Development of the diabetes problem-solving measure for adolescents

Instruments to assess diabetes knowledge, skills and attitudes of people living with diabetes mellitus: A COSMIN-based systematic review

AIMS

Since knowledge, skills, and attitudes influence the adherence to self-care behaviours, the purpose of this review was to identify available instruments that measure diabetes knowledge, skills or attitudes of people living with this health condition and to evaluate their measurement properties.

METHODS

A systematic search was conducted in PubMed, EMBASE, SCOPUS, Web of Science and CINAHL databases. The methodological quality of the included studies was assessed by the Consensus-based Standards for the selection of health Measurement Instruments. Risk of Bias checklist. The results of each study were rated by the updated criteria for good measurement properties and the quality of evidence was graded using a modified Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

This review included 38 instruments that assess diabetes knowledge (n = 26) or skills (n = 6) or attitudes (n = 5) or both three constructs (n = 1). About 40% had satisfactory results for relevance, comprehensiveness, and comprehensibility, and about 30% had unsatisfactory results for comprehensiveness, but these results were supported by very low evidence. Most studies showed indeterminate results for structural validity (50%), internal consistency (98%) and reliability (84%). Instruments that had satisfactory results for construct validity and reliability were supported by low to very low evidence. One responsiveness study was identified, and the result was satisfactory, but supported by low evidence. The Diabetes Knowledge Questionnaire is the instrument with best evidence for use.

CONCLUSIONS

To plan more assertive interventions, researchers need to follow up guidelines to develop instruments with good quality of the measurement proprieties.

A Delphi study to build consensus on the definition and use of big data in obesity research

BACKGROUND

'Big data' has great potential to help address the global health challenge of obesity. However, lack of clarity with regard to the definition of big data and frameworks for effectively using big data in the context of obesity research may be hindering progress. The aim of this study was to establish agreed approaches for the use of big data in obesity-related research.

METHODS

A Delphi method of consensus development was used, comprising three survey rounds. In Round 1, participants were asked to rate agreement/disagreement with 77 statements across seven domains relating to definitions of, and approaches to, using big data in the context of obesity research. Participants were also asked to contribute further ideas in relation to these topics, which were incorporated as new statements (n = 8) in Round 2. In Rounds 2 and 3 participants re-appraised their ratings in view of the group consensus.

RESULTS

Ninety-six experts active in obesity-related research were invited to participate. Of these, 36/96 completed Round 1 (37.5% response rate), 29/36 completed Round 2 (80.6% response rate) and 26/29 completed Round 3 (89.7% response rate). Consensus (defined as > 70% agreement) was achieved for 90.6% (n = 77) of statements, with 100% consensus achieved for the Definition of Big Data, Data Governance, and Quality and Inference domains.

CONCLUSIONS

Experts agreed that big data was more nuanced than the oft-cited definition of 'volume, variety and velocity', and includes quantitative, qualitative, observational or intervention data from a range of sources that have been collected for research or other purposes. Experts repeatedly called for third party action, for example to develop frameworks for reporting and ethics, to clarify data governance requirements, to support training and skill development and to facilitate sharing of big data. Further advocacy will be required to encourage organisations to adopt these roles.

Exploring the acceptability of a 'limited patient consent procedure' for a proposed blood-borne virus screening programme: a Delphi consensus building technique

OBJECTIVE

To identify components of a proposed blood-borne virus (BBV) population screening programme and its associated consent procedure that both the public and health practitioners (HPs) would find acceptable. The proposed BBV screening system would aim to reduce late diagnosis of BBVs and be used in patients undergoing routine blood tests, aided by risk stratification software to target individuals at higher risk of infection.

DESIGN

A Delphi technique was used to build consensus among two separate groups, public participants and HPs in England.

METHODS

A survey incorporating vignettes was developed, with input from an external panel of experts. Over three rounds, 46 public participants and 37 HPs completed the survey, rating statements on a four-point Likert scale. The survey covered issues around stigma and sensitivity, the use of risk stratification algorithms and 'limited' patient consent (ie, preinformed of the option to 'opt-out'). Consensus was defined as >70% of participants agreeing or disagreeing with each statement.

RESULTS

Consensus was achieved among both groups in terms of acceptability of the screening programme. There was also consensus on using patient data to risk-stratify screening algorithms and the need to obtain some form of consent around the time of drawing blood.

CONCLUSIONS

This study found that the special protected status of HIV in England is no longer deemed necessary today and hinders appropriate care. We propose that a novel 'limited consent procedure' could be implemented in future screening programmes.

Development and validation of the hypoglycaemia problem-solving scale for people with diabetes mellitus

OBJECTIVE

To develop and psychometrically test a new instrument, the hypoglycaemia problem-solving scale (HPSS), which was designed to measure how well people with diabetes mellitus manage their hypoglycaemia-related problems.

METHODS

A cross-sectional survey design approach was used to validate the performance assessment instrument. Patients who had a diagnosis of type 1 or type 2 diabetes mellitus for at least 1 year, who were being treated with insulin and who had experienced at least one hypoglycaemic episode within the previous 6 months were eligible for inclusion in the study.

RESULTS

A total of 313 patients were included in the study. The initial draft of the HPSS included 28 items. After exploratory factor analysis, the 24-item HPSS consisted of seven factors: problem-solving perception, detection control, identifying problem attributes, setting problem-solving goals, seeking preventive strategies, evaluating strategies, and immediate management. The Cronbach's α for the total HPSS was 0.83.

CONCLUSIONS

The HPSS was verified as being valid and reliable. Future studies should further test and improve the instrument to increase its effectiveness in helping people with diabetes manage their hypoglycaemia-related problems.

Structured scaffolding for reflection and problem solving in diabetes self-management: qualitative study of mobile diabetes detective

OBJECTIVE

To investigate subjective experiences and patterns of engagement with a novel electronic tool for facilitating reflection and problem solving for individuals with type 2 diabetes, Mobile Diabetes Detective (MoDD).

METHODS

In this qualitative study, researchers conducted semi-structured interviews with individuals from economically disadvantaged communities and ethnic minorities who are participating in a randomized controlled trial of MoDD. The transcripts of the interviews were analyzed using inductive thematic analysis; usage logs were analyzed to determine how actively the study participants used MoDD.

RESULTS

Fifteen participants in the MoDD randomized controlled trial were recruited for the qualitative interviews. Usage log analysis showed that, on average, during the 4 weeks of the study, the study participants logged into MoDD twice per week, reported 120 blood glucose readings, and set two behavioral goals. The qualitative interviews suggested that individuals used MoDD to follow the steps of the problem-solving process, from identifying problematic blood glucose patterns, to exploring behavioral triggers contributing to these patterns, to selecting alternative behaviors, to implementing these behaviors while monitoring for improvements in glycemic control.

DISCUSSION

This qualitative study suggested that informatics interventions for reflection and problem solving can provide structured scaffolding for facilitating these processes by guiding users through the different steps of the problem-solving process and by providing them with context-sensitive evidence and practice-based knowledge related to diabetes self-management on each of those steps.

CONCLUSION

This qualitative study suggested that MoDD was perceived as a useful tool in engaging individuals in self-monitoring, reflection, and problem solving.

Development and validation of the diabetes adolescent problem solving questionnaire

OBJECTIVE

Problem solving is a critical diabetes self-management skill. Because of a lack of clinically feasible measures, our aim was to develop and validate a self-report self-management problem solving questionnaire for adolescents with type 1 diabetes (T1D).

METHODS

A multidisciplinary team of diabetes experts generated questionnaire items that addressed diabetes self-management problem solving. Iterative feedback from parents and adolescents resulted in 27 items. Adolescents from two studies (N=156) aged 13-17 were recruited through a pediatric diabetes clinic and completed measures through an online survey. Glycemic control was measured by HbA1c recorded in the medical record.

RESULTS

Empirical elimination of items using principal components analyses resulted in a 13-item unidimensional measure, the diabetes adolescent problem solving questionnaire (DAPSQ) that explained 56% of the variance. The DAPSQ demonstrated internal consistency (Cronbach's alpha=0.92) and was correlated with diabetes self-management (r=0.53, p<.001), self-efficacy (r=0.54, p<.001), and glycemic control (r=-0.24, p<.01).

CONCLUSION

The DAPSQ is a brief instrument for assessment of diabetes self-management problem solving in youth with T1D and is associated with better self-management behaviors and glycemic control.

PRACTICE IMPLICATIONS

The DAPSQ is a clinically feasible self-report measure that can provide valuable information regarding level of self-management problem solving and guide patient education.

Self-management of Type 1 Diabetes Across Adolescence

PURPOSE

The purpose of this study was to examine differences in self-management behaviors (Collaboration with Parents, Diabetes Care Activities, Diabetes Problem Solving, Diabetes Communication, and Goals) between early, middle, and late adolescence. The role of regimen and gender as covariates in self-management behaviors was also examined.

METHODS

This was a secondary analysis with a cross-sectional descriptive survey design. A sample of 504 participants ages 13 to 21 years from the Self-Management of Diabetes-Adolescent instrument development study were analyzed to determine self-management behaviors in early, middle, and late adolescence. This study was partially guided by the Self and Family Management Framework. This framework contains broad conceptual areas that are thought to pose a risk to or have a protective influence on self-management and family management behaviors and associated outcomes.

RESULTS

Significant findings included a decline between early, middle, and late adolescence in the Collaboration with Parents scale as well as an increase between early and late adolescence on the Diabetes Problem Solving scale. Regimen was a significant covariate for Collaboration with Parents, Diabetes Care Activities, and Diabetes Problem Solving, and gender was a significant covariate for Diabetes Care Activities and Diabetes Communication.

CONCLUSIONS

Clinicians should consider the influence of adolescent stage and development on self-management when educating adolescents. Youth and their families should be educated to consider the implications that regimen will have on daily self-management when making treatment decisions. Furthermore, gender variations can necessitate different educational approaches to meet different needs. Future research should identify other variables that can influence self-management at different points across adolescence.

A new self-report measure of self-management of type 1 diabetes for adolescents

BACKGROUND

The development of instruments to measure self-management in youth with type 1 diabetes has not kept up with current understanding of the concept.

OBJECTIVE

This study aimed to report the development and the testing of a new self-report measure to assess the Self-Management of Type 1 Diabetes in Adolescents (SMOD-A).

METHODS

Following a qualitative study, items were identified and reviewed by experts for content validity. A total of 515 adolescents, 13 to 21 years old, participated in a field study by completing the SMOD-A (either once or twice) and additional measures of diabetes-related self-efficacy (Self-Efficacy for Diabetes Scale), quality of life (Diabetes Quality of Life for Youth Questionnaire), self-management (Diabetes Self-Management Profile), and adherence (Self-Care Inventory). Data were collected also on metabolic control (glycosylated hemoglobin [HbA1c]).

RESULTS

The content validity index was .93. Exploratory alpha factor analyses revealed five subscales: Collaboration With Parents, Diabetes Care Activities, Diabetes Problem Solving, Diabetes Communication, and Goals (alpha = .71 to .85). The stability of the SMOD-A ranged from .60 to .88 at 2 weeks (test-retest) to .59 to .85 at 3 months. Correlations of SMOD-A subscales with Self-Efficacy for Diabetes Scale-Diabetes; Diabetes Quality of Life for Youth Questionnaire satisfaction, impact, and worry; Diabetes Self-Management Profile; and Self-Care Inventory were generally significant and in the expected direction. Collaboration with parents and HbA1c values were related significantly and positively (r = .11); all other SMOD-A subscales were related significantly and negatively to HbA1c (r = -.10 to -.26), demonstrating that better self-management is associated somewhat with better metabolic control and supporting construct validity of the new measure.

DISCUSSION

The SMOD-A has been found to be a reliable, stable, and valid measure of SMOD-A.

Health-related quality of life measurement in children and adolescents: a systematic review of generic and disease-specific instruments

OBJECTIVE

To identify currently available generic and disease-specific health-related quality of life (HRQOL) instruments for children and adolescents up to 19 years old, to describe their content, and to review their psychometric properties.

STUDY DESIGN

Previous reviews on the subject and a new literature review from 2001 to December 2006 (MEDLINE, the ISI Science Citation Index, HealthSTAR and PsycLit) were used to identify measures of HRQOL for children and adolescents. The characteristics (country of origin, age range, type of respondent, number of dimensions and items, name of the dimensions and condition) and psychometric properties (reliability, validity, and sensitivity to change) of the instruments were assessed following international guidelines published by the Scientific Committee of the Medical Outcomes Trust.

RESULTS

In total, 30 generic and 64 disease-specific instruments were identified, 51 of which were published between 2001 and 2005. Many generic measures cover a core set of basic concepts related to physical, mental and social health, although the number and name of dimensions varies substantially. The lower age limit for self-reported instruments was 5-6 years old. Generic measures developed recently focused on both child self-report and parent-proxy report, although 26% of the disease-specific questionnaires were exclusively addressed to proxy-respondents. Most questionnaires had tested internal consistency (67%) and to a lesser extent test-retest stability (44.7%). Most questionnaires reported construct validity, but few instruments analyzed criterion validity (n = 5), structural validity (n = 15) or sensitivity to change (n = 14).

CONCLUSIONS

The development of HRQOL instruments for children and adolescents has continued apace in recent years, particularly with regard to disease-specific questionnaires. Many of the instruments meet accepted standards for psychometric properties, although instrument developers should include children from the beginning of the development process and need to pay particular attention to testing sensitivity to change.

Diabetes problem solving by youths with type 1 diabetes and their caregivers: measurement, validation, and longitudinal associations with glycemic control

OBJECTIVES

This article introduces a new measure of problem-solving skills of youths with type 1 diabetes (T1DM) and adult caregivers in correcting glycemic fluctuations.

METHODS

The Diabetes Problem Solving Interview (DPSI), a structured interview, was validated during a pilot study of a behavioral intervention. DPSI data and measures of diabetes management were obtained at baseline from 114 youths (ages 9-14.5) and 109 caregivers. Glycosylated hemoglobin (HbA(1c)) was measured quarterly over 9 months.

RESULTS

Results confirmed the psychometric adequacy of the DPSI. For caregivers, but not youths, low DPSI scores (indicating poor problem-solving skills) were significantly associated with worse HbA(1c) over 9 months.

CONCLUSIONS

The DPSI has clinical and research utility as a measure of diabetes problem-solving skills. Identification and targeted remediation of caregivers' deficient diabetes problem-solving skills or promotion of youths' utilization of these skills could possibly enhance glycemic control in youths with T1DM.

Problem solving in diabetes self-management and control: a systematic review of the literature

PURPOSE

The purpose of this systematic review is to assess the published literature on problem solving and its associations with diabetes self-management and control, as the state of evidence exists.

DATA SOURCES

PubMed, PsychINFO, and ERIC electronic databases were searched for the years 1990 to the present and for English-language articles, and reference lists from included studies were reviewed to capture additional studies.

STUDY SELECTION

Quantitative and qualitative studies that addressed problem solving as a process or strategy for diabetes self-management were included. Fifty-two studies met the criteria for inclusion.

DATA EXTRACTION

Study design, sample characteristics, measures, and results were reviewed.

DATA SYNTHESIS

Thirty-six studies were quantitative; 16 were conceptual or qualitative. Studies were classified as addressing the problem-solving definition/framework, assessment, intervention, or health care professional issues.

CONCLUSIONS

Problem solving is a multidimensional construct encompassing verbal reasoning/rational problem solving, quantitative problem solving, and coping. Aspects of problem solving can be assessed using newly developed diabetes-specific problem-solving measures for children/adolescents and adults. Cross-sectional studies in adults, but not children/adolescents, provide consistent evidence of associations between problem solving and A1C level. Only 25% of problem-solving intervention studies with children/adolescents and 50% of interventions with adults reported improvement in A1C. Most intervention studies reported an improvement in behaviors, most commonly global adherence in children/adolescents and dietary behavior in adults. Methodological limitations (noninclusion of problem-solving measures, inadequate descriptions of problem-solving interventions, homogenous samples) need to be addressed in future research to clarify the effect of problem solving on diabetes outcomes, identify characteristics of effective interventions, and determine the utility across age and racial/ethnic groups.

Diabetes problem-solving scale development in an adult, African American sample

PURPOSE

The purpose of this pilot study was to examine psychometric properties of the Diabetes Problem-Solving Scale (DPSS), which was designed to assess how adults with type 2 diabetes approach and manage problems encountered in diabetes self-management.

METHODS

Participants were 64 African American adults with type 2 diabetes. The 30-item DPSS and measures of social problem solving, diabetes self-management, and depressive symptoms were administered. Blood samples were collected to measure hemoglobin A1C level.

RESULTS

Cronbach alpha for the DPSS total scale was .77 and ranged from .72 to .78 for subscales. Correlations of the DPSS total score and subscale scores with a standardized social problem-solving scale ranged from 0.30 to 0.46 (all P < .01). Higher DPSS total scores, indicating better self-reported diabetes problem solving, were associated with higher medication adherence, more frequent self-monitoring of blood glucose, and lower hemoglobin A1C level. Of the DPSS subscales, Impulsive Style, Negative Transfer of Past Experience/Learning, and Negative Motivation were differentially associated with reduced self-management and disease control.

CONCLUSION

The DPSS demonstrated acceptable total scale and subscale internal consistency, construct validity, and predictive validity in this pilot sample. The scale may have utility both in identifying associations between diabetes-related problem solving and self-management and in guiding problem solving interventions to improve self-management and control.

Identification of distinct self-management styles of adolescents with type 1 diabetes

OBJECTIVE

Using a profile-based approach to the assessment of diabetes management, the purpose of this study was to identify and evaluate an empirically derived classification system of distinct self-management styles.

RESEARCH DESIGN AND METHODS

Youth with type 1 diabetes (n = 156) aged 10-16 years and their parents were administered a modified version of the Diabetes Self-Management Profile (DSMP). Cluster analyses were performed independently on parent and youth report forms to categorize patients based on their patterns of scores in five diabetes self-management areas.

RESULTS

Cluster analyses revealed three self-management styles that emerged from both youth and parent report: a "methodical style" (33%) with an emphasis on careful meal planning and correct insulin administration; an "adaptive style" (46%), characterized by high rates of blood glucose testing, exercise, and self-care adjustments; and an "inadequate style" (21%) with moderate rates of self-care adjustments and otherwise low DSMP scores. Convergence between parent and youth report classifications was moderate (Cohen's kappa = 0.47, P < 0.0001). A1C was 1.6% higher in the inadequate style group than in both other groups (P < 0.0001), and the classification significantly accounted for differences in A1C above what was explained by an overall DSMP score.

CONCLUSIONS

The findings provide support for recognizing subgroups of patients with unique multidimensional patterns of self-care behaviors. The assessment of self-management styles may prove useful for customized treatments that are targeted directly to the patients' needs.

Family carers in stroke care: examining the relationship between problem-solving, depression and general health

AIMS AND OBJECTIVES

The purpose of this article is to describe the problem-solving abilities of Hong Kong family carers looking after a stroke patients at home and report the relationships between their perceived problem-solving abilities with their depression level, general health status, and the functional recovery of stroke patients.

BACKGROUND

Previous research on supportive interventions for caregiving in stroke care suggests that enhancing carers' problem-solving abilities is useful. Nevertheless, not much is known about the relationship between carers' problem-solving abilities and their physical and psychosocial health and there is notably little work that has been done with the Chinese population.

DESIGN

A cross-sectional and correlational design was used.

METHODS

A convenience sample of 70 family carers, who were the main carers of stroke patients at home, during the first three months poststroke was recruited to complete a self-report questionnaire.

RESULT

Significant correlations were found between the family carers' global perceived problem-solving abilities and higher level of depressive symptoms (r = 0.35, P = 0.01) and poorer perceived health (r = 0.50, P = 0.01) as measured using the Center for Epidemiological Studies - Depression Scale and General Health Questionnaire. Among the three subscales of the Problem-Solving Inventory, problem-solving confidence showed the highest correlation with these variables. The functional ability of the stroke patients as measured using the Modified Barthel Index (MBI) was not associated with any variables.

CONCLUSION

Findings of this study suggest that perception of confidence is a key factor in appraisal of problem-solving among Chinese family carers, which raises questions for future research about the impact of cultural influences on designing and measuring interventions.

RELEVANCE TO CLINICAL PRACTICE

The study has implications for nursing and health care practice and for developing interventions targeted at building self-confidence among Chinese carers.

Assessing regimen adherence of adolescents with type 1 diabetes

OBJECTIVE

The purpose of this study is to evaluate two updated measures of diabetes regimen adherence. The Diabetes Self-Management Profile (DSMP) is a widely used, structured interview. Limitations include a substantial interviewer and respondent time burden and the need for well-trained interviewers to use appropriate prompts and score the open-ended responses. The Diabetes Behavior Rating Scale (DBRS) is a self-administered, fixed-choice survey.

RESEARCH DESIGN AND METHODS

Both measures were administered to 146 youth with type 1 diabetes (aged 11-18 years) and their parents. Items were added to the DBRS to allow for both flexible and conventional regimens, and the DSMP was modified to use standardized wording across items, accommodate flexible regimens, and permit administration by nonmedical interviewers.

RESULTS

Both measures had good evidence of internal consistency (for the DSMP: parent 0.75 and youth 0.70; for the DBRS: parent 0.84 and youth 0.84). Scores on the DSMP and the DBRS were significantly related (r = 0.72 for parents and 0.74 for youth). There was moderate agreement between parent and youth (DSMP, r = 0.51; DBRS, r = 0.48). The measures were correlated with HbA1c for both parent (DSMP, r = -0.35; DBRS, r = -0.35) and youth (DSMP, r = -0.36; DBRS, r = -0.34) reports.

CONCLUSIONS

Both measures exhibit good psychometric properties and good criterion validity but varied in terms of respondent and interviewer burden, issues that should be considered in selecting assessment procedures.

Association of social problem solving with glycemic control in a sample of urban African Americans with type 2 diabetes

The Social Problem-Solving Inventory--Revised, Short Form, was administered to 65 urban African Americans with type 2 diabetes to examine association of generic problem-solving styles and orientation with hemoglobin A1C (A1C). Eighty-five percent of participants had total social problem-solving scores in the Average range or higher. In linear regression models adjusted for education, each interquartile increase in impulsive/careless score was associated with a 0.82 increase in A1C (%) (p = 0.01), and each interquartile increase in avoidant score was associated with a 1.62 increase in A1C (%) (p = 0.004). After adjusting for depressive symptoms, the association of impulsive/careless style with A1C was attenuated, while the association of avoidant problem solving with A1C remained significant (p = 0.01). Associations of rational problem-solving style, positive orientation, and negative orientation with A1C and health behaviors were not statistically significant. Ineffective problem-solving styles may prove to be important targets for intervention to improve glycemic control.

Aspectos psicológicos e controle glicêmico de um grupo de pacientes com Diabetes Mellitus tipo 1 em Minas Gerais

O perfil psicológico e o grau de aceitação do diabetes mellitus tipo 1 (DM1) parecem influênciar diretamente os níveis glicêmicos. Neste trabalho avaliou-se a influência do perfil psicológico nos níveis glicêmicos de pacientes com DM1. Foi realizada análise retrospectiva do cadastro dos participantes do projeto Diabetes Weekend (DW), colônia de fim de semana para DM 1 em Minas Gerais. Em 150 pacientes (66M/84F, 21,6±13,5 anos e duração de DM1 de 8,5±7,9 anos) foram estudados: esquema insulínico, forma de administração de insulina, dose diária de insulina e dose diária na colônia DW, perfil psicológico, glicemia capilar e passado de crise convulsiva, hipoglicemia grave ou cetoacidose (CAD). A glicemia foi monitorizada 4 vezes ao dia com glicosímetro digital. Quanto à forma como os pacientes estão lidando com a doença, 20,9% relataram estar muito bem (G1), 39,5%, bem (G2), 25,6% com dificuldade de controle glicêmico (G3), 9,3% tentando aceitar (G4) e 4,7% relataram estar "péssimos" em relação ao DM1. A glicemia capilar média (GCM, em mg/dl) foi significativamente menor no G1 (169,8; G2: 182,3; G3: 199,3; G4: 200,7). Não houve associação signficante com a história pregressa de CAD, hipoglicemias ou convulsão. A menor aceitação da doença esteve relacionada à duração do DM1 superior a 5 anos (p= 0,017) e à idade (p= 0,000). 13,9% dos pacientes relatam ter vergonha de dizer em público que são diabéticos. A GCM foi significativamente maior nesse grupo em relação aos que não têm vergonha de assumir a doença (246,2 vs. 178,1; p= 0,007). Nos 91 pacientes (60,4%) que relatam ter medo de "passar mal" em público a GCM foi significativamente maior (200,4 vs. 184,5; p= 0,014). A monitorização glicêmica sistemática demonstrou associação positiva entre as dificuldades de lidar com a doença (aspectos psicológicos) e pior controle glicêmico. É importante a abordagem psicológica e multidisciplinar do diabético na busca de um melhor controle metabólico, prevenção de complicações futuras e melhora da qualidade de vida desses indivíduos.

A review of measures of self-management of type 1 diabetes by youth and their parents

PURPOSE

The purpose of this paper was to identify and critique relevant existing instruments designed to measure self-management of type 1 diabetes in children and adolescents.

METHODS

Literature on the self-management of type 1 diabetes in children and adolescents was systematically searched to identify instruments measuring self-management. After eliminating instruments that measured only one aspect of self-management, those published prior to DCCT findings, and those for which little information was available, 6 instruments were identified for review. Each instrument is discussed in terms of history and description of the instrument, definitions, psychometrics, findings from studies using the instrument, availability of the instrument, and evaluation.

RESULTS

All of the instruments measure some of the activities of self-management; 1 expressly measures self-management; 1 measures the frequency of various self-care activities, and 4 measure adherence to prescribed diabetes regimens. Only 1 instrument comprehensively assesses the process of self-management. None measure the goals of self-management.

CONCLUSIONS

Instrument development has been hindered by the lack of clarity concerning the concept of self-management of type 1 diabetes in children and adolescents. Existing measures need to be further developed and new measures need to be designed.

Problem solving in diabetes self-management: a model of chronic illness self-management behavior

Management of chronic illnesses is a significant public health concern that is made more challenging by problems of regimen adherence. Effective self-management of chronic illnesses such as diabetes requires not only technical skill to perform regimen behaviors but also problem-solving skills to manage daily barriers to regimen adherence and to make appropriate adjustments to the self-care regimen. A review of the empirical literature on the relation between problem solving and disease self-management in diabetes, a chronic illness exemplar, illuminates methodological limitations that indicate a need for a theoretical framework for problem solving applied to chronic disease self-management. A problem-solving model of chronic disease self-management is proposed, derived from theories of problem solving in cognitive psychology, educational/learning theory, and social problem solving. Four essential components of problem solving in disease self-management are identified: (a). problem-solving skill, (b). problem-solving orientation, (c). disease-specific knowledge, and (d). transfer of past experience. The model is illustrated, and empirical support for this problem-solving model in the diabetes literature is discussed. The model has utility in driving testable hypotheses regarding the relation of disease-specific problem solving to chronic illness management, in developing problem-solving assessment instruments relevant to disease self-management, and in guiding disease self-management training and interventions.

Increasing problem solving in adolescents with type 1 diabetes: the choices diabetes program

The purpose of this pilot study was to test the hypothesis that adolescents with type 1 diabetes can learn to become better problem solvers in diabetes self-care and thereby improve their metabolic control.

METHODS

Fifty-three adolescents aged 13 to 17 with type 1 diabetes were randomly assigned to either a 6-week problem-solving diabetes education program or to a control group (usual care). A1C levels were obtained as well as assessments of problem solving, frequency of behavior, level of responsibility, and 24-hour behavior recall at baseline and 6 months.

RESULTS

The experimental group participants showed significantly improved problem-solving test scores and A1C values from baseline to 6 months, changes not evident in the control group. At 6 months, the experimental group participants were doing blood glucose testing more often than those in the control group. However, there was no significant difference in problem-solving test scores or A1C values.

CONCLUSIONS

This 6-week intervention for adolescents with diabetes resulted in better problem-solving skills, more frequent blood glucose testing, and improved A1C values. The results suggest that a diabetes problem-solving program for adolescents can be effective in improving metabolic control.