Parent experiences raising young people with type 1 diabetes and celiac disease

School nurses' competency in supporting students with type 1 diabetes: A mixed methods systematic review

Aim To evaluate school nurse and family-reported perceptions of school nurse competencies in supporting students with Type 1 diabetes.

DESIGN

Mixed methods systematic review of the Joanna Briggs Institute methodology.

DATA SOURCES

Five academic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Embase, and Research Information Sharing Service) were used as data sources.

REVIEW METHODS

Qualitative, quantitative, and mixed-method studies published between 2014 and 2023 were included. Two authors independently assessed the eligibility and quality of the included studies. The quality of the included studies was evaluated using a mixed methods assessment tool.

RESULTS

Thirteen qualitative studies, 11 quantitative studies, seven non-randomized studies, and four mixed studies met the inclusion criteria. Consequently, five competencies and 11 sub-competencies were derived under two themes. The two themes were "demand for training in school diabetes care" and "demand for more active cooperation." In particular, the literature confirmed challenges in school nurses' utilization of diabetes devices despite moderate to high confidence in basic diabetes care tasks.

CONCLUSIONS

This systematic review offered useful information from the perspective of stakeholders (school nurses, parents, and students) regarding school nurses' competencies in caring for students with T1D. This can help us understand the various tasks and requirements faced by school nurses, and future capacity development interventions for school nurses that consider these are needed.

Adherence to gluten free diet and problems faced by children with celiac disease and type 1 diabetes mellitus

Introduction

Celiac disease (CD) in children can be associated with Type 1 Diabetes Mellitus (T1DM) as both share autoimmune etiology. Mainstay of treatment in celiac disease is total avoidance of gluten in diet whereas treatment in child with both the diseases will be Insulin therapy, exercise along with gluten free diet (GFD). There is dearth of literature regarding adherence to GFD and barriers for children with both T1DM and CD.

Methods

A questionnaire-based study was done at a tertiary care institute so as to compare the self-reported gluten adherence and the problems faced by children with dual diseases (TIDM and CD) and CD alone. Thirty children of age group 5-14 years each withType 1 DM and CD (T1DMCD group) and celiac disease (CD group) were selected consecutively. A questionnairewas filled by asking questions from either children (above 8 years) or parents (below 8 years) and the results were compiled, compared and further analysed.

Results

Baseline demographic parameters were comparable in both the groups. Gluten adherence was found to be worse in T1DMCD group as compared to CD group. Greater number of problems were experienced by children with both TIDM and CD as compared to children with CD alone (P < 0.05). Financial burden more so in T1DMCD group, unawareness about disease and benefits of GFD, less availability and social isolation were found to be the most significant barriers to diet adherence.

Conclusion

As these children face dual diseases, they should be made more aware regarding benefits of GFD. Such information is valuable to primary care physicians for better management and rehabilitation of children suffering from these chronic diseases.

Vulnerability in Children with Celiac Disease: Findings from a Scoping Review

(1) Background: The scientific literature highlights that children diagnosed with celiac disease (CD) are at a heightened risk of experiencing physical, psychological, and social challenges, impacting their overall healthy childhood development. However, there remains a lack of a clear understanding regarding the factors that contribute to this vulnerability. The purpose of this study is to analyze and map the evidence on the sociopsychosomatic vulnerability of these children and identify gaps in this topic. (2) Methods: Following Joanna Briggs Institute's guidelines for scoping reviews, we executed a detailed search of key electronic databases and explored the grey literature to capture a broad spectrum of studies. Our focus was on identifying research that looked into the multiple dimensions of vulnerability-physical, psychological, and social-in children with CD. We included a diverse range of study designs as well as systematic reviews, ensuring a comprehensive analysis. The selection process was stringent, utilizing clearly defined inclusion and exclusion criteria. (3) Results: We identified 61 studies that met our inclusion criteria. The review highlighted significant adverse health outcomes in children with CD and elucidated various individual and environmental determinants that influenced these vulnerabilities. It also underscored the lack of assessment tools to evaluate the risk of health problems in this population. (4) Conclusions: The findings underscore a critical need for further research to deepen our understanding of the vulnerabilities associated with CD in children. Developing targeted assessment tools will be crucial in stratifying health risks and enhancing care strategies for this vulnerable population.

Lived Experiences of Parents of Children with Celiac Disease: A Descriptive Qualitative Study

Purpose

Celiac disease (CD) is one of the most prevalent food-related illnesses in children, with a global prevalence of approximately 1.4%. CD can create an emotional burden, particularly on mothers, who are mainly responsible for managing challenges related to adherence to a gluten-free diet, high food costs, and food problems in schools and social areas. There is a gap in the literature, and parental experiences of raising children with CD should be explicitly examined. This qualitative study sought to provide insights into the experiences of parents raising a child with CD in the Turkish context.

Methods

This study used a descriptive qualitative research methodology and conducted individual semi-structured video-based dyadic interviews with 19 parents.

Results

Participants experienced both challenges and motivators through management of their children's CD. Analyses of the interview transcripts through the data uncovered three main themes focusing primarily on parental concerns: (1) parental challenges in child's disease management, (2) supportive care needs, and (3) parental expectations.

Conclusion

A multidisciplinary team should approach the child and family immediately after diagnosis, and facilities should support parents with continuing education and psychological, financial, and social assistance.

Managing type 1 diabetes of a child: Parents' perspectives

PURPOSE

Managing type 1 diabetes (T1D) challenges children and their parents. Parents need to learn the necessary skills and later transfer the responsibility of care to their children as they develop. The transition process involves autonomy in behaviour and decision-making. This study explores the shared management experiences of Taiwanese parents and their children with type 1 diabetes.

DESIGN AND METHODS

This study employed a qualitative design using a grounded theory approach. Purposive sampling was used at a medical centre in Taiwan for participant recruitment. Twenty-nine parents of children who had been diagnosed with T1D were interviewed in-depth. Data were analysed using constant comparison and repeated verification.

RESULTS

After a child was diagnosed with T1D, the parents initiated 'Life-long lesson: Growing together with the child on the road to normality'. Three main categories emerged: 'confronting the disease diagnosis', 'establishing supportive and collaborative involvement' and 'assisting the child in building a sense of belonging'. Sub-categories within each significant category were also included.

CONCLUSIONS

Taiwanese parents perhaps have a controlling or directive role for a long period in their child's lives and shared management of their health condition. This study's findings can help healthcare workers better understand the process of parents' shared management of T1D with their children and how to best communicate with children about the disease and care in accordance with the child's stage of development.

Towards an integrated type 1 diabetes management in low-resource settings: barriers faced by patients and their caregivers in healthcare facilities in Ghana

BACKGROUND

In Low-Middle-Income Countries (LMICs), young people living with Type 1 Diabetes Mellitus (T1DM) face structural barriers which undermine adequate T1DM management and lead to poor health outcomes. However, research on the barriers faced by young people living with T1DM have mostly focused on patient factors, neglecting concerns regarding plausible barriers that may exist at the point of healthcare service delivery.

OBJECTIVE

This study sought to explore barriers faced by young people living with T1DM and their caregivers at the point of healthcare service delivery.

METHODS

Data were drawn from a qualitative research in southern Ghana. The research was underpinned by a phenomenological study design. Data were collected from 28 young people living with T1DM, 12 caregivers, and six healthcare providers using semi-structured interview guides. The data were collected at home, hospital, and support group centres via face-to-face interviews, telephone interviews, and videoconferencing. Thematic and framework analyses were done using CAQDAS (QSR NVivo 14).

RESULTS

Eight key barriers were identified. These were: shortage of insulin and management logistics; healthcare provider knowledge gaps; lack of T1DM care continuity; poor healthcare provider-caregiver interactions; lack of specialists' care; sharing of physical space with adult patients; long waiting time; and outdated treatment plans. The multiple barriers identified suggest the need for an integrated model of T1DM to improve its care delivery in low-resource settings. We adapted the Chronic Care Model (CCM) to develop an Integrated Healthcare for T1DM management in low-resource settings.

CONCLUSION

Young people living with T1DM, and their caregivers encountered multiple healthcare barriers in both in-patient and outpatient healthcare facilities. The results highlight important intervention areas which must be addressed/improved to optimise T1DM care, as well as call for the implementation of a proposed integrated approach to T1DM care in low-resource settings.

The Experience of a Gluten-free Diet in Children with Type 1 Diabetes and Celiac Disease

OBJECTIVE

This study examined overall self-reported adherence to gluten-free diet (GFD) in children with type 1 diabetes and celiac disease (T1DCD) compared to children with celiac disease (CD). Secondary objectives included gaining insight into self-reported symptoms, barriers to adherence, and experience of a GFD between groups.

METHODS

Children <18 years old who had been seen at BC Children's Hospital for T1DCD or CD were invited to participate in a web-based questionnaire and medical record review.

RESULTS

A total of 26 children with T1DCD and 46 children with CD participated in the study. The groups' demographics and symptoms of CD were similar; however, a greater proportion of those with T1DCD were asymptomatic at diagnosis (T1DCD 27%; CD 7%; P = 0.016). Overall adherence to a GFD was high in both groups (T1DCD 92%; CD 100%; P = 0.38) but those with T1DCD reported a significantly less positive effect on their health (P = 0.006) and a significantly greater negative effect on activities from a GFD (P = 0.03). Children with T1DCD reported more significant barriers to eating gluten-free at home and at restaurants, specifically with social pressure, cost and taste compared to those with CD only.

CONCLUSION

Children with T1DCD face specific barriers in adherence that are more impactful compared with children living with CD. These children are more often asymptomatic at diagnosis, and they go on to experience different impacts of a GFD spanning across home and social settings. Given the complexity of having a dual diagnosis, CD care should be tailored specifically to children living with T1DCD.

Characterising common challenges faced by parental caregivers of children with type 1 diabetes mellitus in mainland China: a qualitative study

OBJECTIVES

The mental state of parental caregivers affects outcomes in children with type 1 diabetes mellitus (T1DM). This study aimed to qualitatively examine perception of common challenges among parental caregivers of children with T1DM.

SETTING

Semistructured interviews 45-60 min long were conducted with parental caregivers of children with T1DM. Interview recordings were transcribed and coded in NVivo V.11.0 to observe emergent themes.

PARTICIPANTS

Eligible T1DM caregiving parents (parent(s) and/or legal guardian(s)) were identified from caregivers attending visits with children hospitalised or assessed in the Pediatric Neuroendocrinology Department of Shengjing Hospital, China Medical University in Shenyang from January 2018 to June 2019.

PRIMARY AND SECONDARY OUTCOME MEASURES

Not applicable.

RESULTS

A total of 20 T1DM caregiving parents were interviewed, aged 30-53 years, including 7 fathers and 13 mothers, with their children whose mean age was 10.6±2.45 years. Content analysis revealed 5 major themes with 13 subthemes, including persistent psychological stress (catastrophic emotions, emotional distress and altered self-efficacy), family function change (altered family life patterns and changes in parental role/function), challenges in daily management (technical challenges, emotional regulation, parent-child conflict and transition of care autonomy from parent to child), financial burden (cost burden of treatment and altered family economics), and lack of social support (social activity limitations and insufficient support system).

CONCLUSIONS

The period of emotional disturbance during initial diagnosis, psychological stresses of long-term caregiving, and conflict emerging from transition from parental to child responsibility all can cause psychological response detrimental to parental caregivers and children with T1DM. This work provides compelling evidence for the role of assessment and intervention in parental caregivers' psychological and emotional well-being in diabetes care, as well as for the necessity of improved social and school support for children with T1DM in China.

Quality of life of Moroccan children with celiac disease: Arabic translation and validation of a specific celiac disease instrument

PURPOSE

Gluten-free diet (GFD) is a lonely lifelong management for patients with celiac disease (CD), which may affect their quality of life (QoL). This can be evaluated by generic or specific instruments. We aimed to translate, validate and cross-culturally adapt a specific-CD instrument to Moroccan-Arabic version (M-CD-DUX), and then apply it to evaluate the QoL of Moroccan celiac children.

DESIGN AND METHODS

CD-DUX instrument was translated and culturally adapted, and preliminarily evaluated on 15 children and their proxies. The reproducibility and internal consistency of M-CD-DUX were measured by intra-class coefficient (ICC) and Cronbach α tests respectively. The statistical analysis of data consisted was conducted using SPSS, and the Goodness-of-Fit test was measured by SPSS AMOS.

RESULTS

The reliability of M-CD-DUX instrument showed a good internal consistency and reproducibility. The psychometric properties of M-CD-DUX were acceptable, and the instrument's Model fit was good [(Root Mean Square Error of Approximation = 0.062; χ2 = 603.08, p < 0.001]. M-CD-DUX was completed by 52 celiac children and their proxies. It showed a worse QoL for all items and subscales, and no difference was observed between the QoL of celiac children already under GFD and those recently diagnosed.

CONCLUSION

M-CD-DUX was the first reliable and adapted instrument used to evaluate the QoL of celiac children in an Arab country, emphasizing a negative impact of CD on their QoL.

PRACTICE IMPLICATIONS

Therefore, improving their QoL requires to make gluten-free products available to them at an appropriate price as well as a good integration into society.

Challenges and opportunities in measuring the pediatric quality of life: exemplified by research in pediatric gastroenterology

Introduction: Quality of life (QOL) is an important patient-reported outcome measure (PROM). Assessment of QOL in children is challenging particularly because developmental age affects the accuracy of self-reports.Areas covered: This paper gives an overview and expert opinion of the factors impacting quality assessment of pediatric QOL. Given this literature is vast, we focused on QOL measurement in pediatric gastroenterological conditions as an example, but the general principles apply across childhood chronic diseases. Child developmental stage affects self-reports. Younger children are less reliable reporters implicating the need for parental proxies. However, parents may not be as cognizant of their child's internal life especially as the child grows older. Adjustment to disease (QOL initially decreases then improves) as well as the time of year (QOL improves during summer) affects reports of QOL. Furthermore, it is important to acknowledge the impact of the child's disease on caregivers and families' QOL.Expert opinion: The numerous aspects impacting pediatric QOL make assessment and measurement complex. We propose several strategies to guide this process such as assessing both self-report and parent-proxy measures, as well as considering the timing of QOL assessments.

Impact of a Child's Celiac Disease Diagnosis and Management on the Family

BACKGROUND

Little attention has been paid to family-wide repercussions of a child's celiac disease diagnosis and concomitant gluten-free diet management.

AIMS

We quantitatively and qualitatively describe positive and negative family-wide effects of a child's celiac disease diagnosis and disease management.

METHODS

We interviewed 16 families with at least one child currently following a gluten-free diet, with a biopsy-confirmed celiac disease diagnosis ≥ 1 year prior. Mothers and fathers independently rated child's dietary adherence, concern about child's health status, burden in caring for child's dietary needs, and level of change in various aspects of life post- diagnosis. Children rated their own celiac-specific quality of life through a validated scale. Seventy-one in-depth semi-structured interviews were conducted with 16 children with celiac disease, 31 parents, and 24 siblings.

RESULTS

Mothers and fathers rated the effects of their child's celiac disease differently, with mothers reporting more lifestyle changes and heavier burden. Negative and positive themes emerged from the interviews. Mothers felt the burden of managing a gluten-free diet. Fathers felt guilty for carrying a celiac disease-associated gene and both fathers and siblings regretted limited food choices at restaurants and home. The need to be a more creative cook was seen as a positive effect by mothers. Fathers appreciated new family traditions. Siblings felt they had developed empathy for others. A framework is proposed to illustrate these family-wide interactions.

CONCLUSIONS

A child's celiac disease diagnosis and disease management affects the entire family. Our results will inform family-centered interventions that maximize quality of life for families.

The Impact of Celiac Disease on Caregivers' Well-being: An Integrative Review

OBJECTIVES

A diagnosis of celiac disease (CD) requires individuals to adopt a strict gluten-free diet. As children with CD must rely on their caregivers for guidance and support with managing the gluten-free diet, CD may challenge the caregiver's emotional and social well-being. The primary objective of this mixed-methods systematic review was to synthesize research investigating the impact of CD on caregiver's well-being.

METHODS

Five databases were systematically searched from 1990 to 2018 to identify all empirical studies that assessed well-being in caregivers of children (0-18 years) with CD. Qualitative and quantitative data were extracted separately before being integrated to explore key themes across the studies.

RESULTS

Twelve studies were identified that explored the well-being of caregivers of children with CD (3 qualitative, 9 quantitative), reporting on 665 caregivers. The quality of evidence was limited across studies. Synthesis of results revealed 3 themes (Caregiver Responsibility, Caregiver Well-Being and Concern for Child's Health, Implications for the Family) describing the impact of a child with CD on caregiver well-being.

CONCLUSIONS

Caregivers of children with CD may experience difficulties that impact their well-being; specific difficulties identified included the impact of caregivers' social activities, finances, and anxiety. The findings detailed in this review point toward factors that may guide health care personnel to provide support for the caregivers of children with CD.

A Quantitative Assessment of Gluten Cross-contact in the School Environment for Children With Celiac Disease

OBJECTIVES

A gluten-free (GF) diet is the primary treatment for celiac disease (CD). Gluten is used in schools, particularly in early childhood, art, and home-economics classrooms. This study aimed to measure gluten transfer from school supplies to GF foods that a child with CD may eat. Also, to measure efficacy of washing techniques to remove gluten from hands and tables.

METHODS

Five experiments measured potential gluten cross-contact in classrooms: Play-Doh (n = 30); baking project (n = 30); paper mâché (n = 10); dry pasta in sensory table (n = 10); cooked pasta in sensory table (n = 10). Thirty participants ages 2 to 18 were enrolled. Following activities, gluten levels were measured on separate slices of GF bread rubbed on participant's hands and table surfaces. Participants were assigned 1 of 3 handwashing methods (soap and water, water alone, or wet wipe). Repeat gluten transfer measurements were taken from hands and tables. Gluten measurements made using R-Biopharm R7001 R5-ELISA Sandwich assay.

RESULTS

Paper mâché, cooked pasta in sensory tables, and baking project resulted in rates of gluten transfer far greater than the 20 ppm threshold set by Codex Alimentarius Commission. Play-Doh and dry pasta, however, resulted in few gluten transfers to GF bread >20 ppm. Soap and water was consistently the most effective method for removing gluten, although other methods proved as effective in certain scenarios.

CONCLUSIONS

The potential for gluten exposure at school is high for some materials and low for others. For high-risk materials, schools should provide GF supplies and have a robust strategy to prevent gluten cross-contact with food.

Mothers' Experiences of Maze Path of Type 1 Diabetes Diagnosis in Children

Background

Incidence of diabetes Type 1 in children with non-classic symptoms is one of the reasons for the delay in their follow-up. Failure in its diagnosis by the health professional exposes the mothers to many challenges. This study was conducted to explore mothers' experiences in the diagnosis pathway of diabetes Type 1 in children.

Methods

Semi-structured qualitative interviews were conducted with fifteen mothers of children with Type 1 diabetes. they were selected by the purposefull sampling method. Their child had a medical file in diabetes centers in Kerman, Iran, at least one year has passed of diabetes diagnosis in their child and the maximum age of the child is 14 years. Data were analyzed using content analysis. Three themes and nine sub-themes emerged during data analysis.

Results

The extracted themes included “presence in the maze path to the child's disease”, “facing the reality of the child's disease”, and “to grin and bear with new conditions”.

Conclusions

According to the finding, these mothers experienced various challenges. Therefore, identification of these challenges by health professionals to prevent and decrease of Them, is necessary.

Assessment of patient concerns: a review

BACKGROUND

Patient-centred communication is the mainstay of the medical consultation. It includes the assessment of patient concerns and is important in building the doctor-patient therapeutic relationship. Our aim was to perform a literature review to identify relevance of patient concern assessment, to identify what concerns are encountered in various clinical settings and to explore the different methodologies used to obtain them.

METHODS

A narrative review was performed.

RESULTS

Addressing patient concerns is associated with increased patient satisfaction. Unvoiced concerns are associated with unresolved health issues and poor doctor-patient relationships. Different specialities have focused on different aspects of concern assessment. Patient concern assessment studies are mostly qualitative in nature. Not all qualitative methods give similar results. Interviews are more reliable sources of information than questionnaires as no one questionnaire captures all patient concerns. The location where interviews take place is also relevant.

CONCLUSIONS

Assessing patient concerns is associated with positive outcomes. Patient concerns are handled differently by different clinical specialties. Various methodologies have been used for concern assessment. Interviews and questionnaires can often yield different results.

Children and adolescents living with diabetes and celiac disease

Objective To understand the experience of children and adolescents living with type 1 diabetes and celiac disease. Method This is a qualitative exploratory-descriptive study. The participants were 3 children and 2 adolescents. The data were collected by means of semi-structured interviews between January and September 2012 at the participant's residence or at the diabetic outpatient clinic of the Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo in São Paulo, Brazil. The content analysis technique was used to process the data. Results The key aspect of the illness experience of the patients was their diet, but with different meanings. The children had difficulty following the diet, while the adolescents reported that they had greater difficulty coping with the social and affective aspects of their diet. Conclusion The results reinforce the importance of nurses who seek strategies, together with the patients and their families, that help minimize the difficulties of these patients, especially with regard to managing the diet imposed by both diseases.