PREP-T1 (Preteen Re-Education With Parents-Type 1 Diabetes) Feasibility Intervention Results

Parents' perspectives of factors affecting parent-adolescent communication about type 1 diabetes and negotiation of self-management responsibilities

Adolescence is an important time in which young people take on type 1 diabetes (T1D) self-management responsibility. Parents are key facilitators of this process. Little is known about parents' experiences of communicating with their children about T1D during adolescence. Semi-structured interviews were conducted with 32 parents (24 mothers and 8 fathers) of adolescents (11-17 years) living with T1D to explore how parents communicate about T1D and self-management with their adolescent children. Parents were recruited through two national child and adolescent diabetes and endocrine clinics and online advertisement through a national diabetes advocacy organisation. Interviews were transcribed verbatim and thematically analysed. Six themes were identified: parent factors, quality of the parent-adolescent relationship, communication strategies, adolescent factors, communication triggers and family/system factors. Understanding factors that impact communication about self-management between parents and adolescents will enable healthcare professionals to provide support and targeted interventions as parent and adolescent roles change over time.

Tracing the Use of the Family Management Framework and Measure: A Scoping Review

This article reports the results of a scoping review of research applications of the Family Management Style Framework (FMSF) and the Family Management Measure (FaMM). We identified 32 studies based on the FMSF and 41 studies in which the FaMM was used, 17 of which were based on the FMSF. Both the framework and measure have been used by investigators in multiple countries, with most applications of the FaMM outside the United States. Although the FMSF and FaMM were originally developed for use with families in which there was a child with a chronic physical condition, both have been applied to a broader range of health conditions and to studies focusing on families with an adult member facing a health challenge. Based on our findings, we make recommendations for how researchers can more fully address all aspects of the FMSF.

Pre-empting the challenges faced in adolescence: A systematic literature review of effects of psychosocial interventions for preteens with type 1 diabetes

INTRODUCTION

Numerous psychosocial interventions have been conducted in children and adolescents with type 1 diabetes, aiming to improve their self-management and autonomy acquisition. However, these tend to address family conflict and parental perspectives, and a scarce number of interventions explore the outcomes among preteens. This review examined the outcomes of psychosocial interventions for preteens with type 1 diabetes, as an under-researched field to date.

METHODS

A systematic literature review of intervention studies with randomized controlled trial design, targeting preteens with type 1 diabetes, was conducted. Six databases were searched for publication periods from 1995 to October 2019. Quality of the interventions according to the International Society for Pediatric and Adolescent Diabetes (ISPAD), as well as reporting and effect sizes, were assessed.

RESULTS

Twelve studies were selected, covering ten interventions. According to the topics identified, four of these interventions were categorized as self-care programmes, three as psychosocial programmes and three as mixed. All of the interventions, except for one, covered ≥50% of the ISPAD recommendations. Reporting adequacy was negative only in one intervention. Main outcomes were glycemic control and self-management, but effect sizes could only be calculated for half of the interventions with no overall significant effect.

CONCLUSIONS

This review shows a lack of adequate psychosocial interventions targeting preteens with type 1 diabetes and actively involving them as participants. These intervention's educational programmes and methods should be standardized to guarantee successful results. New technologies and peer support implementation could be a promising pathway when designing these studies.

Development and Psychometric Testing of the Peer-Mentor Support Scale for Parents of Children With Type 1 Diabetes and for Youths With Type 1 Diabetes

PURPOSE

The purpose of this study was to develop and evaluate the psychometric properties of the Peer-Mentor Support Scale (PMSS), a measure of peer-mentor support provided to parents of children with type 1 diabetes (T1D) and to youths with T1D.

METHODS

A multistage process was undertaken to include the following: item construction based on qualitive data from those who have experienced peer-mentor support, cognitive interviewing with parents and youths, content validity assessment, pilot testing of the scale, and psychometric evaluation of the PMSS with 165 participants.

RESULTS

The final version of the PMSS included 17 items, scored on a 4-point Likert scale, with higher scores corresponding with greater peer-mentor support. The Cronbach's alpha was .85 (n = 165), and the intraclass correlation coefficient was .78 (n = 38). No significant relationship was found between the PMSS score and general social support, suggesting that peer-mentor support is distinct from general social support. Principal components factor analysis with varimax rotation was performed, indicating that the scale was unidimensional and explained 59.3% of the variance in peer-mentor support.

CONCLUSION

The PMSS is a reliable and valid 17-item instrument that can be used to measure the unique contributions of peer mentorship for parents of children with T1DM and for youths with T1DM.

The role of theories in interventions targeting preteens with Type 1 diabetes: A critical literature review

BACKGROUND

Theory-based interventions have been recommended to target relevant issues and improve outcomes in children and adolescents with Type 1 diabetes. Furthermore, the timing of interventions has been recognized as key to improving outcomes, suggesting a need to focus on preteens (9-12 years old) with Type 1 diabetes. The aim of the present study was to identify the theories that inform interventions targeting preteens with Type 1 diabetes and to analyse the studies for their understandings of theory.

METHODS

We conducted a systematic literature review of intervention studies targeting preteens with Type 1 diabetes to identify the theoretical frameworks applied. Seven databases across different scientific disciplines were searched for papers published between 1995 and 2018.

RESULTS

Twenty-four studies were included in the review. Of these, 14 were categorized as theory-inspired and 10 as theory-related studies. Social cognitive theory appeared most frequently. Most studies did not provide a rationale for their choice and application of theory to inform interventions. The studies were characterized by use of adult-centric theories and a focus on the relationships between children and their parents.

CONCLUSIONS

The present review shows variations and limitations in the description and application of theories across interventions targeting preteens with Type 1 diabetes. This emphasizes the need for future studies to address for what reason and how a certain theory or method is applied. We suggest that interventions might benefit from using theories that are centred on the needs and experiences of children, target family dynamics that include all important family members, and address the mutually constitutive relationship between interventions and the social context in which they are implemented.

Stress and Posttraumatic Stress in Mothers of Children With Type 1 Diabetes

The onset of acute and chronic illness in children frequently triggers episodes of stress and posttraumatic stress symptoms (PTSS) in mothers. Mothers of children with type 1 diabetes (T1D) consistently report high levels of stress and PTSS. The purpose of this integrative review was to review and synthesize the published empirical research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct this integrative literature review. A total of 19 studies were identified from a sample of 128. Stress and PTSS were prevalent in mothers of youth with T1D. While PTSS was most severe at disease onset, symptoms often persisted 1 to 5 years after diagnosis. The diagnosis of T1D in a child was traumatic for mothers. Stress and PTSS in mothers adversely affected children's health. Management of stress symptoms in mothers may lead to improved behavioral and metabolic outcomes in children.