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Davis SL, Jaser SS, Ivankova NV, Lemley T, Rice M. Using Mixed Methods Research in Children with Type 1 Diabetes: a Methodological Review. Curr Diab Rep 2023; 23:147-163. [PMID: 37097408 PMCID: PMC10651325 DOI: 10.1007/s11892-023-01509-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE OF REVIEW Many factors influence disease management and glycemic levels in children with type 1 diabetes (T1D). However, these concepts are hard to examine in children using only a qualitative or quantitative research paradigm. Mixed methods research (MMR) offers creative and unique ways to study complex research questions in children and their families. RECENT FINDINGS A focused, methodological literature review revealed 20 empirical mixed methods research (MMR) studies that included children with T1D and/or their parents/caregivers. These studies were examined and synthesized to elicit themes and trends in MMR. Main themes that emerged included disease management, evaluation of interventions, and support. There were multiple inconsistencies between studies when reporting MMR definitions, rationales, and design. Limited studies use MMR approaches to examine concepts related to children with T1D. Findings from future MMR studies, especially ones that use child-report, may illuminate ways to improve disease management and lead to better glycemic levels and health outcomes.
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Affiliation(s)
- Sara L. Davis
- Maternal Child Health Nursing, University of South Alabama, 5721 USA Dr N, Mobile, AL 36688, USA
| | - Sarah S. Jaser
- Division of Pediatric Endocrinology & Diabetes, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nataliya V. Ivankova
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Trey Lemley
- Biomedical Library, University of South Alabama, Mobile, AL, USA
| | - Marti Rice
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Pasley K, Krivchenia K, Dell ML, McCoy KS, Paul GR. Clinical management of pediatric patients with cystic fibrosis and autism spectrum disorder. Pediatr Pulmonol 2023; 58:1160-1168. [PMID: 36610056 DOI: 10.1002/ppul.26311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cystic Fibrosis (CF) and autism spectrum disorder (ASD) are life-long conditions with intense treatment burdens for patients and families. Patients with a concurrent diagnosis (CF-ASD) experience unique obstacles to CF care. This study describes the experiences of our multidisciplinary CF team in caring for patients with CF-ASD and provides insight into provider and parental perspectives on clinical management. METHODS This is a three-part qualitative study involving (1) retrospective chart review of patients with CF-ASD, (2) surveys with multidisciplinary care team members, and (3) semistructured interviews with caregivers of patients with CF-ASD. Challenges in clinical management of this specific cohort were compiled using data from chart review and care team surveys. Strategies to address these concerns were identified and rated by individual families based on relevance and practicality. RESULTS Within our CF center, 12 patients have an official diagnosis of ASD. Median age of patients with CF-ASD was 8.5 years (range 3-20 years), 67% were male, and 83% were on highly effective modulator therapy. Clinical barriers included sensory processing issues, environmental overstimulation, intolerance to procedures and to disrupted routines. Potentially impactful strategies include patient-specific coping plans, guided behavioral interventions, parental advocacy, and improved communication between the family and multidisciplinary team. CONCLUSION Children with CF-ASD face extraordinary challenges beyond the experience of neurotypical children with CF. Increased awareness of this complex dual diagnosis will help providers be sensitive to the unique needs of these patients, help build consistent and trustworthy relationships with their families and deliver effective clinical care despite limitations.
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Affiliation(s)
- Kimberly Pasley
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Katelyn Krivchenia
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Mary Lynn Dell
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Karen S McCoy
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Grace R Paul
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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Barriers and Benefits Experienced by Caregivers Seeking Medical Care for Their Children with Autism Spectrum Disorders: a Qualitative Meta-synthesis. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00306-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Owen N, Dew L, Logan S, Denegri S, Chappell LC. Research policy for people with multiple long-term conditions and their carers. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221104407. [PMID: 35721799 PMCID: PMC9201348 DOI: 10.1177/26335565221104407] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People with multiple long-term conditions (MLTC) are a growing population, not only in
the United Kingdom but internationally. Health and care systems need to adapt to rise to
this challenge. Policymakers need to better understand how medical education and training,
and service configuration and delivery should change to meet the needs of people with MLTC
and their carers. A series of workshops with people with MLTC and carers across the
life-course identified areas of unmet need including the impact of stigma; poorly
coordinated care designed around single conditions; inadequate communication and
consultations that focus on clinical outcomes rather than patient-oriented goals and
imperfectly integrate mental and physical wellbeing. Research which embeds the patient
voice at its centre, from inception to implementation, can provide the evidence to drive
the change to patient-centred, coordinated care. This should not only improve the lives of
people living with MLTC and their carers but also create a health and care system which is
more effective and efficient. The challenge of MLTC needs to be bought to the fore and it
will require joint effort by policymakers, practitioners, systems leaders, educators, the
third sector and those living with MLTC to design a health and care system from the
perspective of patients and carers, and provide practitioners with the skills and tools
needed to provide the highest quality care.
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Affiliation(s)
- Natalie Owen
- Science, Research & Evidence Directorate, Department of Health and Social Care, London, UK
| | - Leanne Dew
- Science, Research & Evidence Directorate, Department of Health and Social Care, London, UK
| | - Stuart Logan
- NIHR PenARC, University of Exeter Medical School, Exeter, UK
| | | | - Lucy C Chappell
- Science, Research & Evidence Directorate, Department of Health and Social Care, London, UK
- School of Life Course Sciences, King’s College London, London, UK
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Wang L, Li D, Pan S, Zhai J, Xia W, Sun C, Zou M. The relationship between 2019-nCoV and psychological distress among parents of children with autism spectrum disorder. Global Health 2021; 17:23. [PMID: 33632259 PMCID: PMC7905970 DOI: 10.1186/s12992-021-00674-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The psychological distress caused by COVID-19 may be pronounced among the parents of children with autism spectrum disorder (ASD). This study aimed to investigate psychological distress among parents of children with ASD during the COVID-19 pandemic. METHODS A total of 1764 parents of children with ASD and 4962 parents of typically developing (TD) children were recruited. The participants completed an online survey which contained demographic information, the impact due to COVID-19 crisis, resilience, coping styles, anxiety and depression. Hierarchical linear regression was used to assess the contributions of these variables to anxiety and depression. RESULTS After adjusting for demographic variables, the following factors were associated with parents' anxiety and depression symptoms: (i) Whether or not the participants had a child with ASD; (ii) resilience; (iii) coping strategies, and; (iv) the impact due to COVID-19. Among these, the psychological stress caused by COVID-19 played the most important role in parental anxiety (β = 0.353) and depression (β = 0.242) symptoms. Parents of children with ASD had lower levels of resilience and positive coping, and used more negative coping strategies than parents of TD children. Among all participants, 8.0 and 24.2% of parents had symptoms of anxiety and depression, respectively. Compared to parents of TD children, more parents of children with ASD exhibited symptoms of anxiety and depression (12.2% vs. 6.6%; 31.0% vs. 21.7%, respectively). CONCLUSIONS During the COVID-19 pandemic, parents experienced varying levels of anxiety and depression, particularly, parents of children with ASD. More specific attention should be paid to parental mental health and long-term effective intervention programs, that are targeted towards parents of children with ASD, and such programs should be promoted around China in the wake of the COVID-19 crisis.
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Affiliation(s)
- Luxi Wang
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin, 150081, China
| | - Dexin Li
- Department of Children Psychology, Zhuhai Maternal and Child Health Care Hospital, Zhuhai, 519001, China
| | - Shixu Pan
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin, 150081, China
| | - Jinhe Zhai
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin, 150081, China
| | - Wei Xia
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin, 150081, China
| | - Caihong Sun
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin, 150081, China.
| | - Mingyang Zou
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin, 150081, China.
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Aalders J, Hartman E, Pouwer F, Winterdijk P, van Mil E, Roeleveld-Versteegh A, Mommertz-Mestrum E, Aanstoot HJ, Nefs G. The division and transfer of care responsibilities in paediatric type 1 diabetes: A qualitative study on parental perspectives. J Adv Nurs 2021; 77:1968-1979. [PMID: 33591623 PMCID: PMC8048668 DOI: 10.1111/jan.14781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
Aim To determine which factors other than child age play a role in the division and transfer of diabetes care responsibilities between parents and children with type 1 diabetes. Design Qualitative focus group study. Methods Across four sites in the Netherlands, 18 parents (13 mothers) of children (9–14 years) with type 1 diabetes participated in four focus groups in 2015–2016, as part of the research project 'Whose diabetes is it anyway?'. Qualitative content analysis and the constant comparison method were used to analyse the data. Results According to parents, the transfer process included both direct and indirect tasks, had different levels (remembering, deciding, performing), was at times a difficult and stressful process, and showed large variation between families. A large number of child, parent and context factors were identified that affected the division and transfer of diabetes care responsibilities according to parents. Both positive and negative consequences of the transfer process were described for parental and child health, behaviour and well‐being. Parental final evaluations of the division and transfer of diabetes care responsibilities appeared to be dependent on parenting values. Conclusion How families divide and transfer diabetes care tasks appeared to be affected by a complex interplay of child, parent and context characteristics, which had an impact on several parent and child domains. Impact Parents struggle with the right timing of transfer, which calls for more support from diabetes nurses. The identified factors can be used as input for integrating a more family‐based approach into current age‐based guidelines, to improve regular care.
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Affiliation(s)
- Jori Aalders
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders [CoRPS], Tilburg University, Tilburg, The Netherlands.,Department of Psychology, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense, Denmark
| | - Esther Hartman
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders [CoRPS], Tilburg University, Tilburg, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense, Denmark.,School of Psychology, Deakin University, Geelong, Australia
| | - Per Winterdijk
- Diabeter, Center for pediatric and adolescent diabetes care and research, Rotterdam, The Netherlands
| | - Edgar van Mil
- Kidz&Ko, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | | | - Henk-Jan Aanstoot
- Diabeter, Center for pediatric and adolescent diabetes care and research, Rotterdam, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders [CoRPS], Tilburg University, Tilburg, The Netherlands.,Diabeter, Center for pediatric and adolescent diabetes care and research, Rotterdam, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Stuckey HL, Oser SM, Miller EL, Oser TK, Peyrot M, Sharma A. “Not Today, Diabetes”: Using Blog Analysis to Understand Emotional Interactions and Support Among People With Type 1 Diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 1:613569. [PMID: 36993988 PMCID: PMC10041872 DOI: 10.3389/fcdhc.2020.613569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/30/2020] [Indexed: 03/28/2023]
Abstract
The goal of this study is to understand how internet blogs are used by people with type 1 diabetes (T1D) to provide or exchange social support. A stratified, clustered proportionate probability sample of entries from 10 Internet blogs focusing on T1D was obtained. A random sample of 100 days generated 200 blogger posts and 1,606 commenter responses. Entries were coded using qualitative analysis software and analyzed thematically. Blogs were used as a dynamic, interactional form of emotional support from others who understood diabetes from personal experience; and as a source of sharing lived user experience of having diabetes, more often than as a way of communicating medical knowledge or facts about diabetes. Blog participation contributed to a sense of belonging for participants in the “Diabetes Online Community” where there was a shared culture. In conclusion, blogs provide unobtrusive access to the experiences of people with T1D that are driven by their interests rather than those of qualitative research interviewers or healthcare providers. In addition to permitting analysis of the way that participants use blogs to address their own personal wants and needs, blog data can serve as an inexpensive and unobtrusive method for studying topics of interests to researchers and healthcare providers.
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Affiliation(s)
- Heather L. Stuckey
- Department of Medicine, College of Medicine, Pennsylvania State University, Hershey, PA, United States
- *Correspondence: Heather L. Stuckey,
| | - Sean M. Oser
- Department of Medicine, College of Medicine, Pennsylvania State University, Hershey, PA, United States
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Erin L. Miller
- Department of Family Medicine, College of Medicine, Pennsylvania State University, Hershey, PA, United States
| | - Tamara K. Oser
- Department of Medicine, College of Medicine, Pennsylvania State University, Hershey, PA, United States
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Mark Peyrot
- School of Medicine, Loyola University Maryland, Baltimore, MD, United States
| | - Aditi Sharma
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, United States
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Fong HX, Cornish K, Kirk H, Ilias K, Shaikh MF, Golden KJ. Impact of the COVID-19 Lockdown in Malaysia: An Examination of the Psychological Well-Being of Parent-Child Dyads and Child Behavior in Families With Children on the Autism Spectrum. Front Psychiatry 2021; 12:733905. [PMID: 34721108 PMCID: PMC8555492 DOI: 10.3389/fpsyt.2021.733905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The COVID-19 pandemic lockdowns have adversely impacted children on the autism spectrum and their families, especially in Malaysia where this population is often marginalized. The current quantitative research aimed to investigate the impact of the Malaysian COVID-19 lockdown on the behavior and psychological distress of children formally diagnosed with an autism spectrum condition (ASC) as well as the psychological distress and well-being of their parents, in comparison with a typically developing (TD) control group. Methods: The children's ages ranged between 5 and 17 years. The sample included 72 ASC parent-child dyads and 62 TD parent-child dyads. The primary caregiver completed an online survey including the following: demographic and diagnostic information; ASC symptoms; children's inattention, hyperactivity/impulsivity, perceived stress, depression, and anxiety; parents' perceived stress, depression, anxiety, and well-being based on their experience pre- and mid-lockdown (March 18th to June 9th 2020) in Malaysia. Results: Among the ASC group, no significant pre- and mid-lockdown change was found in ASC symptoms (p > 0.05). There were no significant gender differences (boys/girls) in all the child scales. The 2 [diagnosis (ASC, TD)] × 2 [lockdown (pre-lockdown, mid-lockdown)] mixed-model ANOVAs revealed main effects of lockdown on children's attention, hyperactivity/impulsivity, anxiety, and parents' perceived stress, depression, and psychological well-being (p < 0.005). There was a main effect of diagnosis in all child and parent variables, except parents' perceived stress (p >0.005). However, there was no significant interaction effect between diagnosis and lockdown (p >0.005). All child behavior (inattention and hyperactivity/impulsivity) and child psychological distress (anxiety, depression, and perceived stress) were significantly correlated in both the ASC and TD groups (p < 0.005). On the other hand, only some of the parent variables were significantly correlated with child variables (p < 0.0045) in the ASC group while none of the parent variables were significantly correlated with the child variables (p > 0.005) in the TD group. Conclusion: The results provide preliminary evidence indicating negative effects of the Malaysian lockdown on both children on the autism spectrum and TD children, as well as their parents. These quantitative results will be triangulated with the qualitative interview data to provide a holistic understanding of the impact of the pandemic, informing translational policy and practice recommendations.
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Affiliation(s)
- Hui Xian Fong
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Kim Cornish
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Hannah Kirk
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Kartini Ilias
- Department of Basic Sciences, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Karen Jennifer Golden
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia.,Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
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