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Tamborlane W, Shehadeh N. Unmet Needs in the Treatment of Childhood Type 2 Diabetes: A Narrative Review. Adv Ther 2023; 40:4711-4720. [PMID: 37668933 PMCID: PMC10567925 DOI: 10.1007/s12325-023-02642-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023]
Abstract
Type 2 diabetes (T2D) in youth is a global health concern characterized by an increasing incidence and prevalence, especially among disadvantaged socioeconomic subgroups. Moreover, youth-onset T2D is more aggressive and causes earlier, more severe long-term cardio-renal complications compared with T2D in adults. The therapeutic options available are limited and often inadequate, partially due to the numerous challenges in implementing clinical trials for this vulnerable patient population. Over the last few years, a significant effort has been made to develop new effective drugs for children and adolescents with T2D. Specifically, a number of studies are currently generating new data to address the urgent unmet medical need for optimal management of this disease. This review describes the central features of youth-onset T2D and summarizes the available treatments and ongoing studies in pediatric patients.
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Affiliation(s)
- William Tamborlane
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Naim Shehadeh
- Institute of Diabetes, Endocrinology and Metabolism, Rambam Health Care Campus, PO Box 9602, 3109601, Haifa, Israel.
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
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2
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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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3
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Lin PY, Lee TY, Liu CY, Lee YJ. The Effect of Self-Efficacy in Self-Management on Diabetes Distress in Young People with Type 2 Diabetes. Healthcare (Basel) 2021; 9:healthcare9121736. [PMID: 34946462 PMCID: PMC8701179 DOI: 10.3390/healthcare9121736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/24/2021] [Accepted: 12/07/2021] [Indexed: 12/17/2022] Open
Abstract
To understand the relationship among glycemic control, self-efficacy in diabetes management, and diabetes distress in young people with type 2 diabetes, a cross-sectional descriptive study with convenience sampling was designed. A total of 60 young people who had type 2 diabetes (T2D), with 24 (40%) males and 36 (60%) females were included. The mean age was 17.2 and ranged from 10.5 to 24.5 years, and they completed a Perceived Diabetes Self-Management Scale, the Problem Areas in Diabetes Scale and their pharmacologic management and life adjustment. Glycated hemoglobin (HbA1c) was routinely drawn before the outpatient visit. HbA1c and diabetic distress were positively correlated. Self-efficacy was negatively correlated with HbA1c and diabetic distress. In the hierarchical multiple regression analysis, only the duration of illness and self-efficacy remained significant in the final model. The variance for the overall model was 64%, with self-efficacy alone explaining 30% of the variance. In addition, 31.6% of participants had extremely high levels of psychological distress. Conclusions: T2D is an early onset chronic disease, and the young people may have had other health problems, which made the diabetes management a complex process. Nursing staff should regularly assess both the confidence and ability to manage treatment regimen of young people with type 2 diabetes and their psychological distress.
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Affiliation(s)
- Pao-Yu Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
- Department of Nursing, MacKay Junior College of Medicine, Nursing and Management, Taipei 112021, Taiwan
| | - Tzu-Ying Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
- Correspondence:
| | - Chieh-Yu Liu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
| | - Yann-Jinn Lee
- Laboratory of Molecular Medicine, Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei 104217, Taiwan;
- Department of Medical Research, MacKay Memorial Hospital, Taipei 104217, Taiwan
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4
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Archibald MM, Dart A, Wicklow B, Pundyk KJ, Marks SD, Sellers EAC. Youth perceptions and experiences of type 2 diabetes: Protocol for a collaborative knowledge translation approach and qualitative study. J Adv Nurs 2021; 77:3218-3225. [PMID: 33855741 DOI: 10.1111/jan.14845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study is to generate an in-depth understanding of youth perceptions and experiences of living with type 2 diabetes to inform knowledge translation, research and intervention development. DESIGN Interpretive descriptive qualitative study. METHODS Twenty to 25 youth aged 10-18 years with a diagnosis of type 2 diabetes will be purposively recruited through the Diabetes Education Resource for Children and Adolescents in Winnipeg, Manitoba, and through the Improving Renal Complications in Adolescents With Type 2 Diabetes Through the REsearch [iCARE] cohort. Socio-demographic information will be collected. Semi-structured interviews will occur iteratively with inductive thematic analysis. Data will be professionally transcribed and managed using NVivo 1.0 software. The University Ethics Committee approved this study (May 2020). DISCUSSION There is a critical gap in understanding youth experiences of type 2 diabetes. Research involving youth with type 2 diabetes is predominantly quantitative in nature, largely reflecting risk factors, underlying mechanisms and treatment outcomes associated with diabetes management. In-depth qualitative research on youth experiences can help identify youth priorities, provide insight into critical misalignments between stakeholder perspectives, and drive forward a more consolidated youth-centred research agenda. IMPACT Understanding and applying knowledge of youth experiences is critical as the prevalence of, and challenges associated with, youth onset type 2 diabetes continues to increase worldwide. This research will generate a robust interpretive description of youth lived experiences and perceptions of type 2 diabetes where such research is lacking, to inform basic and applied research within an interdisciplinary investigative and clinical research team with relevance to other jurisdictions. In response to calls for youth-oriented research in type 2 diabetes, this work will catalyse collaborative knowledge translation using creative and youth-directed initiatives.
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Affiliation(s)
- Mandy M Archibald
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, Canada
| | - Allison Dart
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Brandy Wicklow
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Katherine J Pundyk
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Seth D Marks
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Elizabeth A C Sellers
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
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5
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Othman N, Wong YY, Lean QY, Mohd Noor N, Neoh CF. Factors affecting self-management among adolescents and youths with type 2 diabetes mellitus: A meta-synthesis. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Havill N, Fleming LK, Knafl K. Well siblings of children with chronic illness: A synthesis research study. Res Nurs Health 2019; 42:334-348. [PMID: 31418465 DOI: 10.1002/nur.21978] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/20/2019] [Indexed: 11/12/2022]
Abstract
Well siblings of chronically ill children experience family disruptions that profoundly affect them. Previous research focusing on well siblings' experiences has often produced inconsistent findings, likely the result of varying study designs and samples. The purposes of this synthesis research study were twofold: (a) to assess the applicability of existing grounded theory of sibling response to a child's cancer to a wider range of childhood conditions; and (b) to refine the existing theory to reflect the experiences of the broader sample. Data for the synthesis came from a National Institute of Nursing Research-funded mixed-methods synthesis examining the intersection of childhood chronic illness and family life. The current analysis was based on well sibling results extracted from 78 research reports published between 2000 and 2014. An existing grounded theory, Creating a Tenuous Balance (CTB), was discovered at the outset of analysis and used as the primary framework for coding and synthesizing results. The focus of most studies was siblings' responses to 14 chronic conditions, with cancer being the most often studied. Results reflected siblings' perspectives of their experiences as well as perspectives of parents and the ill child. The analysis substantiated all four patterns of sibling behavior included in CTB, with the patterns of adapting to changes in personal and family life, and handling strong emotions being especially challenging aspects of the sibling experience. Moreover, the results expanded several aspects of CTB. The analysis provided evidence of the applicability of the theory to a varied group of chronic conditions and enabled us to identify important areas for developing interventions to support siblings.
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Affiliation(s)
- Nancy Havill
- Division of Nursing, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Louise K Fleming
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathleen Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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7
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Nightingale R, McHugh G, Kirk S, Swallow V. Supporting children and young people to assume responsibility from their parents for the self-management of their long-term condition: An integrative review. Child Care Health Dev 2019; 45:175-188. [PMID: 30690751 DOI: 10.1111/cch.12645] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/21/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Children and young people with long-term conditions (LTCs) are usually dependent on, or share management with, their families and are expected to develop self-management skills as they mature. However, during adolescence, young people can find it challenging to follow prescribed treatment regimens resulting in poor clinical outcomes. Though reviews have looked at children's and parents' experiences of self-management, none have explicitly examined the parent-to-child transfer of self-management responsibility. METHODS An integrative review was conducted with the aim of exploring the parent-to-child transfer of LTC self-management responsibility, through addressing two questions: (a) How do children assume responsibility from their parents for self-management of their LTC? (b) What influences the parent-to-child transfer of this responsibility? Eight databases were searched for papers published from 1995 to 2017. Methodological quality was assessed; included papers were synthesized to identify themes. RESULTS Twenty-nine papers were identified. Most papers used qualitative designs and focused on children with diabetes. Participants were predominantly children and/or parents; only two studies included health professionals. Assuming self-management responsibility was viewed as part of normal development but was rarely explored within the context of the child gaining independence in other areas of their life. Children and parents adopted strategies to help the transfer, but there was limited evidence around health professionals' roles and ambivalence around what was helpful. There was a lack of clarity over whether children and parents were aiming for shared management, or self-management, and whether this was a realistic or desired goal for families. Multiple factors such as the child, family, social networks, health professional, and LTC influenced how a child assumed responsibility. CONCLUSIONS Evidence suggests that the parent-to-child transfer of self-management responsibility is a complex, individualized process. Further research across childhood LTCs is needed to explore children's, parents', and professionals' views on this process and what support families require as responsibilities change.
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Affiliation(s)
- Ruth Nightingale
- Great Ormond Street for Hospital NHS Foundation Trust, London, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - Gretl McHugh
- School of Healthcare, University of Leeds, Leeds, UK
| | - Susan Kirk
- School of Health Sciences, University of Manchester, Manchester, UK
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8
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Eva JJ, Kassab YW, Neoh CF, Ming LC, Wong YY, Abdul Hameed M, Hong YH, Sarker MMR. Self-Care and Self-Management Among Adolescent T2DM Patients: A Review. Front Endocrinol (Lausanne) 2018; 9:489. [PMID: 30459707 PMCID: PMC6232899 DOI: 10.3389/fendo.2018.00489] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 08/06/2018] [Indexed: 01/30/2023] Open
Abstract
Uncontrolled hyperglycaemia can lead to macro- and microvascular complications. Adolescents with T2DM develop similar complications as in adults, including cardiovascular disease, stroke, myocardial infarction, renal insufficiency, and chronic renal failure. Although regular medical follow-up is essential to avoid long-term complications, patients with diabetes mellitus need to perform holistic self-care activities such as opting for a healthy diet, physical activity, self-monitoring, and proper medication. To the best of our knowledge, only a limited number of studies have focused on self-care activities and self-management, including self-care practices, supportive networks, and self-care education programs in adolescent with T2DM. Some of the studies focused on the appreciation of self-care in adolescents with T2DM. This review aimed to analyse self-care and self-management among adolescents with T2DM, and discuss the impact of self-care and self-management on glycaemic control. The difficulties faced by adolescents in self-managing their disease are also highlighted. Such information is essential for healthcare providers in promoting self-care practices among adolescents with T2DM. A thorough search of the literature was performed using three databases: Medline, Google Scholar, and Scopus. The articles focused on self-care and self-management of adolescents patients with T2DM aged between 12 and 19 years old were included. Findings from this review reveal that healthy food adaptation, adequate physical activity, proper medication practices, and regular glucose monitoring are the most common self-care practices. Parental involvement and clinician encouragement also contribute toward the practice of self-care and self-management among the adolescents with T2DM. In conclusion, independent self-management regimens and supportive networks for appropriate administration are vital factors to enhance clinical outcomes of adolescents with T2DM.
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Affiliation(s)
- Jafrin Jahan Eva
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Yaman Walid Kassab
- Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia
| | - Chin Fen Neoh
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
- Collaborative Drug Discovery Research Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Long Chiau Ming
- School of Pharmacy, KPJ Healthcare University College, Negeri Sembilan, Malaysia
- Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Yuet Yen Wong
- Faculty of Pharmacy, Universiti Teknologi MARA, Bertam, Malaysia
| | | | - Yet Hoi Hong
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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9
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McGavock J, Durksen A, Wicklow B, Malik S, Sellers EA, Blydt-Hansen T, Chateau D, Dart A. Determinants of Readiness for Adopting Healthy Lifestyle Behaviors Among Indigenous Adolescents with Type 2 Diabetes in Manitoba, Canada: A Cross-Sectional Study. Obesity (Silver Spring) 2018. [PMID: 29533530 DOI: 10.1002/oby.22148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether the readiness for adopting healthy lifestyle behaviors was associated with mental health and comorbid conditions in youth with T2D. METHODS A cross-sectional comparison of various measures of mental health (distress, stress, resilience) and comorbid conditions (glycated hemoglobin, adiposity, hypertension) was conducted within a cohort of indigenous youth with T2D living in Canada, stratified according to their readiness to adopt healthy lifestyle behaviors based on Prochaska's transtheoretical model. RESULTS Within the entire cohort (n = 162), only 14% were considered ready to adopt all healthy lifestyle behaviors. The readiness to adopt all lifestyle behaviors was associated with higher positive mental health (47 vs. 39 units; P < 0.05) and sense of mastery (40 vs. 37 units; P < 0.05), lower perceived stress (27 vs. 29 units; P < 0.05) and distress (8 vs. 10 units; P < 0.05), and better glycemic control (HbA1c: 8.4 ± 2.6% vs. 9.7 ± 2.8%; P < 0.05) compared with youth who were not ready to adopt all lifestyle behaviors. CONCLUSIONS The readiness for adopting healthy lifestyle behaviors is low among adolescents with T2D. Being ready to adopt healthy lifestyle behaviors is associated with better mental health and glycemic control.
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Affiliation(s)
- Jonathan McGavock
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anita Durksen
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sayma Malik
- Department of Clinical Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Ac Sellers
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tom Blydt-Hansen
- Section of Nephrology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, University of Manitoba, Winnipeg, Manitoba, Canada
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Anderson M, Tulloch-Reid MK. "You Cannot Cure It, Just Control It": Jamaican Adolescents Living With Diabetes. Compr Child Adolesc Nurs 2017; 42:109-123. [PMID: 29265943 DOI: 10.1080/24694193.2017.1411406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although adolescence is considered a difficult time for diabetes management, there is little published qualitative research on adolescent Jamaicans with diabetes. This study investigates the experiences of Jamaican adolescents living with diabetes to determine how their needs can be addressed. Nineteen adolescents participated in two urban and two rural focus groups and were asked to draw pictures representing their experiences. Thematic analysis was used to analyze their narratives, while their drawings were analyzed using a variation of Lauritsen and Mathiasen's (2003) method. Results show that control was the central theme: children felt controlled by diabetes and the people in their lives. Diabetes restricted their activities and imposed a sense of difference. Support from those around them could be both helpful and constricting. Children tried to resist control through disregarding the rules, being secretive, defiant, and manipulating others into allowing nonadherence. They also tried to adhere to the rules, find a balance between following them and engaging in desired activities, and to be positive. Those most positive about living with diabetes did not feel controlled by diabetes or others' understandings of it and, with loved ones' support, had rejected diabetes' negative meanings. Extreme distress was felt by rural children. All children had been noncompliant. Healthcare practitioners and policymakers should provide education in schools to facilitate fair and effective treatment. Mental health specialists should assist children to negotiate stigma and distress. Group sessions with significant others are important for collaborative decisions on enabling support.
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Affiliation(s)
- Moji Anderson
- a Department of Sociology, Psychology, and Social Work, University of the West Indies , Mona , Kingston , Jamaica
| | - Marshall K Tulloch-Reid
- b Caribbean Institute for Health Research, University of West Indies , Mona , Kingston , Jamaica
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11
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Huynh E. The Mountain of Health: The Perceptions and Perceived Expectations of Youth Living With Type 2 Diabetes in Winnipeg, Manitoba, Canada, Through a Grounded Theory Study. Can J Diabetes 2017; 42:344-349. [PMID: 29128303 DOI: 10.1016/j.jcjd.2017.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/10/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to explore youth's perceptions of diabetes management. METHODS The study included 8 Manitoban youth with type 2 diabetes (n=7 girls). Each youth participated in a semistructured interview in person, via Skype or over the phone. The constructivist grounded theory methodologic approach guided the analysis of the data. RESULTS Discussions about diabetes and health and its management revealed 2 viewpoints: 1) youth's perceptions and 2) youth's perceptions of health-care providers' expectations. The Mountain of Health was used to conceptualize the complex nature of diabetes management. Youth perceived that health-care providers prioritized physical health-behaviour changes in order to achieve successful diabetes management. Conflictingly, many youth described their mental and emotional health as taking precedence over their physical health. CONCLUSION Future interventionists should be aware of the vast incongruence in patients' perceptions of health in type 2 diabetes and their perceptions of health-care providers' expectations during the development of interventions.
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Affiliation(s)
- Elizabeth Huynh
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
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12
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St George SM, Pulgarón ER, Ferranti D, Agosto Y, Toro MI, Ramseur KC, Delamater AM. A Qualitative Study of Cognitive, Behavioral, and Psychosocial Challenges Associated With Pediatric Type 2 Diabetes in Ethnic Minority Parents and Adolescents. DIABETES EDUCATOR 2017; 43:180-189. [PMID: 28340546 DOI: 10.1177/0145721717691146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose The purpose of this descriptive qualitative study was to explore cognitive, behavioral, and psychosocial challenges associated with having and/or parenting an adolescent with pediatric type 2 diabetes (T2D) from the perspectives of ethnic minority parents and adolescents. Methods Ethnic minority (79.2% non-Hispanic black, 29.6% Hispanic) adolescents (n = 14, 78.6% female, 14.7 ± 1.9 years) and their parents (n = 13, 100% female) participated in either individual family interviews or multifamily focus group sessions. Sessions were audio recorded, transcribed, and coded by a team of 4 raters. QSR NVivo 10 was used to perform a content analysis and to extract coded adolescent and parent responses. Results Six themes corresponding to 3 broad categories (cognitive, behavioral, and psychosocial challenges) emerged. Regarding cognitive challenges, families described difficulties learning about a new disease and managing youth knowledge deficits and/or superficial knowledge. In terms of behavioral challenges, parents and adolescents discussed ongoing difficulties with making and maintaining positive youth health behavior changes as well as with ensuring regimen adherence. Finally, managing youth emotions related to diabetes and navigating social relationships with peers and other family members around the disclosure of T2D were the primary psychosocial challenges to emerge. Conclusions Directions for future research include developing and evaluating brief family interventions and adolescent psychosocial screening measures. Recommendations for clinical practice include increasing family knowledge of T2D, enhancing parenting skills for managing youth behavior change, and conducting routine psychosocial screening during follow-up clinic visits.
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Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida (Dr St. George)
| | - Elizabeth R Pulgarón
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida (Dr Pulgarón, Ms Agosto, Ms Toro, Mr Ramseur, Dr Delamater)
| | - Dina Ferranti
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida (Ms Ferranti)
| | - Yaray Agosto
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida (Dr Pulgarón, Ms Agosto, Ms Toro, Mr Ramseur, Dr Delamater)
| | - Maria I Toro
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida (Dr Pulgarón, Ms Agosto, Ms Toro, Mr Ramseur, Dr Delamater)
| | - Kevin C Ramseur
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida (Dr Pulgarón, Ms Agosto, Ms Toro, Mr Ramseur, Dr Delamater)
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida (Dr Pulgarón, Ms Agosto, Ms Toro, Mr Ramseur, Dr Delamater)
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13
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Owens C, Charles N. Implementation of a text-messaging intervention for adolescents who self-harm (TeenTEXT): a feasibility study using normalisation process theory. Child Adolesc Psychiatry Ment Health 2016; 10:14. [PMID: 27354855 PMCID: PMC4924323 DOI: 10.1186/s13034-016-0101-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 05/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are few interventions that directly address self-harming behaviour among adolescents. At the request of clinicians in Child and Adolescent Mental Health Services (CAMHS) in England and working with them, we redeveloped an adult SMS text-messaging intervention to meet the needs of adolescents under the care of CAMHS who self-harm. METHODS We used normalisation process theory (NPT) to assess the feasibility of delivering it through CAMHS. We planned to recruit 27 young people who self-harm and their clinicians, working as dyads and using the intervention (TeenTEXT) for 6 months. RESULTS Despite strong engagement in principle from CAMHS teams, in practice we were able to recruit only three clinician/client dyads. Of these, two dropped out because the clients were too unwell. We identified a number of barriers to implementation. These included: a context of CAMHS in crisis, with heavy workloads and high stress levels; organisational gatekeeping practices, which limited the extent to which clinicians could engage with the intervention; perceived burdensomeness and technophobia on the part of clinicians, and a belief by many clinicians that CAMHS may be the wrong delivery setting and that the intervention may have better fit with schools and universal youth services. CONCLUSIONS User-centred design principles and the use of participatory methods in intervention development are no guarantee of implementability. Barriers to implementation cannot always be foreseen, and early clinical champions may overestimate the readiness of colleagues to embrace new ideas and technologies. NPT studies have an important role to play in identifying whether or not interventions are likely to receive widespread clinical support. This study of a text-messaging intervention to support adolescents who self-harm (TeenTEXT) showed that further work is needed to identify the right delivery setting, before testing the efficacy of the intervention.
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Affiliation(s)
- Christabel Owens
- University of Exeter Medical School, College House, St. Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Nigel Charles
- University of Exeter Medical School, College House, St. Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
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14
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Hanghøj S, Boisen KA, Schmiegelow K, Hølge-Hazelton B. A Photo Elicitation Study on Chronically Ill Adolescents' Identity Constructions During Transition. Glob Qual Nurs Res 2016; 3:2333393616631678. [PMID: 28462329 PMCID: PMC5342639 DOI: 10.1177/2333393616631678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 01/18/2023] Open
Abstract
Adolescence is an important phase of life with increasing independence and identity development, and a vulnerable period of life for chronically ill adolescents with a high occurrence of insufficient treatment adherence. We conducted four photo elicitation focus group interviews with 14 adolescents (12-20 years) with juvenile idiopathic arthritis to investigate identity constructions during transition. Using a discourse analysis approach, six identity types were identified distributed on normal and marginal identities, which were lived either at home (home arena) or outside home with peers (out arena). Most participants positioned themselves as normal in the out arena and as ill in the home arena. Few participants positioned themselves as ill in an out arena, and they described how peers perceived this as a marginal and skewed behavior. This study contributes to a better understanding of why it can be extremely difficult to live with a chronic illness during adolescence.
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Affiliation(s)
- Signe Hanghøj
- Rigshospitalet and University of Copenhagen, Denmark
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15
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Meehan C, Silverstein J. Treatment Options for Type 2 Diabetes in Youth Remain Limited. J Pediatr 2016; 170:20-7. [PMID: 26681477 DOI: 10.1016/j.jpeds.2015.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/07/2015] [Accepted: 11/05/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Colette Meehan
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL
| | - Janet Silverstein
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL.
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16
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Huynh E, Rand D, McNeill C, Brown S, Senechal M, Wicklow B, Dart A, Sellers E, Dean H, Blydt-Hansen T, McGavock J. Beating Diabetes Together: A Mixed-Methods Analysis of a Feasibility Study of Intensive Lifestyle Intervention for Youth with Type 2 Diabetes. Can J Diabetes 2015; 39:484-90. [DOI: 10.1016/j.jcjd.2015.09.093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/23/2015] [Accepted: 09/29/2015] [Indexed: 12/18/2022]
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17
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Vangeepuram N, Carmona J, Arniella G, Horowitz CR, Burnet D. Use of Focus Groups to Inform a Youth Diabetes Prevention Model. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:532-539.e1. [PMID: 26420055 PMCID: PMC4668804 DOI: 10.1016/j.jneb.2015.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 08/04/2015] [Accepted: 08/10/2015] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To explore minority adolescents' perceptions of their diabetes risk, barriers and facilitators to adopting lifestyle changes, and ideas for adapting a youth diabetes prevention model. METHODS The study was conducted at collaborating community sites in East Harlem, NY. Trained moderators facilitated focus groups, which were audio taped and transcribed. Participants were 21 Latino and African American adolescents aged 14-18 years with a family history of diabetes and no reported personal history of diabetes. The phenomenon of interest was youth input in adapting a diabetes prevention model. Two researchers independently coded transcripts, identified major themes, compared findings, and resolved differences through discussion and consensus. RESULTS Dominant themes included (1) the impact of diabetes on quality of life within adolescents' personal networks; (2) conflict between changing diet and activity and their current lifestyle; (3) lifestyle choices being dictated by cost, mood, body image, and environment, not health; and (4) family, social, and environmental pressures reinforcing sedentary behaviors and unhealthy diets. CONCLUSIONS AND IMPLICATIONS Themes from youth focus groups were framed in the context of an existing youth diabetes prevention conceptual model, with results informing expansion of the model and identification and organization of potential intervention components.
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Affiliation(s)
- Nita Vangeepuram
- Departments of Pediatrics and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Address: 1 Gustave L. Levy Place Box 1202A, New York, NY 10029, Phone: 917-478-2106, Fax: 212-996-9685
| | - Jane Carmona
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY 10029
| | - Guedy Arniella
- Institute for Family Health, 1824 Madison Ave, NY, NY, 10035, Phone: 212-423-4796
| | - Carol R. Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY 10029, Phone: 212-659-9567
| | - Deborah Burnet
- Department of Pediatrics, University of Chicago, AMB B226B, MC 2007 5841 South Maryland Avenue, Chicago, IL 60637, Phone: 773-702-4582
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18
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Protudjer JLP, Dumontet J, McGavock JM. My voice: a grounded theory analysis of the lived experience of type 2 diabetes in adolescence. Can J Diabetes 2015; 38:229-36. [PMID: 25092643 DOI: 10.1016/j.jcjd.2014.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/30/2014] [Accepted: 05/22/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aims of this study were to (1) describe the lived experiences of youth with type 2 diabetes from the perspectives of youth, their primary caregivers and healthcare professionals; (2) explore the barriers and facilitators to adopting lifestyle approaches for diabetes self-management; and (3) generate a relevant grounded theory. METHODS This qualitative study was based on a grounded theory framework and consisted of interviews and focus groups with youth with type 2 diabetes (n=8), their primary caregivers (n=6) and healthcare professionals (n=8). Youth and their primary caregivers were purposely selected to represent extremes of successful self-management through lifestyle therapy. Focus groups were held with healthcare professionals (allied health [n=5]; pediatric endocrinologists [n=3]) in an effort to triangulate responses with youth and their primary caregivers. RESULTS Youth with type 2 diabetes, their primary caregivers and their healthcare professionals described supportive relationships as being important determinants of adopting healthful-living self-management behaviours. All 3 groups also recognized that social determinants of health (i.e. food insecurity, poverty) were significant barriers to adopting healthful living behaviours for families with youth who have type 2 diabetes. Healthcare professionals recognized that the barriers to self-management were different for youth with type 2 diabetes than for youth with type 1 diabetes and felt that families would benefit from a clinic dedicated to meet their unique needs. CONCLUSIONS Supportive relationships and social determinants of health are perceived as being significant determinants of the adoption of healthful behaviours by youth with type 2 diabetes and should be considered in clinical management and future therapeutic trials.
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Affiliation(s)
| | | | - Jonathan M McGavock
- Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada; Department of Pediatrics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Turner KM, Percival J, Dunger DB, Olbers T, Barrett T, Shield JPH. Adolescents' views and experiences of treatments for Type 2 diabetes: a qualitative study. Diabet Med 2015; 32:250-6. [PMID: 25186101 DOI: 10.1111/dme.12577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/18/2014] [Accepted: 08/26/2014] [Indexed: 11/27/2022]
Abstract
AIM To explore adolescents' views and experiences of different treatments for Type 2 diabetes, in order to improve treatment concordance and consider how the current treatment pathway for adolescent Type 2 diabetes could be improved. METHODS In-depth interviews were held with 12 adolescents who had been diagnosed with Type 2 diabetes. Adolescents were sampled from a UK cohort study. Data were analysed thematically. RESULTS Interviewees struggled to maintain lifestyle changes. Insulin, metformin and liraglutide were described as effective but, in some cases, as resulting in side effects. Injected treatments were viewed less favourably than oral medications. Weight loss surgery was considered an acceptable treatment for obese adolescents who had tried other treatments for their diabetes. It was apparent that some adolescents had not been surprised by their diagnosis and did not fully appreciate the implications of having diabetes. It was also evident that some individuals had not told peers about their diagnosis due to fearing how they would react. Factors identified as improving treatment concordance included reminders and viewing treatment as effective and easy to take. CONCLUSIONS Adolescents want treatments that are effective, discrete, easy to take and do not make them different from their peers. As liraglutide was described as effective, and surgery viewed as acceptable in certain circumstances, greater consideration should be given to their potential role in treating adolescent Type 2 diabetes. Practitioners need to ensure that adolescents appreciate the implications of having diabetes and may want to address adolescents' concerns regarding how others view this condition.
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Affiliation(s)
- K M Turner
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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20
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Abstract
The incidence of overweight and obesity among children has increased dramatically in recent decades, with about one-third of children in the U.S. currently being either overweight or obese. Being overweight in early childhood increases risk for later obesity. There is evidence for the efficacy of family-based behavioral treatment to control weight and improve health outcomes. Obesity-related health risks have been documented, including metabolic syndrome. There is also increasing incidence of type 2 diabetes (T2D) among youth in recent years, with obesity and family history of T2D generally present. Lower income and ethnic minority status are associated with both obesity and T2D in youth. Most youth with T2D do not achieve optimal glycemic control, and are at high risk for later health complications. Obesity and T2D represent significant public health issues with potentially great personal and societal cost. Research addressing the prevention of obesity and T2D among youth is urgently needed.
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Affiliation(s)
- Elizabeth R Pulgaron
- Department of Pediatrics, University of Miami Miller School of Medicine, 1601 NW 12th Ave, Miami, FL, USA, 33136
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21
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Hanghøj S, Boisen KA. Self-reported barriers to medication adherence among chronically ill adolescents: a systematic review. J Adolesc Health 2014; 54:121-38. [PMID: 24182940 DOI: 10.1016/j.jadohealth.2013.08.009] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/15/2013] [Accepted: 08/15/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate self-reported barriers to medication adherence among chronically ill adolescents, and to investigate whether barriers are unique to specific chronic diseases or more generic across conditions. METHODS A systematic search of Web of Science, PubMed, Embase, PsycINFO, and CINAHL from January 2000 to May 2012 was conducted. Articles were included if they examined barriers to medication intake among chronically ill adolescents aged 13-19 years. Articles were excluded if adolescent's views on barriers to adherence were not separated from younger children's or caregiver's views. Data was analyzed using a thematic synthesis approach. RESULTS Of 3,655 records 28 articles with both quantitative, qualitative, and q-methodology study designs were included in the review. The synthesis led to the following key themes: Relations, adolescent development, health and illness, forgetfulness, organization, medicine complexity, and financial costs. Most reported barriers to adherence were not unique to specific diseases. CONCLUSION Some barriers seem to be specific to adolescence; for example, relations to parents and peers and adolescent development. Knowledge and assessment of barriers to medication adherence is important for both policy-makers and clinicians in planning interventions and communicating with adolescents about their treatment.
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Affiliation(s)
- Signe Hanghøj
- Center of Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten A Boisen
- Center of Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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23
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Affiliation(s)
- M A Sabin
- Murdoch Childrens Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia
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24
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Schabert J, Browne JL, Mosely K, Speight J. Social stigma in diabetes : a framework to understand a growing problem for an increasing epidemic. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 6:1-10. [PMID: 23322536 DOI: 10.1007/s40271-012-0001-0] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A comprehensive understanding of the social and psychological impact of diabetes mellitus is important for informing policy and practice. One potentially significant, yet under-researched, issue is the social stigma surrounding diabetes. This narrative review draws on literature about health-related stigma in diabetes and other chronic conditions in order to develop a framework for understanding diabetes-related stigma. Our review of the literature found that people who do not have diabetes assume that diabetes is not a stigmatized condition. In contrast, people with diabetes report that stigma is a significant concern to them, experienced across many life domains, e.g., in the workplace, in relationships. The experience of diabetes-related stigma has a significant negative impact on many aspects of psychological well-being and may also result in sub-optimal clinical outcomes for people with diabetes. We propose a framework that highlights the causes (attitudes of blame, feelings of fear and disgust, and the felt need to enforce social norms and avoid disease), experiences (being judged, rejected, and discriminated against), and consequences (e.g., distress, poorer psychological well-being, and sub-optimal self-care) of diabetes-related stigma and also identifies potential mitigating strategies to reduce diabetes-related stigma and/or enhance coping and resilience amongst people with diabetes. The systematic investigation of the experiences, causes, and consequences of diabetes-related stigma is an urgent research priority.
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Affiliation(s)
- Jasmin Schabert
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
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25
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Osman HAM, Elsadek N, Abdullah MA. Type 2 diabetes in Sudanese children and adolescents. Sudan J Paediatr 2013; 13:17-23. [PMID: 27493369 PMCID: PMC4949936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The objective of this study was to determine the prevalence of T2 DM among children and adolescents attending a paediatric and adolescent diabetic clinic in Khartoum -Sudan and to find out the etiological factors, clinical presentation, management and associated co morbidities. This was a retrospective, descriptive hospital based study. The records of all children attending the clinic at Jabir Abu Izz Diabetic Center from January 2006 to December 2009 were reviewed and those who were diagnosed as type 2 DM were identified. Out of 985 patients 38 (4%) were labeled as having type 2 DM. Out of these, 35 (92.1%) had onset between 11-18 years of age and were all pubertal. Three patients (7.9%) were under 10. Female to male ratio was 1.2: 1. Thirty two (84.2%) were from tribes of Arab origin. There were no cases from tribes of southern Sudan of African origin. Risk factors for obesity included: diabetes during pregnancy 15 (39.5%), large for dates 16 (43%) small for dates 12(32%), family history of obesity 10 (26.3%), lack of exercise 32 (87.6%), TV watching for long hours 32(84.3%) and consumption of fast foods. Almost 70% were symptomatic at presentation. Co morbidities included hypertension 22(57.9%), microalbuminuria 7 (18.4%), hyperlipidaemia 6(7%) and none had retinopathy. The mean HbA1C was 9.1% gm/dl. This data confirms that T2 DM is emerging as a health problem among children and adolescents in Sudan mostly as a result of obesity particularly among high socioeconomic group in urban areas and more prevalent in certain ethnic groups.
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Affiliation(s)
- Hala A M Osman
- Khartoum University Pediatric Endocrinology Unit KhartoumSudan
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26
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Brouwer AM, Salamon KS, Olson KA, Fox MM, Yelich-Koth SL, Fleischman KM, Hains AA, Davies WH, Kichler JC. Adolescents and type 2 diabetes mellitus: a qualitative analysis of the experience of social support. Clin Pediatr (Phila) 2012; 51:1130-9. [PMID: 23034947 DOI: 10.1177/0009922812460914] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Research on how adolescents with type 2 diabetes mellitus (T2DM) understand and use social support is limited. Therefore, we explored how adolescents with T2DM experience and perceive social support. METHODS Adolescents with T2DM were interviewed, and data were qualitatively analyzed using Consensual Qualitative Research methodology. RESULTS Four themes emerged: support for nondiabetes and diabetes-specific behaviors, feelings of belonging, and disclosure. All participants expressed emotional and self-care-specific support. For some, disclosure and a sense of belonging with others who had diabetes often led to support elicitation. Participants also expressed a fear of disclosing their diabetes to others. DISCUSSION Adolescents with T2DM value tangible and emotional support for behaviors both related and not related to diabetes. Fear of disclosure was a typical experience with disclosure often limited to close friends and family. Recommendations for health professionals to assist adolescents in promoting appropriate disclosure and means of requesting support are discussed.
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27
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Rhodes ET, Prosser LA, Lieu TA, Songer TJ, Ludwig DS, Laffel LM. Preferences for type 2 diabetes health states among adolescents with or at risk of type 2 diabetes mellitus. Pediatr Diabetes 2011; 12:724-32. [PMID: 21489091 PMCID: PMC4793716 DOI: 10.1111/j.1399-5448.2011.00772.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We evaluated how adolescents with or at risk of type 2 diabetes (T2DM) and their parent/guardians (parents) value health states associated with T2DM. METHODS We interviewed overweight/obese [Body Mass Index (BMI) ≥ 85th percentile], 12-18-yr old adolescents with T2DM, prediabetes, or insulin resistance (IR) and a parent. The standard gamble (SG) method elicited preferences (utilities) for seven hypothetical T2DM health states reported on a scale from 0 (dead) to 1 (perfect health). Adolescent's current health was evaluated with the SG and Health Utilities Index (HUI). RESULTS There were 70 adolescents and 69 parents. Adolescents were 67.1% female and 15.5 ± 2.2 yr old; 30% had T2DM, 30% prediabetes, and 40% IR. Almost half (48.6%) had a BMI > 99th percentile. Parents (83% mothers) were 45.1 ± 7.3 yr old and 75% had at least some college/technical school education. Adolescents and parents rated T2DM with no complications treated with diet as most desirable [median (IQR); adolescent 0.72 (0.54, 0.98); parent 1.0 (0.88, 1.0)] and end-stage renal disease as least desirable [adolescent 0.51 (0.31, 0.70); parent 0.80 (0.65, 0.94)]. However, adolescents' utilities were significantly lower (p ≤ 0.001) than parents for all health states assessed. Adolescents' assessments of their current health with the SG and HUI were not correlated. CONCLUSIONS Adolescents with or at risk of T2DM rated treatments and sequelae of diabetes as significantly worse than their parents. These adolescent utilities should be considered in the evaluation of treatment strategies for youth with T2DM. Family-based programs for T2DM must also be prepared to address conflicting preferences in order to promote shared decision-making.
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Affiliation(s)
- Erinn T. Rhodes
- Division of Endocrinology, Children’s Hospital Boston, Boston, MA, USA, 02115,Department of Pediatrics, Harvard Medical School, Boston, MA, USA, 02115
| | - Lisa A. Prosser
- Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA, 48109,Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA, 02215
| | - Tracy A. Lieu
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA, 02215,Division of General Pediatrics, Children’s Hospital Boston, Boston, MA, USA, 02115
| | - Thomas J. Songer
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA, 15261
| | - David S. Ludwig
- Division of Endocrinology, Children’s Hospital Boston, Boston, MA, USA, 02115,Department of Pediatrics, Harvard Medical School, Boston, MA, USA, 02115
| | - Lori M. Laffel
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA, 02115,Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA, 02215
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Hofman P, Lilleøre SK, Ter-Borch G. Needle with a novel attachment versus conventional screw-thread needles: a preference and ease-of-use test among children and adolescents with diabetes. J Diabetes Sci Technol 2011; 5:1480-7. [PMID: 22226269 PMCID: PMC3262718 DOI: 10.1177/193229681100500623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This usability test investigated the overall preference and usability of the novel NovoTwist® insulin pen needle versus conventional screw-thread needles, when used with Next Generation FlexPen®, in children and adolescents with diabetes. METHODS This was an open-label, randomized, crossover usability test in children and adolescents with type 1 diabetes who administered insulin with an insulin pen. Test needles were NovoTwist and the participant's current screw-thread needle (or NovoFine® needle). Following instruction, participants attached the needle to Next Generation FlexPen, made an injection into a foam cushion, and detached the needle. This procedure was conducted three times with both needles in a random order. Responses to 13 questions on user experience with each needle (including overall preference, ease of attachment/detachment of needle/cap, handling, learning, confidence in attachment, and convenience of use) were subsequently recorded on a six-point rating scale (1 = very difficult; 6 = very easy). RESULTS Fifteen children aged ≥ 6 to ≤ 12 years and 15 adolescents aged ≥ 13 to ≤ 17 years participated in the test. A significantly higher proportion of children and adolescents (77%) indicated that they would prefer to use NovoTwist compared with screw-thread needles (p = .005). NovoTwist was preferred by most children and adolescents for overall ease of use (77%; p = .005), for ease of attachment (87%; p < .001) and detachment (83%; p < .001), and as the most appropriate needle to handle for daily injections (73%; p = .016). The mean rating for confidence in correct needle attachment was not significantly different between the two needle types. Seven out of eight parents of children who required assistance for their daily insulin injections stated that they would be "very likely" to allow their child to attach NovoTwist. CONCLUSIONS These factors may promote confidence in this needle, and thus in self-injecting, among younger patients and their parents.
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Affiliation(s)
- Paul Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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Mulvaney SA, Hood KK, Schlundt DG, Osborn CY, Johnson KB, Rothman RL, Wallston KA. Development and initial validation of the barriers to diabetes adherence measure for adolescents. Diabetes Res Clin Pract 2011; 94:77-83. [PMID: 21737172 PMCID: PMC3200487 DOI: 10.1016/j.diabres.2011.06.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 06/07/2011] [Accepted: 06/09/2011] [Indexed: 10/18/2022]
Abstract
AIMS The purpose of this study was to develop a measure of psychosocial barriers to adherence in adolescents with type 1 diabetes (T1D) and examine relationships to patient characteristics, adherence, and hemoglobin A1C (A1C). METHODS Barriers to diabetes adherence (BDA) items were generated by researchers, clinicians, and patients. Adolescents aged 12-17 with T1D completed the BDA and an adherence measure. Hemoglobin A1C was obtained through medical chart review. RESULTS Factor analysis from 123 adolescents resulted in a 21-item, five-component solution that accounted for 64.5% of the variance. The components were stress and burnout, time pressure and planning, social support, parental autonomy support, and stigma. The BDA total and subscales were internally consistent. The BDA total and some components were associated with adherence and A1C. The BDA was the only predictor of A1C compared to demographic, clinical, and adherence variables (F 6.17, p<.05). Subjects with higher A1C (>8.5) showed a higher level of barriers (F 15.20, p<.001) and a differential profile of barriers (F 5.75, p<.05). CONCLUSIONS The BDA may be useful in research and clinical settings as a compliment to adherence measures and to tailor educational programs. Additional research is necessary to establish test-retest reliability and discriminant validity.
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Affiliation(s)
- Shelagh A Mulvaney
- Vanderbilt University Medical Center, School of Nursing, Nashville, TN 37240, USA.
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Lindsay S, Kingsnorth S, Hamdani Y. Barriers and facilitators of chronic illness self-management among adolescents: a review and future directions. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1752-9824.2011.01090.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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31
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Chudyk A, Shapiro S, Russell-Minda E, Petrella R. Self-monitoring technologies for type 2 diabetes and the prevention of cardiovascular complications: perspectives from end users. J Diabetes Sci Technol 2011; 5:394-401. [PMID: 21527111 PMCID: PMC3125934 DOI: 10.1177/193229681100500229] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objective of this study was to explore facilitators and barriers to the adoption of self-monitoring devices in individuals with type 2 diabetes mellitus (T2DM). METHODS Individuals with T2DM who were currently using one or more devices to monitor their disease participated in focus groups. Transcripts of focus group meetings were coded into themes by two reviewers using NVivo qualitative software. RESULTS Twenty-eight adults with T2DM reported using a blood glucose meter, and almost half reported monitoring their blood pressure. Few individuals consistently monitored other aspects of their cardiovascular health. Four major themes impacting device use/disuse were identified: knowledge gaps, relationships with health care providers, environment, and personal experience. Knowledge barriers included lack of information regarding diabetes and the associated risk of complications. Perceptions of inconvenience, pain, and financial restrictions were important factors influencing the adoption, use, and abandonment of self-monitoring devices. Community-run programs, as well as dieticians and pharmacists, were identified as important resources for accessing information related to T2DM. CONCLUSIONS We identified the need for development of accessible and relevant education material; improved communication of disease-specific information between patients and providers, as well as providers and community resources; and strategies to improve the convenience and cost of monitoring devices.
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Affiliation(s)
- Anna Chudyk
- Aging, Rehabilitation, and Geriatric Care Research Centre, The Lawson Health Research Institute, Parkwood Hospital, London, Ontario, Canada
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Ruhayel SD, James RA, Ehtisham S, Cameron FJ, Werther GA, Sabin MA. An observational study of type 2 diabetes within a large Australian tertiary hospital pediatric diabetes service. Pediatr Diabetes 2010; 11:544-51. [PMID: 20337972 DOI: 10.1111/j.1399-5448.2010.00647.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is emerging as a significant clinical problem within the pediatric population. OBJECTIVE The objective of this study was to identify patients with T2DM in a large tertiary hospital diabetes service and examine aspects relating to clinical course and management. METHODS An initial audit of our diabetes service (over 6 yr) was followed by a 2-yr period of prospective case ascertainment to identify patients with T2DM. Comprehensive data collection was then undertaken in these individuals. RESULTS Within our service (n = 1574), 33 young people with T2DM were identified. Significant levels of co-morbidity were evident - dyslipidaemia (56%), microalbuminuria (45%), hypertension (30%) and abnormal retinal findings (25%). Hypertension was more likely in those with greater initial and follow-up body mass index (BMI) [mean (SD) BMI: 36.3 (5.0) vs. 28.0 (6.3) kg/m(2) , p = 0.001, and 36.8 (5.3) vs. 28.5 (7.8) kg/m(2) , p = 0.007, respectively] and BMI standard deviation score (SDS) [mean (SD) BMI SDS: 2.34 (0.30) vs. 1.72 (0.66), p = 0.001, and 2.26 (0.31) vs. 1.38 (0.87), p < 0.001, respectively], whereas abnormal retinal findings were seen in those with higher HbA1c values at last appointment [geometric mean (range) 10.9 (8.4-13.6) vs. 7.4 (5.6-12.5)%, p = 0.01) and those with greater increases in HbA1c over time (+4.1 (3.1) vs. +0.2 (1.9)%, p = 0.009). Of the 33,9 (27%) were lost to follow-up. CONCLUSIONS At present, T2DM in youth remains a low burden on our services. Patients with this diagnosis, however, have significant problems that present a major challenge to the development of effective management strategies.
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Affiliation(s)
- Sandra D Ruhayel
- Department of Endocrinology and Diabetes at the Royal Children's Hospital, Parkville, Victoria, Australia
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Bowen ME, Rothman RL. Multidisciplinary management of type 2 diabetes in children and adolescents. J Multidiscip Healthc 2010; 3:113-24. [PMID: 21197360 PMCID: PMC3004606 DOI: 10.2147/jmdh.s7840] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Indexed: 12/16/2022] Open
Abstract
Although once considered a disease of adults, the prevalence of type 2 diabetes in youth is increasing at a significant rate. Similar to adults, youth with type 2 diabetes are at increased risk for developing hypertension, lipid abnormalities, renal disease, and other diabetes-related complications. However, children and adolescents with type 2 diabetes also face many unique management challenges that are different from adults with type 2 diabetes or children with type 1 diabetes. To deliver safe, effective, high-quality, cost-effective health care to adolescents with type 2 diabetes, reorganization and redesign of health care systems are needed. Multidisciplinary health care teams, which allow individuals with specialized training to maximally utilize their skills within an organized diabetes treatment team, may increase efficiency and effectiveness and may improve outcomes in children with type 2 diabetes. This review article provides a brief review of type 2 diabetes in children and adolescents, provides an overview of multidisciplinary health care teams, and discusses the role of multidisciplinary health care management in youth with type 2 diabetes.
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Affiliation(s)
- Michael E Bowen
- Veterans Affairs Quality Scholars Fellowship Program, Tennessee Valley Healthcare System, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, TN, USA
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Auslander WF, Sterzing PR, Zayas LE, White NH. Psychosocial resources and barriers to self-management in African American adolescents with type 2 diabetes: a qualitative analysis. THE DIABETES EDUCATOR 2010; 36:613-22. [PMID: 20479133 DOI: 10.1177/0145721710369706] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this qualitative study was to identify psychosocial resources and barriers to self-management among African American adolescents with type 2 diabetes and their mothers. METHODS African American adolescents (n = 10) aged 14 to 19 years old with type 2 diabetes for >1 year and their mothers (n = 10) were recruited from the pediatric diabetes clinic of a large medical center practice. Participants were independently interviewed and responded to a series of open-ended questions concerning illness experiences and resources and barriers to diabetes self-management. This study used a modified grounded theory approach to data coding and analysis. RESULTS Adolescents and mothers shared similar perceptions of resources and barriers to self-management. Resources included mother's role as the primary support person, emergence of greater self-efficacy and coping over time, family recognition of the seriousness of diabetes, and the presence of supportive peers. Barriers included comorbidity, dietary and other regimen challenges, negative peer influences, and financial problems. CONCLUSIONS Resources and barriers identified in this study represent the multiple contexts that influence type 2 diabetes (eg, individual, family, peer, economic, and cultural).
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Affiliation(s)
- Wendy F Auslander
- George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Dr Auslander, Mr Sterzing)
| | - Paul R Sterzing
- George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Dr Auslander, Mr Sterzing)
| | - Luis E Zayas
- School of Social Work, Arizona State University, Phoenix, Arizona (Dr Zayas)
| | - Neil H White
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (Dr White)
- St Louis Children’s Hospital, St Louis, Missouri (Dr White)
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Jaser SS. Psychological problems in adolescents with diabetes. ADOLESCENT MEDICINE: STATE OF THE ART REVIEWS 2010; 21:138-xi. [PMID: 20568561 PMCID: PMC3721971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
For youth with type 1 diabetes (T1DM), the transition into adolescence is often associated with poorer adherence to treatment, deteriorating metabolic control, and increased risk for psychological disorders. The current article summarizes recent findings on psychological problems for adolescents with diabetes, including depression, eating disorders, fear of hypoglycemia, and problems specific to adolescents with T2DM. The impact of family functioning on adolescent adjustment and the importance of parent-child collaboration on treatment management is emphasized. By using the strategies described in this article, primary care providers have the potential to support adolescents with diabetes, while screening for problems that may be better treated by other professionals.
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Affiliation(s)
- Sarah S Jaser
- Yale University School of Nursing, 100 Church Street South, PO Box 9740, New Haven, CT 06536, USA.
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Mcgrath C, Rofail D, Gargon E, Abetz L. Using qualitative methods to inform the trade-off between content validity and consistency in utility assessment: the example of type 2 diabetes and Alzheimer's disease. Health Qual Life Outcomes 2010; 8:23. [PMID: 20152041 PMCID: PMC2844366 DOI: 10.1186/1477-7525-8-23] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 02/12/2010] [Indexed: 05/17/2024] Open
Abstract
BACKGROUND Key stakeholders regard generic utility instruments as suitable tools to inform health technology assessment decision-making regarding allocation of resources across competing interventions. These instruments require a 'descriptor', a 'valuation' and a 'perspective' of the economic evaluation. There are various approaches that can be taken for each of these, offering a potential lack of consistency between instruments (a basic requirement for comparisons across diseases). The 'reference method' has been proposed as a way to address the limitations of the Quality-Adjusted Life Year (QALY). However, the degree to which generic measures can assess patients' specific experiences with their disease would remain unresolved. This has been neglected in the discussions on methods development and its impact on the QALY values obtained and resulting cost per QALY estimate underestimated. This study explored the content of utility instruments relevant to type 2 diabetes and Alzheimer's disease (AD) as examples, and the role of qualitative research in informing the trade-off between content coverage and consistency. METHOD A literature review was performed to identify qualitative and quantitative studies regarding patients' experiences with type 2 diabetes or AD, and associated treatments. Conceptual models for each indication were developed. Generic- and disease-specific instruments were mapped to the conceptual models. RESULTS Findings showed that published descriptions of relevant concepts important to patients with type 2 diabetes or AD are available for consideration in deciding on the most comprehensive approach to utility assessment. While the 15-dimensional health related quality of life measure (15D) seemed the most comprehensive measure for both diseases, the Health Utilities Index 3 (HUI 3) seemed to have the least coverage for type 2 diabetes and the EuroQol-5 Dimensions (EQ-5D) for AD. Furthermore, some of the utility instruments contained items that could not be mapped onto either of the proposed conceptual models. CONCLUSIONS Content of the utility measure has a significant impact on the treatment effects that can be observed. This varies from one disease to the next and as such contributes to lack of consistency in observable utility effects and incremental utility scores. This observation appears to have been omitted from the method development considerations such as reference methods. As a result, we recommend that patients' perspectives obtained via qualitative methods are taken into consideration in the ongoing methods development in health state descriptions for generic utility instruments. Also, as a more immediate contribution to improving decision making, we propose that a content map of the chosen utility measure with patient-reported domains be provided as standard reporting in utility measurement in order to improve the transparency of the trade-offs in relation to patient relevance and consistency.
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Affiliation(s)
- Clare Mcgrath
- Health Technology Assessment Policy, Medical Division, Worldwide Pharmaceutical Operations, 3-1-60 Walton Oaks, Tadworth, Surrey KT20 7NS, UK
| | - Diana Rofail
- Mapi Values, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
| | - Elizabeth Gargon
- Mapi Values, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
| | - Linda Abetz
- Mapi Values, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
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Abstract
Little published research exists on psychosocial issues in adolescents with type 2 diabetes mellitus (T2DM), because until two decades ago, diabetes diagnosed in children and adolescents was almost exclusively type 1 diabetes mellitus or insulin-dependent diabetes. In the past two decades, rates of T2DM have increased, especially in adolescents from families of minority racial and ethnic groups. Youth with T2DM are most often obese, have a parent or other first-degree relative with T2DM, and are of low socioeconomic status. To understand the complex set of interrelated psychological and social influences that affect the well-being of youth with T2DM, levels of influence from determinants of genetics, family, and community/societal and minority ethnic groups must be included.
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Current literature in diabetes. Diabetes Metab Res Rev 2009; 25:i-x. [PMID: 19219862 DOI: 10.1002/dmrr.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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LeClair CA, Marquis M, Villalon L, Strychar I. Healthy Adolescents' Social Representations of Diabetes. Can J Diabetes 2009; 33:170-9. [DOI: 10.1016/s1499-2671(09)33008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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