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Peer and Family Support in Children and Adolescents With Type 1 Diabetes
Abstract
To examine social support and peer and family involvement in relation to diabetes management within a developmental context.
Sixty-eight youths ages 8 to 17 diagnosed with type 1 diabetes participated. This study represents the phase 1 data from a multisystemic, home-based intervention. Data included parent and youth report of disease management and conflict, youth-reported perceptions of support, peer participation in the intervention, and HbA1c.
Adolescents perceived greater diabetes-related peer support than did school-age children. Perceived peer and family support were not correlated with metabolic control. Peer participation in the intervention was correlated with metabolic control.
There is a developmental shift in perceptions of peer support. Increased perceptions of peer and family support overall may not result in improved metabolic control. Social support interventions should focus on the types of support that are most highly associated with positive health outcomes.
... As background literature on the relationship between adolescents with diabetes and their peers, there are qualitative studies [22,44,45] with results describing an erratic social support, i.e., sometimes these adolescents receive this support and sometimes they do not. In this respect, the study by Greco et al. [46] offers a joint intervention of an adolescent with diabetes and a friend or peer, showing a considerable improvement in both knowledge and support offered by this peer. ...
... On this regard, this research cannot deny the possibility of this influence because although it is not implicitly manifested in any discourse, certain degree of gratitude towards the peer group is observable, and therefore some influence may be deducted. Pendley et al. [45] observed that peers' lack of specific knowledge about daily management of diabetes, what may result in two types of behaviors: absence of support or neutral support. Neutral support, coincident with the indifferent role presented here, would consist on not establishing a differentiating barrier between the adolescent with diabetes and the peer group, therefore fostering inclusion, but with bringing a duality: the adolescent with diabetes may perceive this behavior as a form of emotional support which encourages risk behaviors or behaviors which do not favor self-care. ...
... The influence of these roles, rather vague in previous literature [22,56,59,60,62] has been clarified in this pilot study. In contrast to results obtained in other studies [44,45,62], the present wok observes that the protector role not only foster healthy and self-care behaviors which facilitate integration, but also it may develop a crucial role in common scenarios of adolescence (toxic substances consumption, for example) encouraging a 'controlled' consumption to facilitate and improve the integration of the adolescent with diabetes. However, though this attitude may favor integration, it has a negative impact on the adolescent's self-care. ...
The aim of this study was to examine, through the roles of peers with regards to diabetes, the relationship between the support perceived by adolescents with diabetes and their peer-group affiliation. This is a descriptive, phenomenological and retrospective study based on a qualitative methodology. In-depth interviews with 15 people aged 18–35 with type 1 diabetes mellitus diagnosed in their childhood or adolescence were carried out. Data was analyzed through the interpretation of general discourses. Peers have considerable influence on adolescents and provide them social support from different roles. The protective role basically offers emotional support and sends reminders of different aspects of the treatment, while the indifferent role does not meddle in any aspect related to the diabetes. Both roles can foster social integration of adolescents with diabetes into the peer group. The offender role creates social conflicts through discrimination and stigma of adolescents with diabetes. These roles appear during the process of socialization of adolescents with diabetes, where commensality and situations of self-monitoring or administering insulin, key aspect of diabetes treatment, are crucial. Peer groups, depending on the role adopted, may offer support or bring a specific conflict regarding diabetes to their adolescent peer. The combination of roles that friends and peer group play with regards to diabetes will determine the degree of socialization and integration of adolescents with diabetes.
... The conduct of a twofold therapeutic frame aims to confront the challenges of T1DM insulin management as well as SLD, within the family, school and medical setting. The reviewed research has revealed the potential positive effect of the cumulative support, from different contexts that are part of young patients' life, as children and adolescents depend on social support systems, such as family and care providers [96,133]. Both families and related social networks must be involved in the psychosocial assessment and therapeutic intervention, supporting youths' eventually transition to independent self-management of T1DM treatment as adults [70,[133][134][135][136]. ...
... The reviewed research has revealed the potential positive effect of the cumulative support, from different contexts that are part of young patients' life, as children and adolescents depend on social support systems, such as family and care providers [96,133]. Both families and related social networks must be involved in the psychosocial assessment and therapeutic intervention, supporting youths' eventually transition to independent self-management of T1DM treatment as adults [70,[133][134][135][136]. ...
... Managing insulin treatment in school setting, especially in younger children, requires the involvement of teachers, nurses and psychologists. In primary schools they should help youths to understand their condition's seriousness and to manage their feelings of being different or of having a kind of disability [96,133,144]. The intervention at this early period of time, that the peer pressure is milder, is crucial as it will result a more positive attitude towards T1DM management later in adolescence [96,133,144]. ...
Background: A considerable endeavor had taken place in order to understand the associated challenges for children and adolescents with Specific Learning Disorder (SLD) and Type 1 Diabetes Mellitus (T1DM) but also in order to describe the necessary skills and approaches that the care givers have to develop to assist both children and parents. (1) Aim: The aim of this review is twofold. Firstly, to highlight the T1DM’s potential impact on psychological well-being, on cognitive functioning and on school performance in children and adolescents who confront SLD. Secondly, to discuss the necessity of a multidiscipline approach of poor school performance in students with SLD and T1DM, presenting the serious contribution of care providers: (a) parents/carers in the family setting, (b) teachers and psychologists in the school setting and (c) health specialists (pediatricians, nutricians, nurses, child psychiatrists and psychologists) in the medical setting. (2) Methods: In this narrative literature review of 12 selected articles, each one studies a special aspect of approach, during the diagnosis and the treatment of individuals with T1DM and SLD. The review concerns the arising problems and difficulties in the adherence to diagnosis, the management of insulin, the mental and physical wellbeing, the school performance, the cognitive functioning and learning difficulties of patients. We tried to synthesize an interdisciplinary approach that involves collaboration between family, school and medical frame; facilitating children’s and adolescents’ difficulties management, as well as parent and teacher involvement during the intervention implementation. (3) Results: The main issues of concern were examined through the available literature, as different factors had to be re-examined in the previous studies, regarding the potential impact of T1DM in cognitive and psychological functioning, as well as the effects of the intervention/approach/treatment of children and adolescents with SLD and T1DM. (4) Conclusions: Although T1DM diagnosis and demanding treatment are a heavy burden for children and their families, T1DM may or may not be associated with a variety of academic and psychological outcomes. Despite the variability of the reviewed research design quality, it was clearly defined that the impact of T1DM is not uniform across educational and mental variables. Strengthening the children’s physical, psychological and social wellbeing is an especially important factor, as it facilitates the insulin’s management as well as the learning difficulties. This is possible by supporting the parental and teacher involvement in the intervention process. This review highlights the need to reduce the distance between theory/research and practice, in some of the proposed areas in this field of knowledge.
... 31 The remaining 10 were RCTs, of which only six provided information about randomization, and coin toss was the method used in one of them. 32 In addition, the paper by Sullivan-Bolyai et al 17 was a feasibility study; the authors were contacted to obtain additional information about their feasibility study and confirmed that no further data on this intervention were published after this paper. Table 1). ...
... Intervention details can be found in Table 2. Seven of the interventions took place in a healthcare setting (hospital, clinic), and 1 was exclusively home-based. 32 Three trials gave participants the option to choose among undergoing the intervention at home, in a community setting or at a public location. Delivery modes were individual (n = 7), group (n = 2) or combined (n = 2), always including preteens as participants. ...
... Of these six interventions, improved blood glucose/HbA1c levels post-intervention were shown in 5 [27][28][29]31,32,34,36,38 and enhanced levels by a one percentage point in the remaining one. 31 Also, three of these interventions displayed an effect in older participants only (11-to 13-, 13-to 16-and 12-to 14-year-olds). ...
Introduction:
Numerous psychosocial interventions have been conducted in children and adolescents with type 1 diabetes, aiming to improve their self-management and autonomy acquisition. However, these tend to address family conflict and parental perspectives, and a scarce number of interventions explore the outcomes among preteens. This review examined the outcomes of psychosocial interventions for preteens with type 1 diabetes, as an under-researched field to date.
Methods:
A systematic literature review of intervention studies with randomized controlled trial design, targeting preteens with type 1 diabetes, was conducted. Six databases were searched for publication periods from 1995 to October 2019. Quality of the interventions according to the International Society for Pediatric and Adolescent Diabetes (ISPAD), as well as reporting and effect sizes, were assessed.
Results:
Twelve studies were selected, covering ten interventions. According to the topics identified, four of these interventions were categorized as self-care programmes, three as psychosocial programmes and three as mixed. All of the interventions, except for one, covered ≥50% of the ISPAD recommendations. Reporting adequacy was negative only in one intervention. Main outcomes were glycemic control and self-management, but effect sizes could only be calculated for half of the interventions with no overall significant effect.
Conclusions:
This review shows a lack of adequate psychosocial interventions targeting preteens with type 1 diabetes and actively involving them as participants. These intervention's educational programmes and methods should be standardized to guarantee successful results. New technologies and peer support implementation could be a promising pathway when designing these studies.
... This includes integration of daily medical tasks (insulin injections, frequent blood glucose tests) and lifestyle modifications (close monitoring of food intake and regular exercise) in everyday life. 1,2 Although near-normal blood glucose control may decrease the risk of several long-term diabetes complications in individuals with type 1 diabetes, 3,4 adolescents often have difficulty juggling all aspects of such a demanding treatment regimen. Parents and other family members are especially important for adolescents with type 1 diabetes 5 to encourage and provide support for treatment-related behaviours. 2 Anderson and colleagues 6 showed that a low-intensity office-based family intervention for youths with type 1 diabetes increased parental involvement, while decreasing diabetes-related family conflict. ...
... Parents and other family members are especially important for adolescents with type 1 diabetes 5 to encourage and provide support for treatment-related behaviours. 2 Anderson and colleagues 6 showed that a low-intensity office-based family intervention for youths with type 1 diabetes increased parental involvement, while decreasing diabetes-related family conflict. 6,7 Research has highlighted that, during adolescence, young adults strive for autonomy and parents' attempts to monitor/control REVIEW their children's treatment may be viewed as intrusive or nagging. ...
... Consequently, both family members and peers can facilitate optimal diabetes management. 2 Support from peers has been rated as important by adolescents with type 1 diabetes 13 ; peers are more likely than family members to provide companionship and emotional support in relation to diabetes care. 14 In one structured group intervention, adolescents and their friends demonstrated higher levels of knowledge about diabetes and support, as well as a higher ratio of peers to family support. ...
Objective: Although interventions which provide psychosocial support can have a positive impact on diabetes self-care, the impact of family/peer- and theory-based interventions has not yet been clearly identified. This systematic review investigates the randomised controlled trials (RCTs) employing family/peer-based interventions (based on theoretical/ therapeutic frameworks) which aim to improve adolescents’ glycaemic control, psychosocial and/or behavioural functioning.Methods: The Cochrane Library, database of systematic reviews, database of abstracts of reviews of effectiveness and Health Technology Assessment database were searched (from start date until February 2016) for any previously conducted systematic reviews. Seventeen RCTs/interventions were included. The literature was also identified by contacting the leading researchers. Glycaemic control was measured by HbA1c and psychosocial functioning by measures of self-care, knowledge and communication, collaboration/teamwork, quality of life, problem solving, social functioning and family functioning. Only those interventions which reported the use of theories/therapies to manage type 1 diabetes and other psychosocial issues among adolescents (aged 12–17) were included in the present review. Data summarising the key features of the interventions was extracted from each article. Where possible, the effect sizes were calculated.Results: The effect sizes could be computed for HbA1c in six of the 17 interventions. The overall outcomes indicated that interventions including parents have a small to large effect size on a variety of diabetes management and psychosocial outcomes. This review identified interventions, mostly including parents and rarely including peers.Conclusion: The results of this systematic review demonstrate that multicomponent interventions may be more successful for adolescents than ones that just focus on one aspect. Effectiveness is also greater if they demonstrate inter-relatedness with the various aspects of diabetes management. Short-term behavioural approach-based interventions promote improvements in parent/adolescent relationships. Outreach home-based interventions could be a more accessible alternative for intervening with families than office/hospital-based interventions. This approach may also be more acceptable to adolescents and their families. There is a need to develop evaluated interventions for adolescents involving parents. Development should involve stakeholders (ie, adolescents, their families and healthcare professionals) to co-design potentially cost-effective and feasible interventions in the context of NHS diabetes services.
... Collaborative parent-child relationships with high levels of family cohesion, a participatory parenting style, parental monitoring, division of responsibilities for managing diabetes, and collaborative solutions to face difficulties are related to better treatment adherence and glycemic control [34]. Metabolic control is not correlated with perceived support; however, early discontinuation of support can compromise diabetes management [35]. Caregivers play a crucial role in encouraging children to be more proactive in diabetes discussions by allowing them to express their opinions and concerns, share information, and provide solicited guidance. ...
... One in five people with this condition experienced discrimination because of their diagnosis [38]. The feeling of being different is a major challenge in living with diabetes [35,37], and being defined by it may influence engagement in self-management in the presence of peers [16]. Healthcare professionals should work toward the destigmatization of diabetes and consider the psychological aspects and experiences of each patient throughout treatment to design and improve effective interventions [39]. ...
Type 1 diabetes imposes a complex and challenging routine on patients and caregivers. Therefore, considering individual experiences and personal facilitators to promote assertive interventions is crucial. However, no studies have addressed these perspectives in the Brazilian adult population. We aimed to identify psycho-behavioral characteristics perceived as facilitators for coping with the condition. We used a biographical method to conduct semi-structured, face-to-face, in-depth interviews for each participant. Transcripts were analyzed using inductive thematic analysis. Participants (n = 22) were aged 18–57 years (mean: 30.2; standard deviation (SD): 8.7), and the duration since diagnosis was approximately 20.6 years (SD: 4.6). A total of 12 (54.4%) were women, 13 (59.1%) used insulin pumps, 14 (63.6%) had at least a college degree, and 13 (59.1%) had HbA1C (glycated hemoglobin) levels above 58 mmol/mol (7.5%). Five major themes emerged: (1) peer learning, (2) ownership, (3) welcoming experiences, (4) equity, and (5) reframing the path (P.O.W.E.R.). All themes appeared in the lived experiences shared by participants with HbA1C levels below 58 mmol/mol (7.5%). Improved glycemic control can be achieved, and the challenges encountered in diabetes care within similar socioeconomic contexts can be addressed by an interdisciplinary care team that takes P.O.W.E.R. into consideration when providing person-centered care strategies.
... Collaborative parent-child relationships with high levels of family cohesion, participatory parenting style, parental monitoring, division of responsibilities for managing diabetes, and collaborative solutions to face difficulties are related to better treatment adherence and glycemic control [30]. Metabolic control is not correlated with perceived support; however, early discontinuation of support can compromise diabetes management [31]. Caregivers play a crucial role in encouraging children to be more proactive in diabetes discussions by allowing them to express their opinions and concerns, share information, and provide solicited guidance. ...
... One in five people with this condition experienced discrimination because of their diagnosis [34]. The feeling of being different is a major challenge in living with diabetes [31,33], and being defined by it may influence engagement in selfmanagement in the presence of peers [12]. Healthcare professionals should work towards the destigmatization of diabetes and consider the psychological aspects and experiences of each patient throughout treatment to design and improve effective interventions [35]. ...
Type 1 diabetes imposes a complex and challenging routine on patients and caregivers. Therefore, considering individual experiences and personal facilitators to promote assertive interventions is crucial. However, no studies have addressed these perspectives in the Brazilian adult population. We aimed to identify psycho-behavioral characteristics perceived as facilitators for coping with the condition. We used a biographical method to conduct semi-structured, face-to-face, in-depth interviews for each participant. Transcripts were analyzed using inductive thematic analysis. Participants (n = 22) were aged 18–57 years (mean: 30.2, standard deviation (SD): 8.7), and the duration since diagnosis was approximately 20.6 years (SD: 4.6). Twelve (54.4%) were women, 13 (59.1%) used insulin pumps, 14 (63.6%) had at least a college degree, and 13 (59.1%) had HbA1C (glycated hemoglobin) levels above 58 mmol/mol (7.5%). Five major themes emerged: 1) peer learning, 2) ownership, 3) welcoming experiences, 4) equity, and 5) reframe the path (P.O.W.E.R.). All themes appeared in the lived experiences shared by participants with HbA1C levels below 58 mmol/mol (7.5%). Improved glycemic control can be achieved, and the challenges encountered in diabetes care within similar socioeconomic contexts can be addressed, by an interdisciplinary care team that takes P.O.W.E.R into consideration when providing person-centered care strategies.
... In addition, school-aged children (8-11;Trudeau et al., 2019), including those with T1D, face unique developmental challenges, including those around eating behavior, yet this age group has received less attention than young children (Arlinghaus et al., 2018;Patton et al., 2009) and adolescent/ young adults (Greene et al., 2010;Palladino & Helgeson, 2012) with T1D. When aging into school, children with T1D must navigate social interactions with peers, who may provide support (Pendley et al., 2002) and influence behaviors (Wiebe et al., 2016), including those around healthy eating (Ragelinė & Groønhøoj, 2021). For example, youth aged 11-18 report that peers can sometimes make eating in accordance with dietary recommendations more challenging (Schlundt et al., 1994as cited in Palladino & Helgeson, 2012. ...
... For example, youth aged 11-18 report that peers can sometimes make eating in accordance with dietary recommendations more challenging (Schlundt et al., 1994as cited in Palladino & Helgeson, 2012. Another study found that school-age children (8-12 years of age) report less perceived diabetes specific support than teens, highlighting the unique challenges of this age group (Pendley et al., 2002) and the importance of studying healthy eating in this population. Having T1D makes social eating situations more complex as children learn to carry their own snacks to help with blood sugar maintenance, go to the nurse's office around mealtime for support with blood sugar checks, and develop an adaptable diabetes regimen (Chiang et al., 2014;Trudeau et al., 2019). ...
We examined relations among permissive parenting, mealtime behaviors, nutrition, and HbA1c in pediatric type 1 diabetes (T1D). Sixty-three children (Mage = 10.3, SD = 1.9) with T1D and caregivers completed surveys. Permissive parenting significantly negatively correlated with vegetable consumption (r=-0.27, p = .03). It was positively correlated with child resistance to eating (r = 0.48, p < .01), parent aversion to mealtime (r = 0.51, p < .01) and mealtime disturbance (r = 0.48, p < .01). Child resistance to eating did not mediate the relation between permissive parenting and HbA1c or permissive parenting and vegetable consumption. Because permissive parenting relates to eating behaviors, parent-child interventions promoting healthy eating and more effective parenting in T1D should be explored.
... The perception of diabetes related peer support increases along with the developmental changes of adolescence (Shroff Pendley et al., 2002). Friendship is an important vehicle for psychological development. ...
... Conversely, adolescents may perceive their friends as being helpful with respect to their diabetes regime, but this may be limited by the availability of their friends and both the predictability and specificity of the support offered (Shroff Pendley et al., 2002). 53 ...
... Peer-to-peer education creates an opportunity for children, adolescents, and parents to exchange experiences and coping strategies that can facilitate a more nuanced understanding of diabetes management, improve clinical outcomes, and facilitate adherence [23,24]. Moreover, observing their peers successfully manage ACC can motivate children to adhere to ACC, as it makes the method seem achievable and socially acceptable. ...
The care needs of children and adolescents with type 1 diabetes and their families are frequently approached as if they were identical to those of adults, overlooking the distinct challenges young people may face. It has been stated that children and adolescents often find conventional conversations with diabetes specialists tiresome and unpleasant. The present study focuses on familial experiences of an advanced carbohydrate counting program tailored to children and adolescents. The data encompass semi-structured interviews with families who participated in a group-based child-centered advanced carbohydrate counting program. The analysis revealed five themes: (1) peer-to-peer interaction is an essential determinant of sharing and learning; (2) illness perception significantly influences dietary intake; (3) normalization of diabetes in everyday life eases the disease burden; (4) repetition of dietary knowledge is important for retention; and (5) creating a safe and playful learning environment is crucial to engaging children and adolescents in their own treatment. The present findings suggest that it would be beneficial to explore and consider alternative teaching approaches that are adapted to a more interactive and engaging learning environment that is specifically tailored to children and adolescents. This entails moving away from traditional individual approaches.
... Te percentage of PwD whose insulin doses were decided by themselves or their mothers was signifcantly higher in the SEP group. Tis may be because mothers are usually the main caregivers, in charge of executing the diabetes care plan and in direct contact with the diabetes clinical team [40,41], especially when engaged in the SEP. Te percentage of PwD with frst-degree relatives with T1D at the time of diagnosis was more in the pre-SEP group. ...
Background and Aim. Early diabetes education for persons with type 1 diabetes (T1D) is important to achieve early glycemic control. We had developed a dietary structured education program (SEP) to provide patients with the required skills for optimal diabetes management. Our aim was to study the effect of our program and factors that might affect its outcomes. Methods. This is a retrospective medical chart review study at Jordan University Hospital. The glycemic control of children who were diagnosed with T1D and included in the SEP between June 2017 and December 2019, was compared with those who were exposed to the conventional diabetes education, between January 2014 and December 2016. Various factors were assessed for the possible effects on the SEP outcomes. Results. The average age at diagnosis for the 112 persons with diabetes (PwD) included in the dietary SEP was 8.30 ± 3.87 years. Glycated hemoglobin was lower in children in the SEP group at 6 months ( P value = 0.001) and 12 months ( P = 0.032 ) but not at 24 months ( P = 0.290 ). SEP had better effect on patients older than 5 years. The possible predictors of glycemic control for the SEP group at 12 months included the mother’s educational level and the number of hospital admissions due to DKA and hyperglycemia during the first year after diagnosis. Conclusion. Our dietary SEP was associated with better glycemic control than conventional diabetes education, at 6 and 12 months after diagnosis. It had a positive effect, mainly in PwD patients who are older than 5 years and had higher maternal educational level.
... indicating average blood glucose levels of 250-300. Level 4, "poor control," describes patients with A1C values > 11.4%, indicating average blood glucose levels greater than 300 [24]. ...
... A 98% agreement-rate was obtained. Because of initial non-agreement about inclusion, 16 (2%) full-text articles were discussed until consensus was reached [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. ...
Background
The division of care responsibilities between parents and children with type 1 diabetes, and an optimal transfer of responsibilities from parent to child over time are assumed to be key for optimal diabetes outcomes during childhood and adolescence. However, an overview of instruments assessing this division as well as their psychometric qualities is currently lacking.
Objective
To 1) identify all existing instruments, 2) evaluate their psychometric properties, and 3) provide an overview of scoring methods.
Methods
Pubmed and PsycINFO were searched using an a priori defined search string. Peer-reviewed studies in English using an instrument assessing the division of diabetes care responsibilities between children (6-18 years) and parents were included. In total, 84 of 725 articles qualified, covering 62 unique samples.
Results
Thirteen questionnaires were identified. The Diabetes Family Responsibility Questionnaire (DFRQ) was most frequently used across studies. Instructions, content and number of tasks, response options, and scoring methods varied across questionnaires. Recent studies often adapted questionnaires, contributing to the heterogeneity across measures. Overall, reporting and quality of psychometric properties was suboptimal.
Conclusion
The division of diabetes care responsibilities can be operationalized with various instruments, each having its strengths and weaknesses but all with limited psychometric support. To measure the division of diabetes care responsibilities more adequately, an updated version of the popular DFRQ or a new scale needs to be developed and evaluated.
... Additionally, peer relations can also impact T1D, with adolescence a time when eating out and drinking alcohol with friends becomes commonplace. This social context can add complications to a CYP's relationship with diet, body image and T1D and must therefore be considered when designing an intervention for this population (13). ...
Children and young people (CYP) with type 1 diabetes (T1D) are twice as likely to develop disordered eating (T1DE) and clinical eating disorders than those without. This has significant implications for physical and mental health, with some eating disorders associated with repeated diabetic ketoacidosis and higher HbA1c levels, both of which are life threatening. There is currently limited psychological support for CYP and families with T1D but increasingly, policy and practice are suggesting disordered eating in T1D may be effectively prevented through psychological intervention. We describe the development and theoretical underpinnings of a preventative psychological intervention for parents of CYP aged 11-14, with T1D. The intervention was informed by psychological theory, notably the Information Motivation Behaviour Skills model and Behaviour Change Technique Taxonomy. The intervention was co-developed with an expert advisory group of clinicians, and families with T1D. The manualised intervention includes two online group workshops, and supplementary online materials. The intervention continues to evolve, and feasibility findings will inform how best to align the intervention with routine care in NHS diabetes teams. Early detection and intervention are crucial in preventing T1DE, and it is hoped that the current intervention can contribute to improving the psychological and physical wellbeing of young people and families managing T1D.
... Youth with T1D also frequently report poor social support and low connectedness, particularly youth from lower socioeconomic backgrounds [74,75]. Youth with T1D may thus experience elevations in both perceived burdensomeness and thwarted belongingness. ...
Purpose of Review
The manuscript reviews the extant literature on suicide-related thoughts and behaviors among youth and young adults with pediatric diabetes. This evidence is presented within the context of current theories of the etiology of suicidal behavior to highlight how diabetes may contribute to suicide risk, and to support providers in understanding the interplay between pediatric diabetes and suicide risk. The manuscript also reviews evidence-based approaches to suicide prevention suitable for use in pediatric healthcare settings, with suggestions for their application to this unique population.
Recent Findings
Several recent studies identify heightened rates of suicidal ideation, suicide attempts, and suicide among youth and young adults with pediatric diabetes, as compared with their peers without diabetes. Evidence-based suicide prevention approaches frequently emphasize the importance of reducing suicidal youths’ access to potentially lethal means for suicidal behavior. This approach may require special considerations for youth with pediatric diabetes, due to their need to carry sufficient quantities of insulin and the dangers of inaccurate insulin dosing and/or overdose. Suggestions for suicide prevention for this population include risk screening as part of routine diabetes care, early prevention, education for youth and families, and provider awareness of risk factors, warning signs, and implications for diabetes care.
Summary
Youth and young adults with diabetes reported elevated rates of suicide-related behaviors as compared with their peers without diabetes. Existing suicide prevention approaches may require substantial adaptation for use with youth and young adults with diabetes. Further research is needed to examine how to best prevent suicidal behaviors among this population.
... For adolescents, relationships with peers are of much greater importance than for children of lower age [78]. This applies to healthy children as well as sick ones [79][80][81]. The diagnosis of the disease leads to a change in interactions with peers, causing difficulty in forming relationships or testing the power of friendship. ...
Background:
Multiple sclerosis (MS) is a chronic disease of the central nervous system that also develops in patients under 18 years of age. The disease negatively affects the quality of life (QoL) of children and adolescents. We conducted a literature review. The aim of the review was to identify the QoL of pediatric patients with MS and assess the factors determining their QoL.
Methods:
We analyzed studies published between 2000 and 2020 in PubMed, Scopus, Science Direct, Web of Science, and EBSCO databases.
Results:
In all, 17 studies were included in the review. The most common tool in assessing QoL was the generic module PedsQL. The range of mean/median global score of QoL was 53.8-81.7. The worst QoL was dominantly reported in the school and emotional spheres, on the contrary, the disease's least determined area of QoL was the social and physical dimension. In particular, disability and fatigue were important predictors of QoL.
Conclusions:
MS negatively affects the school and emotional spheres in particular, so it is important to pay greater attention to these spheres of life of MS patients. As the review studies pay insufficient attention to the analysis of positive factors and their impact on the QoL of MS patients, research should integrate these phenomena. The use of MS-targeted tools in future research in the pediatric MS population is also appropriate.
... Adolescents with type 1 diabetes (T1D) are challenged with balancing normal social, emotional, and biological changes 1,2 with the intense demands of chronic disease self-management. 3,4 Adolescents with T1D can experience decreased quality of life, 5 mental health concerns such as depression and anxiety, [6][7][8] and are at increased risk for the development of diabetes-related complications. 9,10 Therefore, clinical practice guidelines recommend regular assessment and screening for a wide variety of psychosocial issues (e.g., psychosocial well-being, family functioning, Diabetes-Related Quality of Life (DRQoL), and psychiatric disorders). ...
Background
We describe the implementation and evaluation of an integrated, stepped care model aimed to identify and address the concerns of adolescents with type 1 diabetes (T1D) associated with diabetes-related quality of life (DRQoL), emotional well-being and depression.
Methods
The care model with 4 steps: 1) Systematic identification and discussion of concerns salient to adolescents; 2) Secondary screening for depressive symptoms when indicated; 3) Developing collaborative treatment plans with joint physical and mental health goals; and 4) Psychiatric assessment and embedded mental health treatment; was implemented into an ambulatory pediatric diabetes clinic and evaluated using quantitative and qualitative methods.
Results
There were 236 adolescents (aged 13-18 years) with T1D that were enrolled in the care model. On average adolescents identified 3 concerns associated with their DRQoL and 25% indicated low emotional well-being. Fifteen adolescents received a psychiatric assessment and embedded mental health treatment. Both adolescents and caregivers were appreciative of a broader, more holistic approach to their diabetes care and to the greater focus of the care model on adolescents, who were encouraged to self-direct the conversation. Parents also appreciated the extra level of support and the ability to receive mental health care for their adolescent from their own diabetes care team.
Conclusion
The initial findings from this project indicate the acceptability and, to limited extent, the feasibility of an integrated stepped care model embedded in an ambulatory pediatric diabetes clinic led by an interdisciplinary care team. The care model facilitated the identification and discussion of concerns salient to youth and provided a more holistic approach.
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... From traditional practices that are sometimes idealised or partially rejected through processes of innovation, young people forge cultural capital by imitating their mothers; trial and error; using information from cookbooks, culinary TV shows or dedicated websites; and interacting around food with their peers (Garabuau-Massaoui, 2002;Nawas 2011;Rageliene & Gronhoj, 2020). Through horizontal or intra-social generational relationships, they thus build their own food cultural capital (Bourdieu, 1979), which reaches its peak in early adolescence (Fuligni et al., 2001) while parental influence decreases (Shroff Pendley et al., 2002). They innovate by incorporating new culinary standards based on internet discoveries on specialized sites or 'foodie' blogs, but especially by interacting with peers who are also interested in food discovery, culinary hybridisation, and the association and creation of new dishes (Brown et al., 2015;Finnerty et al., 2009;Stok et al., 2014). ...
In recent decades, the food cultures of the Pacific populations have undergone a profound transition, particularly because the increasing trade exchanges with Western countries have facilitated access to a wide range of processed foods. Essentially, a new normative model of eating is now taking the place of the traditional models. The aims of this qualitative study were to explore what ‘eating well’, ‘good food’ and ‘bad food’ now mean in the New Caledonian family context and, more broadly, to categorise the current food practices and representations in adolescents’ families. A double qualitative methodology was applied: 59 face-to-face interviews with 30 parents and 29 adolescents in both rural and urban areas and 15 collective structured discussions with middle-school classes (11- to 16-year-olds) of almost 25 students each. The main results showed various normative frames for nutrition, food quantities, local provenance, and personal taste. Food practices were related to food availability (having a home garden or involvement in family farming), socioeconomic status and community. In addition, access to nutritional information, temporal and financial constraints mostly in the urban area, and the role of food socialisation between parents and children had an impact on food practices and perceptions. The permanence of food cultures, mainly observed in families in rural areas, and the social inequalities in urban areas regarding food availability are highlighted. The positive perception of ‘local food’ as ‘cultural’, ‘organic’ and ‘healthy’ may help policymakers communicate clear messages to reach a sustainable food system.
... Factors that influence therapeutic non-adherence are aspects of the relationship between doctor and patient (including the ability to offer effective communication), time available for the visits [19], opportunity to have a continuous relationship with the same doctor [20,21], patient's characteristics (demographics, self-management, empowerment, locus of control) and the type of pathology (medical history, seriousness of the disease, symptoms, co-morbidities). ...
Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease and affects less than 5 people in 10000. There are many effective treatments, including blood pressure management, physical activity, low sodium diet and hydration. Nursing therapeutic education is part of the care of the patient affected by ADKPD and includes knowledge and management of the co-morbidities, level of compliance of the pharmacological therapy, with a focus on anti-hypertensive therapy and Tolvaptan, compliance with dietetic advices and lifestyle adjustments. Methods: A sample of 50 patients affected by ADPKD will receive an intervention that consists of receiving education about pharmacological therapy, diet and lifestyle. The nurse will use standard educational procedures to inform the patients about the importance of compliance to pharmacological therapy, low sodium diet and moderate physical activity. Results: Therapeutic education in patients affected by ADPKD with chronic kidney disease (CKD) can have a positive impact on patient’s health by improving compliance with pharmacological therapy, diet and lifestyle. Conclusions: Therapeutic education improves the patient’s knowledge of the disease, treatments and correct behaviors in order to promote an independent management of the disease. The patient would be empowered to modify wrong behaviors and obtain a balance between his and the disease’s needs and therefore improving compliance with treatments and improving quality of life.
... Behavior is a fundamental part of this control system and, in the absence of automated insulin delivery systems, it is the main driver of glycemic control [42,43]. The stated (nominal) goal of this system is to properly control glucose; nevertheless, patients have subtle, adaptive, and context-varying goals, such as reducing stress [44], social pressure [45,46], and time required to manage their disease. Variability in therapy modes, devices, drugs, and, most importantly, the natural physiological variability often require patients to continuously adjust their behavior. ...
This chapter surveys current efforts to characterize hypothesized relationships between accuracy and outcomes. We show that the latter range from the clinical to the financial, from the immediate to the long term. We discuss approaches used here that include the use of vastly different methodologies ranging from direct clinical observations and surveys to modeling and simulation-based studies to meta-analysis. In the end, and despite their methodological differences, these studies deliver a clear and consistent message. Inaccurate blood glucose monitoring (BGM) systems can negatively affect the patient's glycemic control, quality of life, and finances. Continued use of inaccurate BGM systems may result in an increased prevalence of long-term health complications affecting both the patient's quality of life and the financial health of the family. When the analysis switches focus to an entire population, these effects aggregate over time to affect worker productivity and healthcare costs.
... Success is measured by social and mental well-being as well as by standard of living and QOL, of the family as a whole and of each member [27]. The concept of QOL has gained currency over the past decade as a way of assessing the global outcome of a variety of medical condition, including psychiatric disorder [28]. ...
... Finding of a study done by Greco P et. al., (2001) (43) , about peer group intervention for (44) . These results may be justified that, as adolescent experience more intimacy and disclose information, as it is typical in normative development, and they may also share more disease-related information and, in turn, perceive their peers as offering more support for their diabetes (45) . ...
... Although friends make up a large part of the social context of young people's everyday life, little attention has been paid to the role of friends in diabetes-specific functioning. [26][27][28] In the literature, friends are frequently mentioned as both a source of support, especially emotional support, [29][30][31] and as an obstacle to diabetes self-management. 32 Further, peer support and peer conflict are found to be significantly associated with glycemic control in emerging adults. ...
Objective:
Suboptimal glycemic control and psychosocial challenges are significant concerns for adolescents and emerging adults (collectively young people) with type 1 diabetes. Knowledge about young peoples' attitudes towards living with type 1 diabetes is inadequate, but the issue is important in the development of strategies to improve glycemic control and psychosocial well-being. This study explored young peoples' perceptions of living with type 1 diabetes.
Methods:
An exploratory, qualitative design was employed. Data were collected through five participatory workshops with 19 young people (age 15-25). Data were thematically analyzed.
Results:
The overall depiction of living with type 1 diabetes was paradoxical; it affected everything and nothing. Living with type 1 diabetes was a balancing act between accommodating a "normal" way of living and self-management tasks of the treatment regimen. Participants' perceptions reflected shifting accounts that could be divided into five themes: (1) special rules during youth, (2) striving for autonomy, (3) an uncertain future, (4) social support, and (5) stigma and disclosure.
Discussion:
It is important to probe for the multiple and interrelated social contexts that underlie young peoples' motives for adhering to and deviating from treatment regimens. Future studies should focus on relational aspects, including stigma mechanisms, the role of friends, and facilitation of balanced parental involvement.
... Not only the hormonal changes of puberty contribute to higher levels of insulin resistance, but also the transference of the responsibility for diabetes self-care from parents to adolescents and peer group pressure may negatively interfere with diabetes management tasks (Hochhausser et al. 2008). Additionally, higher family support and involvement in diabetes tasks can lead to more opportunities to conflict situations related to diabetes management between parents and adolescents, which can explain why older adolescents showed worse diabetes outcomes (Pendley et al., 2002;Neylon et al., 2013;Pereira et al., 2008). ...
Adherence and glycemic control usually decrease during adolescence and family relationships influence diabetes outcomes. This study analyzed the interaction effect of adolescents’ family support, age, and gender in the relationship between adherence and glycemic control in adolescents with Type 1 Diabetes. The sample included 100 adolescents with Type 1 Diabetes and one of their parents during a routine endocrinology appointment. Adolescents answered the Self-Care Inventory—Revised, the Diabetes Family Behavior Scale and were also assessed on the glycosylated hemoglobin. The three-way interaction between adherence, family support, and adolescents’ age/gender was both negatively significant and explained 24.12% and 22.02% of the variance, respectively. Higher family support, being female, and younger age moderated the relationship between adherence and glycemic control. According to results, it is important that intervention programs provide negotiation skills, according to adolescent’s age and gender in the process of transferring diabetes management responsibility in order to promote better adherence to diabetes self-care, glycemic control, and prevent family conflicts regarding diabetes management.
... Several studies have shown that a mother's knowledge and education played an important role in glycemic control and mothers with more knowledge of diabetes and better education maintained better glycemic control for their children [37]. This is because mothers are usually the primary caregivers conducting coordination and execution of the child's diabetes care plan with the medical team [38]. Contrary to what we expected, there is no significant correlation between the increased frequency of self-monitoring blood glucose (SMBG) and optimal metabolic control, a clear difference from previous reports [14,39]. ...
Background:
Achieving adequate metabolic control in children with type 1 diabetes is important in slowing the progression of future microvascular and macrovascular complications, but still it is a universal challenge. We aim to investigate possible factors associated with poor metabolic outcomes in Jordan as an example of a country with limited resources.
Methods:
This is a retrospective chart review study of children with type 1 diabetes. Several clinical and personal characteristics were tested for association with metabolic control reflected by HbA1c levels. Linear logistic regression analysis was used to evaluate possible predictors of metabolic control. One-way ANOVA analysis was used to detect significant differences in HbA1c between categories.
Results:
Significant predictors of metabolic control were found. A one-year increase in age led to an increase in HbA1c by 0.053% (P = 0.044). A decline in HbA1c levels was predicted in children who have precise amount of carbohydrates or who are receiving insulin at school (-0.46% (P = 0.014) and -0.82% (P = 0.004), respectively). When family members other than mothers decided the insulin dose, the HbA1c level increased by 0.74% (P = 0.005).
Conclusion:
Poor metabolic control was associated with age, dietary noncompliance, not receiving insulin at school, and absence of direct mother care. Our study is one of the few studies from Middle East evaluating predictors of metabolic control. Global research studies help in giving universal insight towards developing more effective multidisciplinary team approach for diabetes care and education.
... Multisystem interventions are typically multicomponent and target change across several ecological systems by focusing on the broad context in which youth exist. Examples include interventions that focus on individual youth and parent-child interactions (e.g., BFST-D; Wysocki et al., 2000), families and community members (Pendley et al., 2002), and individual youth and their peer groups (Greco, Pendley, McDonell, & Reeves, 2001). For youth unlikely to respond to office-based interventions, Multisystemic Therapy (MST)-Health Care (Ellis et al., 2004) and Novel Interventions in Children's Health care (NICH: Harris et al., 2013) are intensive programs developed for youth and families experiencing multiple risk factors across more than one system. ...
Introduction:
Youth with type 1 diabetes (T1D) experiencing self-management difficulties are at risk of irreversible long-term health problems and consume a disproportionate amount of health care resources. Behavioral health interventions for this population have shown limited long-term effects, perhaps because of limited research on and intervention in relevant environments. To effectively intervene, providers must first thoroughly understand how risk factors interact with various contexts (e.g., school, home, hospital) to determine opportunities for the development of relevant interventions.
Method:
This review utilized an ecological systems framework to examine the state of the literature with regard to risk factors for poor T1D outcomes and associated intervention.
Results:
This review identified that, whereas risk factors in some systems (e.g., individual, family) have received disproportionate scrutiny, other environments and contexts (e.g., school, medical system) have been relatively neglected by researchers. Similarly, interventions that target understudied environments are lacking, and the majority of rigorously studied interventions only target a single context. Perhaps this accounts for the lack of interventions shown to have a long-term impact on glycemic control.
Discussion:
Our review demonstrates that researchers and funding agencies should prioritize efforts that (a) examine the influence of underexamined environments (e.g., primary care clinics, schools) and interactions (e.g., health care provider to parent, school nurse to youth) on T1D outcomes, (b) place increased emphasis on inclusion of understudied populations (e.g., families of minority racial/ethnic backgrounds), and (c) develop and evaluate interventions that specifically are tailored for these settings, interactions, and populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... [5] The short-and long-term complications of T1DM cause serious problems in the life of children and their families and if not controlled properly, it can speed up the vascular changes and cause serious physical complications including visual, renal, cardiovascular, and neural disorders. [6] There are several studies that have investigated the family support and metabolic control of children with T1DM in international level, [7][8][9][10][11][12][13][14][15][16] but less study in national level was found in literature. [6,17,18] On the other hand, much research has focused on advancements in the clinical management of T1DM diabetes and not much attention has been paid to the effect of parents' education and occupation. ...
BACKGROUND/AIM
Parents have an important role to play in supporting adolescents with type 1 diabetes mellitus (T1DM). Their education and occupation are important factors for the management of this disease. This study aimed to investigate the parental support that Iranian adolescents with T1DM experience and to examine the effect of parents’ education and occupation on adolescents’ perceived the parental support and metabolic control.
METHODS
This is a cross-sectional survey. The participants were 98 adolescents (aged 11–18 years) with T1DM referred to Endocrinology Clinics of Shahid Rahimi and Shahid Madani hospitals in Khorramabad, Iran, in 2016. For evaluating the adolescents’ perceptions of parental support, the family version of Diabetes Social Support Questionnaire was employed. It measures in five diabetic care areas (insulin administration, blood testing, meal planning, exercise, and emotional support). Data were analyzed in SPSS version 22 software using descriptive statistics and inferential tests including Pearson correlation test, ANOVA, and independent t-test.
RESULTS
The parents’ educational level had a significant relationship with adolescents’ perceived parental support and hemoglobin A1c (HbA1c) level (P < 0.05). Occupation of father had no significant influence on his supportive behavior and HbA1c level in adolescents, but mother's occupation significantly influenced them (P < 0.05). In adolescents with higher perceived parental support, the mean HbA1c was lower.
CONCLUSIONS
Parents with higher educational level can improve the metabolic control and provide better meal planning in adolescents with T1DM.
... In the present study, peers relationship disturbances were correlated with low self-esteem in the familial subscale (P = 0.01). This is in line with Pendley et al. (19) and Seiffge-Krenke (20) studies. Pendley et al. (19) demonstrated that daily treatment is the main source of patients' concerns, particularly in adolescence. ...
Background: The aim of this study was to assess self-esteem in children and adolescents with growth hormone deficiency and to establish the factors influencing self-esteem in children and adolescents with growth hormone deficiency. Methods: This cross-sectional study was carried out on 26 children and adolescents, aged 8 to 18, with a total growth hormone deficiency. The Cooper Smith self-esteem inventory was used in this study. Results: Patients with growth hormone deficiency had low self-esteem in more than 50% of the cases. Among the studied factors influencing the self-esteem, such as school performance, disturbance in parent-child and peers-child relationships, perceived by parents, and parents’ acceptance of the illness, there was a correlation in most of the subscales. Conclusions: Growth hormone impaired children and adolescents require psychological counseling and comprehensive care.
... Not all behaviours intended to be supportive are viewed as such, emphasizing this distinction between support actually received and perceptions of support. In line with developmental shifts in support preferences, parental support for self-management may come be to viewed as 'nagging' (Shroff Pendley et al., 2002), highlighting the importance of stable peer support throughout university. In fact, others have noted that little research explores support for university students with T1D. ...
University poses unique challenges surrounding disclosure for students living with type 1 diabetes, with implications for social support and self-management. Semi-structured interviews with students and peer interviewers living with type 1 diabetes explored university experiences of disclosure and social support. Thematic analysis identified three major themes: disclosure as a measured process, the need for lived experience for true understanding and personal growth and self-awareness. Findings emphasize the need to scaffold the university transition for individuals with type 1 diabetes as disclosure can elicit effective social support. In addition, the importance of lived experience suggests support from students with type 1 diabetes could considerably impact diabetes management.
... The self-management mobile app is being developed to lead to changes in each of the three factors. For example, to change the adolescents' environmental factors, we will provide social support through a forum feature [22][23][24]. We believe that receiving messages from their parents via the self-management mobile app will also be a part of the environmental change [25][26][27][28]. ...
Background:
Type 1 diabetes mellitus (T1DM) afflicts approximately 154,000 people under the age of 20 in the United States. Most people with T1DM are diagnosed at a young age, and parents have to take on the responsibility of T1DM management. Eventually, the child must begin to transition to self-management. Adolescents often struggle to take on responsibility for all the necessary tasks to successfully self-manage their T1DM. In fact, approximately three-quarters of adolescents are not achieving American Diabetes Association-recommended glycated hemoglobin (HbA1c) targets. This lack of adherence can lead to negative health outcomes.
Objective:
The goals of this interdisciplinary proposal are as follows: (1) to develop a unique and theory-driven technology using a mobile phone app to promote self-management behaviors for adolescents aged 10-15 years with T1DM and their parents and (2) to explore the feasibility and impact of the self-management mobile app.
Methods:
This study has two phases: app development and pilot testing. In the app development phase, the app will be conceptualized and a prototype will be tested. In Phase 2, the mobile app will undergo pilot testing to determine its feasibility and impact on diabetes self-management.
Results:
The pilot test was launched in September 2017. Data collection for the final pilot test is underway, and results are forthcoming.
Conclusions:
Adolescents with T1DM and their parents can have a difficult time managing the transition of diabetes care. It is hoped that this app can help. The focus groups and prototype testing have indicated promising outcomes of app use.
Trial registration:
ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628 (Archived by WebCite at http://www.webcitation.org/72tHXTE2Z).
International registered report identifier (irrid):
RR1-10.2196/10803.
... Yet, who is involved in management likely extends beyond parents and partners to include other types of close relationships. From late childhood onward, friends become a more frequent source of diabetes-related support (Pendley et al., 2002), and siblings may also be involved. Across adulthood, adult children may be involved in diabetes care (Jacobson and Wood, 2004). ...
Relationships are linked with positive and negative self-management and illness outcomes for individuals with type 1 diabetes. Explanations for these mixed associations have remained separated in psychosocial research in type 1 diabetes by relationship type (e.g. parent vs spouse) and individual's age (e.g. adolescence vs older adulthood). In this conceptual review, we present a novel perspective that close relationships across the lifespan may be beneficial for illness self-management when they support individuals' sense of autonomy, defined from a Basic Psychological Needs perspective. Processes of autonomy support are crucial for promoting illness management across all ages and relationship types.
... The number of SMBG measurements in the school setting was significantly higher for individuals who were helped by their friends and those who measured SMBG in the classrooms. The findings suggest that a supportive school system including peer participation for diabetes-care should be developed [28,29]. Family supports of diabetes management did not affect the frequency of daily SMBG, which was consistent with previous studies [22,23]. ...
Background:
This study aimed to evaluate the relationship between the frequency of self-monitoring of blood glucose (SMBG) and glycosylated hemoglobin (HbA1c) levels among Korean adolescents with type 1 diabetes mellitus (T1DM). Factors affecting the SMBG frequency were analyzed in order to improve their glycemic control.
Methods:
Sixty-one adolescents aged 13 to 18 years with T1DM were included from one tertiary center. Clinical and biochemical variables were recorded. Factors associated with SMBG frequency were assessed using structured self-reported questionnaires.
Results:
Average total daily SMBG frequency was 3.8±2.1 and frequency during the school day was 1.3±1.2. The mean HbA1c level was 8.6%±1.4%. As the daily SMBG frequency increased, HbA1c levels declined (P=0.001). The adjusted odds of achieving the target HbA1c in participants who performed daily SMBG ≥5 significantly increased 9.87 folds (95% confidence interval [CI], 1.58 to 61.70) compared with those performed SMBG four times a day. In the subjects whose SMBG frequency <1/day during the school day, an 80% reduction in the adjusted odds ratio 0.2 (95% CI, 0.05 to 0.86) showed compared to the group with performing two SMBG measurements in the school setting. The number of SMBG testing performed at school was significantly high for individuals assisted by their friends (P=0.031) and for those who did SMBG in the classrooms (P=0.039).
Conclusion:
Higher SMBG frequency was significantly associated with lower HbA1c in Korean adolescents with T1DM. It would be necessary to establish the school environments that can facilitate adequate glycemic control, including frequent SMBG.
... Selain ibu bapa, rakan sebaya turut memainkan peranan penting dalam kehidupan seharian remaja kerana mereka banyak melakukan aktiviti bersama, sama ada di sekolah atau semasa aktiviti riadah (La Greca & Thompson, 1998;Pendley et al., 2002). Terdapat bukti kukuh yang menunjukkan sokongan sosial daripada rakan-rakan mempengaruhi remaja terhadap penjagaan diri, yang mana sokongan ini dapat meningkatkan kawalan metabolik (Lehmkuhl et al., 2009;Palladino & Helgeson, 2012). ...
Kajian ini bertujuan untuk meningkatkan tahap penguasaan tiga konstruk menulis literasi bahasa Melayu (LBM) murid menerusi pendekatan pengajaran kolaboratif seorang mengajar seorang membantu (PPKSMSM). Bagi murid yang telah menguasai guru memberikan pengayaan, manakala murid yang belum menguasai guru perlu melaksanakan pemulihan mengikut konstruk yang belum dikuasai murid dan selaras dengan Kurikulum Standard Sekolah Rendah (KSSR) bahasa Melayu. Melaksanakan pemulihan dan pengayaan bukan pekara yang mudah. Ini demikian kerana, guru perlu mengenalpasti tahap keupayaan penguasaan murid dan mengabungjalin dengan aktiviti Kurikulum Standard Sekolah Rendah (KSSR) Bahasa Melayu. Pengajaran kolaboratif seorang mengajar seorang membantu (PPKSMSM) merupakan pendekatan secara kolaboratif antara guru dalam melaksanakan pengajaran dan pemudahcaraan (PdPc) dengan sokongan pentadbir dan pegawai pembimbing. Kaedah pengumpulan data yang digunakan dalam kajian ini menerusi ujian pra dan pos, pemerhatian, analisis dokumen dan temu bual daripada dua orang murid dan guru yang terlibat. 100% peningkatan penguasaan menulis literasi Bahasa Melayu murid berlaku menerusi pendekatan PPKSMSM. Peningkatan minat murid dalam menulis juga berlaku selepas intervensi dijalankan. PPKSMSM turut membantu para guru dalam perlaksanaan pemulihan dan pengayaan serta peningkatan penguasaan menulis literasi Bahasa Melayu dalam program LINUS.
... Diyabetli adölesanların, hastalık yönetimi, metabolik kontrollerin devamlılığı konularında aile ve arkadaş desteğinin olduğu belirtilmektedir [27,33]. Çalışmada T1DM'lu hastaların çalışma sonrası toplam sosyal destek ve arkadaştan, öğretmenden alınan desteğin puan ortalamalarının arttığı (p<0.05) ...
... Parent awareness about the impact of diabetes on children is also important. A study conducted in the United States by Pendley et al. [23] revealed that increasing awareness of family support overall may not result in improvement of diabetic control, therefore family support was not associated with metabolic control. A review of the literature on family support for adolescents with diabetes indicated that increased family cohesion and family organization was related to better psychosocial outcomes in adolescents [24]. ...
Objective: To assess the prevalence of emotional and behavioral changes, depression symptoms, as well as risk factors that affect the development of depression in children and adolescents with type 1 or 2 diabetes. Methods: A cross-sectional study was conducted with the department of pediatric and endocrinology on children and adolescents with type 1 or 2 diabetes at various ambulatory diabetic centers in Makkah, Saudi Arabia, between July and September 2017. The study had three parts: collection of participant personal data, and completion of two self-report depression inventories, the Center for Epidemiological Studies Depression Scale for Children (CES-DC) and Strengths and Difficulties Questionnaire (SDQ). The personal data questionnaire assessed the socioeconomic status of the family and its effect on the patient's condition. Pearson's regression was also used to test correlation between depression score and other variables. Results: Approximately 67.5% of the 120 patients were at risk of depression based on the CES-DC scale. The SDQ showed that 10% of the patients were borderline and 30% abnormal in the emotional aspect, 14.2% were borderline and 30% abnormal in the conduct aspect, 10% were borderline and 10%abnormal in the hyperactivity aspect, 24.2% were borderline and 10.8% abnormal in the hyperactivity aspect and 8.3% were borderline and 9.2% abnormal in the prosocial aspect. Conclusion: Depressive symptoms have a high prevalence among children and adolescents with diabetes, including other abnormalities in the emotional, conduct, hyperactivity, peer and prosocial aspects. All children and adolescents with diabetes should be screened for depressive symptoms, as well as other social and psychological abnormalities. Abstract The prevalence of psychological and behavioral changes among children and adolescents with diabetes in Makkah, Saudi Arabia.
... 5,13-15 SCT posits a reciprocal relationship between an individual's environment, personal factors and behaviours. [16][17][18] The overall goals of this app and the app intervention were designed using SCT. For example, we hope to change the individual's personal factors by providing social support through the parent/child messaging feature, [19][20][21][22] including prompts to set small and achievable daily goals, reminders and educational tips about living with T1D to improve the adolescents' self-efficacy. ...
Introduction:
Type 1 diabetes impacts approximately 1.25 m Americans, many of them young children. As a child grows, there is a transition towards independence and they must learn to manage their diabetes independently. The objective of this study was to design, develop and conduct a prototype test to assess the satisfaction and feasibility of a mobile app for adolescents with type 1 diabetes and their parents to aid in this transition.
Methods:
Ten parent/adolescent groups used MyT1DHero for four weeks. They were given a pre-test/post-test survey regarding family conflict with three tasks of diabetes management and the general tone of family communication. At post-test they were asked questions regarding their satisfaction and perception of ease of use of the app. They also participated in short interviews regarding the app. Additionally, we used server data to examine actual app usage.
Results:
The parents' perceptions of conflict around the results of the blood sugar tests increased ( t(9) = 2.71, p = .02) as did perceptions of conflict around logging the blood sugar results ( t(9) = 3.67, p = .005). The adolescents perceived increased conflict surrounding the results around logging the blood sugars results ( t(9) = 3.09, p = .01).There was no change in the tone of general family communication. During the prototype testing, we discovered that the app crashed repeatedly and several of the functions were not working properly. In the interview data, three main themes emerged, app-crashing issues, problems with notifications and positive feedback.
Discussion:
Through this process, all of the reported issues were corrected and new features were planned for subsequent versions. A smartphone application has the potential to be a novel intervention for engaging adolescents and their parents in positive communication to support type 1 diabetes management.
... As in the general developmental literature, peers become increasingly influential sources of support for diabetes management during adolescence (see Burroughs, Harris, Pontious, & Santiago, 1997;Gallant, 2003;La Greca, Bearman, & Moore, 2002;Palladino & Helgeson, 2012 for reviews).This developmental shift is evident in several ways. Friends are more commonly cited as a source of support for diabetes by adolescents than by children (Shroff-Pendley et al., 2002) and while peer support for diabetes remains stable across adolescence, family support declines Carcone, Ellis, Weisz, & Naar-King, 2011;Skinner, et al., 2000). Support from family also appears to serve different functions than support from friends during adolescence, with families providing more instrumental support for diabetes (e.g., help with insulin dose) and friends providing emotional support and companionship La Greca et al., 1995). ...
Developing individuals and their families benefit from a warm and supportive relationship that fosters the development of good self-regulatory skills in the child needed for a host of positive developmental outcomes. Children and parents face special challenges to self-regulation when faced with a child's chronic illness. A developmental model is presented that traces how positive parental involvement is coordinated with a child's self-regulation skills (regulation of cognition, emotion, and behavior) that are essential for positive health management. This involves different temporal patterns of coordination of child and parent (and other close relationships) that lead to accumulating regulatory developments that afford benefits for managing illness. This process begins early in infancy through attachment and develops into childhood and adolescence to involve the coordination of parental monitoring and child disclosure that serves as a training ground for the expansion of social relationships beyond the family during emerging adulthood. The specific case of families dealing with type 1 diabetes is used to illustrate the transactional and dynamic nature of parent-child coordination across development. We conclude that a developmental model of parent-child coordination holds promise for understanding positive health outcomes and offers new methodological and statistical tools for the examination of development of both child and parent.
... Peers may become more knowledgeable, involved and supportive surrounding diabetes (Pendley et al., 2002), although whether such peer support is beneficial for diabetes outcomes is unclear (Palladino & Helgeson, 2012). Moreover, emerging adults begin to leave their pediatric providers and embark in new relationships with adult care providers (e.g. ...
The study examined how ‘transition readiness’ skills develop from relationship processes with parents, friends, and healthcare providers. During their senior year of high school and one year later, participants (N = 217) with type 1 diabetes completed measures of transition readiness skills (Self-Management; Self-Advocacy), adherence, HbA1c, and relationships with providers (patient-centered communication), parents (monitoring/knowledge), and friends (knowledge/helpfulness) surrounding diabetes. Self-Management skills increased across time. Higher friend knowledge/helpfulness during emerging adulthood was associated with increased Self-Management skills. Adherence improved when relationships with providers and friends matched transition readiness skills, indicating that these relationships may facilitate transition skills in early emerging adulthood.
p style="text-align: justify;">The paper examines the relationship of children with insulin-dependent diabetes (type 1 diabetes) with their mother and peers. The study involved 30 children aged 10–12 years (M=11.26; SD=0.69), and their mothers. 14 mother–child pairs formed the experimental group of children with type 1 diabetes; 16 mother–child pairs were included in the control group. The methods used were "Parent-child interaction"; the "Family relationship test"; the "My usual day with a child" essay; the "My usual day with mom" conversation with the child; the "Features of interaction with the parent" questionnaire for teachers; the "Features of communication of the child" questionnaire for teachers and educators; a modified version of the "Unfinished sentences" methodology. The results of the study suggest that control, exactingness, guardianship on the part of the mother can act as a way of coping with the situation of the child's illness. Mothers of children with diabetes are more focused on their own feelings and experiences; the main target of their concern is the health and education of the child. It is noted that children with diabetes, when interacting with peers, more often than healthy peers, demonstrate conformity, a friendly or neutral attitude, preferring to avoid situations of conflict or to solve them with the help of an adult. The links between the low competence of a child with type 1 diabetes in the ability to negotiate with peers, take leadership positions, and a "cooperating" relationship with the mother were revealed. Maternal control and hyper-indulgence in relation to healthy children is associated with a low level of interaction of the child with peers, his ability to solve communicative tasks.</p
Aim: This systematic review aims to investigate the effectiveness of peer education in the self-management of schoolchildren and adolescents with chronic diseases. Methods: This study examined Turkish and English studies in the literature. It included experimental and quasi-experimental studies published in PubMed, Cochrane, and EBSCOhost on the effectiveness of peer education given to children aged 7-18 years about self-management of their disease. As a result of the review, nine articles were included in the study. The results were tabulated and presented in a narrative. Results: The studies included 1,890 participants between the ages of 7 and 29. Some of the studies administering programs identified as "peer education programs" reported that these programs improved self-management, quality of life, well-being, feelings of happiness, academic performance, pulmonary function, self-evaluation, social support, and general communication perceptions, as well as reducing like a teak undesirable behaviours and cost. However, some studies indicated that these programs were not effective in improving the skills of coping with pain, controlling emotions, perceiving social support, self-efficacy, health-care management, quality of life, and glycemic control. Conclusion: The study results showed that peer education programs might facilitate children and adolescents in adapting to the chronic diseases in their life, increase their quality of life, satisfaction, self-management, and self-efficacy skills, improve healthy behaviours, and lessens the intensity of their bad moods and reduce hospital costs. It is recommended that pediatric nurses providing care for patients with chronic diseases learn and utilize peer education methods. Therefore, a more enjoyable education environment could be established, leading pediatric patients to participate and improve the effectiveness of these programs.
Background
Multisystemic Therapy® (MST®) is an intensive, home‐based intervention for families of youth with social, emotional, and behavioural problems. MST therapists engage family members in identifying and changing individual, family, and environmental factors thought to contribute to problem behaviour. Intervention may include efforts to improve communication, parenting skills, peer relations, school performance, and social networks. MST is widely considered to be a well‐established, evidence‐based programme.
Objectives
We assessed (1) impacts of MST on out‐of‐home placements, crime and delinquency, and other behavioural and psychosocial outcomes for youth and families; (2) consistency of effects across studies; and (3) potential moderators of effects including study location, evaluator independence, and risks of bias.
Search Methods
Searches were performed in 2003, 2010, and March to April 2020. We searched PsycINFO, MEDLINE, ERIC, NCJRS Abstracts, ProQuest and WorldCAT dissertations and theses, and 10 other databases, along with government and professional websites. Reference lists of included articles and research reviews were examined. Between April and August 2020 we contacted 22 experts in search of missing data on 16 MST trials.
Selection Criteria
Eligible studies included youth (ages 10 to 17) with social, emotional, and/or behavioural problems who were randomly assigned to licensed MST programmes or other conditions. There were no restrictions on publication status, language, or geographic location.
Data Collection and Analysis
Two reviewers independently screened 1802 titles and abstracts, read all available study reports, assessed study eligibility, and extracted data onto structured electronic forms. We assessed risks of bias (ROB) using modified versions of the Cochrane ROB tool and What Works Clearinghouse standards.
Where possible, we used random effects models with inverse variance weights to pool results across studies. We used odds ratios for dichotomous outcomes and standardised mean differences for continuous outcomes. We used Hedges g to adjust for small sample sizes. We assessed the heterogeneity of effects with χ² and I ². Pairwise meta‐analyses are displayed in forest plots, with studies arranged in subgroups by location (USA or other country) and investigator independence. We provide separate forest plots for conceptually distinct outcomes and endpoints. We assessed differences between subgroups of studies with χ ² tests.
We generated robust variance estimates, using correlated effects (CE) models with small sample corrections to synthesise all available outcome measures within each of nine outcome domains. Exploratory CE analyses assessed potential moderators of effects within these domains.
We used GRADE guidelines to assess the certainty of evidence on seven primary outcomes at one year after referral.
Main Results
Twenty‐three studies met our eligibility criteria; these studies included a total of 3987 participating families. Between 1983 and 2020, 13 trials were conducted in the USA by MST program developers and 10 studies were conducted by independent teams (three in the USA, three in the UK, and one each in Canada, the Netherlands, Norway, and Sweden).
These studies examined outcomes of MST for juvenile offenders, sex offenders, offenders with substance abuse problems, youth with conduct or behaviour problems, those with serious mental health problems, autism spectrum disorder, and cases of child maltreatment. We synthesised data from all eligible trials to test the claim that MST is effective across clinical problems and populations.
Most trials compared MST to treatment as usual (TAU). In the USA, TAU consisted of relatively little contact and few services for youth and families, compared with more robust public health and social services available to youth in other high‐income countries. One USA study provided “enhanced TAU” to families in the control group, and two USA studies compared MST to individual therapy for youth.
The quality of available evidence for MST is mixed. We identified high risks of bias due to: inadequate randomisation procedures (in 9% of studies); lack of comparability between groups at baseline (65%); systematic omission of cases (43%); attrition (39%); confounding factors (e.g., between‐group differences in race, gender, and attention; 43%); selective reporting of outcomes (52%); and conflicts of interest (61%). Most trials (96%) have high risks of bias on at least one indicator.
GRADE ratings of the quality of evidence are low or moderate for seven primary outcomes, with high‐quality evidence from non‐USA studies on out‐of‐home placement.
Effects of MST are not consistent across studies, outcomes, or endpoints. At one year post randomisation, available evidence shows that MST reduced out‐of‐home placements in the USA (OR 0.52, 95% confidence interval [CI] 0.32 to 0.84; P < .01), but not in other countries (OR 1.14, CI 0.84 to 1.55; P = .40). There is no overall evidence of effects on other primary outcomes at one year. When we included all available outcomes in CE models, we found that MST reduced placements and arrests in the USA, but not in other countries. At 2.5 years, MST increased arrest rates in non‐USA countries (OR 1.27, CI 1.01 to 1.60; P = .04) and increased substance use by youth in the UK and Sweden (SMD 0.13, CI −0.00 to 0.27; P = .05). CE models show that MST reducesd self‐reported delinquency and improved parent and family outcomes, but there is no overall evidence of effects on youth symptoms, substance abuse, peer relations, or school outcomes. Prediction intervals indicate that future studies are likely to find positive or negative effects of MST on all outcomes.
Potential moderators are confounded: USA studies led by MST developers had higher risks of bias, and USA control groups received fewer services and had worse outcomes than those in independent trials conducted in other high‐income countries. The USA/non‐USA contrast appears to be more closely related to effect sizes than than investigator independence or risks of bias.
Authors' Conclusions
The quality of evidence for MST is mixed and effects are inconsistent across studies. Reductions in out‐of‐home placements and arrest/conviction were observed in the USA, but not in other high‐income countries. Studies that compared MST to more active treatments showed fewer benefits, and there is evidence that MST may have had some negative effects on youth outside of the USA. Based on moderate to low quality evidence, MST may reduce self‐reported delinquency and improve parent and family outcomes, but there is no overall evidence of effects on youth symptoms, substance abuse, peer relations, or school outcomes.
Abstract
Background: Successful interventions are needed to enhance the predominant, purposeful and enduring outcome for children and adolescents with Type 1 diabetes. The role of psychoeducational interventions is encouraging adaptation to chronic disease like Type 1 diabetes has received acknowledgement and advocating greater involvement of patients in their own care. Objective: The purpose of this study aimed to provide an overview of the current literature regarding the psycho-educational interventions for adolescents with type 1 diabetes. Methods: The researcher searched major databases such as PubMed, PsycINFO, MEDLINE, Scopus, Google Scholar and ISI Proceedings article. Inclusion criteria as systematic reviews, Meta-analysis, descriptive study, and overview based on traditional reviews published in existing literature. Also included cross sectional, experimental and randomized controlled study. The titles of papers are reviewed, abstracts have gotten and looked into, and full copies of chosen papers have been acquired. Result: No study has focused on a particular psychological disorder such as conduct disorder or depression, or any other behavioral issues, which are known to be increased in adolescents with Type 1 diabetes. Very few studies have been focused on systematic theoretical contribution to construct psycho-educational intervention, particularly, as based on behavioral and cognitive-behavioral approaches. Integrative or hybrid model intervention would be more viable to type 1 diabetes specifically for adolescents and children. Conclusion: This overview has featured the need to extend the base for psycho-educational interventions, especially in the Indian context.
Peer support has been proposed as a way of addressing the psychosocial problems young people with chronic conditions experience and improving their health and wellbeing. The chapter examines definitions of peer support and its theoretical underpinnings, approaches and components. Programmes have been developed for young people with many different chronic conditions and are mainly based on three models described in the chapter. It will be revealed that research investigating whether peer support improves health and wellbeing reports conflicting results. However, research exploring young peoples’ views of peer support programmes consistently suggests they are valued for reducing feelings of difference and social isolation and for developing condition-related knowledge, coping strategies and communication skills. The potential risks posed by peer support will be considered and how its professed philosophical foundation of empowerment has been questioned. The chapter suggests that to ensure programmes are acceptable and appropriate, young people need to be involved in their coproduction and that programmes need to be theoretically informed. Moreover, the complexity of programmes in terms of their multiple interacting components, the real-life context in which they are delivered and the importance of individualisation means that alternative evaluation designs to randomised controlled trials need to be considered.
This book focuses on young people (12-25 years old) growing up with a chronic somatic condition and/or physical disability, facing different challenges during their transition to adulthood and to adult healthcare services. Becoming an adult often proves extra challenging for them, because the adaptive tasks related to living with a chronic condition can clash with developmental milestones. Finding a good balance and integrating these tasks in daily life is also referred to as self-management.
This book addresses self-management and empowerment of young people with chronic conditions as well as the Positive Youth Development concept. It elaborates on theories and approaches and offers a complete overview of self-management interventions for young people with chronic conditions, emphasizing on the tasks of medical, emotion and role management. It also elaborates on the roles and tasks of professionals, as well as the patient-provider relationship; the shifting roles between young people and their parents and the role of peer support.
This book is unique in its broad view on self-management, i.e. it goes beyond medical management and focuses on young people achieving their maximum potential and a good quality of life. Furthermore, the book employs a positive youth development approach, focusing on empowerment and growth rather than problems or issues.
It offers an overview of the state-of-the-art and evidence concerning self-management support for young people with various chronic conditions. As such it is of benefit for all healthcare professionals working in care for young people, but also for researchers interested in this topic
The aim of this Campbell Systematic Review was to evaluate the effect of multi‐systemic therapy (MST) on adolescents with social, emotional, and behavioural problems based on the best available evidence. The effect is measured by a range of behavioural and psychosocial outcomes, including the number of institutional placements and arrests, the incidence of drug abuse, and personal relationships, social skills, absence from school, etc.
The review is exclusively based on randomised controlled trials in which random allocation between MST and usual treatment has taken place. 266 reports were selected on the basis of title and abstract. Of these 35 were found actually to be effect studies. And finally, eight of the 35 effect studies met the pre‐set quality criteria laid down in the original Campbell/Cochrane review.
The Campbell/Cochrane review concludes that MST does not have consistently better effects than other types of interventions ‐ for example, restrictive institutional placement. On the other hand, nothing indicates that MST has any negative overall effects. All in all, MST does not seem to be any better or any poorer than other treatments. The Campbell/Cochrane review concludes that there are no consistent differences in outcome between the adolescents subject to MST and those subject to alternative treatment. This conclusion is based on the best available evidence on the effectiveness of MST.
Synopsis
Results of eight randomised controlled trials of Multisystemic Therapy (MST) conducted in the USA, Canada, and Norway indicate that it is premature to draw conclusions about the effectiveness of MST compared with other services. Results are inconsistent across studies that vary in quality and context. There is no information about the effects of MST compared with no treatment. There is no evidence that MST has harmful effects.
Abstract
Background
Multisystemic Therapy (MST) is an intensive, home‐based intervention for families of youth with social, emotional, and behavioral problems. Masters‐level therapists engage family members in identifying and changing individual, family, and environmental factors thought to contribute to problem behavior. Intervention may include efforts to improve communication, parenting skills, peer relations, school performance, and social networks. Most MST trials were conducted by program developers in the USA; results of one independent trial are available and others are in progress.
Objectives
To provide unbiased estimates of the impacts of MST on restrictive out‐of‐home living arrangements, crime and delinquency, and other behavioral and psychosocial outcomes for youth and families.
Search strategy
Electronic searches were made of bibliographic databases (including the Cochrane Library, C2‐SPECTR, PsycINFO, Science Direct and Sociological Abstracts) as well as government and professional websites, from 1985 to January 2003. Reference lists of articles were examined, and experts were contacted.
Selection criteria
Studies where youth (age 10–17) with social, emotional, and/or behavioral problems were randomised to licensed MST programs or other conditions (usual services or alternative treatments).
Data collection & analysis
Two reviewers independently reviewed 266 titles and abstracts; 95 full‐text reports were retrieved, and 35 unique studies were identified. Two reviewers independently read all study reports for inclusion. Eight studies were eligible for inclusion. Two reviewers independently assessed study quality and extracted data from these studies.
Significant heterogeneity among studies was identified (assessed using Chi‐square and I ² ), hence random effects models were used to pool data across studies. Odds ratios were used in analyses of dichotomous outcomes; standardised mean differences were used with continuous outcomes. Adjustments were made for small sample sizes (using Hedges g). Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were used.
Main results
The most rigorous (intent‐to‐treat) analysis found no significant differences between MST and usual services in restrictive out‐of‐home placements and arrests or convictions. Pooled results that include studies with data of varying quality tend to favor MST, but these relative effects are not significantly different from zero. The study sample size is small and effects are not consistent across studies; hence, it is not clear whether MST has clinically significant advantages over other services.
Reviewers' conclusions
There is inconclusive evidence of the effectiveness of MST compared with other interventions for youth. There is no evidence that MST has harmful effects.
Background
Adherence in type 1 diabetes has previously been found to be improved with effective social support. However, research has so far been unable to elucidate the effect of social support from peers in adolescents with type 1 diabetes, with studies concluding they may be both positively and negatively related to self-care and glycaemic control. The present study explores the experience of social support from peers in adolescents with type 1 diabetes using a qualitative methodology to address this lack of consensus in the literature, using the research question: “what is the meaning and experience of social support from peers in adolescents with type 1 diabetes?”Methods
Semi-structured interviews using the Diabetes Social Support Interview schedule were employed. Twelve participants aged 15–18 were recruited from paediatric outpatient services. Transcripts were analysed using thematic analysis.ResultsTwo overarching themes were noted within transcripts; A Sense of Normality and “They Think It’s Helpful, But It’s Not”. Overall, participants reported a desire for global support from peers and explored how and why diabetes-specific support behaviours were more likely to be interpreted as harassing.Conclusions
These findings suggest that diabetes-specific support may not always be advantageous in aiding adolescents to reach and maintain optimal self-care. In addition, participants emphasise the acceptability of advice provided by peers with type 1 diabetes, making peer support and mentoring programmes an excellent candidate for future research.
Social support has garnered significant attention as a contextual factor influencing and shaping individual behaviors, particularly in patients with diabetes. Within the social ecological model of health behavior, social support serves as primarily an interpersonal sphere of influence; however, it also serves as a mechanism for connecting individuals with the surrounding institutional/organizational, community, and policy environments. Family and peer support is one specific type of social support, but can provide all four categories of social support established in the literature: emotional support, tangible support, informational support, and companionship support. This chapter discusses evidence for the relationship between family and peer support in patients with type 1 and type 2 diabetes on health outcomes. Consistent with the general social support literature, family and peer support are generally associated with improved glycemic control, better self-care, and higher quality of life; however, the type and timing of support are factors that have not yet been fully examined. While family and peer support has been investigated heavily in youth with type 1 diabetes, less focus has been given to its importance in adulthood. Future interventions aimed at family and peer support should consider how to homogenize the use of support and consider specific population-based factors that should be considered to address sociodemographic and cultural factors.
Adolescence is an important developmental period associated with greater prominence of peer relationships and poorer glycemic control among youth with type 1 diabetes. In this chapter, we summarize the literature on friend and peer support, conflict during this period, and their links to psychological well-being and diabetes outcomes. We identified 34 articles on this topic from a previous review and literature searches in PsycINFO and MEDLINE. Overall, studies revealed general friend support was linked with greater psychological well-being and (to a lesser extent) better self-care but was unrelated to glycemic control. Research focused on diabetes-specific friend support was inconclusive. General friend conflict was associated with poorer psychological well-being, but findings were mixed for diabetes outcomes. Research examining links between diabetes-specific friend conflict and psychological and diabetes outcomes was inconsistent. In sum, the literature on friend and peer relationships and their links to psychological well-being and diabetes outcomes is mixed. Future research can benefit from making finer distinctions in the conceptualization and measurement of friend and peer relationships, examining potential moderator variables, and probing mechanisms underlying links between friend and peer relationships and outcomes and by considering the broader social context (family relationships) in which such relationships are situated.
Youth with type 1 diabetes (T1D) are tasked with managing their diabetes across complex systems (e.g., family, school, and medical systems), and their diabetes is often impacted by functioning within and across these systems. To effectively intervene, providers must first identify the system or systems in which risk factors exist for any given youth and then subsequently choose a relevant intervention. This chapter examines the state of the literature with regard to behavioral interventions, exploring both single system and multisystem approaches. As this chapter demonstrates, the overwhelming majority of interventions developed for youth with T1D address problems within a single system. However, youth with a combination of risk factors across a number of systems are a particularly vulnerable group, and improvements to outcomes within this group are essential to population health improvements and overall cost savings in pediatric diabetes care. While not yet standard care, there are several intensive, multisystem interventions that have demonstrated success with high-need, high-cost youth with T1D. As such, a case example is presented in order to demonstrate the utility of one multisystem intervention, Novel Interventions in Children’s Healthcare (NICH), and the barriers to implementing such interventions within our current healthcare model are discussed.
Background
Childhood long‐term conditions are usually diagnosed in infancy or early childhood. Little is known about the particular experiences and needs of young people who receive a chronic illness diagnosis during adolescence or late childhood. This paper will examine this experience in relation to Multiple Sclerosis (MS) which is increasingly being diagnosed before adulthood.
Aims
To explore how young people experience an MS diagnosis.
Methods
Qualitative study using a grounded theory approach. In‐depth interviews were conducted with 21 young people diagnosed with MS. Participants were recruited through health service and voluntary sector organisations in the United Kingdom.
Findings
Young people's pre‐illness normality was disrupted by the diagnosis of a chronic illness (MS). Participants experienced their body as changed physically, cognitively and emotionally and as changeable due to symptom unpredictability. This influenced how participants perceived and presented their identity, disrupted their relationships and altered their future biography. Young people developed strategies to manage their condition and identities in order to incorporate MS into their current and future lives which required continual illness and identity work in response to changing symptoms, social contexts and relationships.
Conclusions
While young peoples’ experience of living with chronic illness has been widely explored, the aftermath of diagnosis has been under‐researched from their perspective. This study contributes to this knowledge gap by illuminating how young people experience a chronic illness diagnosis and negotiate the resulting changes to their identity, relationships and future. The findings suggest that young people need preparation and support in disclosing their diagnosis to others. Professionals supporting young people with long‐term conditions need to work closely with specialist mental health services to ensure they receive appropriate emotional support. Schools have an important role in ensuring young people with long‐term conditions achieve their academic potential and receive appropriate careers advice.
This chapter addresses the issue of behavioral interventions to improve regimen adherence, quality of life, and physical health for children who have chronic health conditions. The chapter reviews child and family intervention approaches addressing three common childhood chronic health conditions – obesity, asthma, and diabetes, as well as global prevalence, physiological complications, and related psychosocial issues for each condition. Many intervention studies employ an ecological model and have foundations in social cognitive and/or self-determination theory. Across conditions, interventions have aimed to improve disease management skills, regimen adherence, and psychological and family functioning through various approaches to treatment. While some interventions with older adolescents target personal motivation and self-management, others utilize support from parents, peers, and changes in the school environment or other community settings. Results indicate that a number of evidence-based interventions utilizing educational, behavioral and psychosocial, psychological, peer, and digital technology approaches that incorporate the family are helpful for managing these conditions, as well as improving psychosocial issues associated with them. The concluding section discusses and summarizes the results of intervention studies for these conditions and addresses future research needs. While most of the intervention studies for obesity, asthma, and diabetes reviewed were conducted in the USA, many techniques addressing family relationships, behavior change, coping skills, and social issues may be applicable to children and families worldwide and may generalize to children with other chronic health conditions.
Little is known about social networks in childhood, and even less is known about the networks of ethnically diverse children. Interviews were conducted with 333 African-American, Anglo/European-American, and Hispanic-American public school children in Grades 1–2, 4–5, and 8–9. The research was based on the social convoy model (R. L. Kahn & T. C. Antonucci, 1980), in which social networks are viewed as dynamic hierarchic structures affording the provision of support across the life span. An adapted convoy mapping procedure evidenced good test–retest reliability at all ages, and convoy support measures were associated with self-concept and teacher-rated sociability and mood. For all ethnic groups, the results reflect the significance of close family relations across age, an increase in involvement with extended family in middle childhood, and the emergent role of peers as support providers in adolescence.
Assessed 122 2nd, 4th, 6th, and 8th graders' perceptions of the social support provided by friends. During individual interviews, Ss were asked about the frequency of emotional support or intimate self-disclosure, tangible support or prosocial behavior, and other types of support provided by a particular friend. Ss were also asked about the frequency of conflicts with the friend and the frequency of supportive interactions and conflicts with a classmate who was only an acquaintance. Factor analyses revealed an increase with grade in the differentiation between the support and conflict dimensions of friendship and acquaintanceship. At all grades, Ss perceived friends as more supportive than acquaintances, but explanations for the lack of support from acquaintances changed with grade. Sixth graders often gave personal attributions (e.g., saying that the acquaintances were selfish or hostile). Eighth graders favored more situational attributions (e.g., saying that they had few supportive interactions with acquaintances because they rarely came in contact with them). The potential value of perceived-support measures in research on the consequences of friendship is discussed. (27 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study examined sharing of diabetes responsibilities between mothers and their diabetic children and the relationship between patterns of mother-child sharing of responsibility for diabetes tasks and demographic variables, adherence, and metabolic functioning in children with insulin-dependent diabetes mellitus (IDDM). A factor analysis of the Diabetes Family Responsibility Questionnaire (DFRQ), a 17-item questionnaire developed for the present study, resulted in a meaningful three-factor solution. Factors included responsibilities related to regimen tasks, General Health Maintenance, and Social Presentation of Diabetes. Analysis indicated that the DFRQ had adequate internal consistency and concurrent validity. One hundred and twenty-one children with IDDM, 6-21 years of age, and their mothers completed the DFRQ. Glycosylated hemoglobin (HbA1c) was used to index the child's level of metabolic control. Results of multiple regression analyses indicated that the child's age, disease duration, and sex are significant predictors of mother and child patterns of sharing diabetes responsibilities. Disagreements between mothers and children in perceptions of who is assuming responsibility and adherence level were significant predictors of HbA1c. Results indicated that children assume increasing responsibility with increasing age. Clinicians should not assume that mothers and children communicate about the sharing of diabetes responsibilities in the family or about changes in expectations of who is responsible as children develop. To foster better control and adherence in diabetic children, members of the health care team can help to identify diabetes tasks for which no one in the family takes responsibility.
Diabetes knowledge tests, used in conjunction with measures of patient attitudes and behaviors, can provide a useful basis for assessing educational needs and designing appropriate instructional experiences. Accurate decisions require instruments that measure patient knowledge of diabetes and its management with high reliability and validity. Data obtained from more than 950 administrations of two parallel forms of a Diabetes Patient Knowledge Test have provided documentation of patient knowledge levels, insight into the effectiveness of educational programs, and support for ongoing program revisions. These data have also allowed study of the psychometric properties of the test instruments, including factor structure, reliability, and validity. Each test form has an overall reliability of 0.89 and the forms are of equal difficulty. Five subcomponents (factors) labeled "Carbohydrates," "Blood Sugar," "Basics," "Food Exchanges," and "Insulin Administration" are measured in the tests. Evidence of content, construct, concurrent, and discriminant validity has been demonstrated.
Research on diabetes management and the family has been traditionally viewed within a linear model, in which parental attitudes toward diabetes are seen as the principal influence on the child's adjustment and metabolic control. Recently the focus of research has shifted to the broader family milieu, with an emphasis on patterns of cooperation and conflict among all family members in implementing the treatment regimen. As investigators have begun to study the entire family, the linear model of parental influences has been overshadowed by a systems model of family interaction, based on the concept of mutual influences among all individuals in the family. Several methodological problems have characterized research in this area, such as inadequate assessments of family functioning, unreliable indices of metabolic control, and insensitivity to differences in age and disease variables. Future studies of diabetes management will have much to gain from consideration of the role of the father and siblings in treatment, attention to the diabetic child's impact on family functioning, and recognition of sources of support and stress outside the family that affect adaptation to diabetes.
This research compares the family environments of diabetic adolescents in good (HbA1c less than 10), fair (10 greater than or equal to HbA1c less than or equal to 14), and poor (HbA1c greater than 14) control. Fifty-eight adolescents diagnosed with type 1 diabetes and their parents (mothers) were independently assessed with structured interviews, the Moos Family Environment Scale, and adolescents also completed the Piers-Harris Children's Self-Concept Scale. As compared with adolescents in poor control, those in good control reported fewer diabetes-related symptoms and had less anxiety and a more positive self-concept. Well-controlled youths also reported more cohesion and less conflict among family members. More parents of well-controlled youths stated that family members were encouraged to behave independently. In addition, more parents of poorly controlled adolescents believed that diabetes had negatively affected the child's personality, physical well-being, schooling, and participation in activities away from home. These findings suggest a complex interplay between the diabetic adolescent's psychological and physical functioning, metabolic control, and the family environment.
Investigated problem-solving ability and reported regimen adherence among children, early adolescents, and middle adolescents with IDDM in response to hypothetical social situations where a choice between diabetes regimen adherence and peer desires must be made. Sixty-seven 8- to 17-year-olds with IDDM from two distinct U.S. geographical areas participated. Results indicated that compared to children with IDDM, adolescents with IDDM had better problem-solving abilities in response to social pressure situations, possibly reflecting their greater cognitive maturity. However, adolescents were also more likely to choose behaviors that are less regimen adherent. Differences in levels of problem-solving ability and adherence between the two regional subsamples were also found. Similar developmental patterns were found in both groups, showing the robust nature of the observed age-related trend of decreasing adherence in social situations despite increasing problem-solving abilities. Findings were interpreted in the context of normal adolescent development. Results are conceptually important for those interested in the transaction between peer and social influences and adherence for children and adolescents with IDDM, as well as other health behaviors.
The long-term consequences of early adolescents' orientation toward peers for their adjustment during high school were assessed. Approximately 1,200 adolescents completed questionnaires in the 7th grade and in the 10th or 12th grades; course grades were also obtained from the students' school records. Early adolescents who were willing to sacrifice their talents, school performance, and parents' rules engaged in greater problem behavior and evidenced lower academic achievement than did other adolescents during high school. The poorer adjustment of adolescents with this extreme orientation toward peers was mediated by their reported involvement in deviant peer groups. In contrast, a tendency to seek advice from peers more than from parents during early adolescence had little implication for later adjustment. Discussion focuses on the need to consider the role of peer dependence along with the effects of supportive friendships during adolescence.
Assessed 122 2nd, 4th, 6th, and 8th graders' perceptions of the social support provided by friends. During individual interviews, Ss were asked about the frequency of emotional support or intimate self-disclosure, tangible support or prosocial behavior, and other types of support provided by a particular friend. Ss were also asked about the frequency of conflicts with the friend and the frequency of supportive interactions and conflicts with a classmate who was only an acquaintance. Factor analyses revealed an increase with grade in the differentiation between the support and conflict dimensions of friendship and acquaintanceship. At all grades, Ss perceived friends as more supportive than acquaintances, but explanations for the lack of support from acquaintances changed with grade. Sixth graders often gave personal attributions (e.g., saying that the acquaintances were selfish or hostile). Eighth graders favored more situational attributions (e.g., saying that they had few supportive interactions with acquaintances because they rarely came in contact with them). The potential value of perceived-support measures in research on the consequences of friendship is discussed. (27 ref)
BACKGROUND
Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications.
METHODS
A total of 1441 patients with IDDM -- 726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly.
RESULTS
In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of ≥ 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of ≥ 300 mg per 24 hours) by 54 percent (95 percent confidence interval, 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia.
CONCLUSIONS
Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.
Bases for a developmental approach to the nature and functions of mother-child and father-child relationships are considered in connection with research findings from studies of middle-childhood and adolescent subjects and their parents. The framework for the review was derived from two sources: (1) recent conceptualizations of close relationships and (2) implications in general theories of socialization regarding different contributions of mothers and fathers to development during middle childhood and adolescence. Relationships between offspring and their mothers were found to contrast with father-offspring relationships in both middle childhood and adolescence, and differences appear to become more pronounced in some areas as a function of maturational changes associated with the transition to adolescence. The analysis points to the inadvisability of considering relationships with parents to be monolithic and a-developmental. In addition, it makes clear the need for a developmental theory of relationships to serve as a guide to further research on the linkages between ontogenetic change in individuals and the relationships of which they are a part.
This study examined several developmental and behavioral aspects of diabetes care in relationship to metabolic control in youngsters with diabetes These included the degree to which youngsters assumed responsibility for diabetes care, their adherence with the treatment regimen, and youngsters' and parents knowledge about diabetes Youngsters and their mothers completed a test of diabetes knowledge, mothers rated children's involvement in several aspects of diabetes care, and medical staff rated youngsters adherence with the diabetes regimen Glycosylated hemoglobin (HbAI) levels indexed metabolic control Age differences were noted in that older children knew more about diabetes, assumed more responsibility for self-care, but were less adherent with certain aspects of the treatment regimen Preadolescents who assumed greater responsibility for glucose testing and measuring insulin were in poorer control than those whose families were more involved Moreover, among preadolescents, parents' knowledge of diabetes was related to metabolic control but children's knowledge was not In contrast, adolescents diabetes knowledge, but not their parents', was related to diabetes control After controlling for age, duration of diabetes, and level of adherence, it was found that youngsters who assumed more responsibility for charting glucose and eating on time were in poorer diabetic control These findings question the wisdom of encouraging youngsters' responsibility for selfcare without ensuring that diabetes management skills are implemented effectively. This study examined several developmental and behavioral aspects of diabetes care in relationship to metabolic control in youngsters with diabetes These included the degree to which youngsters assumed responsibility for diabetes care, their adherence with the treatment regimen, and youngsters' and parents knowledge about diabetes Youngsters and their mothers completed a test of diabetes knowledge, mothers rated children's...
Second- and sixth-grade boys were paired with a friend or an acquaintance (N = 120), and each dyad completed a problem-solving task under 1 of 3 incentive conditions-cooperative (shared rewards), competitive (proportional rewards), or no reward contingencies. Communicative exchange, affective expression, synchrony of task-oriented behavior, and task performance were examined for evidence of purported mutuality in children's friendship relations. Greater mutuality and social responsivity characterized the interactions of friends as compared with the interactions of acquaintances; however, developmental differences in responsivity and mutuality were not apparent in these 2 age groups. The reciprocal exchange between friends was present regardless of reward contingencies and appeared to culminate in better task performance for friendship pairs. The characteristics and function of mutuality in children's friendship relations were discussed.
review current knowledge about friendships in childhood and early adolescence / focuses on conceptions about friendships, but several aspects of friendship behavior are also discussed
examine developmental differences in attitude and value similarity between friends, the impact of friends on the individual's behavior, and the relationship between friendship choice and peer status / both developmental discontinuity and continuity is present in the literature on friendship (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Summarizes recommended systems-level and clinical-level changes advocated within the task force report concerning the poor condition of mental health services for children. Systems-level recommendations include reducing use of restrictive services, increasing availability of home- and community-based services, increasing services integration and provider accountability, reforming mechanisms for financing services, and training providers in the delivery of more cost-effective services. Clinical-level recommendations include providing more flexible, individualized, and comprehensive services, and approaches that empower families. Values and principles for the system of care are described. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this study, 549 youths in the fourth grade, seventh grade, tenth grade, and college completed Network of Relationship Inventories assessing their perceptions of their relationships with significant others. The findings were largely consistent with 7 propositions derived from major theories of the developmental courses of personal relationships. In particular, mothers and fathers were seen as the most frequent providers of support in the fourth grade. Same-sex friends were perceived to be as supportive as parents in the seventh grade, and were the most frequent providers of support in the tenth grade. Romantic partners moved up in rank with age until college, where they, along with friends and mothers, received the highest ratings for support. Age differences were also observed in perceptions of relationships with grandparents, teachers, and siblings. Finally, age differences in perceived conflict, punishment, and relative power suggested that there was a peak in tension in parent-child relationships in early and middle adolescence. Discussion centers around the role various relationships are perceived as playing at different points in development.
This article reviews changes in parent-child relationships during puberty, emphasizing the developmental processes that might be implicated in these changes. Evidence suggests increases in conflict and less warm interactions in relationships between parents and children during puberty. Changes are assumed to be short term, although little longitudinal research has directly addressed the issue of long-lasting effects. Other developmental changes occurring for the adolescent, the parent, or both (such as social cognitive or self-definitional change), as well as other relationship changes, personality characteristics, and the sheer number of life events or transitions have all been posited as potential contributors to changes in the parent-child relationship for young adolescents. These possible contributors, however, have seldom been studied in conjunction with pubertal changes. Such integrative research is necessary to test various models through which puberty, social relationships, social cognitive, self-definitional, and other processes influence one another and are influenced by one another during the transition to adolescence.
Evaluated and compared the support provided by family members and friends for adolescents' diabetes care. Family and friend
support also were examined in relation to other measures of social support, to demographic variables (age, gender, duration
of diabetes) and to adherence. Using a structured interview, 74 adolescents with diabetes described the ways that family members
and friends provided support for diabetes management (insulin shots, blood glucose monitoring, eating proper meals, exercise),
and for helping them to “feel good about their diabetes.” Families provided more support than friends for three management
tasks (insulin injections, blood glucose monitoring, meals); this support was largely instrumental. In contrast, friends provided
more emotional support for diabetes than families. Greater family support was related to younger age, shorter disease duration,
and better treatment adherence. Implications of the findings include encouraging parents to remain involved in adolescents'
treatment management, and involving peers as supportive companions for meals and exercise.
The goal of this study was to identify parental behaviors that relate to adherence and metabolic control in a population of young adolescents with insulin-dependent diabetes mellitus (IDDM), and to understand the interrelationships among the variables of parental involvement, adherence to blood glucose monitoring, and glycemic control.
A cross-sectional design was used to investigate parental involvement in diabetes regimen tasks in 89 youth, aged 10 to 15 years, with IDDM. Levels of parental involvement in blood glucose monitoring (BGM) and insulin administration were evaluated through interviews. Assessment of adherence was made by physicians or nurses, independent of patient or parent reports of adherence. Glycemic control was assessed with glycosylated hemoglobin (HbA1c) (reference range, 4% to 6%).
There were significant differences in the mean HbA1c values between the older (13 to 15 years of age) (HbA1c = 8.9% +/- 1.03%) and younger (10 to 12 years) patients (HbA1c = 8.4% +/- 1.06%) (p < 0.02). Parental involvement in BGM was significantly related to adherence to BGM (number of blood sugar concentrations checked daily) in both groups of adolescent patients. The younger patients monitored their blood glucose levels more frequently than did the older patients, 39% of the younger patients checked sugar concentrations four or more times daily compared with only 10% of the older group (p < 0.007). In a multivariate model controlling for age, gender, Tanner staging, and duration of diabetes, the frequency of BGM was a significant predictor of glycemic control (R2 = 0.19, p < 0.02). Increased frequency of BGM was associated with lower HbA1c levels. When the frequency of BGM was zero or once a day, the mean HbA1c level was 9.9% +/- 0.44 (SE); when the frequency of BGM was two or three times a day, the mean HbA1c level was 8.7% +/- 0.17; and when the frequency of BGM was four or more times daily, the mean HbA1c level was 8.3% +/- 0.22.
Parental involvement in BGM supports more frequent BGM in 10- to 15-year-old patients with IDDM. This increased adherence to BGM is associated with better metabolic control (i.e., lower HbA1c levels). These findings suggest that encouraging parental involvement in BGM with 10- to 15-year-old patients with IDDM may help to prevent the well-documented deterioration in glycemic control and adherence to treatment that often occurs in later adolescence.
To devise and implement a structured intervention for integrating peers into diabetes care in a healthy and adaptive manner.
Adolescents with diabetes (n = 21) and their best friends (n = 21) participated in a group intervention aimed at increasing diabetes knowledge and social support of diabetes care. Measures of social support, knowledge about diabetes and support, diabetes functioning, and social functioning were obtained prior to and following intervention.
Following the intervention, adolescents and their friends demonstrated higher levels of knowledge about diabetes and support, as well as a higher ratio of peer to family support, and friends demonstrated improved self-perception. Parents reported decreased diabetes-related conflict.
Peer group intervention approaches may result in increased positive peer involvement in adolescents' diabetes care.
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