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Pan L, Yeung NCY. Positive Psychology Interventions for Improving Self-management Behaviors in Patients with Type 1 and Type 2 Diabetes: a Narrative Review of Current Evidence. Curr Diab Rep 2023; 23:329-345. [PMID: 37910312 DOI: 10.1007/s11892-023-01525-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW Interests have been emerging in using positive psychology interventions (PPIs) to improve diabetes self-management (DSM) behaviors (e.g., blood glucose monitoring, physical activity). To explore the impact of those interventions on DSM behaviors, we summarized the evidence of PPIs on self-management behaviors among both type 1 diabetes (T1D) and type 2 diabetes (T2D) patients between 2012 and 2022. RECENT FINDINGS Among the eight studies identified, different study designs and types of PPIs were apparent. Typical PPIs (e.g., activities enhancing positive affect/gratitude/self-affirmation/optimism) were usually applied to T1D patients (N = 5); PPIs were usually combined with motivational interviewing for T2D patients (N = 3). Contrary to expectations, PPIs did not consistently demonstrate positive effects on self-management behaviors' change regardless of the types of diabetes patients, compared to the control groups. Improvements in diabetes patients' self-management behaviors from PPIs are still unclear. Future studies should more rigorously evaluate and identify the active ingredients of PPIs for behavioral changes among diabetes patients.
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Affiliation(s)
- Lihua Pan
- JC School of Public Health and Primary Care, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, School of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Nelson C Y Yeung
- JC School of Public Health and Primary Care, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, School of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
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Supervising Without Controlling: A New Authority intervention for Adolescents with Type 1 Diabetes. JOURNAL OF CHILD AND FAMILY STUDIES 2022. [DOI: 10.1007/s10826-021-02186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Bell T, Noar SM, Lazard AJ. Narrative Vs. Standard of Care Messages: Testing How Communication Can Positively Influence Adolescents with Type 1 Diabetes. JOURNAL OF HEALTH COMMUNICATION 2021; 26:626-635. [PMID: 34649469 DOI: 10.1080/10810730.2021.1985657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Adolescents with type 1 diabetes (T1D) face a variety of challenges in disease management, and many struggle to achieve optimal glycemic control. Health communication through didactic messaging about the importance of self-management is a commonly used strategy for this population, but narratives have been underutilized. The purpose of this study was to determine if narratives would provide a better tool to improve disease management for adolescents overcoming T1D-specific issues. Adolescent ages 12-17 (N = 191) were enrolled in an online experiment and viewed sets of narratives or standard of care messages. Outcomes were broken into three categories: message evaluation, specifically perceived message effectiveness (PME), and positive emotional reactions; beliefs such as self-efficacy, outcome expectations, and stress and burnout perceptions, and behaviors including disease management and interpersonal communication. Narratives did not significantly outperform standard of care messages, but both message types scored high on PME and other outcomes. We conclude that both narrative and didactic formats may offer utility for healthcare providers working with adolescents, in that narratives provide stories that may inspire positive emotions while standard of care messages provide the necessary clinical information needed to set goals for self-management.
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Affiliation(s)
- Trevor Bell
- College of Liberal Arts, California State University, Long Beach, California, USA
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, North Carolina, USA
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McCollum DC, O'Grady MJ. Diminished school-based support for the management of type 1 diabetes in adolescents compared to younger children. Diabet Med 2020; 37:779-784. [PMID: 31654586 DOI: 10.1111/dme.14160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 01/08/2023]
Abstract
AIMS To evaluate diabetes management at school in a large cohort of adolescents with type 1 diabetes and to compare the level of support provided to adolescents with that provided to younger children. METHODS Questionnaires were distributed to adolescents with type 1 diabetes attending nine regional and tertiary paediatric diabetes services in the Republic of Ireland. The data collected included patient demographics, treatment regimen and support provided for self-care management. Results were compared with a similar cohort of primary school children with type 1 diabetes, studied using similar methodology. RESULTS The study cohort comprised 405 adolescents with a median age of 15 years, of whom 215 (54%) were on multiple daily injections and 128 (32%) were on pump therapy. Eighty-five percent of pump users administered their bolus insulin in classrooms, whereas 76% of those on a multiple daily injection regimen injected outside the classroom. Girls were less likely to administer bolus insulin in an office (10% vs 19%) and more likely to administer it in the bathroom (50% vs 34%; P=0.01). Twenty-five adolescents (12%) on multiple daily injection regimens did not administer bolus insulin at school. Compared to primary school children with type 1 diabetes, adolescents were less likely to use pump therapy, have an emergency treatment plan and have a designated staff member responsible for care needs. CONCLUSIONS Support provided to adolescents with type 1 diabetes is diminished compared with that provided to younger schoolchildren.
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Affiliation(s)
- D C McCollum
- Department of Paediatrics, Regional Hospital Mullingar, Co. Westmeath, Dublin, Ireland
| | - M J O'Grady
- Department of Paediatrics, Regional Hospital Mullingar, Co. Westmeath, Dublin, Ireland
- Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland
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Schmidt S, Markwart H, Bomba F, Muehlan H, Findeisen A, Kohl M, Menrath I, Thyen U. Differential effect of a patient-education transition intervention in adolescents with IBD vs. diabetes. Eur J Pediatr 2018; 177:497-505. [PMID: 29340756 DOI: 10.1007/s00431-017-3080-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 11/26/2022]
Abstract
UNLABELLED Patient education programs (PEPs) to improve disease management are part of standard and regular treatment in adolescents with diabetes. In Germany, youth with inflammatory bowel disease (IBD) receive individual counseling but not PEPs in group settings. Generic PEPs have been developed in order to improve transition from child-centered to adolescent health services. The aim of the study was to investigate the effects of a transition-oriented PEP on quality of life (QoL) and self-management in young patients with IBD (PEP naive), compared to patients with diabetes (familiar with PEPs). A 2-day transition workshop was oriented at improving psychosocial skills and addressed both generic as well as specific aspects of the condition. A controlled trial on the outcomes of a generic transition-oriented PEP was conducted in 14- to 20-year-old patients with IBD (n = 99) and diabetes (n = 153). Transition competence and QoL were assessed at baseline and 6-month follow-up. Results show that the intervention lead to a significant increase in QoL only in patients with IBD. The PEP significantly improved transition competence in both groups, however to a higher extent in subjects with IBD. CONCLUSION Transition-oriented PEPs can have differential effects in different patient groups. However, this needs further longitudinal investigations. What is Known: • To date, evidence has accumulated concerning the effectiveness of patient education programs (PEPs) in pediatric health care for chronic conditions such as type 1 diabetes, asthma, atopic dermatitis, or obesity but is less documented in inflammatory bowel disease (IBD). In particular, PEPs in the transition period have not been investigated in youth with IBD. • The current study focuses on evaluating a PEP for transition preparation and management designed to be generically used across different chronic conditions since many aspects of managing chronic conditions share commonalities across conditions. The 2-day workshop included condition-specific modules adapted to the specific medical needs but was otherwise similar in quality and organization among different conditions. What is New: • The transition-oriented PEP was effective in enhancing self-management and transition management skills in both patients with IBD and diabetes; however, effects were higher in youth with IBD. A significant impact of the intervention on patients' QoL compared to the control group was only identified in youth with IBD. • We recommend that patients with IBD have access to PEP as a standard treatment as well as to a transition program during the course of illness.
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Affiliation(s)
- Silke Schmidt
- Department Health and Prevention, Institute of Psychology, Ernst-Moritz-Arndt-University of Greifswald, Robert-Blum-Str. 13, 17487, Greifswald, Germany.
| | - Henriette Markwart
- Department Health and Prevention, Institute of Psychology, Ernst-Moritz-Arndt-University of Greifswald, Robert-Blum-Str. 13, 17487, Greifswald, Germany
| | - Franziska Bomba
- Department of Child and Adolescent Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Holger Muehlan
- Department Health and Prevention, Institute of Psychology, Ernst-Moritz-Arndt-University of Greifswald, Robert-Blum-Str. 13, 17487, Greifswald, Germany
| | - Annette Findeisen
- Department of Child and Adolescent Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Martina Kohl
- Department of Child and Adolescent Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Ingo Menrath
- Department of Child and Adolescent Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Ute Thyen
- Department of Child and Adolescent Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
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Feldman MA, Anderson LM, Shapiro JB, Jedraszko AM, Evans M, Weil LEG, Garza KP, Weissberg-Benchell J. Family-Based Interventions Targeting Improvements in Health and Family Outcomes of Children and Adolescents with Type 1 Diabetes: a Systematic Review. Curr Diab Rep 2018; 18:15. [PMID: 29457190 DOI: 10.1007/s11892-018-0981-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW A systematic review was conducted of family-based interventions to improve glycemic control, adherence, and psychosocial outcomes in children and adolescents with type 1 diabetes (T1D). Electronic databases were searched for randomized controlled trials (RCTs) published since the seminal Diabetes Control and Compliance Trial (DCCT). Interventions are summarized and findings reviewed to help guide clinical practice and future research. RECENT FINDINGS Twenty-five RCTs are reviewed. The majority of studies (n = 15) focused on interventions targeting both children and adolescents and their caregivers and were delivered in diabetes clinics, outpatient settings, mental health clinics, or participants' homes. Family-based interventions for youth with T1D appear effective at improving diabetes and family-centered outcomes. Additional research is needed to examine the pathways to improvement in glycemic control, as outcomes were mixed. Future research should also involve measures beyond HbA1c given new markers for sustained health improvement and outcomes are being explored.
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Affiliation(s)
- Marissa A Feldman
- Child Development and Rehabilitation Center, Johns Hopkins All Children's Hospital, 880 Sixth Street South, Suite 420, Saint Petersburg, FL, 33701, USA.
| | - Lindsay M Anderson
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Aneta M Jedraszko
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Meredyth Evans
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lindsey E G Weil
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kimberly P Garza
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Goh CSY, Mohamed A, Lee YS, Loke KY, Wee HL, Khoo EYH, Griva K. The associations of self-care, illness perceptions and psychological distress with metabolic control in Singaporean adolescents with Type 1 Diabetes Mellitus. Health Psychol Behav Med 2016. [DOI: 10.1080/21642850.2015.1115728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Schmidt S, Herrmann-Garitz C, Bomba F, Thyen U. A multicenter prospective quasi-experimental study on the impact of a transition-oriented generic patient education program on health service participation and quality of life in adolescents and young adults. PATIENT EDUCATION AND COUNSELING 2016; 99:421-428. [PMID: 26597543 DOI: 10.1016/j.pec.2015.10.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 10/17/2015] [Accepted: 10/28/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of the study was to test the effects of a generic transition-oriented patient education program on adolescents' health service participation and quality of life (QoL). METHODS We conducted a controlled trial comparing participants of 29 transition workshops with treatment as usual in 274 adolescents (16.8 mean age, SD=1.76) diagnosed with type I diabetes (DM), cystic fibrosis (CF) or inflammatory bowel disease (IBD). A two-day transition workshop was carried out at 12 sites in Germany, focusing in standardized modules on adjustment to adult care settings, organization of future disease management, career choices and partnership. Study outcomes were health-related transition competence, self-efficacy, satisfaction with care, patient activation and QoL. Measures were assessed at baseline and six-month follow-up. RESULTS Repeated-measurement covariance analysis using age as a covariate showed that the transition workshop significantly affected transition competence, self-efficacy and satisfaction with school care six months post intervention. The intervention did not significantly affect patient activation and QoL. However, post-hoc analysis suggested different effects across conditions. CONCLUSION The program has a positive effect on the competence of adolescents in the transition phase. PRACTICE IMPLICATIONS The study demonstrates that an intervention can be effective in preparing adolescents with chronic conditions for transitions.
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Affiliation(s)
- Silke Schmidt
- Department Health and Prevention, University of Greifswald, Germany.
| | | | - Franziska Bomba
- Department of Child and Adolescent Health, University of Lübeck, Germany
| | - Ute Thyen
- Department of Child and Adolescent Health, University of Lübeck, Germany
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Cognitive, behavioral and goal adjustment coping and depressive symptoms in young people with diabetes: a search for intervention targets for coping skills training. J Clin Psychol Med Settings 2015; 22:45-53. [PMID: 25614324 PMCID: PMC4336408 DOI: 10.1007/s10880-015-9417-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the present study was to find relevant coping factors for the development of psychological intervention programs for young people with Type 1 (T1) diabetes. A wide range of coping techniques was studied, including cognitive coping, behavioral coping and goal adjustment coping. A total of 78 young people with T1 diabetes participated. They were contacted through a social networking website, several Internet sites, and flyers. A wide range of coping techniques appeared to be related to depressive symptoms. Especially the cognitive coping strategies self-blame, rumination, refocus positive, and other-blame, together with goal adjustment coping, were of importance. A large proportion of the variance of depressive symptoms could be explained (65 %). These findings suggest that these specific coping strategies should be part of coping skills trainings for young people with T1 diabetes.
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Pelicand J, Fournier C, Le Rhun A, Aujoulat I. Self-care support in paediatric patients with type 1 diabetes: bridging the gap between patient education and health promotion? A review. Health Expect 2015; 18:303-11. [PMID: 23311712 PMCID: PMC5060779 DOI: 10.1111/hex.12041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study examines how the term 'self-care' imported from health promotion has been used in the context of patient education interventions for paediatric patients with type 1 diabetes. METHODS Thirty articles over the last decade were analysed, using a qualitative method of thematic coding and categorizing. RESULTS The term 'self-care' has been mainly used as a synonym for self-management of one's condition and treatment. Indeed, the activities performed by paediatric patients independently or with the help of their parents under the term 'self-care' fail to explicitly take into account the general health and life dimensions of self-care, as defined in health promotion. Although such dimensions are implicitly present when it comes to define the parents' and health-care providers' roles in supporting the children's emerging self-care capacity, their importance is acknowledged as a way of strengthening the children's and their families' capacity to respond to illness demands, rather than in relation to their general well-being. CONCLUSION The discourse on self-care in the field of paediatric diabetes therefore appears to be oriented more towards disease and prevention, rather than health promotion. The psychosocial dimension of self-care should be particularly investigated, as young patients need to be supported in their efforts to gain autonomy not only in relation to the management of their condition, but in their lives in general.
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Affiliation(s)
- Julie Pelicand
- Pediatric DiabetologyHospital Necker‐Enfants MaladesParisFrance
| | | | | | - Isabelle Aujoulat
- Institute of Health & Society (IRSS), Université Catholique de LouvainBrusselsBelgium
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Maranda L, Lau M, Stewart SM, Gupta OT. A novel behavioral intervention in adolescents with type 1 diabetes mellitus improves glycemic control: preliminary results from a pilot randomized control trial. DIABETES EDUCATOR 2015; 41:224-30. [PMID: 25614529 DOI: 10.1177/0145721714567235] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to develop and pilot-test an innovative behavioral intervention in adolescents with type 1 diabetes mellitus (T1DM) incorporating structured care of a pet to improve glycemic control. METHODS Twenty-eight adolescents with A1C > 8.5% (69 mmol/mol) were randomly assigned to either the intervention group (care of a Betta splendens pet fish) or the control group (usual care). Adolescents in the intervention group were given instructions to associate daily and weekly fish care duties with diabetes self-management tasks, including blood glucose testing and parent-adolescent communication. RESULTS After 3 months, the participants in the intervention group exhibited a statistically significant decrease in A1C level (-0.5%) compared with their peers in the control group, who had an increase in A1C level (0.8%) (P = .04). The younger adolescents (10-13 years of age) demonstrated a greater response to the intervention, which was statistically significant (-1.5% vs 0.6%, P = .04), compared with the older adolescents (14-17 years of age). CONCLUSIONS Structured care of a pet fish can improve glycemic control in adolescents with T1DM, likely by providing cues to perform diabetes self-management behaviors.
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Affiliation(s)
- Louise Maranda
- Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester, Massachusetts (Dr Maranda)
| | - May Lau
- Division of General Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas (Dr Lau)
| | - Sunita M Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas (Dr Stewart)
| | - Olga T Gupta
- Division of Endocrinology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas (Dr Gupta)
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Nabors LA, Kichler JC, Burbage ML, Swoboda CM, Andreone TL. Children's Learning and Goal-Setting at a Diabetes Camp. Diabetes Spectr 2014; 27:257-63. [PMID: 25647047 PMCID: PMC4231935 DOI: 10.2337/diaspect.27.4.257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective. This study provides information about children's learning and goal attainment related to change in their self-management skills during a diabetes camp. Design and methods. One hundred and thirty-one children completed an evaluation for the first year (year 1), and 68 children completed an evaluation for the second year (year 2). All of the children had type 1 diabetes. During both years, parents provided information about goals for their child before camp started. Children's learning about diabetes self-management, as well as their satisfaction with camp, was assessed at the end of the camp session. In the evaluation for year 2, a goal-setting intervention was also developed, and its effectiveness was assessed through both physicians' and children's reports. Results. Children learned new information during camp about recognizing and managing the signs of hypo- and hyperglycemia and about counting carbohydrates and rotating insulin pump sites. Children were better able to recall their self-management goals in year 2. In terms of benefiting from camp, boys reported learning more than girls about diabetes management, whereas girls were more likely than boys to report that greater opportunities to express feelings were of value. Conclusions. Goal-setting was successful in improving children's recall of their self-management goals. Children benefited from the supportive and educational camp atmosphere. Future research should assess the benefits of camp across multiple camp settings and determine whether educational benefits have long-term effects on children's goal-setting and knowledge and whether these benefits lead to psychosocial improvements.
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Jaser SS, Patel N, Linsky R, Whittemore R. Development of a positive psychology intervention to improve adherence in adolescents with type 1 diabetes. J Pediatr Health Care 2014; 28:478-85. [PMID: 24786582 PMCID: PMC4273905 DOI: 10.1016/j.pedhc.2014.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/21/2014] [Accepted: 02/23/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Novel interventions are needed to improve adherence to treatment in adolescents with type 1 diabetes. In this article, we describe the development, feasibility, and acceptability of a positive psychology intervention for this population. METHOD Adolescents and their parents (n = 39) were randomly assigned to either a positive psychology intervention or an attention control group. Quantitative and qualitative data were collected on feasibility and acceptability. Descriptive and content analysis methods were used. RESULTS Recruitment was successful, participation and satisfaction were high in both groups, and retention was excellent over 6 months. In the positive psychology group, adolescents and their parents noted benefits related to increased positive communication and thinking more about diabetes care. We also identified challenges to implementation. DISCUSSION Although more research is indicated, a positive psychology framework emphasizing positive emotions and strengths, rather than problems, may be beneficial to adolescents living with a complex chronic illness.
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Affiliation(s)
- Sarah S. Jaser
- Associate Professor, Department of Pediatrics, Vanderbilt University, Nashville, TN
| | - Niral Patel
- Research Analyst, Department of Pediatrics, Vanderbilt University, Nashville, TN
| | - Rebecca Linsky
- Research Assistant, School of Nursing, Yale University, New Haven, CT
| | - Robin Whittemore
- Associate Professor, School of Nursing, Yale University, New Haven, CT
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Husted GR, Thorsteinsson B, Esbensen BA, Gluud C, Winkel P, Hommel E, Zoffmann V. Effect of guided self-determination youth intervention integrated into outpatient visits versus treatment as usual on glycemic control and life skills: a randomized clinical trial in adolescents with type 1 diabetes. Trials 2014; 15:321. [PMID: 25118146 PMCID: PMC4247629 DOI: 10.1186/1745-6215-15-321] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 07/23/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Providing care for adolescents with type 1 diabetes is complex, demanding, and often unsuccessful. Guided self-determination (GSD) is a life skills approach that has been proven effective in caring for adults with type 1 diabetes. To improve care, GSD was revised for adolescents, their parents, and interdisciplinary healthcare providers (HCP) to create GSD-Youth (GSD-Y). We evaluated the impact of GSD-Y after it was integrated into pediatric outpatient visits versus treatment-as-usual, focusing on glycemic control and the development of life skills in adolescents with type 1 diabetes. METHODS Seventy-one adolescents (mean age: 15 years, mean duration of diabetes: 5.7 years, mean HbA1c: 77 mmol/mol (9.1%), upon entering the study) from two pediatric departments were randomized into a GSD-Y group (n = 37, GSD-Y was provided during individual outpatient sessions) versus a treatment-as-usual group (n = 34). The primary outcome was the HbA1c measurement. The secondary outcomes were life skills development (assessed by self-reported psychometric scales), self-monitored blood glucose levels, and hypo- and hyperglycemic episodes. The analysis followed an intention-to-treat basis. RESULTS Fifty-seven adolescents (80%) completed the trial, and 53 (75%) completed a six-month post-treatment follow-up. No significant effect of GSD-Y on the HbA1c could be detected in a mixed-model analysis after adjusting for the baseline HbA1c levels and the identity of the HCP (P = 0.85). GSD-Y significantly reduced the amotivation for diabetes self-management after adjusting for the baseline value (P = 0.001). Compared with the control group, the trial completion was prolonged in the GSD-Y group (P <0.001), requiring more visits (P = 0.05) with a higher rate of non-attendance (P = 0.01). GSD-Y parents participated in fewer of the adolescents' visits (P = 0.05) compared with control parents. CONCLUSIONS Compared with treatment-as-usual, GSD-Y did not improve HbA1c levels, but it did decrease adolescents' amotivation for diabetes self-management. TRIAL REGISTRATION ISRCTN 54243636, registered on 10 January 2010. Life skills for adolescents with type 1 diabetes and their parents.
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Affiliation(s)
- Gitte R Husted
- Department of Pediatrics, Nordsjællands Hospital Hillerød, University of Copenhagen, Dyrehavevej 29, 3400 Hillerød, Denmark.
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Hofmann B. Ethical challenges with welfare technology: a review of the literature. SCIENCE AND ENGINEERING ETHICS 2013; 19:389-406. [PMID: 22218998 DOI: 10.1007/s11948-011-9348-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 12/20/2011] [Indexed: 05/31/2023]
Abstract
Demographical changes in high income counties will increase the need of health care services but reduce the number of people to provide them. Welfare technology is launched as an important measure to meet this challenge. As with all types of technologies we must explore its ethical challenges. A literature review reveals that welfare technology is a generic term for a heterogeneous group of technologies and there are few studies documenting their efficacy, effectiveness and efficiency. Many kinds of welfare technology break with the traditional organization of health care. It introduces technology in new areas, such as in private homes, and it provides new functions, e.g. offering social stimuli and entertainment. At the same time welfare technology is developed for groups that traditionally have not been extensive technology users. This raises a series of ethical questions with regard to the development and use of welfare technologies, which are presented in this review. The main challenges identified are: (1) Alienation when advanced technology is used at home, (2) conflicting goals, as welfare technologies have many stakeholders with several ends, (3) respecting confidentiality and privacy when third-party actors are involved, (4) guaranteeing equal access and just distribution, and (5) handling conflicts between instrumental rationality and care in terms of respecting dignity and vulnerability. Addressing these issues is important for developing and implementing welfare technologies in a morally acceptable manner.
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Affiliation(s)
- Bjørn Hofmann
- Center for Medical Ethics, University of Oslo, PO Box 1130, Blindern, 0318, Oslo, Norway.
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Lindsay S, Kingsnorth S, Mcdougall C, Keating H. A systematic review of self-management interventions for children and youth with physical disabilities. Disabil Rehabil 2013; 36:276-88. [PMID: 23614359 PMCID: PMC3934376 DOI: 10.3109/09638288.2013.785605] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 02/08/2013] [Accepted: 03/11/2013] [Indexed: 11/13/2022]
Abstract
PURPOSE Evidence shows that effective self-management behaviors have the potential to improve health outcomes, quality of life, self-efficacy and reduce morbidity, emergency visits and costs of care. A better understanding of self-management interventions (i.e. programs that help with managing symptoms, treatment, physical and psychological consequences) is needed to achieve a positive impact on health because most children with a disability now live well into adulthood. METHOD A systematic review of self-management interventions for school age youth with physical disabilities was undertaken to assess their effectiveness. Comprehensive electronic searches using international web-based reference libraries were conducted for peer-reviewed and gray literature published between 1980 and January 2012. Eligible studies examined the effectiveness of self-management interventions for children and youth between 6 and 18 years of age with congenital or acquired physical disabilities. Studies needed to include a comparison group (e.g. single group pre/post-test design) and at least one quantifiable health-related outcome. RESULTS Of the 2184 studies identified, six met the inclusion criteria; two involved youth with spina bifida and four with juvenile arthritis. The majority of the interventions ran several sessions for at least 3 months by a trained interventionist or clinician, had one-to-one sessions and meetings, homework activities and parental involvement. Although outcomes varied between the studies, all of the interventions reported at least one significant improvement in either overall self-management skills or a specific health behavior. CONCLUSIONS While self-management interventions have the potential to improve health behaviors, there were relatively few rigorously designed studies identified. More studies are needed to document the outcomes of self-management interventions, especially their most effective characteristics for children and youth with physical disabilities. Implications for Rehabilitation There is some evidence to suggest that self-management interventions for children and youth with spina bifida and arthritis can improve self-management behaviors and health outcomes. Parents' involvement should be considered in encouraging self-management behaviors at different stages of their child's development. Much work is needed to explore the longer term implications of self-management interventions for youth with physical disabilities as well as the impact on health care utilization.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation HospitalToronto, ONCanada
- Department of Occupational Science and Occupational Therapy, Graduate Department of Rehabilitation Sciences, University of TorontoToronto, ONCanada
| | | | - Carolyn Mcdougall
- Department of Occupational Science and Occupational Therapy, Graduate Department of Rehabilitation Sciences, University of TorontoToronto, ONCanada
- Centre for Participation and Inclusion, Holland Bloorview Kids Rehabilitation HospitalONCanada
| | - Heather Keating
- Centre for Participation and Inclusion, Holland Bloorview Kids Rehabilitation HospitalONCanada
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Anderson BJ. Behavioral research in pediatric diabetes: putting the evidence to work for advocacy and education. Pediatr Diabetes 2012; 13:77-80. [PMID: 21545676 DOI: 10.1111/j.1399-5448.2011.00778.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Dr Henri Lestradet was a founding member of the International Study Group for Diabetes (in childhood and adolescence) (ISGD), and his influence on the scope and vision of this organization was profound. A brief biography of Dr Lestradet and a summary of how his original ISGD evolved into the current International Society for Pediatric and Adolescent Diabetes (ISPAD) will be presented first. Second, consistent with Dr Lestradet's vision for children with diabetes worldwide, I will suggest five areas of behavioral research in diabetes in which there is strong evidence that can be used to create educational and advocacy initiatives for children with diabetes. Finally, I will recommend several priorities for behavioral research in the next decade which will help to strengthen Prof. Lestradet's legacy of support for children with diabetes and their families.
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Affiliation(s)
- Barbara J Anderson
- Baylor College of Medicine, Department of Pediatrics, Psychology Section, Houston, TX 77030, USA.
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Abstract
Adaptation to type 1 diabetes is optimized in the presence of ongoing family support and supervision. Therefore, it is particularly important to understand how family interactions influence adaptation to the illness. The purpose of this paper is to review the current literature on family interaction in youth with type 1 diabetes. Recent advancements in the literature include greater specificity of types of parental involvement, attention to the role of fathers, acknowledgment of the impact of parental distress, increased use of observational methods, and awareness of the impact of culture. Continued parental involvement-particularly monitoring-in the management of diabetes care is important as children transition into adolescence, and the best outcomes are evident when this involvement occurs in a warm, collaborative manner. Parents need support in managing their own distress to maintain this type of involvement.
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Schober E, Wagner G, Berger G, Gerber D, Mengl M, Sonnenstatter S, Barrientos I, Rami B, Karwautz A, Fritsch M. Prevalence of intentional under- and overdosing of insulin in children and adolescents with type 1 diabetes. Pediatr Diabetes 2011; 12:627-31. [PMID: 21435136 DOI: 10.1111/j.1399-5448.2011.00759.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of insulin under- and overdosing in paediatric patients. RESEARCH DESIGN AND METHODS Cross-sectional study including 241 patients (age 14.0 + 2.7 yr, 42.5% males) with type 1 diabetes from 21 diabetic outpatient clinics. Haemoglobin A1c (HbA1c), height, and weight were available from clinical records. Patients were interviewed with the Diabetes Self-Management Profile (DSMP) interview. T test, U test, and chi-squared test were used for comparison. RESULTS On the basis of the DSMP, 103 (42.7%) patients (group A) showed adherence to the therapeutic insulin regimen, while 71 (29.5%) patients (group B) confessed intentional over and/or under-dosing of insulin. Sixty-seven (27.8%) adolescents (group C) reported management problems leading to unintended inappropriate insulin dosages. In group B, 55 (22.8%) injected higher insulin doses and 58 (24.1%) omitted insulin. Patients of group B compared to group A were older 15.0 (±2.5) vs. 14.0 (±2.5) yr (p < 0.01), older at onset 9.5 (±3.6) vs. 8.3 (±3.8) yr (p = 0.05), were more often girls (69 vs. 45.6%), had a higher actual HbA1c (8.7 ± 1.7 vs. 7.8 ± 1.2%), and a higher average HbA1c in the previous year (8.3 ± 1.6 vs. 7.9 ± 1.2%) (p < 0.01). No significant differences could be found between group A and group C. CONCLUSION Intentional overdosing of insulin is almost as prevalent in children and adolescents as insulin omission. Females are more at risk.
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Affiliation(s)
- Edith Schober
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
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Husted GR, Thorsteinsson B, Esbensen BA, Hommel E, Zoffmann V. Improving glycaemic control and life skills in adolescents with type 1 diabetes: a randomised, controlled intervention study using the Guided Self-Determination-Young method in triads of adolescents, parents and health care providers integrated into routine paediatric outpatient clinics. BMC Pediatr 2011; 11:55. [PMID: 21672252 PMCID: PMC3164223 DOI: 10.1186/1471-2431-11-55] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 06/14/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adolescents with type 1 diabetes face demanding challenges due to conflicting priorities between psychosocial needs and diabetes management. This conflict often results in poor glycaemic control and discord between adolescents and parents. Adolescent-parent conflicts are thus a barrier for health care providers (HCPs) to overcome in their attempts to involve both adolescents and parents in improvement of glycaemic control. Evidence-based interventions that involve all three parties (i.e., adolescents, parents and HCPs) and are integrated into routine outpatient clinic visits are lacking. The Guided Self-Determination method is proven effective in adult care and has been adapted to adolescents and parents (Guided Self-Determination-Young (GSD-Y)) for use in paediatric diabetes outpatient clinics. Our objective is to test whether GSD-Y used in routine paediatric outpatient clinic visits will reduce haemoglobin A1c (HbA1c) concentrations and improve adolescents' life skills compared with a control group. METHODS/DESIGN Using a mixed methods design comprising a randomised controlled trial and a nested qualitative evaluation, we will recruit 68 adolescents age 13-18 years with type 1 diabetes (HbA1c > 8.0%) and their parents from 2 Danish hospitals and randomise into GSD-Y or control groups. During an 8-12 month period, the GSD-Y group will complete 8 outpatient GSD-Y visits, and the control group will completes an equal number of standard visits. The primary outcome is HbA1c. Secondary outcomes include the following: number of self-monitored blood glucose values and levels of autonomous motivation, involvement and autonomy support from parents, autonomy support from HCPs, perceived competence in managing diabetes, well-being, and diabetes-related problems. Primary and secondary outcomes will be evaluated within and between groups by comparing data from baseline, after completion of the visits, and again after a 6-month follow-up. To illustrate how GSD-Y influences glycaemic control and the development of life skills, 10-12 GSD-Y visits will be recorded during the intervention and analysed qualitatively together with individual interviews carried out after follow-up. DISCUSSION This study will provide evidence of the effectiveness of using a GSD-Y intervention with three parties on HbA1c and life skills and the feasibility of integrating the intervention into routine outpatient clinic visits. Danish Data Association ref nr. 2008-41-2322. TRIAL REGISTRATION ISRCTN54243636.
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Affiliation(s)
- Gitte R Husted
- The Research Department & Paediatric Ward, Hillerød Hospital, Denmark
| | | | - Bente Appel Esbensen
- Research Unit, Department of Nursing and Health Science, Glostrup Hospital, Glostrup, Denmark
| | - Eva Hommel
- Steno Diabetes Center, Gentofte, Denmark
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Harris MA, Freeman KA, Duke DC. Getting (the most) out of the research business: interventions for youth with T1DM. Curr Diab Rep 2010; 10:406-14. [PMID: 20821285 DOI: 10.1007/s11892-010-0142-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We review research on psychosocial interventions to improve outcomes for youth with type 1 diabetes mellitus. Specifically, we discuss individual- and small group-focused, family-focused, group-focused, and other interventions. After reviewing extant research in each area, we discuss how the current evidence base may be used to inform clinical practice. Finally, we conclude by discussing variations in effects of interventions on different outcomes (eg, glycemic control, family functioning) and how to consider this evidence when selecting treatments to transport into clinical settings.
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Affiliation(s)
- Michael A Harris
- Pediatrics and Psychiatry, Division of Psychology, Child Development & Rehabilitation Center, Oregon Health & Science University, 707 SW Gaines, Portland, OR 97239, USA
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Lehmkuhl HD, Storch EA, Cammarata C, Meyer K, Rahman O, Silverstein J, Malasanos T, Geffken G. Telehealth behavior therapy for the management of type 1 diabetes in adolescents. J Diabetes Sci Technol 2010; 4:199-208. [PMID: 20167185 PMCID: PMC2825642 DOI: 10.1177/193229681000400125] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Poor management of type 1 diabetes mellitus (T1DM) may result in serious medical complications. Psychological intervention may improve adherence to medical regimens; however, access to trained professionals is limited, particularly in rural communities. Telehealth interventions may address this by allowing families to access services at home; however, little is known about the efficacy of such services. METHOD This study presents results from a pilot trial of a randomized waitlist controlled trial of Telehealth Behavioral Therapy (TBT) for youths with T1DM. Primary outcome measures were adherence to the diabetes regimen, glycemic control, and level of family discord. Thirty-two youths (23 female) with T1DM (aged 9 to 17 years) and one parent or caregiver participated. Telehealth Behavioral Therapy sessions were conducted thrice weekly for 12 weeks by phone and lasted an average of 15 min each. RESULTS Results indicated that youths in treatment decreased their hemoglobin A1c by 0.74 compared to 0.09 in the waitlist, though this was not statistically significant. Youths in treatment reported increased unsupportive and decreased caring parental behaviors. CONCLUSION Telehealth Behavioral Therapy improves access to knowledgeable providers and results in a clinically significant improvement in glycemic control. Despite some youths experiencing an increase in unsupportive parental behaviors, TBT is a promising method of service delivery that warrants further investigation.
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Affiliation(s)
- Heather D Lehmkuhl
- Department of Psychology, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
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Lewin AB, LaGreca AM, Geffken GR, Williams LB, Duke DC, Storch EA, Silverstein JH. Validity and reliability of an adolescent and parent rating scale of type 1 diabetes adherence behaviors: the Self-Care Inventory (SCI). J Pediatr Psychol 2009; 34:999-1007. [PMID: 19423660 DOI: 10.1093/jpepsy/jsp032] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Accurate assessment of diabetes regimen adherence behaviors in youth is a challenging endeavor and is limited by a paucity of empirically supported measures. The purpose of this research is to further demonstrate the validity and reliability of the Self-Care Inventory (SCI), a youth and parent report measure of adherence with diabetes self-care behaviors. The SCI was chosen given its ease of implementation, applicability to multiple diabetes regimens, and dual parent/youth formats. METHODS Participants were 164 youth with type 1 diabetes and a parent. Measures were administered at regular office visits to a tertiary care diabetes clinic. RESULTS The SCI has strong psychometric properties, including adequate internal consistency, parent-youth agreement, and test-retest agreement. Relations between the SCI and a structured interview of diabetes adherence (the Diabetes Self-Management Profile; DSMP) and hemoglobin A1c (HbA1c) were strong. CONCLUSIONS In addition to demonstrating strong psychometrics, this research provides independent support for the SCI. Thus, the SCI is consistent with recent criteria proposed by Quittner et al. (Journal of Pediatric Psychology, 33, 916-936) for an empirically supported measure of regimen adherence. Although other methods of accessing adherence may provide more comprehensive assessments, the brevity, ease-of-implementation, and robustness for multiple regimens makes the SCI an ideal tool for clinicians and researchers.
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Affiliation(s)
- Adam B Lewin
- Department of Psychiatry & Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA.
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