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Pabedinskas KL, Courtney J, Barrowman N, Zankar S, Richardson C, Stevens L, Goldbloom EB, Lawrence SE, Zuijdwijk C, Lawson ML, Robinson ME, Dover S, Ahmet A. Implementation and evaluation of a longitudinal diabetes educational programme for adolescents. BMJ Open Qual 2023; 12:e002361. [PMID: 37507143 PMCID: PMC10387648 DOI: 10.1136/bmjoq-2023-002361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION International guidelines recommend structured and continuous educational programmes to expand diabetes knowledge and self-efficacy in youth. To address these recommendations within a paediatric diabetes clinic, we conducted a three-phase quality improvement project aimed at improving adolescents' confidence in diabetes self-management skills. METHODS In phase 1, the Diabetes Learning Centre (DLC), an educational programme for adolescents with type 1 diabetes (T1D) ages 13-17 years, was developed and implemented. Programme feasibility was evaluated through programme attendance rates. Phase 2 aimed to guide ongoing programme development and optimisation. DLC attendees rated their baseline confidence in overall and individual T1D self-management skills on a 5-point Likert scale. Patient characteristics were summarised using descriptive statistics and the association between patient characteristics and overall confidence in T1D self-management was evaluated. Phase 3 used patient surveys to evaluate patient satisfaction and reported change in confidence in self-management skills following DLC attendance. RESULTS In phase 1, 232 (81%) of eligible adolescents attended the DLC during the study period. In phase 2, median overall confidence in diabetes management on a Likert scale (0-4) was 3, representing 'quite confident', although confidence was low in some essential self-management skills. Higher confidence was associated with lower HbA1c (p<0.001). In phase 3, 77 (85%) of participants reported high levels of satisfaction with the DLC. 106 (82%) of completed worksheets were associated with improved confidence in the diabetes self-management skill addressed. CONCLUSIONS Implementation of a longitudinal T1D educational model was feasible with good uptake in an existing T1D programme. While confidence at baseline was quite high for overall T1D self-management, it was low in some essential self-management skills, highlighting the need for this programme and specific educational gaps. Adolescents reported improvements in confidence and high levels of satisfaction following DLC attendance. Our model provides a replicable programme template to address longitudinal education needs.
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Affiliation(s)
| | - Jennilea Courtney
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nicholas Barrowman
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Sarah Zankar
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Richardson
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Liz Stevens
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ellen B Goldbloom
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sarah E Lawrence
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Caroline Zuijdwijk
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Margaret L Lawson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Marie-Eve Robinson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Saunya Dover
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Alexandra Ahmet
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Corathers S, Williford DN, Kichler J, Smith L, Ospelt E, Rompicherla S, Roberts A, Prahalad P, Basina M, Muñoz C, Ebekozien O. Implementation of Psychosocial Screening into Diabetes Clinics: Experience from the Type 1 Diabetes Exchange Quality Improvement Network. Curr Diab Rep 2023; 23:19-28. [PMID: 36538250 PMCID: PMC9763798 DOI: 10.1007/s11892-022-01497-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Although advances in diabetes technology and pharmacology have significantly and positively impacted diabetes management and health outcomes for some, diabetes care remains burdensome and can be challenging to balance with other life priorities. The purpose of this article is to review the rationale for assessment of psychosocial domains in diabetes care settings and strategies for the implementation of psychosocial screening into routine practice. Survey data from the Type 1 Diabetes Exchange Quality Improvement Network is highlighted. RECENT FINDINGS Implementation of psychosocial screening requires identifying the population; selecting validated tools to assess target domains; determining frequency of screening and mode of survey delivery; and scoring, interpreting, documenting, and facilitating referrals such that these processes are part of clinical workflows. Recognizing the influence of psychosocial factors for people with diabetes (PWD), professional society guidelines for comprehensive diabetes care recommend the integration of psychosocial screening into routine care.
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Affiliation(s)
- Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Desireé N Williford
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Laura Smith
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | - Priya Prahalad
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marina Basina
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cynthia Muñoz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA, USA
- University of Mississippi School of Population Health, Jackson, MS, USA
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Nagendran S, Patel N, Turner PJ. Oral immunotherapy for food allergy in children: is it worth it? Expert Rev Clin Immunol 2022; 18:363-376. [PMID: 35285356 DOI: 10.1080/1744666x.2022.2053675] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Oral immunotherapy (OIT) is effective at inducing desensitization in food-allergic individuals, and is a valid therapeutic option for those allergic to peanut, cow's milk and egg. However, there is a high rate of dose-related adverse events, and at least one fatality to OIT has been reported. AREAS COVERED We provide an update on the broader framework of issues which will impact on the availability and uptake of OIT. EXPERT OPINION The need for standardized products remains controversial. A licensed product exists for peanut-OIT, but OIT can also be safely achieved using peanut-containing foods at much lower cost. For other allergens, OIT can only be done with non-pharma products - something which has been done safely for over 2 decades. There is a need to develop personalized protocols for OIT, particularly for the 20% of patients unable to tolerate standard OIT. Cost-effectiveness is dependent on improved quality of life, but evidence for this is currently lacking, and is a key evidence gap. OIT is likely to be cost-effective, particularly if noncommercial products are used. There may be a trade-off: in patients with lower reaction thresholds, a commercial product may be needed for initial updosing, until a level of desensitization is achieved when they can be switched to natural food products.
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Affiliation(s)
| | - Nandinee Patel
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, UK
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Burrell S, Patel N, Vazquez-Ortiz M, Campbell DE, DunnGalvin A, Turner PJ. Self-administration of adrenaline for anaphylaxis during in-hospital food challenges improves health-related quality of life. Arch Dis Child 2021; 106:558-563. [PMID: 32948514 PMCID: PMC8142442 DOI: 10.1136/archdischild-2020-319906] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the impact of anaphylaxis on health-related quality of life (HRQL) and self-efficacy in food-allergic patients undergoing in-hospital food challenge. DESIGN Secondary analysis of a randomised controlled trial. SETTING Specialist allergy centre. PATIENTS Peanut-allergic young people aged 8-16 years. INTERVENTIONS Double-blind, placebo-controlled food challenge to peanut, with HRQL and self-efficacy assessed using validated questionnaire, approximately 2 weeks prior to and 2 weeks after challenge. Where possible, anaphylaxis was treated with self-injected adrenaline (epinephrine). MAIN OUTCOME MEASURES Change in HRQL and self-efficacy. RESULTS 56 participants had reactions at food challenge, of whom 16 (29%) had anaphylaxis. Overall, there was an improvement in HRQL (mean 2.6 points (95% CI 0.3 to 4.8); p=0.030) and self-efficacy (mean 4.1 points (95% CI 2.4 to 5.9); p<0.0001), independent of whether anaphylaxis occurred. Parents also reported improved HRQL (mean 10.3 points (95% CI 5.9 to 14.7); p<0.0001). We found evidence of discordance between the improvement in HRQL and self-efficacy as reported by young people and that perceived by parents in their child. CONCLUSIONS Anaphylaxis at food challenge, followed by self-administration of injected adrenaline, was associated with an increase in HRQL and self-efficacy in young people with peanut allergy. We found no evidence that the occurrence of anaphylaxis had a detrimental effect. Young people should be encouraged to self-administer adrenaline using their autoinjector device to treat anaphylaxis at in-hospital challenge. TRIAL REGISTRATION NUMBER NCT02149719.
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Affiliation(s)
- Sarah Burrell
- Section of Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, UK
| | - Nandinee Patel
- Section of Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, UK
| | - Marta Vazquez-Ortiz
- Section of Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, UK
| | - Dianne E. Campbell
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Audrey DunnGalvin
- School of Applied Psychology, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Paul J. Turner
- Section of Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, UK,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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Hershey JA, Morone J, Lipman TH, Hawkes CP. Social Determinants of Health, Goals and Outcomes in High-Risk Children With Type 1 Diabetes. Can J Diabetes 2021; 45:444-450.e1. [PMID: 33863638 DOI: 10.1016/j.jcjd.2021.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Despite advances in technology and type 1 diabetes (T1D) care, children from low-income families continue to have suboptimal outcomes and increased health-care utilization. In this study, we describe social determinants of health (SDOH) in high-risk children with T1D, as well as their SDOH-related priority goals, and assess the correlation between SDOH, glycemic control and health-care utilization. METHODS Caregivers of children aged 4 to 18 years with a diagnosis of T1D of >1 year, poor glycemic control (glycated hemoglobin [A1C] ≥9.5%) or high health-care utilization (≥2 diabetes-related hospitalizations, emergency department attendances or missed outpatient appointments in the previous year) were included. Primary caregiver health-related quality of life (HRQOL), self-efficacy (Maternal Self-Efficacy in Diabetes [MSED] scale) and SDOH were assessed. Goals were identified after assessment by a community health worker. RESULTS Fifty-three families were included, most (n=48, 91%) of whom had government insurance. Children had a median age of 13.4 (interquartile range [IQR], 12 to 15.3) years and a median A1C of 11.1% (IQR, 10% to 13%). Almost half of the families (n=24, 45%) reported at least 1 adverse SDOH. One or more adverse SDOH was associated with significantly lower total HRQOL scores (56.6 [IQR, 38.5 to 70.7] vs 77.8 [IQR, 60.8 to 92.4], p=0.004), but not associated with A1C (p=0.3), emergency department visits (p=0.9) or MSED (p=0.5). CONCLUSIONS Screening for adverse SDOH and addressing these barriers to glycemic control is not part of routine T1D care. In children with poorly controlled T1D and high health-care utilization, we have demonstrated a high prevalence of adverse SDOH, which may represent a modifiable factor to improve outcomes in this patient population.
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Affiliation(s)
- Jennifer A Hershey
- Department of Social Work, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Jennifer Morone
- Yale University School of Medicine, New Haven, Connecticut, United States; Veterans Affairs Office of Academic Affiliations, West Haven, Connecticut, United States
| | - Terri H Lipman
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States; Department of Pediatrics and Child Health, University College Cork, Cork, Ireland.
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Otis M, Zhu J, Mustafa-Kutana SN, Bernier AV, Ma Shum J, Soros Dupre AA, Wang ML. Testing Usability and Feasibility of a Mobile Educator Tool for Pediatric Diabetes Self-Management: Mixed Methods Pilot Study. JMIR Form Res 2020; 4:e16262. [PMID: 32356773 PMCID: PMC7229529 DOI: 10.2196/16262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/02/2019] [Accepted: 02/10/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mobile interventions hold promise as an intervention modality to engage children in improving diabetes self-management education, attitudes, and behaviors. OBJECTIVE This pilot study aimed to explore the usability, acceptability, and feasibility of delivering a mobile diabetes educational tool to parent-child pairs in a clinical setting. METHODS This mixed methods pilot study comprised two concurrent phases with differing study participants. Phase 1 used user testing interviews to collect qualitative data on the usability and acceptability of the tool. Phase 2 used a single-arm pre- and poststudy design to quantitatively evaluate the feasibility and preliminary efficacy of the intervention. Study participants (English-speaking families with youth aged 5-14 years with insulin-dependent diabetes) were recruited from an urban hospital in Massachusetts, United States. In phase 1, parent-child pairs were invited to complete the intervention together and participate in 90-min user testing interviews assessing the tool's usability and acceptability. Interview transcripts were analyzed using a directed content analysis approach. In phase 2, parent-child pairs were invited to complete the intervention together in the clinical setting. Measures included parental and child knowledge, attitudes, and behaviors related to diabetes management (self-report surveys) and child hemoglobin A1c levels (medical record extractions); data were collected at baseline and 1-month follow-up. Pre- and postoutcomes were compared using paired t tests and the Fisher exact test. RESULTS A total of 11 parent-child pairs (N=22) participated in phase 1 of the study, and 10 parent-child pairs (N=20) participated in phase 2 of the study. Participants viewed the mobile educational tool as acceptable (high engagement and satisfaction with the layout, activities, and videos) and identified the areas of improvement for tool usability (duration, directions, and animation). CONCLUSIONS The findings from this pilot study suggest that the mobile educational tool is an informative, engaging, and feasible way to deliver diabetes self-management education to parents and children in an urban hospital setting. Data will inform future iterations of this mobile diabetes educational intervention to improve usability and test intervention efficacy.
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Affiliation(s)
- Marisa Otis
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Jack Zhu
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Suleiman N Mustafa-Kutana
- Division of Pediatric Endocrinology and Metabolism, Boston Medical Center, Boston, MA, United States
| | - Angelina V Bernier
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL, United States
| | - Julio Ma Shum
- Division of Pediatric Endocrinology and Metabolism, Boston Medical Center, Boston, MA, United States
| | - Arlette A Soros Dupre
- Division of Pediatric Endocrinology and Metabolism, Boston Medical Center, Boston, MA, United States
| | - Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
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Sethe D, Büssing A, Hilgard D, Berger B. [Validation of the German Version of Pediatric Self-Efficacy for Diabetes-Type-1 Scale]. Psychother Psychosom Med Psychol 2020; 70:349-357. [PMID: 32069510 DOI: 10.1055/a-1088-1316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Since there is no suitable tool for measuring the specific, diabetes-related self-efficacy in children with type-1-diabetes in German language, this paper presents the construction and validation of Pediatric Self-Efficacy for Diabetes-Type-1 Scale (PSEDT-1). The intention was to develop a guideline-compliant, pediatric, revised self-efficacy scale on the basis of Grossman, Brink and Hauser̓s SED. DESIGN Children with type 1 diabetes (N=221) were included in a clinical, multi-centre validation study. To assess sensitivity to change, 85 of these children were asked to complete the PSEDT-1 before, immediately after, and 6 months after inpatient diabetes training. PSEDT-1 has been associated with scales that measure constructs that are similar and different in terms of content. The interpretation of the correlation results should provide information on validity. The PSEDT-1 was thus reviewed using the German Multidimensional Self-Assessment Scale (MSWS), the German questionnaire on health and illness-related control beliefs (KKG). RESULTS The reliability results showed a good internal consistency with Cronbach's α=0,87; the discriminatory power of the items was acceptable. Exploratory factor analysis identified 4 factors that account for 54% of the variance: 1) diabetes self-management skill, 2) (medical) insulin management competence, 3) (general) self-assertiveness, 4) autonomous self-regulation. The construct validity of PSEDT-1 has been evaluated by estimating its association with other variables. It was possible to verify the theoretically expected correlation patterns. In addition, the study results showed indications of sufficiently high sensitivity to change. DISCUSSION The results suggest that PSEDT-1 is a valid and reliable tool that, in addition to the scale values of the competence areas of diabetes self-management, medical management, and general self-assertion, also determines the scale value of autonomous self-regulation to assess diabetes-related self-efficacy.
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Affiliation(s)
- Dominik Sethe
- Department für Humanmedizin, Universität Witten/Herdecke Fakultät für Gesundheit, Witten
| | - Arndt Büssing
- Department für Humanmedizin, Universität Witten/Herdecke Fakultät für Gesundheit, Witten
| | | | - Bettina Berger
- Department für Humanmedizin, Universität Witten/Herdecke Fakultät für Gesundheit, Witten
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Van Allen J, Noser AE, Littlefield AK, Seegan PL, Clements M, Patton SR. Measuring Self-Efficacy in the Context of Pediatric Diabetes Management: Psychometric Properties of the Self-Efficacy for Diabetes Scale. J Pediatr Psychol 2019; 43:143-151. [PMID: 29106615 DOI: 10.1093/jpepsy/jsx094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/02/2017] [Indexed: 11/12/2022] Open
Abstract
Objective The Self-Efficacy for Diabetes Scale (SED) is a widely used measure of diabetes-specific self-efficacy with three subscales: diabetes-specific self-efficacy (SED-D), medical self-efficacy (SED-M), and general self-efficacy (SED-G). The present study examined the factor structure and construct validity of the SED in 116 youth, aged 10-16 years (13.60 ± 1.87), with type 1 diabetes mellitus. Methods Confirmatory factor analysis (CFA) was used to examine the factor structure of the SED. Correlational and regression analyses examined relations between subscales and select outcomes. Results CFA of the original three-factor structure provided a poor fit to the data. Factor models using rescaled items were tested. Results provided preliminary evidence for the SED-D as an independent one-factor model, and for a reduced one-factor model. Significant associations were found between the SED subscales, responsibility for diabetes management, and glycated hemoglobin. Conclusions Results provide limited support for the SED-D as a reliable and valid measure of diabetes-specific self-efficacy.
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Affiliation(s)
- Jason Van Allen
- Clinical Psychology Program, Department of Psychological Sciences, Texas Tech University
| | - Amy E Noser
- Clinical Child Psychology Program, University of Kansas
| | - Andrew K Littlefield
- Clinical Psychology Program, Department of Psychological Sciences, Texas Tech University
| | - Paige L Seegan
- Clinical Psychology Program, Department of Psychological Sciences, Texas Tech University
| | - Mark Clements
- Division of Endocrinology & Diabetes, Department of Pediatrics, Children's Mercy Hospital
| | - Susana R Patton
- Department of Pediatrics, University of Kansas Medical Center
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Mangla P, Chopra A, Sudhanshu S, Bhatia E, Dabadghao P, Gupta S, Bhatia V. Validation of a diabetes knowledge test for Indian children, adolescents and young adults with type 1 diabetes mellitus. Prim Care Diabetes 2019; 13:283-287. [PMID: 30581070 DOI: 10.1016/j.pcd.2018.12.001] [Citation(s) in RCA: 2] [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] [Received: 04/22/2018] [Revised: 11/29/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Diabetes knowledge has a large impact on glycemic control. There is a pressing need for creation of validated tests of knowledge for different ethnic groups. OBJECTIVE To create and validate a diabetes knowledge test (DKT) for young Indians with type 1 diabetes mellitus (T1DM). METHODS We created a 34 item Hindi language DKT, with basic (19-questions) and advanced (15-questions) components. It was administered to 77 consecutive patients who had previously received in-hospital diabetes education. We hypothesized that the test scores would be higher for patients residing in urban regions, for patients with higher maternal education, and those with lower HbA1c. Cronbach's alpha (α) was used to calculate the test reliability. RESULTS The DKT score was significantly higher in families with higher (>class 12th) maternal formal education compared with lower [70.0 (95% C.I. 67.2-73.5) vs 54.2 (95% C.I. 44.0-57.3), p<0.001] and urban residence compared with rural [68.5 (95% C.I. 63.4-70.6) vs 54.5 (95% C.I. 42.5-61.7), p<0.001]. It had negative correlation with HbA1c (r=-0.268, p=0.019). The Cronbach's α was 0.87 for the entire test, and for the basic and advanced components was 0.78 and 0.74 respectively. CONCLUSION The DKT India is a valid and reliable instrument to evaluate diabetes knowledge in Hindi speaking Indian children, adolescents and young adults with T1DM.
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Affiliation(s)
- Pragya Mangla
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Aditi Chopra
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Siddhnath Sudhanshu
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Eesh Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Suchit Gupta
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Vijayalakshmi Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India.
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Psychometric properties of the Escala de Autoeficacia para la Depresión en Adolescentes (EADA) among Latino youth with type 1 diabetes. Diabetol Int 2019; 10:126-137. [PMID: 31139531 DOI: 10.1007/s13340-018-0378-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
Type 1 Diabetes (T1D) adolescents have higher depression rates than controls. Self-efficacy has been proposed as a mediator of therapeutic changes. Few scales assess emotional self-efficacy in adolescents. None have been validated with T1D youth. We examined the psychometric properties of the Escala de Autoeficacia para la Depresión en Adolescentes (EADA) with 51 T1D youth (aged 12-17 years), enrolled in a depression treatment study. Adolescents and one parent each completed several measures. Youth completed the EADA. We used alpha coefficient to estimate its internal consistency and Pearson correlation to assess its concurrent and construct validity. We found an internal consistency of 0.93 for the EADA total score, with alpha values ranging from 0.71 to 0.85 for its subscales. EADA scores significantly (p ≤ 0.05) diverged from self-reports of depression, hopelessness/helplessness, suicidal ideation, self-esteem/guilt problems, depression-related cognitive alterations, hypoglycemic symptoms, and problems in quality of life. Its scores converged with youth's life satisfaction, self-efficacy for diabetes, self-care behaviors, and perceptions about the quality of group therapy climate and family social support. Our findings document EADA's reliability and validity when used with T1D youth and extend the supporting evidence on its psychometric properties to a clinical sample of Latino adolescents.
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Lacomba-Trejo L, Valero-Moreno S, Casaña-Granell S, Prado-Gascó VJ, Pérez-Marín M, Montoya-Castilla I. Questionnaire on adaptation to type 1 diabetes among children and its relationship to psychological disorders. Rev Lat Am Enfermagem 2018; 26:e3088. [PMID: 30462792 PMCID: PMC6248801 DOI: 10.1590/1518-8345.2759.3088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022] Open
Abstract
Objective: to study the psychometric properties of an adaptive disease response
questionnaire for use with Spanish children with type 1 diabetes; to analyse
this response in this sample and to observe the relationship between
adaptive response and levels of anxiety-depression. Method: a total of 100 patients with type 1 diabetes aged between nine and 16 years
(M=12.28, SD=1.78) participated in the study, of which 59% were children.
Data was collected in public hospitals via interviews using the Adaptive
Disease Response Questionnaire and Anxiety and Depression Scale. The data
was analysed using Pearson correlations, multiple hierarchical linear
regressions, Student’s t Test for independent samples, and Cohen’s d effect
size to determine reliability and validity. Result: the instrument was shown to have adequate psychometric properties. Adaptive
response was generally high. Adaptive response is negatively related to
emotional distress, being a better predictor of depression than of anxiety.
There was no association betwee adaptation and sex and age. Conclusion: promoting a better adaptive response appears to reduce emotional distress,
especially in the case of depression, regardless of the age or gender of the
patients.
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Affiliation(s)
- Laura Lacomba-Trejo
- Universitat de València, Facultad de Psicología, València, Comunidad Valenciana, Spain
| | - Selene Valero-Moreno
- Universitat de València, Facultad de Psicología, València, Comunidad Valenciana, Spain
| | - Sara Casaña-Granell
- Universitat de València, Facultad de Psicología, València, Comunidad Valenciana, Spain
| | | | - Marián Pérez-Marín
- Universitat de València, Facultad de Psicología, València, Comunidad Valenciana, Spain
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12
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Kong L, Hu P, Yang L, Cui D. The effectiveness of peer support on self‐efficacy and quality of life in adults with type 2 diabetes: A systematic review and meta‐analysis. J Adv Nurs 2018; 75:711-722. [PMID: 30289552 DOI: 10.1111/jan.13870] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/30/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Ling‐Na Kong
- School of Nursing Chongqing Medical University Chongqing China
- The first Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Ping Hu
- The first Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Li Yang
- School of Nursing Harbin Medical University Harbin China
| | - Dan Cui
- School of Nursing Harbin Medical University Harbin China
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13
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Pierce JS, Aroian K, Schifano E, Milkes A, Schwindt T, Gannon A, Wysocki T. Health Care Transition for Young Adults With Type 1 Diabetes: Stakeholder Engagement for Defining Optimal Outcomes. J Pediatr Psychol 2018; 42:970-982. [PMID: 28460055 DOI: 10.1093/jpepsy/jsx076] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/29/2017] [Indexed: 11/12/2022] Open
Abstract
Objectives Research on the transition to adult care for young adults with type 1 diabetes (T1D) emphasizes transition readiness, with less emphasis on transition outcomes. The relatively few studies that focus on outcomes use a wide variety of measures with little reliance on stakeholder engagement for measure selection. Methods This study engaged multiple stakeholders (i.e., young adults with T1D, parents, pediatric and adult health care providers, and experts) in qualitative interviews to identify the content domain for developing a multidimensional measure of health care transition (HCT) outcomes. Results The following constructs were identified for a planned measure of HCT outcomes: biomedical markers of T1D control; T1D knowledge/skills; navigation of a new health care system; integration of T1D into emerging adult roles; balance of parental involvement with autonomy; and "ownership" of T1D self-management. Discussion The results can guide creation of an initial item pool for a multidimensional profile of HCT outcomes.
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Affiliation(s)
| | - Karen Aroian
- College of Nursing, University of Central Florida
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14
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Noser AE, Patton SR, Van Allen J, Nelson MB, Clements MA. Evaluating Parents' Self-Efficacy for Diabetes Management in Pediatric Type 1 Diabetes. J Pediatr Psychol 2017; 42:296-303. [PMID: 27550634 DOI: 10.1093/jpepsy/jsw072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/29/2016] [Indexed: 01/06/2023] Open
Abstract
Objective To examine the factor structure and construct validity of the Maternal Self-Efficacy for Diabetes Management Scale (MSED) in 135 youth ( Mage = 13.50 ± 1.83 years), with type 1 diabetes mellitus. Method The study used exploratory factor analysis (EFA) to examine the factor structure and correlations to examine relationships among MSED factors and select parent and child diabetes-related health behaviors and outcomes. Results EFA identified an 11-item three-factor solution (χ 2 (25, n = 133) = 40.22, p < .03, RMSEA = 0.07, CFI = 0.98, TLI = 0.97), with factors corresponding to parents' perceived ability to manage their child's diabetes (MSED-M), problem-solve issues surrounding glycemic control (MSED-P), and teach their child about diabetes care (MSED-T). Correlational analyses revealed significant associations between the MSED-M and MSED-T and parent-reported optimism and youth's diabetes-specific self-efficacy. The MSED-T was also associated with glycated hemoglobin and self-monitoring blood glucose. Conclusions Results provide preliminary evidence for the reliability and validity of a three-factor solution of the MSED.
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Affiliation(s)
- Amy E Noser
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Susana R Patton
- Department of Pediatrics, University of Kansas Medical Center, Kansas, USA
| | - Jason Van Allen
- Clinical Psychology Program, Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Michael B Nelson
- Department of Pediatrics, University of Utah School of Medicine, USA
| | - Mark A Clements
- Division of Endocrinology and Diabetes, Department of Pediatrics, Children's Mercy Kansas City, Missouri, USA
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15
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Noser AE, Huffhines L, Clements MA, Patton SR. Diabetes conflict outstrips the positive impact of self-efficacy on youth adherence and glycemic control in type 1 diabetes. Pediatr Diabetes 2017; 18:614-618. [PMID: 27859979 PMCID: PMC6233994 DOI: 10.1111/pedi.12471] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To examine whether self-efficacy buffers the deleterious consequences of diabetes-specific family conflict on self-monitoring blood glucose (SMBG) and glycated hemoglobin (HbA1c) in youth with type 1 diabetes mellitus (T1DM). METHODS A total of 129 youth with T1DM (aged 10-16 years) completed measures of diabetes-specific family conflict and self-efficacy for diabetes management, and their blood glucose meter data and HbA1c were extracted from the electronic medical record. We preformed moderation analyses to examine whether self-efficacy moderated the association that diabetes-specific family conflict had with SMBG and HbA1c. We used simple slopes analyses to probe significant interactions. RESULTS Our results indicated that self-efficacy moderated the association that diabetes-specific family conflict had with SMBG and HbA1c. The pattern of these findings showed that high self-efficacy buffered the negative impact of diabetes conflict on HbA1c. However, benefits of high self-efficacy for more frequent SMBG was only apparent in the context of low diabetes-specific family conflict. CONCLUSIONS Study findings highlight the interactive relationship between diabetes-specific family conflict and self-efficacy in relation to SMBG and glycemic control. These findings suggest that family functioning and youth's self-efficacy are promising intervention targets for families having trouble with SMBG and HbA1c.
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Affiliation(s)
- Amy E. Noser
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045
| | - Lindsay Huffhines
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045
| | - Mark A. Clements
- Division of Endocrinology & Diabetes, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri 64108
| | - Susana R. Patton
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas 66103
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16
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Colson S, Côté J, Collombier M, Debout C, Bonnel G, Reynaud R, Lagouanelle-Simeoni MC. Adaptation transculturelle et tests psychométriques d’outils de mesure de l’efficacité personnelle et de l’adhésion thérapeutique pour une population d’adolescents diabétiques de type 1 français. Rech Soins Infirm 2017:16-27. [DOI: 10.3917/rsi.127.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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17
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Parham SC, Kavanagh DJ, Gericke CA, King N, May J, Andrade J. Assessment of Motivational Cognitions in Diabetes Self-Care: the Motivation Thought Frequency Scales for Glucose Testing, Physical Activity and Healthy Eating. Int J Behav Med 2016; 24:447-456. [DOI: 10.1007/s12529-016-9607-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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Kim CJ, Schlenk EA, Ahn JA, Kim M, Park E, Park J. Evaluation of the Measurement Properties of Self-reported Medication Adherence Instruments Among People at Risk for Metabolic Syndrome: A Systematic Review. DIABETES EDUCATOR 2016; 42:618-34. [PMID: 27352922 DOI: 10.1177/0145721716655400] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE The purpose of this study was to present a systematic review of available published studies that evaluated the measurement properties of self-reported instruments assessing global medication adherence in adults at risk for metabolic syndrome. METHODS The authors searched PubMed, EMBASE, PsycINFO, and CINAHL in January 2015 for appropriate studies. The methodological quality (based on reliability, validity, responsiveness, and interpretability) of selected studies was assessed with the COSMIN checklist (Consensus-Based Standards for the Selection of Health Measurement Instruments). RESULTS Of the 44 studies reviewed, 32 used classical test theory, and 14 used self-reported medication adherence instruments. More than half the studies included patients with hypertension, followed by diabetes, dyslipidemia, and increased body mass index. Among the measurement properties, internal consistency, hypothesis testing, and structural validity were frequently assessed items, whereas only 1 study evaluated responsiveness, and none evaluated measurement error. The MMAS-8 (Morisky Medication Adherence Scale-8 items) and the Hill-Bone scale were the most frequently used instruments. They were found to be well validated, with strong evidence for internal consistency and strong positive evidence for reliability, structural validity, hypothesis testing, and criterion validity. CONCLUSIONS The MMAS-8 and Hill-Bone scale seem to be well-validated instruments for assessing medication adherence in adults at risk for metabolic syndrome. These findings may assist clinicians with selecting the appropriate instruments for assessing medication adherence in this population. However, further studies might be needed to define concepts to better understand the dimensions of each medication adherence instrument.
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Affiliation(s)
- Chun-Ja Kim
- Ajou University College of Nursing and Institute of Nursing Science, Suwon, South Korea (Dr C. Kim, Dr J. Park)
| | - Elizabeth A Schlenk
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA (Dr Schlenk)
| | - Jeong-Ah Ahn
- Ajou University College of Nursing, Suwon, South Korea (Dr Ahn, Ms M. Kim)
| | - Moonsun Kim
- Ajou University College of Nursing, Suwon, South Korea (Dr Ahn, Ms M. Kim)
| | - Eunyoung Park
- Department of Nursing Science, Sangji University, Wonju, South Korea (Dr E. Park)
| | - JeeWon Park
- Ajou University College of Nursing and Institute of Nursing Science, Suwon, South Korea (Dr C. Kim, Dr J. Park)
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19
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Bultas MW, Schmuke AD, Moran V, Taylor J. Psychosocial Outcomes of Participating in Pediatric Diabetes Camp. Public Health Nurs 2015. [DOI: 10.1111/phn.12218] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Vicki Moran
- School of Nursing; Saint Louis University; St. Louis Missouri
| | - John Taylor
- School of Nursing; Saint Louis University; St. Louis Missouri
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20
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Amiri F, Vafa M, Gonder-Frederick L. Glycemic Control, Self-Efficacy and Fear of Hypoglycemia Among Iranian Children with Type 1 Diabetes. Can J Diabetes 2015; 39:302-7. [PMID: 25797114 DOI: 10.1016/j.jcjd.2014.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study was designed to test the reliability of a Persian version of 2 questionnaires to assess the level of fear of hypoglycemia (FoH) and self-efficacy in diabetes management and their association with glycated hemoglobin (A1C) and parents' demographic characteristics in a sample of children with type 1 diabetes. DESIGN We assessed 61 children with type 1 diabetes (35 boys and girls, 6.0 to 12.7 years of age) using the Hypoglycemia Fear Survey-Child version (HFS-C) and Self-Efficacy for Diabetes Scale-Child version (SED-C). Their glycemic control was evaluated by A1C levels. RESULTS The internal consistency of the Persian version of HFS-C and SED-C were very good. Our results showed that children older than 10 years of age report lower levels of FoH, which are related to higher levels of self-efficacy (r=-.30, p=0.025 and r=-.30, p=0.02, respectively). Of the children, 42.3% of girls and 31.4% of boys reported that low blood sugar is a big problem for them. These findings suggest that FoH is a significant concern for this target group. Only 19.7% of children had controlled diabetes based on A1C levels. There was no significant association between higher A1C levels and other variables, including HFS-C, SED-C and parents' demographic characteristics. CONCLUSIONS The Persian version of HFS-C and SED-C are reliable and valid measures of the fear of hypoglycemia and of self-efficacy in children with type 1 diabetes, and these questionnaires could be used in our country for identifying those children who may need diabetes education and other supports. The association between greater self-efficacy and lower fear of hypoglycemia suggests that addressing self-efficacy in diabetes education courses may be effective in helping to overcome FoH.
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Affiliation(s)
- Fatemehsadat Amiri
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Linda Gonder-Frederick
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
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21
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Markowitz JT, Garvey KC, Laffel LMB. Developmental changes in the roles of patients and families in type 1 diabetes management. Curr Diabetes Rev 2015; 11:231-8. [PMID: 25901503 PMCID: PMC4826732 DOI: 10.2174/1573399811666150421114146] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 02/06/2023]
Abstract
Developmentally-tailored diabetes self-care education and support are integral parts of contemporary multidisciplinary T1D care. The patient with T1D must have the support of the family and the diabetes team to maintain the rigors of diabetes management, but the specific roles of patients and families with regard to daily diabetes tasks change considerably throughout the developmental span of early childhood, middle childhood/school-age years, and adolescence. This review provides a framework of key normative developmental issues for each of these developmental stages. Within this context, ideal family diabetes management is reviewed within each developmental stage and anticipated challenges that can arise during these stages and that can adversely impact diabetes management are presented. This paper also summarizes empirical evidence for specific intervention and care strategies to support optimal diabetes management across these stages in order to maximize opportunities for a successful transfer of diabetes management tasks from parents to maturing youth. Finally, the review provides an emphasis on approaches to promote family teamwork and adolescent diabetes self-care adherence as well as opportunities to use novel technology platforms as a means to support optimal diabetes management.
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Affiliation(s)
- Jessica T Markowitz
- Pediatric, Adolescent, & Youth Adult Section, Joslin Diabetes Center, Boston, MA, USA.
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