric patients. Pediatric patients, especially patients with multiple conditions or oncology patients, were most involved in studies in the United States, United Kingdom, and Canada. Pediatric patients were most often asked to express their views on questions from daily clinical care and the individual interview was the most used method. In general, the extent to which pediatric patients are engaged in health care increases with age. DISCUSSION This scoping review shows that there is an increasing interest in pediatric patient engagement. However, lack of uniformity about the definition of pediatric patient engagement and clear information for clinicians hinders engagement. This overview can inform clinicians and researchers about the different ways in which pediatric patient engagement can be shaped and can guide them to engage pediatric patients meaningfully in their projects.
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Affiliation(s)
- Lorynn Teela
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental health and Digital health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child development, Amsterdam, The Netherlands
| | - Lieke E Verhagen
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hedy A van Oers
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental health and Digital health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child development, Amsterdam, The Netherlands
| | - Esmée E W Kramer
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Joost G Daams
- Amsterdam UMC location University of Amsterdam, Research Support, Medical Library, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mariken P Gruppen
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Department of General Pediatrics, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maria J Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Lotte Haverman
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health, Mental health and Digital health, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, Child development, Amsterdam, The Netherlands.
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Göthesson J, Håkansson L, Olinder AL, Hanberger L, Mörelius E, Nilsson S, Forsner M. Children's and adolescent's narratives about pain and negative experiences in diabetes treatment. J SPEC PEDIATR NURS 2023; 28:e12396. [PMID: 36316154 DOI: 10.1111/jspn.12396] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 08/04/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022]
Abstract
UNLABELLED Pain and fear associated with needle procedures have been found to be more common among children and adolescents treated for type 1 diabetes (T1D) than among others in their age group. Furthermore, high glycated haemoglobin (HbA1c) values are associated with needle-related fear. AIM To describe negative experiences of needle procedures in childhood diabetes treatment from children's and adolescents' own perspectives. METHODS Short written narratives (n = 83) and drawings (n = 2) from children and adolescents treated for T1D, aged 7-18 years, were subjected to inductive qualitative content analysis. RESULTS Negative experiences with needle procedures had many facets, such as pain and fear, changing over time and affecting everyday life. All kinds of needle procedures caused difficulties, but venipunctures were described as the worst. CONCLUSION All needle procedures involved in diabetes treatment are potentially experienced as creating pain and fear, but the negative experiences are multifaceted and vary between individuals. These experiences create suffering for children and adolescents, and influence their daily lives. Besides finding techniques to decrease the number of needle procedures in the treatment, research should focus on implementing methods to decrease pain, fear, and other negative experiences as well as to promote self-coping. This is urgent, since needle-related fear has an impact on glycaemic control and therefore increases the risk of long-term complications. CLINICAL IMPLICATIONS When caring for children and adolescents with diabetes, their previous experiences with needle procedures need to be considered.
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Affiliation(s)
- Johanna Göthesson
- Department of Clinical Science and Education, Sachs' Children and Youths Hospital, Södersjukhuset, Stockholm, Sweden
| | - Linnéa Håkansson
- Department of Women's & Children's Health, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Lindholm Olinder
- Department of Clinical Science and Education, Sachs' Children and Youths Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lena Hanberger
- Division of Nursing, Department of Health, Medicine and Care Sciences, Linköping University, Linköping, Sweden
| | - Evalotte Mörelius
- Department of Nursing and Midwifery, Edith Cowan University and Perth Children's Hospital, Perth, Western, Australia
| | - Stefan Nilsson
- Department of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Forsner
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Biosciences and Nutrition, Karolinska Instituten, Stockholm, Sweden
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Asaad M, Forde R, AlFares A, Bin Abbas B, Sturt J. Experiences and needs of Saudi mothers when a child or adolescent is diagnosed with type 1 diabetes mellitus: a qualitative study. Int J Qual Stud Health Well-being 2022; 17:2107151. [PMID: 35924381 PMCID: PMC9359183 DOI: 10.1080/17482631.2022.2107151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim To explore the experiences of Saudi mothers with children or adolescents who have Type 1 diabetes mellitus at time of diagnosis. Background The Kingdom of Saudi Arabia (KSA) has one of the highest incidence rates of Type 1 diabetes mellitus in children and adolescents in the world. Few studies have considered the most appropriate methods of support for parents in the KSA and none report the experiences of Saudi mothers. Design Phenomenological inquiry. Method Qualitative interviews were conducted with 11 Saudi mothers and data were analysed following Giorgi’s 5-step method. Results The lived experiences of Saudi mothers coalesced around three overarching themes and eight subthemes: 1. In the dark (mother’s instinct, challenges of diagnosis phase, cultural reflections); 2. Empowerment (methods of support, mother’s health and wellbeing); 3. Coping and acceptance (stigma and cultural perceptions, coping strategies, transformation and adaptation). Conclusions Effective interventions delivered in other countries to support mothers may be effective in the KSA. However, the central role that Saudi mothers play in the management of their child’s condition, and the place of Islam in Saudi society, indicate the need for customized methods of support that take into account psychosociocultural needs of both mother and child.
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Affiliation(s)
- Mariam Asaad
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Rita Forde
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Abdullah AlFares
- Department of Pediatrics, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Bassam Bin Abbas
- Department of Pediatrics, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
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Rankin D, Kimbell B, Hovorka R, Lawton J. Adolescents' and their parents' experiences of using a closed-loop system to manage type 1 diabetes in everyday life: qualitative study. Chronic Illn 2022; 18:742-756. [PMID: 33472409 PMCID: PMC9643806 DOI: 10.1177/1742395320985924] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Type 1 diabetes can have life-shattering consequences for adolescents and parents. A closed-loop system is a cutting-edge technology which automatically regulates glucose to reduce the burden of diabetes management. We explored adolescents' and parents' experiences of using this technology to understand how it affects their biographies and everyday lives. METHODS In-depth interviews with 18 adolescents newly diagnosed with type 1 diabetes and 21 parents after ≥12 months experience using closed-loop technology. Data were analysed thematically. RESULTS Participants reported very few disruptions to their lives when using a closed-loop. Reports of family conflict were minimal as the closed-loop enabled dietary flexibility and glucose levels to be checked effortlessly. Adolescents described doing 'normal' activities without worrying about high/low glucose, and parents reported allowing them to do so unsupervised because the closed-loop would regulate their glucose and keep them safe. Some adolescents expressed concerns about the visibility of components and, to avoid stigma, described curtailing activities such as swimming. Participants described how the closed-loop enabled adolescents to be in control of, or create distance from, diabetes. DISCUSSION The closed-loop has life-enhancing consequences for both adolescents and parents and helps to reduce the biographical disruption of type 1 diabetes in this age group.
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Affiliation(s)
- D Rankin
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - B Kimbell
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - R Hovorka
- Wellcome Trust - Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - J Lawton
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Taraban L, Wasserman R, Cao VT, Eshtehardi SS, Anderson BJ, Thompson D, Marrero DG, Hilliard ME. Diabetes-Related Worries and Coping Among Youth and Young Adults With Type 1 Diabetes. J Pediatr Psychol 2022; 47:1145-1155. [PMID: 35773974 PMCID: PMC9582784 DOI: 10.1093/jpepsy/jsac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Although mood and anxiety symptoms are common in youth with type 1 diabetes (T1D), little research has described their worries across developmental stages or the strategies they use to cope with these worries. This secondary data analysis aimed to describe and characterize common T1D-related worries and coping strategies from middle childhood through young adulthood. METHODS Twenty-three youth (9 children, 7 adolescents, and 7 young adults) completed semistructured qualitative interviews about health-related quality of life. We coded interview transcripts using thematic analysis to generate common themes of diabetes-related worries and coping strategies. RESULTS Participants' worries fell into four major themes: Managing Blood Glucose, Self-Efficacy for Diabetes Management, Interpersonal Relationships, and Lifestyle Impact, and eight youth denied having diabetes-related worries. Coping strategies fell into the three major themes: Attempts to Change Source of Worry, Attempts to Change Reactions to Worry, and Attempts to Orient Away from the Worry. CONCLUSIONS Youths' worries about various aspects of living with and feeling able to self-manage diabetes are important to consider across pediatric development as they can impact youths' participation in daily activities and future plans. By adolescence, youth report longer-term worries about the health and lifestyle implications of diabetes. Youths' reported coping strategies are generally consistent with existing coping frameworks, though our data suggest some possible refinements. Social support emerged as an important coping strategy for all age groups. Thus, interventions supporting youth in building and strengthening their social networks may be particularly beneficial in helping youth cope with their diabetes-related worries across development.
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Affiliation(s)
- Lindsay Taraban
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, USA
| | - Rachel Wasserman
- Nemours Children’s Health and University of Central Florida College of Medicine, USA
| | - Viena T Cao
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, USA
| | - Sahar S Eshtehardi
- Department of Psychological Health and Learning Sciences, University of Houston, USA
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, USA
| | - Debbe Thompson
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, USA
| | | | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, USA
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11
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Nightingale R, McHugh GA, Swallow V, Kirk S. Shifting responsibilities: A qualitative study of how young people assume responsibility from their parents for self-management of their chronic kidney disease. Health Expect 2022; 25:1919-1929. [PMID: 35770677 PMCID: PMC9327865 DOI: 10.1111/hex.13549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The responsibility for managing a long-term condition (LTC) such as chronic kidney disease (CKD) typically transfers from parent to child, as children become older. However, children can find it challenging to become independent at managing their LTC, and evidence for how healthcare professionals (HCPs) support transfer of responsibility is limited. This study aimed to explore how young people with CKD assume responsibility for managing their condition and the HCP's role during this process. METHODS Sampling, qualitative data collection and analysis were guided by a constructivist grounded theory approach. Individual and dyadic interviews, and focus groups, were conducted with 16 young people aged 13-17 years with CKD, 13 parents and 20 HCPs. FINDINGS A grounded theory, shifting responsibilities, was developed that provides new insights into how young people's, parents' and HCPs' constructions of the transfer of responsibility differed. These diverse constructions contributed to multiple uncertainties around the role of HCPs, when the process started and was completed and whether the endpoint of the process was young people's self-management or young person-parent shared management. CONCLUSION Families would benefit from HCP support over a longer timeframe that integrates assuming self-management responsibility with gaining independence in other areas of their lives and focuses on young people 'doing' self-management. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery.
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Affiliation(s)
- Ruth Nightingale
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Gretl A McHugh
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Sue Kirk
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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12
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Nettleton JA, Burton AE, Povey RC. "No-one realises what we go through as Type 1s": A qualitative photo-elicitation study on coping with diabetes. Diabetes Res Clin Pract 2022; 187:109876. [PMID: 35439539 DOI: 10.1016/j.diabres.2022.109876] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/22/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
AIMS Type 1 diabetes (T1D) has physical, emotional, and social consequences and little is known how adults cope with the condition long term. This research aimed to use a novel photo-elicitation technique to gain in-depth insight into the personal coping experiences of adults living with T1D. METHODS In-depth photo elicitation interviews were employed to collect data and transcripts were analysed using thematic analysis. RESULTS Participant-led data revealed an overarching theme of the relentlessness of the condition. Continuous self-management tasks infiltrated participants' lives and had a significant impact on coping experiences. A range of techniques and resources were used to cope including using alarms and reminders, diabetes technology, interpersonal relationships, supportive healthcare services and seeking a mind-body balance. CONCLUSIONS Technology shows promise for easing the burden of the condition, expert-led online support would be of benefit, and peer support should be prioritised within interventions for adults with T1D.
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Affiliation(s)
- J A Nettleton
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University
| | - A E Burton
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University.
| | - R C Povey
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University
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13
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Husted GR, Hansen RN, El-Souri M, Lorenzen JK, Iversen PB, Rossing CV. What do persons with diabetes want from community pharmacies? A qualitative study. Pharm Pract (Granada) 2022; 20:2677. [PMID: 35919802 PMCID: PMC9296095 DOI: 10.18549/pharmpract.2022.2.2677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 11/14/2022] Open
Abstract
Background Diabetes is a demanding disease with a complex treatment regimen. Many persons with diabetes have difficulty managing their disease and taking medication as prescribed, possibly because they lack knowledge and sometimes misinterpret medical benefits. Community pharmacies continuously provide professional counselling to persons with diabetes. Objective This study aimed to explore 1) which services adults with type 1 and type 2 diabetes want from community pharmacies and 2) how pharmacies can meet these wishes. Methods A qualitative, explorative study design using focus group interviews was chosen. Informants were recruited from Region Zealand in Denmark. Data were digitally recorded, transcribed verbatim and analyzed by means of thematic analysis. Results Thirteen adults (11 female) with the mean age of 66.2 years (range 49-81 years) participated in one physical (n=6) or one online (n=7) focus group interview. Ten had type 2 diabetes, three had type 1 diabetes. The average duration of participants' diabetes was 13.4 years (range 2.3-33.0 years). The analysis revealed three overall themes of the functions which the informants would like community pharmacies to fulfil: 1) raise awareness of pharmacies' counselling service and competences; 2) act as a dialogue partner; 3) be a source of information and guidance about local activities and support. Conclusion The informants did not regard community pharmacies as a natural part of the healthcare system or as a place where they would expect counselling. They would like the community pharmacy to make their medical competences and services obvious and the community pharmacy staff to act as a dialogue partner and provide competent counselling. The informants would like to have a contact person with diabetes competences with whom they can book an appointment to complement over-the-counter counselling. They experience a gap in their care between routine visits in the healthcare system and suggest that community pharmacies counselling services become a natural supplement and that healthcare professionals in the primary and secondary sectors inform patients about the services - especially for patients newly diagnosed with diabetes. Finally, they would like a formal collaboration between diabetes associations and community pharmacies to make their competences, services and information visible.
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Affiliation(s)
- Gitte Reventlov Husted
- PhD, MScN, Consultant, Department of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
| | - Rikke Nørgaard Hansen
- MSc Pharmacy, Head of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
| | - Mira El-Souri
- MSc Pharmacy, Consultant, Department of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
| | | | | | - Charlotte Verner Rossing
- PhD, MSc. Pharmacy, Director of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
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14
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Rankin D, Kimbell B, Allen JM, Besser REJ, Boughton CK, Campbell F, Elleri D, Fuchs J, Ghatak A, Randell T, Thankamony A, Trevelyan N, Wilinska ME, Hovorka R, Lawton J. Adolescents' Experiences of Using a Smartphone Application Hosting a Closed-loop Algorithm to Manage Type 1 Diabetes in Everyday Life: Qualitative Study. J Diabetes Sci Technol 2021; 15:1042-1051. [PMID: 34261348 PMCID: PMC8411472 DOI: 10.1177/1932296821994201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Closed-loop technology may help address health disparities experienced by adolescents, who are more likely to have suboptimal glycemic control than other age groups and, because of their age, find diabetes self-management particularly challenging. The CamAPS FX closed-loop has sought to address accessibility and usability issues reported by users of previous prototype systems. It comprises small components and a smartphone app used to: announce meal-time boluses, adjust ("boost" or "ease-off") closed-loop insulin delivery, customize alarms, and review/share data. We explored how using the CamAPS FX platform influences adolescents' self-management practices and everyday lives. METHODS Eighteen adolescents were interviewed after having ≥6 months experience using the closed-loop platform. Data were analyzed thematically. RESULTS Participants reported feeling less burdened and shackled by diabetes because closed-loop components were easier to carry/wear, finger-pricks were not required, the smartphone app provided a discreet and less stigmatizing way of managing diabetes in public, and they were able to customize alarms. Participants also reported checking and reviewing data more regularly, because they did so when using the smartphone for other reasons. Some reported challenges in school settings where use of personal phones was restricted. Participants highlighted how self-management practices were improved because they could easily review glucose data and adjust closed-loop insulin delivery using the "boost" and "ease-off" functions. Some described how using the system resulted in them forgetting about diabetes and neglecting certain tasks. CONCLUSIONS A closed-loop system with small components and control algorithm on a smartphone app can enhance usability and acceptability for adolescents and may help address the health-related disparities experienced by this age group. However, challenges can arise from using a medical app on a device which doubles as a smartphone. TRIAL REGISTRATION Closed Loop From Onset in Type 1 Diabetes (CLOuD); NCT02871089; https://clinicaltrials.gov/ct2/show/NCT02871089.
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Affiliation(s)
- David Rankin
- Usher Institute, Medical School,
University of Edinburgh, UK
- David Rankin, PhD, Usher Institute,
University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
| | - Barbara Kimbell
- Usher Institute, Medical School,
University of Edinburgh, UK
| | - Janet M. Allen
- Wellcome Trust – Medical Research
Institute of Metabolic Science, University of Cambridge, UK
- Department of Paediatrics, University of
Cambridge, UK
| | - Rachel E. J. Besser
- NIHR Oxford Biomedical Research Centre,
Oxford University Hospitals NHS Foundation Trust, UK
- Department of Paediatrics, University of
Oxford, UK
| | - Charlotte K. Boughton
- Wellcome Trust – Medical Research
Institute of Metabolic Science, University of Cambridge, UK
| | | | | | - Julia Fuchs
- Wellcome Trust – Medical Research
Institute of Metabolic Science, University of Cambridge, UK
- Department of Paediatrics, University of
Cambridge, UK
| | - Atrayee Ghatak
- Alder Hey Children’s NHS Foundation
Trust, Liverpool, UK
| | | | - Ajay Thankamony
- Addenbrookes Hospital, Cambridge
University Hospitals NHS Foundation Trust, UK
| | | | - Malgorzata E. Wilinska
- Wellcome Trust – Medical Research
Institute of Metabolic Science, University of Cambridge, UK
- Department of Paediatrics, University of
Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust – Medical Research
Institute of Metabolic Science, University of Cambridge, UK
- Department of Paediatrics, University of
Cambridge, UK
| | - Julia Lawton
- Usher Institute, Medical School,
University of Edinburgh, UK
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15
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Demanding devices - Living with diabetes devices as a pre-teen. Soc Sci Med 2021; 286:114279. [PMID: 34428602 DOI: 10.1016/j.socscimed.2021.114279] [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: 12/09/2020] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022]
Abstract
Diabetes technology is an integral part of the lives of children with type 1 diabetes (T1D). However, children's experiences with these technologies are often overlooked. Furthermore, little is known about psychosocial aspects of technology use during children's transition to adolescence. The aim of this study was to explore how children with T1D perceive, make sense of and handle diabetes technologies in their everyday lives. Data were obtained from interviews with 18 children with T1D aged 10-14 years (pre-teens). The interviews were conducted between March and August 2019 in Denmark. Photos were used as probes to facilitate discussion and reflection about issues pre-teens found important. The study was informed by a technology-in-practice perspective to articulate how diabetes technologies were embedded in practices of use. The analysis focused on insulin pumps and technologies for continuous glucose monitoring (CGM). We found that these technologies introduced tensions regarding dependence and independence, wanted and unwanted attention, worries and peace of mind, treatment and care, visibility and invisibility as well as control and loss of control. We synthesized the tensions into the following three themes which characterized the pre-teens' relationship with diabetes technology: 1) demanding devices, 2) the social context of using diabetes technologies, and 3) care and support through data. Our findings indicate the need for researchers and clinicians to engage with the social and emotional dimensions of living with diabetes technologies. Importantly, this includes recognizing the norms underlying diabetes technologies and how these inform care in pre-teens with T1D.
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16
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Lawton J, Hart RI, Kimbell B, Allen JM, Besser REJ, Boughton C, Elleri D, Fuchs J, Ghatak A, Randell T, Thankamony A, Trevelyan N, Hovorka R, Rankin D. Data Sharing While Using a Closed-Loop System: Qualitative Study of Adolescents' and Parents' Experiences and Views. Diabetes Technol Ther 2021; 23:500-507. [PMID: 33605790 PMCID: PMC8252900 DOI: 10.1089/dia.2020.0637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective: To understand and explore data sharing practices among adolescents and their parents using a closed-loop system. Methods: Eighteen adolescents (aged 11-18 years) and 19 parents were interviewed after adolescents had ∼6 months experience of using a closed-loop system, which permitted them to share glucose and insulin data with parents/caregivers. Data were analyzed thematically. Results: There was considerable variability in how parent-child dyads perceived, valued, and undertook data sharing. Parents of early adolescents (11-13 years) reported making extensive use of "real time" data to remotely manage their child's diabetes and early adolescents described needing and wanting this input. Parents of middle adolescents (14-16 years) described making greater use of retrospective data. To avoid conflict and encourage and support their son/daughter's autonomy, these individuals reported practicing watchful waiting and only intervening after concerns about a pattern of problematic behavior or their child's safety arose. Middle adolescents indicated that data sharing had been done primarily for the benefit of their parents, although they also noted quality of life benefits for themselves. Among late adolescents (17+ years), parents were simply remote because their son/daughter had not permitted access to their data. Participants recommended clear ground rules be put in place about when, and how, data sharing should be used. Conclusions: To help parent-child dyads use data sharing in ways which minimize conflict and optimize constructive parental support, we recommend tailored input and support, which takes account of family dynamics, the young person's developmental maturity, and the different ways in which data are used across the adolescent age range.
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Affiliation(s)
- Julia Lawton
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, United Kingdom
- Address correspondence to: Julia Lawton, BA, PhD, Usher Institute, Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Ruth I. Hart
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Barbara Kimbell
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Janet M. Allen
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Elizabeth Jane Besser
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Charlotte Boughton
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Daniela Elleri
- Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Julia Fuchs
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Atrayee Ghatak
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- Children's Services, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Nicola Trevelyan
- Department of Child Health, Southampton Children's Hospital, Southampton, United Kingdom
| | - Roman Hovorka
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - David Rankin
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, United Kingdom
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17
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Leung JMWS, Tang TS, Lim CE, Laffel LM, Amed S. The four I's of adolescent transition in type 1 diabetes care: A qualitative study. Diabet Med 2021; 38:e14443. [PMID: 33107064 DOI: 10.1111/dme.14443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/23/2020] [Indexed: 02/05/2023]
Abstract
AIMS To explore adolescent perspectives on programme design in the transition to adult care. METHODS We conducted five focus groups on adolescents with type 1 diabetes nearing the age of transition to adult care. Study participants also completed an embedded survey where they rated a wide range of potential transition interventions. Focus group transcripts were analysed with three iterations of line-by-line coding to triangulate themes and subthemes. RESULTS Four themes were identified: Individualization-how to personalize the transition experience (having choices in the transition experience, meeting adult provider before transition and specific transition preparation); Identity-how the world relates to my diabetes (stigma of type 1 diabetes, confusion with type 2 diabetes, diagnosis disclosure and resilience); Interconnection-how my support system can help me with my diabetes (peer support, near peer support, parental support, loss of bond with paediatric team and fear of not having a bond with adult team); and Impediment-how my diabetes limits me (self-care takes work and time, unpredictability and restrictiveness, and emotional burden). Highly rated interventions from the survey included: good communication between the paediatric and adult teams, medical summary of past diabetes care, and having paediatric and adult teams in the same building. CONCLUSIONS The design of future transition interventions for adolescents with type 1 diabetes should address the issues of Individualization, Identity, Interconnection and Impediment. Collaborative processes between paediatric and adult providers were also rated as important strategies to facilitate the transition to adult care.
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Affiliation(s)
- Joseph M W S Leung
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Tricia S Tang
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Catherine E Lim
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Shazhan Amed
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
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18
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Ness MM, Saylor JL, Ji X, Bell A, Habermann B. Challenges Experienced by Parents of Emerging Young Adults With Type 1 Diabetes Mellitus During the Transition to College. DIABETES EDUCATOR 2020; 46:435-443. [PMID: 32734833 DOI: 10.1177/0145721720943120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study is to gain a deeper understanding of the challenges experienced by parents of emerging young adults (EYAs) with type 1 diabetes mellitus (T1DM) who completed their freshman or sophomore year of college. METHODS Using a descriptive, qualitative design, 16 parents participated in semistructured interviews that explored factors impacting the college transition for parents of college freshmen and sophomores with T1DM. Participants were recruited from local endocrinology clinics as well as the College Diabetes Network (CDN) Parent Facebook page, the CDN Facebook page, the CDN Twitter feed, and the Delaware Chapter of the JDRF (formerly Juvenile Diabetes Research Foundation). Researchers used a thematic analysis to analyze the data and develop categories. Interviews were conducted and recorded via video conferencing from July 2019 to September 2019. RESULTS Results represent data from 16 interviews comprising 15 (94%) mothers and 1 father. Thematic analysis resulted in the emergence of 3 themes: managing parental concerns, changes in the parental role, and identifying sources of parental support. Parents identified several challenges including the EYAs' ability to manage T1DM at college, communication with the EYA, and the availability of support for parents. CONCLUSION Parents experience several challenges during their EYA's transition to college with T1DM. Supporting the needs of parents and EYAs during this time may serve to reduce diabetes-related complications for EYAs and increase overall quality of life for both members of the dyad.
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Affiliation(s)
| | | | - Xiaopeng Ji
- School of Nursing, University of Delaware, Newark, Delaware
| | - Ann Bell
- School of Nursing, University of Delaware, Newark, Delaware
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19
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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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20
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Bellis EK, Li AD, Jayasinghe YL, Girling JE, Grover SR, Peate M, Marino JL. Exploring the Unmet Needs of Parents of Adolescent Girls with Heavy Menstrual Bleeding and Dysmenorrhea: A Qualitative Study. J Pediatr Adolesc Gynecol 2020; 33:271-277. [PMID: 31874316 DOI: 10.1016/j.jpag.2019.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVE To provide insight into the unmet needs of parents of adolescents with heavy menstrual bleeding or dysmenorrhea, in the context of their daughters' menstrual concerns. DESIGN Qualitative interview study using semi-structured interviews. SETTING Gynecology outpatient clinic at The Royal Children's Hospital, Melbourne, Australia. PARTICIPANTS Parents of adolescent girls with heavy menstrual bleeding or dysmenorrhea recruited from an adolescent gynecology clinic between May and August 2018. INTERVENTIONS In depth, semi-structured interviews with 24 parents whose daughters had heavy menstrual bleeding or dysmenorrhea. Data were analyzed using a grounded theory approach. MAIN OUTCOME MEASURES Themes derived from interview transcripts about the supportive care needs of parents. RESULTS Thirteen themes emerged in the interviews across 4 areas of need: (1) experiences with healthcare, (2) informational needs, (3) support and acceptance, and (4) financial impacts. Across the interviews, parents identified a need for greater awareness and education among parents and daughters, health professionals, and the broader community. CONCLUSION This research confirmed that parents play a significant role in daughters' menstrual health care and have a series of unmet needs. Strategies and interventions specifically targeting these parents may be warranted.
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Affiliation(s)
- Emily K Bellis
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Anna D Li
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Yasmin L Jayasinghe
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, VIC, Australia; Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, VIC, Australia
| | - Jane E Girling
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, VIC, Australia; Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Sonia R Grover
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, VIC, Australia.
| | - Jennifer L Marino
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia
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21
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Whittemore R, Coleman J, Delvy R, Zincavage R, Ambrosoli JA, Shi L, Kato B, Marceau L. An eHealth Program for Parents of Adolescents With T1DM Improves Parenting Stress: A Randomized Control Trial. DIABETES EDUCATOR 2019; 46:62-72. [PMID: 31808376 DOI: 10.1177/0145721719890372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the short-term effects of the Type 1 Teamwork program for parents of adolescents with type 1 diabetes mellitus (T1DM) on the primary outcome of psychosocial stress. METHODS The study was a randomized wait-list control trial evaluating an eHealth program to reduce parenting stress around T1DM management during adolescence through interactive sessions on the safe transfer of responsibility, positive communication, and stress management. The primary outcome was psychosocial stress (parenting stress specific to child illness and general stress). Secondary outcomes included depressive and anxiety symptoms, parent support for adolescent autonomy, family conflict, and adolescent metabolic control (A1C). Data were collected at baseline, 3 months, and 6 months online. Mixed-model analyses were conducted, using intent-to-treat procedures. RESULTS Parents (n = 162) had a mean age of 45.6 (±5.3) years, were 98% female, 91% white, 91% married/partnered, 51% of high income, and geographically dispersed around the United States. Parents reported that adolescents had a mean A1C of 7.9% (±1.2%) and T1DM duration of 5.08 (±3.62) years. At 6 months, parents in the Type 1 Teamwork group demonstrated less parenting stress compared with the control group. There were no differences between groups on general stress or secondary outcomes. Attrition at 6 months was 32% in the treatment group and 11% in the control group. CONCLUSIONS An eHealth program for parents of adolescents with T1DM improves parenting stress in a sample of parents from across the United States.
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Affiliation(s)
| | | | | | | | | | - Ling Shi
- HealthCore, Inc, Watertown, Massachusetts
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22
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Ness MM, Saylor J, Selekman J. Barriers and Facilitators Influencing Parental Transition of College-Bound Youth with Type 1 Diabetes Mellitus: An Integrative Review. Curr Diab Rep 2019; 19:57. [PMID: 31302793 DOI: 10.1007/s11892-019-1179-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review was to synthesize current research about potential barriers impacting parents as they transition their college-bound youth with type 1 diabetes mellitus (T1DM) to college. RECENT FINDINGS Seven studies, 5 qualitative and 2 quantitative, met the qualifications for inclusion in this study by focusing on parents and were included in this review. Three potential barriers impacting the parental experience during the transition of their youth with T1DM to college were identified: developing and promoting autonomy, evolving relationships and roles in the parent/youth dyad, and distress. Parents consistently indicated concern about their youth's ability to self-manage their T1DM and lack of support for their own transition. This review indicates that several barriers may influence parents of adolescents with T1DM as they transition to becoming the parent of a college-bound youth with T1DM. The parental transition of launching their youth to college is more complex and unique for parents of youth with T1DM parents of youth without chronic conditions. Additional research focusing on the identification of desired supports for parents and the development of specific interventions to assist parents as they transition with their college-bound youth with T1DM is recommended.
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Affiliation(s)
- Michelle M Ness
- University of Delaware, McDowell Hall, Newark, DE, 19716, USA.
| | - Jennifer Saylor
- University of Delaware, McDowell Hall, Newark, DE, 19716, USA
| | - Janice Selekman
- University of Delaware, McDowell Hall, Newark, DE, 19716, USA
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23
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Rasmussen GS, Kragballe K, Maindal HT, Lomborg K. Caring for young people with moderate to severe psoriasis: an interpretive description of parental perspectives. J DERMATOL TREAT 2019; 31:227-234. [PMID: 30835580 DOI: 10.1080/09546634.2019.1590523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Psoriasis often sets on during childhood or adolescence, when parents have great importance for the young people's self-management, well-being, and quality of life. The aim of this study was to understand parents' perspectives on young people's daily life with psoriasis in order to improve adolescents' self-management.Method: Adopting interpretive, description methodology (ID), focus group discussion, and interviews were conducted with eight parents of adolescents with psoriasis. The analysis was inductive with an iterative comparative approach. Main themes conveying participants' perceptions were identified for constructing a coherent narrative of parents' perspectives on their young people's transition with psoriasis through adolescence.Results: Parents initially perceived psoriasis mainly a physical and treatment-related burden and not until late realized its socio-emotional impact. They eventually found themselves balancing between declining treatment due to fear of side effects and acknowledging the impact on their young people's quality of life and their desire for effective treatment.Conclusions: Caring for young people with psoriasis is a stressful process involving experimental learning to understand and manage the complexity of psoriasis and its impact on adolescents' emotional and social life. Future research should consider integration of shared decision-making and self-management support interventions in routine daily care as focus points.
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Affiliation(s)
| | - Knud Kragballe
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Holtz BE, Mitchell KM, Hershey DD, Cotten SR, Holmstrom AJ, Richman J, Dunneback JK, Wood MA. Using an mHealth App to Transition Care of Type 1 Diabetes from Parents to Teens: Protocol for a Pilot Study. JMIR Res Protoc 2018; 7:e10803. [PMID: 30377142 PMCID: PMC6234347 DOI: 10.2196/10803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/20/2018] [Accepted: 08/14/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) afflicts approximately 154,000 people under the age of 20 in the United States. Most people with T1DM are diagnosed at a young age, and parents have to take on the responsibility of T1DM management. Eventually, the child must begin to transition to self-management. Adolescents often struggle to take on responsibility for all the necessary tasks to successfully self-manage their T1DM. In fact, approximately three-quarters of adolescents are not achieving American Diabetes Association-recommended glycated hemoglobin (HbA1c) targets. This lack of adherence can lead to negative health outcomes. OBJECTIVE The goals of this interdisciplinary proposal are as follows: (1) to develop a unique and theory-driven technology using a mobile phone app to promote self-management behaviors for adolescents aged 10-15 years with T1DM and their parents and (2) to explore the feasibility and impact of the self-management mobile app. METHODS This study has two phases: app development and pilot testing. In the app development phase, the app will be conceptualized and a prototype will be tested. In Phase 2, the mobile app will undergo pilot testing to determine its feasibility and impact on diabetes self-management. RESULTS The pilot test was launched in September 2017. Data collection for the final pilot test is underway, and results are forthcoming. CONCLUSIONS Adolescents with T1DM and their parents can have a difficult time managing the transition of diabetes care. It is hoped that this app can help. The focus groups and prototype testing have indicated promising outcomes of app use. TRIAL REGISTRATION ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628 (Archived by WebCite at http://www.webcitation.org/72tHXTE2Z). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/10803.
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Affiliation(s)
- Bree E Holtz
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI, United States
| | - Katharine M Mitchell
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI, United States
| | - Denise D Hershey
- College of Nursing, Michigan State University, East Lansing, MI, United States
| | - Shelia R Cotten
- Department of Media and Information, Michigan State University, East Lansing, MI, United States
| | - Amanda J Holmstrom
- Department of Communication, Michigan State University, East Lansing, MI, United States
| | - Joshua Richman
- Department of Surgery, University of Alabama-Birmingham, Birmingham, AL, United States
| | - Julie K Dunneback
- Department of Pediatric Endocrinology, Sparrow Health System, Lansing, MI, United States
| | - Michael A Wood
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
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Husted GR, Weis J, Teilmann G, Castensøe-Seidenfaden P. Exploring the Influence of a Smartphone App (Young with Diabetes) on Young People's Self-Management: Qualitative Study. JMIR Mhealth Uhealth 2018; 6:e43. [PMID: 29490897 PMCID: PMC5856925 DOI: 10.2196/mhealth.8876] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 12/14/2022] Open
Abstract
Background Adequate self-management is the cornerstone of preventing type 1 diabetes mellitus (T1DM) complications. However, T1DM self-management is challenging for young people, who often struggle during the transition from childhood to adulthood. The mobile health (mHealth) app Young with Diabetes (YWD) was developed in collaboration with young people to enhance their T1DM self-management during this transition. Objective The purpose of this study was to explore the influence of YWD on young people’s self-management during a 12-month period. Methods A qualitative explorative approach was used, comprising a purposive sample of 20 young people (11 females and 9 males, ages 15 to 23 years, with app use of 3 to 64 days) from 3 pediatric and 3 adult departments. Participants were interviewed individually using a semistructured interview guide. Data were collected from January to March 2017 and analyzed using thematic analysis. Results A total of 5 themes were identified: (1) not feeling alone anymore (“we are in this together”); (2) gaining competence by sharing experiences and practical knowledge (“they know what they are talking about”); (3) feeling safer (“it’s just a click away”); (4) breaking the ice by starting to share thoughts and feelings and asking for help (“it is an outstretched hand”); and (5) lack of motivating factors (“done with the app”). Young people reported that YWD promoted self-management by peer-to-peer social support, exchanging messages with health care providers, and sharing YWD with parents. Participants recommended YWD as a supplement to self-management for newly diagnosed young people with T1DM and suggested improvements in app content and functionality. Conclusions The mHealth app YWD has the potential to support self-management. In particular, peer-to-peer support reduced feelings of loneliness and helped young people to gain knowledge and skills for managing T1DM. A need exists for alternative ways to train health care providers in using YWD and to support collaboration between young people and their parents to further improve young people’s self-management of T1DM.
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Affiliation(s)
- Gitte Reventlov Husted
- Pediatric and Adolescent Department, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Janne Weis
- Department of Neonatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Grete Teilmann
- Pediatric and Adolescent Department, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
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Lendahls L, Edvardsson I. The Health and Well-Being among Children with Diabetes and Low HbA1c—A Qualitative Study in Sweden. Health (London) 2018. [DOI: 10.4236/health.2018.105044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Rasmussen GS, Kragballe K, Maindal HT, Lomborg K. Experience of Being Young With Psoriasis: Self-Management Support Needs. QUALITATIVE HEALTH RESEARCH 2018; 28:73-86. [PMID: 29192872 DOI: 10.1177/1049732317737311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Psoriasis is a long-term condition with a possibly cumulative life course impairment. Young people struggle to minimize its effects on appearance and functioning. To date, the self-management needs of adolescents suffering from psoriasis have been underinvestigated. Using focus groups and individual interviews, we present an interpretive description of young people's experiences of living with psoriasis, the challenges they face, and the support they need to relieve suffering and come to terms with their condition. This process is characterized by loneliness, the self-imposition of limitations, and the lack of personalized knowledge and communication skills to manage the impact of disease and society's reactions. Our study provides insight into needs of early interventions tailored to address condition, role, and emotional management, involving parent education, peer support, storytelling, and roles for professionals. We argue that further research should involve young people, their parents, and professionals in the development and evaluation of interventions.
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Affiliation(s)
| | | | | | - Kirsten Lomborg
- 2 Aarhus University, Aarhus, Denmark
- 4 Metropolitan University College, Copenhagen, Denmark
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28
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Castensøe-Seidenfaden P, Reventlov Husted G, Teilmann G, Hommel E, Olsen BS, Kensing F. Designing a Self-Management App for Young People With Type 1 Diabetes: Methodological Challenges, Experiences, and Recommendations. JMIR Mhealth Uhealth 2017; 5:e124. [PMID: 29061552 PMCID: PMC5673883 DOI: 10.2196/mhealth.8137] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 12/25/2022] Open
Abstract
Background Young people with type 1 diabetes often struggle to self-manage their disease. Mobile health (mHealth) apps show promise in supporting self-management of chronic conditions such as type 1 diabetes. Many health care providers become involved in app development. Unfortunately, limited information is available to guide their selection of appropriate methods, techniques, and tools for a participatory design (PD) project in health care. Objective The aim of our study was to develop an mHealth app to support young people in self-managing type 1 diabetes. This paper presents our methodological recommendations based on experiences and reflections from a 2-year research study. Methods A mixed methods design was used to identify user needs before designing the app and testing it in a randomized controlled trial. App design was based on qualitative, explorative, interventional, and experimental activities within an overall iterative PD approach. Several techniques and tools were used, including workshops, a mail panel, think-aloud tests, and a feasibility study. Results The final mHealth solution was “Young with Diabetes” (YWD). The iterative PD approach supported researchers and designers in understanding the needs of end users (ie, young people, parents, and health care providers) and their assessment of YWD, as well as how to improve app usability and feasibility. It is critical to include all end user groups during all phases of a PD project and to establish a multidisciplinary team to provide the wide range of expertise required to build a usable and useful mHealth app. Conclusions Future research is needed to develop and evaluate more efficient PD techniques. Health care providers need guidance on what tools and techniques to choose for which subgroups of users and guidance on how to introduce an app to colleagues to successfully implement an mHealth app in health care organizations. These steps are important for anyone who wants to design an mHealth app for any illness.
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Affiliation(s)
| | - Gitte Reventlov Husted
- Pediatric and Adolescent Department, Nordsjællands Hospital, Hillerød, University of Copenhagen, Hillerød, Denmark
| | - Grete Teilmann
- Pediatric and Adolescent Department, Nordsjællands Hospital, Hillerød, University of Copenhagen, Hillerød, Denmark
| | - Eva Hommel
- Steno Diabetes Center, Gentofte, Denmark
| | - Birthe Susanne Olsen
- Pediatric and Adolescent Department, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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