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McFadden NT, Wilkerson AH, Jaiswal J, Chaney BH, Stellefson ML, Carmack HJ, Lovett K. Barriers and Facilitators Impacting Disease and Symptom Management Among College Students With Type 1 Diabetes: A Qualitative Study. Am J Health Promot 2024; 38:704-715. [PMID: 38342487 DOI: 10.1177/08901171241233407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
PURPOSE This study aimed to explore barriers and facilitators impacting disease and symptom management among college students living with Type 1 Diabetes (T1D). DESIGN A qualitative, phenomenological approach using semi-structured, one-on-one interviews. SETTING Interviews conducted on Zoom (n = 28) and in-person (n = 3). PARTICIPANTS Purposive sample of 31 college students living with T1D for at least 2 years who attended large, 4-year public universities in the Southeastern United States. METHOD This study was theoretically informed using the Middle-Range Theory of Self-Care of Chronic Illness Integration of Symptoms to develop interview questions. Interviews were transcribed verbatim and uploaded in NVivo. Data were analyzed thematically using a codebook developed by the research team using the theory as a framework. Trustworthiness was established using an audit trail, memos, and negative case analysis. RESULTS Four themes described barriers: diabetes burnout, challenges adjusting to a college lifestyle, difficulty receiving medical supplies, and insurance limitations. Five themes explained facilitators: years of experience managing T1D, tangible support with medical supplies, informational support for disease management, and emotional/technological support for disease and symptom management. CONCLUSION Barriers and facilitators in this study should be addressed in future T1D interventions for college students. Findings can also guide healthcare professionals, health promotion practitioners, family, friends, and significant others on how to better support college students as they manage T1D.
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Affiliation(s)
- Ny'Nika T McFadden
- Department of Health and Human Performance, Texas State University, San Marcos, TX, USA
| | - Amanda H Wilkerson
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Jessica Jaiswal
- Department of Family and Community Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Beth H Chaney
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Heather J Carmack
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kylie Lovett
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
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Mayberry LS, Wiebe DJ, Parks M, Campbell MS, Beam AB, Berg CA. Acceptability and feasibility of FAMS-T1D mHealth intervention to optimize self- and social regulation for emerging adults with type 1 diabetes. Pilot Feasibility Stud 2024; 10:68. [PMID: 38689356 PMCID: PMC11059732 DOI: 10.1186/s40814-024-01497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Among emerging adults with type 1 diabetes (T1D), self-regulation and social regulation skills can help avoid high A1c and diabetes distress. FAMS (Family/friend Activation to Motivate Self-care) is mobile phone-delivered intervention that supports development of these skills and is efficacious among adults with type 2 diabetes. However, the acceptability and feasibility of the FAMS intervention among emerging adults with T1D are unknown. METHODS Therefore, we adapted FAMS for in a new disease context and developmental stage and then conducted a 3-month mixed-methods pre-post pilot study. Participants were emerging adults with T1D and a friend/family member enrolled as a support person (optional). Feasibility/acceptability outcomes and associated progression thresholds were recruitment (≥ 70% eligible emerging adults), retention (≥ 85%), intervention engagement (≥ 70%), and satisfaction (≥ 70%). We also collected qualitative feedback to determine if the intervention addressed relevant needs and explored changes in outcomes of interest (family/friend involvement, self-efficacy, self-management, distress, A1c). RESULTS Recruitment rates indicate recruitment of emerging adults with T1D (n = 30) and their support persons (n = 20) is feasible - 79% of emerging adults who screened as eligible enrolled and 70% of enrolled emerging adults invited a support person. Emerging adults completed 98% of coaching sessions, and response rates to automated text messages were median 85% IQR [68%, 90%]. Changes in selected measures for outcomes of interest were in expected directions suggesting sensitivity to changes occasioned by the intervention in a future evaluative trial. Emerging adults said FAMS-T1D helped with setting realistic goals, motivated them to prioritize diabetes goals, and increased support, indicating acceptability of the intervention in this new disease and developmental context. CONCLUSIONS Findings suggest potential for FAMS-T1D to engage emerging adults and their support persons and feasibility for an evaluative trial examining effects on self-regulation (self-efficacy, self-management), social regulation (family/friend involvement), and outcomes (diabetes distress, A1c). TRIAL REGISTRATION We did not register this study on ClinicalTrials.gov because the purpose of the study was to assess the feasibility and acceptability of the intervention and study procedures and measures in preparation for a future trial. The purpose of that future trial will be to evaluate the effect of the intervention on health-related biomedical and behavioral outcomes, and that trial will be registered accordingly.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA.
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Deborah J Wiebe
- Department of Psychological Sciences and the Health Science Research Institute, University of California, Merced, CA, USA
| | - Makenzie Parks
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | | | - Aislinn B Beam
- Department of Psychological Sciences and the Health Science Research Institute, University of California, Merced, CA, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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Núñez-Baila MÁ, Gómez-Aragón A, Marques-Silva AM, González-López JR. Lifestyle in Emerging Adults with Type 1 Diabetes Mellitus: A Qualitative Systematic Review. Healthcare (Basel) 2024; 12:309. [PMID: 38338194 PMCID: PMC10855310 DOI: 10.3390/healthcare12030309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Emerging adulthood is a transitional stage with significant lifestyle changes, making it especially challenging for those living with type 1 diabetes mellitus. This systematic review synthesizes qualitative research to explore how emerging adulthood (18-29 years) influences lifestyle behaviors in individuals with type 1 diabetes mellitus. CINAHL, Cochrane Library, Global Health, Nursing & Allied Health Premium, PsycINFO, PubMed, Scopus, and WOS were searched for original qualitative studies addressing the lifestyle of 18-31-year-olds with type 1 diabetes mellitus, published between January 2010 and March 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-five studies met the inclusion criteria and their findings were categorized into eight topics (emotions and feelings, nutrition, perceptions, risky behaviors, self-care, sleep, social relationships, and stigma) using meta-aggregation, as outlined in the Joanna Briggs Institute Manual for Evidence Synthesis. The spontaneity characteristic of emerging adulthood can undermine self-care. This is because new environments, schedules, and relationships encountered during this life stage often lead to the neglect of diabetes management, owing to the various social, academic, and occupational demands. This review highlights the necessity of creating health promotion strategies tailored to the unique lifestyle aspects of emerging adults with type 1 diabetes mellitus.
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Affiliation(s)
- María-Ángeles Núñez-Baila
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
| | - Anjhara Gómez-Aragón
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
| | - Armando-Manuel Marques-Silva
- Department of Nursing, Escola Superior de Enfermagem de Coimbra, 3004-011 Coimbra, Portugal;
- Unidade de Investigação em Ciências da Saúde: Enfermagem (UICISA: E), 3004-011 Coimbra, Portugal
| | - José Rafael González-López
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
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Mayberry LS, Wiebe D, Parks M, Campbell M, Beam A, Berg C. Acceptability and Feasibility of FAMS-T1D mHealth intervention to optimize self- & social regulation for emerging adults with type 1 diabetes. RESEARCH SQUARE 2023:rs.3.rs-2667134. [PMID: 38045417 PMCID: PMC10690330 DOI: 10.21203/rs.3.rs-2667134/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Among emerging adults with type 1 diabetes (T1D), self-regulation and social regulation skills can help avoid high A1c and diabetes distress. FAMS (Family/friend Activation to Motivate Self-care) is mobile phone-delivered intervention that supports development of these skills and is efficacious among adults with type 2 diabetes. However, the acceptability and feasibility of the FAMS intervention among emerging adults with T1D is unknown. Methods Therefore, we adapted FAMS for in a new disease context and developmental stage then conducted a 3-month mixed-methods pre-post pilot study. Participants were emerging adults with T1D and a friend/family member enrolled as a support person (optional). Feasibility/acceptability outcomes and associated progression thresholds were recruitment (≥ 70% eligible emerging adults), retention (≥ 85%), intervention engagement (≥ 70%) and satisfaction (≥ 70%). We also collected qualitative feedback to determine if the intervention addressed relevant needs and explored changes in outcomes of interest (family/friend involvement, self-efficacy, self-management, distress, A1c). Results Recruitment rates indicate recruitment of emerging adults with T1D and their support persons is feasible - 79% of emerging adults who screened as eligible enrolled and 70% of enrolled emerging adults invited a support person. Emerging adults completed 98% of coaching sessions, and response rates to automated text messages were median 85% IQR [68%, 90%]. Changes in selected measures for outcomes of interest were in expected directions suggesting sensitivity to changes occasioned by the intervention in a future evaluative trial. Emerging adults said FAMS-T1D helped with setting realistic goals, motivated them to prioritize diabetes goals, and increased support, indicating acceptability of the intervention in this new disease and developmental context. Conclusions Findings suggest potential for FAMS-T1D to engage emerging adults and their support persons and feasibility for evaluation of effects on hypothesized intervention targets and outcomes in a subsequent evaluative trial. Trial Registration We did not register this study on clinicaltrials.gov because the purpose of the study was to assess the feasibility and acceptability of the intervention and study procedures and measures in preparation for a future trial. The purpose of that future trial will be to evaluate the effect of the intervention on health-related biomedical and behavioral outcomes and that trial will be registered accordingly.
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Hage TW, Nilsen JV, Karlsen KM, Lyslid MH, Wennersberg AL, Wisting L. "I am not alone". A qualitative feasibility study of eating disorders prevention groups for young females with type 1 diabetes. J Eat Disord 2023; 11:42. [PMID: 36941696 PMCID: PMC10027265 DOI: 10.1186/s40337-023-00767-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE The overall aim of the current study was to qualitatively explore the feasibility of eating disorder prevention groups for people with type 1 diabetes (T1D). METHOD A generic qualitative focus group design was applied. 17 participants accepted the invitation to attend focus group interviews after completing the intervention. Five focus groups were conducted in total. RESULTS The qualitative analysis generated one overarching theme, named the benefit of meeting peers with a lived experience of T1D and body image concerns, and four themes: the need for an integrated focus on diabetes, personal relevance, providing sufficient balance between structure and flexibility and enabling a different perspective. CONCLUSION Results show overall positive feedback regarding the content and structure of the intervention, and underline the importance of targeting preventive efforts to specific risk groups.
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Affiliation(s)
- Trine Wiig Hage
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. Box 4956, 0424, Oslo, Norway.
| | - Jan-Vegard Nilsen
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. Box 4956, 0424, Oslo, Norway
| | | | | | - Anne Louise Wennersberg
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. Box 4956, 0424, Oslo, Norway
| | - Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. Box 4956, 0424, Oslo, Norway
- Oslo Diabetes Centre, Oslo, Norway
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Hagger V, J. Lake A, Singh T, Hamblin PS, Rasmussen B. The experiences and support needs of students with diabetes at university: An integrative literature review. Diabet Med 2023; 40:e14943. [PMID: 36001083 PMCID: PMC10087720 DOI: 10.1111/dme.14943] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022]
Abstract
AIMS Commencing university presents particular challenges for young adults with diabetes. This integrative literature review aimed to synthesise the research exploring the experiences and support needs of university students with diabetes. METHODS Medline, CINAHL, PsychInfo and EMBASE databases were searched for quantitative and qualitative studies, among undergraduate and postgraduate students with type 1 or type 2 diabetes conducted in the university setting. Two reviewers independently screened titles, abstracts and full-text articles. Data were analysed thematically and synthesised narratively utilising the ecological model as a framework for interpreting findings and making recommendations. RESULTS We identified 25 eligible papers (20 studies) utilising various methods: individual interview, focus group, survey, online forum. Four themes were identified: barriers to self-care (e.g. lack of structure and routine); living with diabetes as a student; identity, stigma and disclosure; and strategies for managing diabetes at university. Students in the early years at university, recently diagnosed or moved away from home, reported more self-care difficulties, yet few accessed university support services. Risky alcohol-related behaviours, perceived stigma and reluctance to disclose diabetes inhibited optimal diabetes management. CONCLUSION Despite the heterogeneity of studies, consistent themes related to diabetes self-care difficulties and risky behaviours were reported by young adults with diabetes transitioning to university life. No effective interventions to support students with diabetes were identified in this setting. Multilevel approaches to support students to balance the competing demands of study and diabetes self-care are needed, particularly in the early years of university life.
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Affiliation(s)
- Virginia Hagger
- School of Nursing and MidwiferyDeakin UniversityBurwoodVictoriaAustralia
- The Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Amelia J. Lake
- The Australian Centre for Behavioural Research in DiabetesDiabetes VictoriaMelbourneVictoriaAustralia
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
| | - Tarveen Singh
- School of Nursing and MidwiferyDeakin UniversityBurwoodVictoriaAustralia
| | - Peter S. Hamblin
- Western HealthSt. AlbansVictoriaAustralia
- Department of Medicine, Western HealthUniversity of MelbourneSt. AlbansVictoriaAustralia
| | - Bodil Rasmussen
- School of Nursing and MidwiferyDeakin UniversityBurwoodVictoriaAustralia
- The Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Faculty of Health SciencesUniversity of Southern Denmark and Steno Diabetes CentreOdenseDenmark
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Raymaekers K, Berg CA, Helgeson VS. Development of Peer Relationships From Adolescence into Emerging Adulthood: Comparing Males and Females With and Without Type 1 Diabetes. J Pediatr Psychol 2022; 47:804-815. [PMID: 35303080 PMCID: PMC9297080 DOI: 10.1093/jpepsy/jsac019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Friendships and romantic relationships are important sources of support that contribute to well-being for youth across adolescence and emerging adulthood and may be especially important for those with a chronic illness. We examined gender differences in trajectories of peer relationships among those with type 1 diabetes (T1D) and how they differ from those without. METHODS Individuals with T1D (N = 132) and controls (N = 131) completed questionnaires across 11 years (M age = 12 years at baseline). Trajectories of friend support, conflict, and companionship were estimated from ages 11 to 23. Romantic support and conflict trajectories were estimated from ages 17 to 23. RESULTS Females experienced more friend support than males, especially in comparison to males with T1D. Control females experienced highest levels of romantic support and lowest levels of romantic conflict. In comparison to control males, males with T1D experienced less friend support in early adolescence and less companionship in late adolescence and emerging adulthood. In comparison to control females, females with T1D experienced less friend support in late adolescence and more romantic conflict in emerging adulthood. CONCLUSIONS Findings that males with T1D report less friend support and companionship compared to control males, and females with T1D report less friend support and more romantic conflict than control females are of concern as these results suggest those with T1D may be missing out on important aspects of peer relationships. Understanding the broader social network of peer relationships may be useful to clinicians as they assist individuals in garnering support in general and for their diabetes.
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Affiliation(s)
- Koen Raymaekers
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Fonds Wetenschappelijk Onderzoek, Flanders, Belgium
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, Pittsburgh, USA
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Wilson C, Spencer G. The mental health support needs of university students with long-term physical health conditions. HEALTH EDUCATION 2022. [DOI: 10.1108/he-01-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeSupporting the mental health of university students is a key priority for higher education. Students living with long-term health conditions are at increased risk of poor mental health; yet little work has focused on their particular mental health needs or indeed, the implications for health education in the university setting. This study sought to identify the mental health support needs of students with long-term conditions, including best ways for universities to support these students.Design/methodology/approachA UK national online survey of 200 university students living with long-term physical health conditions (e.g. asthma, endometriosis, epilepsy) was conducted in 2019.Findings95% of respondents reported that their long-term condition/s had at least a moderate impact on their mental wellbeing, with 81% reporting that they felt depressed and anxious at least once a month because of their health. The most common suggestion for how universities can better support their mental wellbeing was to raise awareness about long-term conditions on campuses, with many reporting a lack of understanding about long-term conditions from academic and support services staff members – with negative impacts on their mental health. Because of this, some respondents reported a reluctance to come forward and seek help from university services, with 25% not formally disclosing their conditions.Originality/valueThese reported concerns underscore the need to develop health education amongst university staff about long-term conditions and to ensure these students are supported with their health at university.
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Ledford CJ, Villareal C, Williams EW, Cafferty LA, Jackson JT, Seehusen DA. Patient Decision-Making About Self-Disclosure of a Type 2 Diabetes Diagnosis: A Qualitative Study. Diabetes Spectr 2022; 35:327-334. [PMID: 36082012 PMCID: PMC9396723 DOI: 10.2337/ds21-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Effective self-management of type 2 diabetes requires receiving support, which can result from disclosing the diagnosis to a support network, including coworkers, family, and friends. As a primarily invisible disease, diabetes allows people to choose whether to disclose. This study qualitatively explores the factors that influence a person's decision to disclose diabetes to others. METHODS Research coordinators recruited 22 interview participants, ranging in age from 32 to 64 years, whose medical records included a diagnosis code for type 2 diabetes. Participants received care from one of two U.S. medical centers. Semi-structured interviews lasted approximately 1 hour and were audio-recorded and professionally transcribed. Verification strategies such as memo-keeping and maintaining methodological coherence/congruence were used throughout analysis to promote rigor. RESULTS In patients' descriptions of their decision-making processes regarding whether to disclose their diagnosis, six themes emerged. Three motivations prompted open disclosure: 1) to seek information, 2) to seek social support, and 3) to end the succession of diabetes, and the other three motivations prompted guarded disclosure: 4) to prepare for an emergency, 5) to maintain an image of health, and 6) to protect employment. CONCLUSION Based on our findings, we recommend three communicative actions for clinicians as they talk to patients about a diabetes diagnosis. First, clinicians should talk about the benefits of disclosure. Second, they should directly address stereotypes in an effort to de-stigmatize diabetes. Finally, clinicians can teach the skills of disclosure. As disclosure efficacy increases, a person's likelihood to disclose also increases. Individuals can use communication as a tool to gain the knowledge and support they need for diabetes self-management and to interrupt the continuing multigenerational development of diabetes within their family.
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Affiliation(s)
- Christy J.W. Ledford
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | | | | | - Lauren A. Cafferty
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- Military Primary Care Research Network, Bethesda, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD
| | - Jeremy T. Jackson
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- Military Primary Care Research Network, Bethesda, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD
- Corresponding author: Jeremy T. Jackson,
| | - Dean A. Seehusen
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA
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Gray AL, Campbell MS, Berg CA, Wiebe DJ. Qualitative analysis of helpful and unhelpful aspects of social relationships among young adults with type 1 diabetes. Diabet Med 2021; 38:e14441. [PMID: 33108672 PMCID: PMC8590457 DOI: 10.1111/dme.14441] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022]
Abstract
AIMS Young adulthood is a high-risk time for type 1 diabetes management when individuals are managing diabetes within changing social contexts and new social relationships. This qualitative study examined helpful and unhelpful aspects of social relationships in the daily lives of young adults with type 1 diabetes. METHODS Semi-structured qualitative interviews with 29 young adults with type 1 diabetes (ages 22-24, mean = 23 years; 55% female) explored: (a) who in the past week was present when diabetes management occurred; (b) what others did that was helpful or unhelpful for diabetes management; (c) what made helpful and unhelpful aspects of social relationships more or less likely; and (d) what young adults disclosed to others about diabetes. RESULTS Romantic partners and parents were commonly present and helpful in giving reminders and offering instrumental support, but the presence of trusted individuals was also helpful to management. Co-workers and friends were present during episodes of diabetes management but were often unhelpful, especially when lacking knowledge about participants' diabetes or its management. Participants also discussed conflicting and spontaneous changes in schedules were unhelpful to management. Disclosing diabetes to others and planning for social context barriers were described as strategies to facilitate helpful and reduce unhelpful aspects of social relationships. CONCLUSIONS Young adults face social barriers to management if they are unable to utilize their relationships effectively. Interventions to promote disclosure to trusted others and planning to avoid social context-related barriers to diabetes management may facilitate more effective self-management at this high-risk time of development.
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Affiliation(s)
- Avia L Gray
- Department of Psychological Sciences, Univeristy of California, Merced, Merced, CA, USA
| | | | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Deborah J Wiebe
- Department of Psychological Sciences, Univeristy of California, Merced, Merced, CA, USA
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Johansen CB, Rothmann MJ, Andersen A, Beck-Nielsen H, Pouwer F. The role of parental support for emerging adults with type 1 diabetes: A scoping review. Pediatr Diabetes 2020; 21:995-1030. [PMID: 32301182 DOI: 10.1111/pedi.13022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emerging adults with type 1 diabetes often have poor diabetes self-care and pose a considerable therapeutic challenge. They simultaneously handle a life phase characterized by instability, identity exploration, and transitions and manage a chronic illness that demands structure, self-discipline, and repeated health care contacts. Relation to parents is often ambivalent but typically remains the most stable social support, so parental support could potentially be helpful for diabetes self-care and wellbeing. METHOD This scoping review aimed to identify, summarize and analyze empirical studies (for instance interview studies, questionnaire studies and intervention studies) exploring parental support for emerging adults with type 1 diabetes. Studies were identified in PsycInfo, PubMed, Scopus, and Google Scholar. Data were extracted by one author and checked by another. Study results were synthesized by a convergent mixed methods approach and qualitative thematic analysis. RESULTS We included 26 studies (2829 participants), 16 interview studies, 10 questionnaire studies, and no intervention studies. Five overarching themes were identified: self-care and glycemic control, diabetes-related emotional wellbeing, support characteristics, ambivalence and harms, and core support providers. Parents tended to contribute positively to diabetes self-care, glycemic control, and psychological wellbeing. However, emerging adults did not want to be too dependent on their parents and family, and family could also act unsupportively; when absent, disinterested in diabetes or controlling. CONCLUSION This review underlines that parental support still plays a role for diabetes self-care and wellbeing in emerging adults with type 1 diabetes. Age-appropriate parental support therefore seems a promising path to investigate further.
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Affiliation(s)
- Clea Bruun Johansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Anette Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Frans Pouwer
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
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Creaven AM, Higgins NM, Ginty AT, Gallagher S. Social support, social participation, and cardiovascular reactivity to stress in the Midlife in the United States (MIDUS) study. Biol Psychol 2020; 155:107921. [PMID: 32598908 DOI: 10.1016/j.biopsycho.2020.107921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/21/2022]
Abstract
This study tested two hypotheses of associations between dimensions of social connectedness and cardiovascular reactivity to acute stress: (1) high social support predicts diminished cardiovascular responses to stress (i.e., the stress-buffering model of social support), and (2) diminished cardiovascular responses predict lower social participation, a form of motivated behaviour. Participants (N = 606) in the main Midlife in the United States study completed measures of social support and social participation and underwent psychophysiological stress testing. In unadjusted analyses, social support was positively, rather than inversely, associated with reactivity. Results withstood adjustment for several control variables, but not for depressive symptoms, which was associated with diminished reactivity. Further, diminished reactivity was associated with lower social participation, but not in fully adjusted models. No robust evidence was observed for either the stress-buffering model, or for an association between diminished reactivity and lower social participation. The implications for our understanding of links between social connectedness and cardiovascular reactivity are discussed.
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Affiliation(s)
- Ann-Marie Creaven
- Department of Psychology, Centre for Social Issues Research, & Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland.
| | - Niamh M Higgins
- Department of Psychology, Mary Immaculate College, University of Limerick, South Circular Road, Limerick, Ireland.
| | - Annie T Ginty
- Department of Psychology and Neuroscience, Baylor University, TX, United States.
| | - Stephen Gallagher
- Department of Psychology, Centre for Social Issues Research, & Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland.
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Kelly CS, Berg CA, Lansing AH, Turner SL, Munion AK, Tracy EL, Wiebe DJ. Keeping parents connected in early emerging adulthood: Diabetes-related disclosure and solicitation. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2019; 33:809-818. [PMID: 31355650 PMCID: PMC6776686 DOI: 10.1037/fam0000565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Emerging adults with Type 1 diabetes benefit when parents remain knowledgeable of their self-management. Yet how early emerging adults remain connected with parents while they experience normative declines in involvement and move out of the parental home is unclear. The present study examined how disclosure to, and solicitation from, parents may (a) be a way that emerging adults and parents remain connected, (b) occur with different methods of contact (i.e., face-to-face; non-face-to-face), and (c) associate with diabetes management differently for those living in versus outside of the parental home. Early emerging adults with Type 1 diabetes (N = 202; Mage = 18.81 years; 66% female) completed measures of their methods of contact with parents; diabetes-related disclosure to, and solicitation from, parents; and diabetes management as part of a 14-day daily diary. General linear models found that face-to-face contact was associated with greater disclosure to parents, for both those living in and out of the parental home. Individuals who lived outside the parental home used more non-face-to-face contact (e.g., texting) than those in the parental home. Multilevel models revealed that higher disclosure to mothers on a daily basis (within-persons) and to mothers and fathers overall (between-persons) was associated with better diabetes management similarly for those living in versus out of the parental home. Results suggest that face-to-face contact may be most effective for keeping parents "in the know" about diabetes management. Moreover, disclosure and solicitation continue to support diabetes management even as individuals move out of the parental home. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Deborah J. Wiebe
- University of California, Merced, Psychological Sciences
and Health Sciences Research Institute
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Ersig AL. An Exploratory Study: Transition to Adulthood for College Students with Type 1 Diabetes and Their Parents. J Pediatr Nurs 2019; 46:12-17. [PMID: 30811974 DOI: 10.1016/j.pedn.2019.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/13/2019] [Accepted: 01/13/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE The transition to college and adulthood can be challenging for young adults with chronic health conditions and their parents. Few studies have simultaneously explored the experiences of college students and their parents during the transition to college. The purpose of this study was to explore the transition to adulthood for college students with type 1 diabetes (T1D) and their parents. DESIGN AND METHODS A descriptive exploratory study was conducted with college students with T1D and their parents. Data were collected online using quantitative surveys and open-ended questions. Descriptive statistics were generated for quantitative measures. Analysis of responses to open-ended questions used qualitative description. RESULTS College students (18-24 years) and parents described challenges with life-stage stress, diabetes management worries, and concern about T1D-related long-term complications. Respondents also described the critical role of the college peer network for support and help in case of crisis situations. Students reported stress related to uncertainty in diabetes management, while parents described constant worry about their child's diabetes. CONCLUSIONS Findings support the importance of assessing anticipated and current stressors of college students with T1D and other chronic health conditions and their parents during and after transition to college. PRACTICE IMPLICATIONS Nurses can support students and parents by providing anticipatory guidance about the transition to college. Assistance identifying established sources of support on college campuses, as well as planning for potential crisis situations, may help reduce stress experienced by students and parents.
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Affiliation(s)
- Anne L Ersig
- The University of Wisconsin-Madison, School of Nursing, Madison, WI, United States of America..
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