Longitudinal trajectories of illness perceptions among adolescents with type 1 diabetes

Humanistic burden of pediatric type 1 diabetes on children and informal caregivers: systematic literature reviews

BACKGROUND

Diagnosis of children with type 1 diabetes (T1D) imposes an unprecedented burden on children and their caregivers.

OBJECTIVE

To assess the burden of T1D on children and their informal caregivers, both after a recent diagnosis or after a longer duration of disease.

METHODS

A series of systematic literature reviews were performed to explore the burden of T1D on children with the disease and their primary informal caregivers, based on the time of diagnosis. After the extraction of the qualitative and quantitative data from the included studies, two literature-based conceptual frameworks were developed: on the burden of pediatric T1D on children, and on informal caregivers. A third conceptual framework on the shared burden of pediatric T1D on both children and informal caregivers as part of the same family unit was also developed.

RESULTS

The review of literature has identified a series of factors that affect the quality of life of children with T1D and their informal caregivers, with a direct impact on physical, emotional, and social outcomes. Generally, female patients and older adolescents experience more worry and stress that affects their quality of life. Other categories of factors affecting the child's and caregiver's burden include social, emotional, and physical factors, treatment-related and disease-related factors, as well as their coping abilities. Anxiety, depression, stress, and worry were commonly found among children and caregivers, starting with the diagnosis of T1D and continuing over time in relation to new challenges pertaining to aging or the disease duration.

CONCLUSION

T1D causes a significant burden to affected children and their caregivers, both independently and through transactional interaction within the family unit. Disease burden can be reduced by strengthening individuals for the benefit of the whole family.

Trajectories of illness perceptions in paediatric cancer patients and their parents and associations with health-related quality of life: Results of a prospective-longitudinal study

OBJECTIVE

In paediatric oncology, little is known about trajectories of illness perceptions and their longitudinal associations with health-related quality of life (HRQoL). Therefore, the aim of this study was to investigate changes in illness perceptions in children and parents over a one-year-period and to investigate predictive value of child's and parent's illness perceptions during acute treatment for child's HRQoL 1 year later.

METHODS

N = 65 child-parent-dyads participated in a longitudinal study (retention rate: 80.2%). Children were 4-18 years of age and underwent acute cancer treatment at baseline. Children and parents reported on their own illness perceptions (Illness-Perception-Questionnaire-Revised), as well as on the child's HRQoL (KINDL-R) at baseline and one-year-follow-up. Paired-samples t-tests were calculated to investigate changes over time. A hierarchical multiple regression analysis was performed to investigate predictive value of child's and parent's illness perceptions for child's HRQoL.

RESULTS

Child's HRQoL t(63) = -6.73, p < 0.001, their perceptions of coherence (i.e. understanding; t(54) = -2.36, p = 0.022) and consequences of their illness (t(54) = 2.86, p = 0.006), and parent's perception of cyclical trajectory (t(61) = 2.06, p = 0.044) improved from baseline to 1-year-follow-up. All other illness perceptions remained stable. Exploratory post-hoc analyses showed differences in the pattern of change in age-, gender-, and diagnosis-specific subgroups. After controlling for baseline levels of HRQoL, child's perceptions of symptoms and consequences were independent predictors of their HRQoL 1 year later (R2 = 0.396, F(2,52) = 10.782, p < 0.001), whereas no parent's illness perceptions added predictive value.

CONCLUSION

In paediatrics, child's and parent's illness perceptions should be assessed. Our findings highlight the importance of illness perceptions as potential modifiable variables in interventions to improve child's HRQoL.

Continuous glucose monitoring empowers adolescents to take responsibility of diabetes management

BACKGROUND

Managing diabetes is especially challenging for adolescents, and they often struggle to believe they can manage the condition. Illness perception has been widely associated with better diabetes management outcomes, but the influence of continuous glucose monitoring (CGM) on adolescents has been largely neglected.

AIM

The study aimed to explore the illness perception of a group of adolescents living with type 1 diabetes (T1D) using CGM.

SETTING

The study was conducted at a medical centre that provides diabetes care services to youth living with T1D in Parktown, South Africa.

METHODS

A qualitative research approach using semi-structured online interviews was used to gather data that was thematically analysed.

RESULTS

Themes emerging from the data confirmed that CGM creates a sense of control over diabetes management as blood glucose measures were more visible. A sense of normalcy was established as CGM influences a new routine and a way of life, integrating diabetes into a young person's identity. Despite the users' awareness of being different due to diabetes management, CGM assisted in creating a sense of belonging, contributing to developing a better quality of life.

CONCLUSION

Findings of this study support the use of CGM as a means of empowering adolescents struggling with diabetes management to achieve better treatment outcomes. The important role of illness perception in facilitating this change was also evident.Contribution: By listening to the adolescent's voice, CGM was identified as a possible intervention to empower adolescents to improve diabetes management.

Diabetes representations on adherence and quality of life: Do parents and adolescents differ?

Type 1 diabetes is one of the most frequent chronic diseases in adolescents. To manage diabetes and prevent complications, a set of self-care behaviors needs to be implemented into family daily routines. This study analyzed diabetes representations in adolescents and their parents, the dissimilarities between them, and the relationship between illness dissimilarities and adherence/quality of life (QoL) in adolescents with type 1 diabetes. The sample included 200 participants: 100 adolescents with type 1 diabetes and 100 parents who accompanied the adolescents. Adolescents were assessed on adherence (Self-Care Inventory-Revised), quality of life (Diabetes QoL) and family support (Diabetes Family Behavior Scale). Both adolescents and parents were assessed on illness representations (Brief-Illness Perception Questionnaire). Dissimilarities in illness representations between parents and adolescents were performed using Olsen et al's proposal. Parents showed a more negative representation of diabetes than adolescents. Adolescents' illness representations, the dissimilarities between adolescents' and parents' illness representations, and family support were associated with adolescents' adherence and QoL. Higher family support moderated the relationship between the dissimilarity in timeline representations and QoL, explaining 17.8% of the variance on QoL. Adolescent's  gender (male) was a moderator in the relationship between adolescent's coherence and QoL, explaining 18.6% of the variance on QoL. Adolescent's gender (female) was a moderator in the relationship between timeline and QoL, explaining 11.9% of the variance on QoL. Being a male parent was a moderator in the relationship between adolescent's concerns and QoL, explaining 13.5% of the variance on QoL. Intervention programs should focus on illness representations, particularly on the dissimilarities between adolescents and parents, as well as on family support in order to promote adolescents' adherence and QoL.

Smile with diabetes: reflections on illness perception and diabetes management behaviors of adolescents in private health care in South Africa

Background

The association between illness perception and diabetes management has been well established in adults but is not clearly understood for adolescents. This article reflects on qualitative findings on illness perception from the perspective of adolescents, and suggests future research to operationalize findings.

Methods

Qualitative document analysis was conducted on four research projects forming part of the Smile with Diabetes project, which aims to investigate psychosocial variables in diabetes management, including illness perception, within the adolescent and youth populations. Thematic analysis was used to derive four themes from the qualitative and review studies examined in the document analysis.

Results

The voices of the adolescents were evident as four prominent themes: 1) living with diabetes leads to a sense of being different; 2) integration of diabetes into identity is critical, but difficult to achieve; 3) fear of potential negative consequences motivates adherence to treatment; 4) diabetes management is difficult, but possible.

Conclusion

The findings not only confirmed the importance of illness perception in the management of diabetes by adolescents, but also indicate that illness perceptions should be investigated from a developmental perspective, specifically taking identity development into consideration in this group. Adolescents should be made aware of how their thinking about diabetes and its management affects their experience of living with diabetes and its future management. This study further contributes to the literature by focusing on the patient's voice in understanding living with a chronic condition, and reassures that positive outcomes are possible when living with a chronic condition such as diabetes.

Healthcare Workers Beliefs about COVID-19; a Longitudinal, Mixed Methods Analysis

The psychological impact of COVID-19 on Health Care Workers (HCWs) has been widely reported. Few studies have sought to examine HCWs personal models of COVID-19 utilising an established theoretical framework. We undertook a mixed methods study of beliefs about COVID-19 held by HCWs in the Mid-West and South of Ireland during the first and third waves of COVID-19. Template analysis was undertaken on the free text responses of 408 HCWs about their perceptions of the Cause of COVID-19 as assessed by the Brief Illness Perception Questionnaire (B-IPQ). Responses were re-examined in the same cohort for stability at 3 months follow-up (n = 100). This analytic template was subsequently examined in a new cohort (n = 253) of HCWs in the third wave. Female HCWs perceived greater emotional impact of COVID-19 than men (t = -4.31, df405, p < 0.01). Differences between occupational groups were evident in relation to Timeline (F4,401 = 3.47, p < 0.01), Treatment Control (F4,401 = 5.64, p < 0.001) and Concerns about COVID-19 (F4,401 = 3.68, p < 0.01). Administration staff believed that treatment would be significantly more helpful and that COVID-19 would last a shorter amount of time than medical/nursing staff and HSCP. However, administration staff were significantly more concerned than HSCP about COVID-19. Template analysis on 1059 responses to the Cause items of the B-IPQ identified ten higher order categories of perceived Cause of COVID-19. The top two Causes identified at both Waves were 'individual behavioural factors' and 'overseas travel'. This study has progressed our understanding of the models HCWs hold about COVID-19 over time, and has highlighted the utility of the template analysis approach in analysing free-text questionnaire data. We suggest that group and individual occupational identities of HCWs may be of importance in shaping HCWs responses to working through COVID-19.

Illness perception in children with cerebral palsy, a longitudinal cohort study

Background

The perception of a disorder could be of importance both in problem solving behaviors, and in the emotional approach towards a disorder.

Aims

In this paper, we wanted to assess changes in illness perception in children with Cerebral Palsy (CP) over a four-year interval, to compare parental and self-ratings, and to assess illness perceptions according to co-occurring medical and psychiatric disorders.

Methods

Parents in a cohort of children with CP (N = 36), filled in the Illness Perception Questionnaire at age seven and again at age eleven, and self-reports were gathered at age eleven. Stability across time, informant differences and scores according to motor function, intellectual disability and the prevalence of psychiatric disorders were assessed.

Results

We found stable parental perceptions across a four –year interval. Parents reported significantly higher impact of CP on the child, than that reported by the child itself. In children with a more severe motor disability and/or co-occurring psychiatric disorders, parents reported significantly higher median scores for perceived impact of the CP condition on symptoms, duration of the condition, and impact on leisure activities, compared to those who had less severe motor disability and/or intellectual abilities within the normal range.

Conclusions

We propose that illness perception should be included in the follow-up of children with CP, as it may provide a mutual understanding between the child/family and professionals involved in follow-up services, with possible impact on treatment adherence and outcome of the condition.

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Parents reported significantly more negative impact of CP than their children.

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Parents reported stable perception of their child's CP across a four-year period.

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Parents and children reported significant impact of CP on leisure activities.

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Impact of CP was significant in children with co-occurring psychiatric disorders.

Illness Perceptions of COVID-19 in Europe: Predictors, Impacts and Temporal Evolution

Objective: Illness perceptions (IP) are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors (within demographics and contact with COVID-19) and examine the impacts of IP on perceived stress and preventive behaviors.

Methods: This was a time-series-cross-section study of 7,032 participants from 16 European countries using multilevel modeling from April to June 2020. IP were measured with the Brief Illness Perception Questionnaire. Temporal patterns were observed considering the date of participation and the date recoded to account the epidemiological evolution of each country. The outcomes considered were perceived stress and COVID-19 preventive behaviors.

Results: There were significant trends, over time, for several IP, suggesting a small decrease in negativity in the perception of COVID-19 in the community. Age, gender, and education level related to some, but not all, IP. Considering the self-regulation model, perceptions consistently predicted general stress and were less consistently related to preventive behaviors. Country showed no effect in the predictive model, suggesting that national differences may have little relevance for IP, in this context.

Conclusion: The present study provides a comprehensive picture of COVID-19 IP in Europe in an early stage of the pandemic. The results shed light on the process of IP formation with implications for health-related outcomes and their evolution.

'It kinda sucks': Illness perception of a group of South African adolescents with type 1 diabetes mellitus

Background

Living with diabetes is challenging, especially for adolescents at risk of poor glycaemic control. Understanding the illness perceptions of this group is important to be able to develop interventions for this growing population in need.

Aim

This study explored the illness perception amongst adolescents living with type 1 diabetes (T1D) and how these perceptions interacted with the management of T1D.

Setting

This study was conducted at a medical centre providing care for adolescents living with T1D in Parktown, South Africa.

Methods

A qualitative, explorative design with semi-structured interviews was followed. A non-random purposive sampling method was utilised. The illness perception amongst eight adolescents, aged 12–18 years, at risk of poor glycaemic control, was analysed through thematic analysis.

Results

Two subthemes related to illness perception were generated, namely (1) illness perception of T1D is negative and (2) living with T1D leads to a sense of being different. Furthermore, two subthemes were generated in relation to how illness perceptions interacted with diabetes management, namely (3) management of T1D is challenging and (4) management of T1D is motivated by fear.

Conclusion

This group of adolescents with at-risk glycaemic control believed that T1D is difficult to manage, leading to a largely negative perception of the disease. This study contributes to the body of literature on adolescents where illness perception may play a role in adhering to diabetes care plans. This research may give additional insights into the awareness of illness perception in designing successful interventions.

The division and transfer of care responsibilities in paediatric type 1 diabetes: A qualitative study on parental perspectives

Aim

To determine which factors other than child age play a role in the division and transfer of diabetes care responsibilities between parents and children with type 1 diabetes.

Design

Qualitative focus group study.

Methods

Across four sites in the Netherlands, 18 parents (13 mothers) of children (9–14 years) with type 1 diabetes participated in four focus groups in 2015–2016, as part of the research project 'Whose diabetes is it anyway?'. Qualitative content analysis and the constant comparison method were used to analyse the data.

Results

According to parents, the transfer process included both direct and indirect tasks, had different levels (remembering, deciding, performing), was at times a difficult and stressful process, and showed large variation between families. A large number of child, parent and context factors were identified that affected the division and transfer of diabetes care responsibilities according to parents. Both positive and negative consequences of the transfer process were described for parental and child health, behaviour and well‐being. Parental final evaluations of the division and transfer of diabetes care responsibilities appeared to be dependent on parenting values.

Conclusion

How families divide and transfer diabetes care tasks appeared to be affected by a complex interplay of child, parent and context characteristics, which had an impact on several parent and child domains.

Impact

Parents struggle with the right timing of transfer, which calls for more support from diabetes nurses. The identified factors can be used as input for integrating a more family‐based approach into current age‐based guidelines, to improve regular care.

The impact of psychological aspects, age, and BMI on eating disorder psychopathology among adult males and females with type 1 diabetes

This study investigated correlates of eating disorder (ED) psychopathology among adults with type 1 diabetes (T1D). A total of 282 males (n = 112) and females (n = 170) with T1D (18–79 years) participated. Overall, psychological aspects (i.e. illness perceptions, coping strategies, insulin beliefs, anxiety, and depression) were associated with ED psychopathology. Associations were generally stronger among females than males. In a regression model, age, BMI, personal control, and anxiety explained 51% of the variance in ED psychopathology among females, whereas BMI, personal control, and anxiety explained 47% of the variance among males. Greater clinical awareness of health psychological aspects may contribute to reduce the risk of developing ED.

Patient Health Beliefs and Characteristics Predict Longitudinal Antihypertensive Medication Adherence in Adolescents With CKD

Objective

To investigate longitudinal associations of health beliefs, which included self-efficacy, outcome expectancies, and perceived barriers, and demographic risk factors (i.e., age, gender, race, and family income) with antihypertensive medication adherence in adolescents with chronic kidney disease (CKD) over 24 months.

Method

The sample included 114 adolescents (M age = 15.03 years, SD = 2.44) diagnosed with CKD. Adolescents reported their self-efficacy for taking medications, medication outcome expectancies, and barriers to adherence at baseline and 12 and 24 months after baseline. Antihypertensive medication adherence was assessed via electronic monitoring for 2 weeks at baseline and 6, 12, 18, and 24 months after baseline.

Results

Adherence increased and then decreased over the 2-year study period (inverted U-shape). Self-efficacy, outcome expectancies, and barriers did not change over time. Older adolescent age, female gender, African American race, <$50,000 annual family income, and public health insurance were associated with lower adherence. However, family income was the primary demographic risk factor that predicted adherence over time (≥$50,000 annual family income was longitudinally associated with higher adherence). Higher self-efficacy and more positive and less negative outcome expectancies across time were also associated with higher antihypertensive medication adherence across time.

Conclusions

Clinical interventions should be developed to target medication self-efficacy and outcome expectancies to improve long-term antihypertensive medication adherence in adolescents with CKD. Family income may be considered when conceptualizing contextual factors that likely contribute to adolescents' consistent challenges with medication adherence over time.

Adherence to insulin pump treatment declines with increasing age in adolescents with type 1 diabetes mellitus

AIM

This study assessed the impact of illness perceptions, emotional responses to the disease and its management, and patient characteristics on the adherence to optimal insulin pump management in adolescents with type 1 diabetes mellitus.

METHODS

From May to December 2013 and May 2015 to September 2016, we investigated 90 adolescents (50% boys), 12-18 years with type 1 diabetes. We analysed the association of optimal adherence to insulin pump therapy to age, gender, diabetes duration, results of questionnaires relating to fear and problems of self-testing, illness perceptions, emotional distress and family conflicts. Optimal adherence was defined as bolusing insulin on average ≥2.5/3 main meals/d.

RESULTS

Adolescents with suboptimal adherence were on average 1.8 years older (95% Confidence Interval 1.09-2.50 years, P < .001) than those with optimal adherence. After adjustment for age, no other patient or parent factors were related to optimal adherence.

CONCLUSION

Adherence to insulin pump self-management in adolescents with type 1 diabetes declined with increasing age, illustrating the challenges of transition of self-management from parents to the adolescent patient themselves.

Exploring agendas of patients attending family medicine clinics in Jordan. A qualitative content analysis study

OBJECTIVES

To explore concerns, beliefs, and expectations of patients who attend Family Medicine clinics in  the University of Jordan Hospital, Amman, Jordan. Methods: A qualitative descriptive design was used. Semi-structured interviews were conducted with 143 patients (84% females, mean age 45.3±17.8 years) between September and December 2016. A validated patient's agenda form included open-ended questions on patients' main concerns, beliefs, and expectations was used. A qualitative content analysis of answers was completed by coding answers into categories. Results: A good aggregate inter-rater reliability for coding categories was found (κ-values ranging from 0.76-0.88). The most common concern of participants were the need to receive treatment for an acute illness, followed by the desire for clarification on health condition. Forty percent of participants believed that their symptoms were caused by a health condition rather than lifestyle, while 32.5% had no speculations related to the causes behind their symptoms. The highest percentage of patients expected doctors to provide information related to their health condition. Conclusion: The most prominent needs of participants were the need for information and explanation regarding health condition. Family doctors are encouraged to use agenda forms to enhance patient communications and improve outcomes of consultations.

Illness acceptance in adolescents: A concept analysis

AIM

To strengthen the theoretical understanding of illness acceptance in adolescents and to inform healthcare strategies geared toward supporting adolescents with chronic illness.

BACKGROUND

Illness acceptance is associated with positive health outcomes. Though well understood in adults with chronic illness, less is known about how this phenomenon ensues in adolescents. Adolescents may have a difficult time accepting an illness due to their unique developmental needs. Consequently, they are vulnerable to poor health outcomes.

DESIGN

Concept analysis.

DATA SOURCES

A literature search through 2 databases (PubMed and PsycINFO) and a hand-search through Google were conducted to identify uses of the concept.

REVIEW METHODS

The Walker and Avant method of concept analysis.

RESULTS

Four attributes of illness acceptance were identified: understanding of illness, overcoming limitations, normalization, and readiness for responsibility. Antecedents that predisposed illness acceptance included peer and family support, disease management education, and developmental readiness. Positive consequences of illness acceptance included high self-esteem, improved quality of life, resilience, identity formation, and better disease control.

CONCLUSIONS

Establishing a standardized conceptual understanding of how illness acceptance ensues in adolescents can enable nurses and other health professionals to tailor developmentally appropriate care strategies and optimize the overall quality of life for this unique patient population.

Disturbed eating, illness perceptions, and coping among adults with type 1 diabetes on intensified insulin treatment, and their associations with metabolic control

This study investigated associations between psychological aspects and metabolic control among adults with type 1 diabetes ( n = 282). Linear regression analyses demonstrated that the illness perception personal control and the coping strategy seeking emotional social support explained 23.2 percent of the variance in hemoglobin A1c among females ( β = 0.40, p < 0.001 and β = −0.22, p < 0.01, respectively). Among males, only personal control remained significant, explaining 13.9 percent of the variance in hemoglobin A1c ( β = 0.37, p < 0.001). The associations between psychological correlates and hemoglobin A1c indicate that addressing such aspects clinically may facilitate metabolic control, thereby potentially contributing to reduce the risk of complications.

A triadic perspective on control perceptions in youth with type 1 diabetes and their parents: Associations with treatment adherence and glycemic control

AIMS

A family approach was applied to examine youth, maternal, and paternal control perceptions in relation to type 1 diabetes outcomes in adolescents and emerging adults. Mean levels of personal and treatment control were compared among patients and parents. Their associations with diabetes outcomes were examined as well.

METHODS

The sample included 330 patient-mother-father triads. Patients' (48% male) mean age was 18.25 years (SD = 2.98). All respondents reported on their control perceptions and youth treatment adherence. Physicians provided HbA1c-values.

RESULTS

Paired-samples t-tests revealed higher personal control in patients compared to parents. Regression analyses examined if control perceptions predicted treatment adherence and HbA1c. Main effects for patient and maternal personal control and two-way interactions showed the best outcomes when both patients and mothers reported high personal control. Main effects of patient, maternal, and paternal treatment control and three-way interaction terms revealed better outcomes in case of high treatment control in patients and at least one parent, while the poorest outcomes were observed in case of low treatment control in all respondents.

CONCLUSIONS

The findings highlight the importance of parental control perceptions on top of patients' own perceptions. A family perspective on illness perceptions and their associations with diabetes outcomes is encouraged.

Measuring illness perceptions in the family context: psychometric properties of the IPQ-R adapted for adolescent-caregiver dyads

OBJECTIVES

Given the lack of validated measures assessing illness perceptions in families, the aim of our study was the development and psychometric testing of an adapted version of the Illness Perceptions Questionnaire-Revised (IPQ-R) allowing for Common Sense Model-based dyadic assessment of adolescents' and caregivers' perceptions of a chronic illness in adolescence.

METHODS

Using a cross-sectional survey design, factor structure, reliability and validity of the adapted measure You-IPQ-R were tested in a sample of adolescents with asthma (N = 155) and their primary caregivers (N = 132). Analysis included a dyadic methodology (dyadic confirmatory factor analyses) and examination of the suitability of the measure for different age groups.

RESULTS

Both the adolescent and the caregiver versions of the You-IPQ-R revealed good overall validity and reliability. For all Common Sense Model dimensions except for timeline cyclical in the caregiver version, unidimensional scales aligning with the original IPQ-R structure could be confirmed. Age-specific analyses revealed good to excellent measurement properties in adolescents aged 14 years or older, but considerably poorer indices in younger adolescents.

CONCLUSION

The dyadically validated You-IPQ-R will enable researchers and clinicians to compare illness perceptions in adolescent-caregiver dyads and to assess the effects of family illness perceptions' congruence upon medical, psychosocial and behavioural outcomes.

A systematic review of non-genetic predictors and genetic factors of glycated haemoglobin in type 1 diabetes one year after diagnosis

Type 1 diabetes (T1D) results from autoimmune destruction of the pancreatic βcells. Although all T1D patients require daily administration of exogenous insulin, their insulin requirement to achieve good glycaemic control may vary significantly. Glycated haemoglobin (HbA1c) level represents a stable indicator of glycaemic control and is a reliable predictor of long-term complications of T1D. The purpose of this article is to systematically review the role of non-genetic predictors and genetic factors of HbA1c level in T1D patients after the first year of T1D, to exclude the honeymoon period. A total of 1974 articles published since January 2011 were identified and 78 were finally included in the analysis of non-genetic predictors. For genetic factors, a total of 277 articles were identified and 14 were included. The most significantly associated factors with HbA1c level are demographic (age, ethnicity, and socioeconomic status), personal (family characteristics, parental care, psychological traits...) and features related to T1D (duration of T1D, adherence to treatment …). Only a few studies have searched for genetic factors influencing HbA1c level, most of which focused on candidate genes using classical genetic statistical methods, with generally limited power and incomplete adjustment for confounding factors and multiple testing. Our review shows the complexity of explaining HbA1c level variations, which involves numerous correlated predictors. Overall, our review underlines the lack of studies investigating jointly genetic and non-genetic factors and their interactions to better understand factors influencing glycaemic control for T1D patients.

Illness perception of adolescents with well-controlled type 1 diabetes mellitus

In this study, to explore the illness perceptions of adolescents with well-controlled type 1 diabetes mellitus in South Africa, semi-structured interviews were conducted with nine, purposively selected adolescents (mean = 13.9 years; median = 12). Themes that emerged from the thematic analysis include the following: accepting diabetes and the diabetes care plan as part of their lives; viewing diabetes as manageable and as their responsibility; and the important role of gaining information on diabetes and diabetes management. These perceptions contributed to adherence to diabetes care plans and should be explored and developed among adolescents with type 1 diabetes mellitus to improve their diabetes management.

Differences in illness perception between children with cancer and other chronic diseases and their parents

BACKGROUND

The purpose of this study was to explore the differences in illness perception between children with cancer and other chronic diseases. A secondary aim was to examine the similarities and differences between the illness perception of these children and their parents.

METHODS

The Revised Illness Perception Questionnaire (IPQ-R) was used to measure the children's and parents' illness perceptions. In this study, 184 children (ages 8-18 years) and their caregivers completed the questionnaires.

RESULTS

This study shows that children with cancer feel that they have greater control over their treatment compared to the other two groups. The children's parents have more pessimistic views of the illness than their children.

CONCLUSION

Examinations of illness perceptions among paediatric cancer patients and their families are essential in designing psychosocial interventions for these families. The clinical value of our results can help better understand the cancer-specific features of illness perceptions.

Impact of quality of life (QoL) on glycemic control (HbA1c) among adolescents and emerging adults with long-duration type 1 diabetes: A prospective cohort-study

OBJECTIVE

To evaluate the impact of self-reported chronic-generic and condition-specific quality of life (QoL) on glycemic control among adolescents and emerging adults with long-duration type 1 diabetes (T1D) in a longitudinal design.

METHODS

The database used was a nationwide cohort study of patients with ≥10 years T1D duration at baseline in Germany. The baseline questionnaire survey was conducted in 2009-2010, the follow-up survey in 2012-2013; additional clinical data of routine care procedures were linked. QoL was assessed by the DISABKIDS chronic generic module (DCGM-12) and diabetes module (DM) with treatment and impact scales. Regression analyses were conducted for the outcome hemoglobin A1c (HbA1c) at follow up with baseline DISABKIDS scores as predictors and sociodemographic and health-related covariates.

RESULTS

At baseline, the included 560 patients had a mean age of 15.9 (SD 2.3) years, a diabetes duration of 13.0 (2.0) years, and an HbA1c of 67 (14.2) mmol/mol. Mean follow-up time was 3.0 (0.6) years. Univariate analyses indicated associations between baseline QoL scores and HbA1c at follow-up (β[DCGM-12] = -0.174 (SE 0.038), β[DM treatment] = -0.100 (0.022), β[DM impact] = -0.177 (0.030), p < .001). The associations remained significant after adjustment for sociodemographic and illness-related factors, but dissolved (p > .60) when additionally adjusting for baseline HbA1c. In patients with poor baseline HbA1c (>75 mmol/mol), significant associations were observed between DCGM-12 and DM impact scores and follow-up HbA1c (β[DCGM-12] = -0.144 (0.062), p = .021; β[DM impact] = -0.139 (0.048), p = .004).

CONCLUSIONS

QoL was inversely associated with HbA1c after 3 years in the course of T1D only in patients poorly controlled at baseline.

Disease Knowledge, Illness Perceptions, and Quality of Life in Adolescents With Sickle Cell Disease: Is There a Link?

Disease knowledge, illness perceptions, and quality of life (QOL) were examined in 150 adolescents (mean age = 16.1 years, SD = 1.9; 49.3% males) with sickle cell disease (SCD). Females had higher knowledge (P = .004), lower QOL (P = .02), and perceived their illness to be more unpredictable (P = .03). Those with more severe disease perceived their illness to be unpredictable with worse outcomes. Those with higher knowledge scores perceived their illness to be chronic, made more sense of their illness, and perceived greater personal and treatment control. Final hierarchical regression model showed that secondary education as compared to primary education level (P < .001) was positively correlated whereas disease severity (P < .001), perceived unpredictability (P = .024), and negative emotions (P < .001) were negatively correlated with QOL. Health practitioners should assess adolescents’ illness perceptions and encouraging continuing schooling and addressing emotional/psychological problems could improve their QOL.

Longitudinal Trajectories of Metabolic Control From Childhood to Young Adulthood in Type 1 Diabetes From a Large German/Austrian Registry: A Group-Based Modeling Approach

OBJECTIVE

Worsening of glycemic control in type 1 diabetes during puberty is a common observation. However, HbA_1c remains stable or even improves for some youths. The aim is to identify distinct patterns of glycemic control in type 1 diabetes from childhood to young adulthood.

RESEARCH DESIGN AND METHODS

A total of 6,433 patients with type 1 diabetes were selected from the prospective, multicenter diabetes patient registry Diabetes-Patienten-Verlaufsdokumentation (DPV) (follow-up from age 8 to 19 years, baseline diabetes duration ≥2 years, HbA_1c aggregated per year of life). We used latent class growth modeling as the trajectory approach to determine distinct subgroups following a similar trajectory for HbA_1c over time.

RESULTS

Five distinct longitudinal trajectories of HbA_1c were determined, comprising group 1 = 40%, group 2 = 27%, group 3 = 15%, group 4 = 13%, and group 5 = 5% of patients. Groups 1-3 indicated stable glycemic control at different HbA_1c levels. At baseline, similar HbA_1c was observed in group 1 and group 4, but HbA_1c deteriorated in group 4 from age 8 to 19 years. Similar patterns were present in group 3 and group 5. We observed differences in self-monitoring of blood glucose, insulin therapy, daily insulin dose, physical activity, BMI SD score, body-height SD score, and migration background across all HbA_1c trajectories (all P ≤ 0.001). No sex differences were present. Comparing groups with similar initial HbA_1c but different patterns, groups with higher HbA_1c increase were characterized by lower frequency of self-monitoring of blood glucose and physical activity and reduced height (all P < 0.01).

CONCLUSIONS

Using a trajectory approach, we determined five distinct longitudinal patterns of glycemic control from childhood to early adulthood. Diabetes self-care, treatment differences, and demographics were related to different HbA_1c courses.

Adolescents with Type 1 Diabetes--The Impact of Gender, Age, and Health-Related Functioning on Eating Disorder Psychopathology

Objective

To investigate correlates of eating disorder psychopathology in adolescent males and females with type 1 diabetes.

Method

A total of 105 adolescents with type 1 diabetes (42% males), aged 12–20 years, were recruited from the Norwegian Childhood Diabetes Registry in this population-based study. All participants were interviewed with the Child Eating Disorder Examination. Additionally, the Brief Illness Perception Questionnaire, the Adolescent Coping Orientation for Problem Experiences and the Beliefs about Medicines Questionnaire were administered to assess health-related functioning. Clinical data were obtained from the Norwegian Childhood Diabetes Registry.

Results

Significant gender differences were demonstrated in the pattern of correlates of eating disorder pathology. Among females, eating disorder psychopathology was significantly associated with body mass index adjusted for age and gender, age, insulin restriction, coping, illness perceptions, and perceptions of insulin concern. In a regression model, age, illness perceptions, and insulin restriction remained significantly associated with eating disorder psychopathology, explaining 48% of the variance. None of the variables were associated with eating disorder psychopathology among males.

Discussion

Greater clinical awareness of illness perceptions, attitudes toward insulin, and insulin restriction may potentially decrease the risk of developing eating disorders among female adolescents with type 1 diabetes, and the subsequent increased morbidity and mortality associated with comorbid type 1 diabetes and eating disorders.

Adolescent and parental perceptions about asthma and asthma management: a dyadic qualitative analysis

BACKGROUND

Considering that asthma management is a family affair - with specific challenges in adolescence - a better understanding of both adolescent and parental perspectives on asthma and its treatment are needed as these constructs may substantially account for variation in illness-related behaviour and functioning. The present study aimed to (1) explore adolescents' and caregivers' perceptions about asthma and asthma management and (2) examine congruence and dissimilarities within the adolescent-caregiver dyads.

METHODS

Data collection was conducted separately for adolescents and caregivers using a focus group approach for the adolescents and telephone interviews for parental data collection. In total, dyadic data from n = 15 adolescent patients with asthma (aged 11-17 years, M = 14.9) and their mothers (aged 37-55 years, M = 46.3) were considered in the study. The interviews were transcribed verbatim and analysed in a dyad-focused multistep qualitative content analysis procedure using the software.

RESULTS

The results demonstrated high complexity in the perceptions among adolescents and mothers and reflected 113 specific themes that could be assigned to four main topics: asthma beliefs, representations of asthma treatment, perceptions about individual asthma management and perceptions about family asthma management. Dyadic analyses revealed congruence in the adolescent-caregiver dyads in most of the themes. However, we also found issues where divergent perceptions became evident including, for example, perceptions of asthma's general impact on adolescents' life or the question of who takes the main responsibility in asthma management.

CONCLUSIONS

Adolescents' and caregivers' perceptions were found to reflect a great variety of beliefs regarding the adolescents' illness and illness-related behaviour on both the individual and the family level. The study adds to the illness perceptions literature by providing a systemic perspective that was rather rarely presented in prior research.