Factors affecting health adaptation of Chinese adolescents with type 1 diabetes: A path model testing

Resilience in adolescents with type 1 diabetes: An integrative review

PROBLEM

Despite advances in diabetes technology, many adolescents with type 1 diabetes (T1D) cannot achieve target metabolic control. Resilience is associated with better outcomes in diabetes care. The aim of this review is to synthesize studies on resilience in adolescents with T1D, particularly how the concept of resilience has been explored.

METHODS

This integrative review was carried out according to Whittemore and Knafl's framework. A systematic search was conducted in the CINAHL, PubMed/Medline and PsycInfo databases. Eligibility criteria included studies on resilience in adolescents with T1D, aged 13 to 18 years, that were published in English in peer-reviewed scientific journals. The Mixed Methods Appraisal Tool was used to assess study quality.

RESULTS

The review included twenty-four studies. Resilience was defined as the ability or capacity, or the process, to maintain physical and psychological well-being despite exposure to significant stressors or distress events. Diabetes resilience was defined as achieving positive psychosocial and health outcomes despite the challenges of living with T1D. Studies were quantitative (n = 21), qualitative (n = 1) and mixed methods (n = 2). Six resilience instruments were found. The DSTAR-Teen was the most used and the only instrument for adolescents with T1D.

CONCLUSIONS

This review highlighted the need for an explicit definition of the concept of resilience because previous studies used different definitions or lacked a definition. In the future, a more precise concept analysis of resilience in adolescents with T1D is warranted.

IMPLICATIONS

The DSTAR-Teen is a promising resilience measure with good psychometric properties for further studies in adolescents with T1D.

Measuring resilience for Chinese-speaking populations: a systematic review of Chinese resilience scales

Introduction

Despite the rapid growth of interdisciplinary resilience research in Chinese contexts, no study has systematically reviewed individual-level measurement scales for Chinese-speaking populations. We report a systematic review of scales developed for or translated/adapted to Chinese-speaking contexts, where we assessed how widely used scales fare in terms of their psychometric qualities.

Methods

Studies included in this review must have been published in peer-reviewed English or Chinese journals between 2015-2020 and included self-reported resilience scales in Chinese-speaking populations. Searches were conducted in PsycINFO, CNKI (completed in May 2021), and PubMed (completed in January 2024). We developed coding schemes for extracting relevant data and adapted and applied an existing evaluation framework to assess the most frequently used resilience scales by seven methodological criteria.

Results

Analyses of 963 qualified studies suggested that Chinese resilience scales were used in a diverse range of study contexts. Among 85 unique kinds of resilience measures, we highlighted and evaluated the three most frequently used translated scales and three locally developed scales (nine scales in total including variations such as short forms). In short, resilience studies in Chinese contexts relied heavily on the translated 25-item Connor-Davidson Resilience Scale, which scored moderately on the overall quality. The locally developed Resilience Scale for Chinese Adolescents and Essential Resilience Scale received the best ratings but could use further development.

Discussion

We discussed how future work may advance widely used scales, and specified seven methodological recommendations for future resilience scale development with existing and new scales in and beyond the Chinese study contexts. We further addressed issues and challenges in measuring resilience as a process and called on researchers to further develop/evaluate process measures for Chinese-speaking populations.

Relationship between resilience and self-care in people with chronic conditions: A systematic review and meta-analysis

BACKGROUND

Living with chronic condition(s) is difficult, due in part to the complexities of effective disease self-care. Self-care has been considered a challenging process according to the literature which describes multiple barriers patients with chronic conditions experience. Resilience has the potential to buffer the adversities of daily self-care and maintain physical and emotional well-being. No systematic review and meta-analysis have been conducted to synthesise and quantify the relationship between resilience and self-care across chronic conditions.

AIMS

(1) To examine how the definitions and measurements of self-care and resilience align with the middle-range theory of self-care of chronic illness (i.e. self-care maintenance, self-care monitoring, and self-care management) and 3 Rs of resilience process from the society-to-cells framework (i.e. resistance, recovery and rebound) across different chronic conditions; and (2) to examine whether and the degree to which resilience is correlated with self-care across different chronic conditions.

DESIGN

Systematic review and meta-analysis, following PRISMA guidelines.

METHODS

PubMed, CINAHL, SocINDEX and PsychINFO were searched for quantitative studies published from January 2000 through July 2020. Descriptive data were summarised using numerical counting to provide an overview of the study characteristics. Definitions and measurements of self-care and resilience were synthesised narratively based on self-care and resilience theories. Numerical data with Pearson's product-moment correlation among observational studies were examined using meta-analysis.

RESULTS

This review included 20 articles, involving 9,269 individuals across 11 chronic conditions. Despite self-care and resilience being defined and operationalised in a variety of ways, most definitions shared some underlying core constructs. Meta-analysis showed a positive relationship between resilience and self-care across chronic conditions. Findings from interventional studies indicated a bidirectional relationship between resilience and self-care.

CONCLUSIONS

Overall, resilience was positively associated with self-care in people with chronic conditions. Longitudinal and experimental studies are needed to better understand the causal relationship between resilience and self-care.

RELEVANT TO CLINICAL PRACTICE

Resilience has the potential to buffer the adversities of daily self-care and maintain physical and emotional well-being. The positive relationship between resilience and self-care found in this review provides preliminary evidence for clinicians to not only focus on reducing barriers and risk factors of self-care but also to improve or increase patients' resilience through various evidence-based interventions.

The Self-Management Experiences of Adolescents with Type 1 Diabetes: A Descriptive Phenomenology Study

Many adolescents with type 1 diabetes experience challenges in achieving good glycemic control and have insufficient understanding in executing interventions for glycemic control. This study aimed to understand self-management experiences of adolescents with type 1 diabetes in Taiwan. In this descriptive phenomenological study, we conducted in-depth interviews with 18 adolescents with type 1 diabetes from the pediatric outpatient clinic of a medical center. Data were analyzed using the Colaizzi's method. Four themes were identified: (1) misconception regarding self-management of blood glucose; (2) conflict between depending on and breaking away from parental assistance for glycemic control; (3) encounter with disruptions in glycemic control regimen due to the presence of schedule changes; and (4) lack of motivation to achieve good glycemic control. The findings indicated that the misconceptions of adolescents with type 1 diabetes about managing glycemic levels resulted from an insufficient understanding of self-management of diabetes. In Taiwan, the heavy emphasis of academic achievement and changes of schedules during breaks tended to disrupt the regimen for glycemic control. Healthcare professionals are encouraged to provide individualized education focusing on the adolescents' misconceptions regarding self-management of diabetes.

Assessing resiliency in paediatric rehabilitation: A critical review of assessment tools and applications

BACKGROUNDS

Resiliency has attracted a growing interest in paediatric rehabilitation as a key capacity for disabled children and their families to thrive. This study aimed to identify measures used to assess resiliency of disabled children/youth and their families and critically appraise the current use of resiliency measures to inform future research and practice.

METHODS

A two-stage search strategy was employed. First, systematic reviews of resiliency measures published since 2000 were searched. Second, full names of measures identified in at least two systematic reviews were searched across four electronic databases. Included studies assessed resiliency among children/youth (0-18 years old) with chronic health conditions and/or disabilities and their families. Identified articles were then analysed to discern the study's definition of resiliency, authors' rationales for measurement selection, and types of perceived adversities facing the study participants.

RESULTS

From an initial yield of 25 measures identified in five systematic reviews, 11 were analysed in two or more reviews. The second stage yielded 41 empirical studies published between 2012 and 2018, which used 8 of the 11 resiliency measures searched by name. Of 41, 17 studies measured resiliency of disabled children/youth, 23 assessed resiliency within family members, and 1 studied both children/youth and their families. Our critical appraisal identified inconsistencies between the studies' definition of resiliency and chosen measures' operationalization, implicit assumption of disabilities as a developmental risk that automatically results in life adversities, and the tendency among family studies to reduce resiliency down to stress coping skills. Research that encompasses contextual factors and developmental influences is lacking.

CONCLUSIONS

There is a need for a situated measurement approach that captures multiple interacting factors shaping resiliency over one's life course. Resiliency measures would benefit from a greater focus on a person-environment transaction and an alternative definition of resiliency that accounts for multiple capacities to navigate through disabling environments.

Translation and its Psychometric Characteristic of the Diabetes Strengths and Resilience Measure among Chinese Adolescents with type 1 Diabetes

PURPOSE

This study is designed to develop a Chinese version of the Diabetes Strengths and Resilience Measure for Adolescents (DSTAR-Teen) and evaluate its psychometric characteristics.

DESIGN AND METHODS

One hundred and twenty adolescents with type 1 diabetes (Mean age = 16.3 ± 5.1, 51.7% male, Mean HbA1c = 7.6 ± 2.2%) were enrolled from one national endocrine center in China. Participants were administered with the DSTAR-Teen and the related psychosocial instruments to evaluate the reliability and validity. The DSTAR-Teen was adapted into Chinese version prior to data collection.

RESULTS

The Chinese DSTAR-Teen demonstrated adequate reliability (Cronbach's α coefficients = 0.90, intraclass correlation coefficient = 0.98). A minimum detectable change at the 95% confidence level was 5.8 points. In exploratory and confirmatory factorial analyses, a three-factor structure emerged with a variance of 67.4%, demonstrating construct validity. Moreover, resilience was significantly associated with glycated hemoglobin, diabetes distress and self-care behavior as hypothesized, further supporting validity.

CONCLUSION

The Chinese version of the DSTAR-Teen is a psychometrically sound instrument that may capture the adaptive attitudes and behaviors associated with diabetes management.

PRACTICE IMPLICATIONS

This scale can be used in both clinical and research settings with the aim of identifying diabetes specific strengths and improving the health outcomes in adolescents with type 1 diabetes.

Family Support towards Resilience in Adolescents with Type I Diabetes: A Preliminary Study in Indonesia

The prevalence of diabetes has increased in adolescents. Diabetic adolescents need ongoing support from their families, and the family plays an important role in the management of the disorder. This study aimed to identify the relationship between family support and resilience in adolescents with Type 1 Diabetes Mellitus (T1DM). Quantitative data analysis was conducted using simple logistic regression. Meanwhile, qualitative data were analyzed using content analysis. The results show that the median duration of a T1DM diagnosis was 4 years, which was dominated by early adolescents in the study group (41.9%); the mean resilience score was 67.95 (range 0-100) with 53.5% of the participants had low resilience, and 55.8% of the respondents received a high level of family support. Logistic regression test results indicate that significant family support is associated with resilience.

Family management affecting transition readiness and quality of life of Chinese children and young people with chronic diseases

Transition from pediatric to adult health care is a key milestone for children and young people (CYP) with chronic conditions. Family management (FM) and self-management are two important concepts during the process. This study aimed to explore the relationships between FM, self-management and transition readiness, and quality of life (QoL), and identify the potential CYP or family factors influencing the relationships. Data about FM, self-management and transition readiness, QoL, and various contextual factors were collected from 268 caregiver-child pairs. Structural equation modeling was used to examine the relationships between all variables. Results revealed that the easy aspects of FM mediated the relationships between the challenging aspects of FM, self-management and transition readiness, and QoL of CYP. Self-management and transition readiness mediated the relationship between the easy aspects of FM and QoL. Contextual factors indirectly influenced CYP's transition readiness and QoL through different aspects of FM. The results imply that to ensure the smooth transition from pediatric to adult health care and improve the CYP's QoL, strengthening CYP's independence and self-management competencies, combined with the support of the easy aspects of FM, seem to be useful strategies to increase CYP's readiness for transfer.

Factors associated with diabetic nephropathy in children, adolescents, and adults with type 1 diabetes

BACKBROUD/PURPOSE

Microalbuminuria and macroalbuminuria are markers of diabetic nephropathy (DN). The purpose of this study was to unravel the risk factors for DN in the young patients with type 1 diabetes (T1D).

METHODS

341 patients (160 males) with T1D diagnosed at the age 7.6 ± 4.0 years with disease duration 11.5 ± 6.5 years were assessed. Among them, 185 were young adults (aged 18.0-36.2 years). Urinary albumin creatinine ratio (UACR) was checked on morning spot urine. Microalbuminuria and macroalbuminuria were defined as a UACR of 30-300 mg/g and >300 mg/g, respectively, in at least 2 consecutive specimens.

RESULTS

50 (14.7%) patients were classified as microalbuminuria and 13 (3.8%) as macroalbuminuria. In all patients, multivariate logistic regression revealed that the most significant risk factors were average HbA1c (%), OR (95% CI) = 1.76 (1.37-2.25), P = 0.002); and male sex, OR = (odd ratio 2.31 (1.19-4.46), P = 0.013). In adult patients, the most significant factors were average HbA1c, OR = 1.74 (1.32-2.31), P = 0.003; and systolic blood pressure, OR = 1.06 (1.01-1.11), P = 0.011. Survival analysis showed average HbA1c levels significantly influenced the development of DN.

CONCLUSION

The most important risk factors for DN were average HbA1c and age. When microalbuminuria is detected, proper treatment with ACEIs or ARBs and improving glycemic control can delay progression of DN.