Paediatric parenting stress in fathers and mothers of young children with Type 1 diabetes: a longitudinal study

Cardiac rhythm devices in pediatric patients: Impact on family functioning and parent's health-related quality of life

This study compares the impact of children's cardiac rhythm devices and health status on their parents with that of healthy controls. Furthermore, it aims to ascertain whether sociodemographic characteristics and medical data are associated with parent-reported impacts. This cross-sectional study is part of a comprehensive single-center study of long-term psychosocial outcomes in pediatric patients with pacemakers and implantable cardioverter defibrillators. The study includes 69 patients with their parents: 69 mothers and 57 fathers. Parents responded to the Pediatric Quality of Life Inventory Family Impact Module and to open-ended questions assessing impact on family life and treatment satisfaction. Parents reported more negative impact on family life than healthy controls in all three summary scores. Among fathers, presence of a child's congenital heart disease and female sex is associated with lower family function. No group differences emerged regarding device type. Positive and negative cognitive aspects predominated for patients' mothers and fathers. However, one substantial difference is that mothers reported more positive and negative emotional impact than fathers. We conclude that parents' well-being should be addressed in clinical contexts, especially through emotional and practical support and open communication focused on parents' worries and concerns.

The Turkish version of the problem areas in diabetes-parents of teens (P-PAID-T): Cross-cultural adaptation, reliability, and validity

OBJECTIVE

To examine the Turkish validity and reliability of the Problem Areas in Diabetes- Parents of Teens (P-PAID-T) scale and its psychometric properties for determining the parents' diabetes-related distress.

METHODS

The study included the parents of 200 adolescents with T1DM for at least a year. P-PAID-T and a demographic data form were used for data collection. Davis technique was used for the content validity of the scale. The scale's reliability was tested using test-retest, and its internal reliability was analyzed with Cronbach's alpha test. Exploratory Factor Analysis (EFA) was used to analyze the factor structure. Confirmatory Factor Analysis (CFA) was used to evaluate the fit of the scale.

RESULTS

69.5% (n = 139) of the participants were mothers. Compared to the fathers, the mothers' mean P-PAID-T score was significantly higher. Parents of sons, who used insulin injections for their children, and had a college degree or higher education level had higher P-PAID-T scores. The test-retest correlation coefficient of the scale was 0.977. The Cronbach α value of the scale was 0.901. The results of confirmatory factor analysis were x2/df = 2.931, GFI = 0.736, CFI = 0.711, NFI = 0.628, NNFI = 0.660, RMSEA = 0.141.

CONCLUSION

The Turkish version of P-PAID-T was a valid and reliable screening tool for measuring diabetes stress in parents of adolescents with T1DM.

PRACTICE IMPLICATIONS

Nurses could use the Turkish version of P-PAID-T to monitor parental diabetes distress and organize interventions; also Turkish P-PAID-T could facilitate research on diabetes distress for parents of adolescents with T1DM.

Illness-related parental stress and quality of life in children with kidney diseases

BACKGROUND

This cross-sectional study investigated quality of life (QoL) and illness-related parental stress in children with kidney diseases by (1) comparing mean levels of these two variables between several kidney disease categories; (2) exploring correlations between QoL and parental stress; and (3) describing which disease category reports lowest QoL and highest parental stress.

METHODS

We included 295 patients with a kidney disease (0-18 years) and their parents, followed at 6 reference centers for pediatric nephrology. Children's QoL was assessed by the PedsQL™ 4.0 Generic Core Scales, and illness-related stress by the Pediatric Inventory for Parents. All patients were divided into 5 kidney disease categories according to the multidisciplinary care program criteria prescribed by the Belgian authorities: (1) structural kidney diseases, (2) tubulopathies and metabolic diseases, (3) nephrotic syndrome, (4) acquired diseases with proteinuria and hypertension, and (5) kidney transplantation.

RESULTS

Child self-reports showed no differences in QoL between kidney disease categories, in contrast to parent proxy reports. Parents of transplant patients reported lower QoL in their child and more parental stress compared with the 4 non-transplant categories. QoL and parental stress were negatively correlated. Lowest QoL and highest parental stress scores were mainly found in transplant patients.

CONCLUSIONS

This study showed lower QoL and higher parental stress in pediatric transplant patients compared with non-transplants, based on parent reports. Higher parental stress is associated with worse QoL in the child. These results highlight the importance of multidisciplinary care for children with kidney diseases, with special attention to transplant patients and their parents. A higher resolution version of the Graphical abstract is available as Supplementary information.

The burdens faced by parents of preschoolers with type 1 diabetes mellitus: an integrative review

PURPOSE

This study examined the literature concerning the burdens of parents of preschool-aged children diagnosed with type 1 diabetes mellitus.

METHODS

We employed an integrative review methodology based on Whittemore and Knafl's framework. The literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across four electronic databases: PubMed, Web of Science, the Cumulative Index to Nursing Allied Health Literature (CINAHL), and PsycINFO. Ultimately, 18 articles were included in the review.

RESULTS

The review yielded four themes: (1) parental burdens, (2) factors related to the burdens, (3) coping strategies, and (4) implications for clinical practice. Parents experienced psychological, physical, and social burdens due to the diabetes care of their children. Several factors influenced burdens, including child-related characteristics such as age, severity of diabetes, and hospitalization experience, as well as parental factors like family income, race, and residential area. Parents initially felt burdened when their child was diagnosed with type 1 diabetes, but over time, they often adapted to the situation through support and sharing of responsibilities. Parents desired education and interventions reflecting the unique characteristics of preschoolers.

CONCLUSION

This integrative literature review revealed that parents experience numerous burdens when their child is diagnosed with diabetes. Future research should focus on developing interventions to address parents' psychological difficulties, including tracking parental psychological changes over time. Tailored nursing interventions should also be provided to parents of preschool-aged children, as opposed to the more generic nursing interventions traditionally applied across all age groups of children in clinical settings.

School Nurse-Parent Partnership in School Health Care for Children with Type 1 Diabetes: A Hybrid Method Concept Analysis

PURPOSE

To define school nurse-parent partnerships in school health care for children with type 1 diabetes (T1D) and determine its attributes using a hybrid model.

METHODS

This method involves a three-phase process: theoretical, fieldwork, and analytical. A literature review was conducted during the theoretical phase. A literature search of articles from January 1991 to February 2020 was conducted using relevant electronic databases. Eighty-three articles that met the inclusion criteria were completely read. Fieldwork data were collected through individual interviews from February to July 2019 in South Korea. In the fieldwork phase, interviews were conducted individually with 22 mothers of students with T1D and 20 school nurses recruited by purposeful sampling. Inductive content analysis was conducted. The findings from the theoretical phase were integrated with those from the fieldwork phase, and the final concept was derived.

RESULTS

School nurse-parent partnership in school health care for children with T1D has been defined as an interactive process of maintaining a balanced responsibility and providing tailored care to meet needs by establishing trusting relationships and communicating transparently and openly. This analysis yielded four attributes: trusting relationships, transparent and open communication, balanced responsibility, and providing tailored care to meet needs-this entails providing nursing actions by advocating for students and performing a negotiated role together or individually for student and family.

CONCLUSION

The findings of this study add to the importance of an attribute of balancing responsibility for partnership in school health care. The results show that this partnership could contribute to the development of a scale, theory, and nursing intervention in school health care for children with T1D.

Factors Associated With Parenting Stress in Parents of Children With Nephrotic Syndrome: A Cross-Sectional Study

Limited empirical studies were identified to quantify parenting stress in parents of children with nephrotic syndrome (NS). This cross-sectional study aimed to address this gap by examining the prevalence and factors associated with parenting stress. Two hundred two Chinese parents of children with NS were investigated by using the Parenting Stress Index-Short Form (PSI-SF), the Parenting Sense of Competence Scale (PSCS), the Social Support Rating Scale (SSRS), and a demographic questionnaire. The results showed that parents of children with NS experienced higher parenting stress, and 67.8% of participants reported clinical levels of parenting stress. Fathers, parents with a primary education background, low social support and parenting sense of competence, and children with a prolonged treatment childhood NS reported higher parenting stress. Developing corresponding improvement interventions targeting parenting sense of competence, or providing extra disease-related support and education for parents might lessen parenting stress.

Parenting Stress over the First Year of Inflammatory Bowel Disease Diagnosis

OBJECTIVE

A diagnosis of inflammatory bowel disease (IBD) in children can disrupt the family, including altered routines and increased medical responsibilities. This may increase parenting stress; however, little is known about parenting stress changes over the first year following an IBD diagnosis, including what demographic, disease, or psychosocial factors may be associated with parenting stress over time.

METHODS

Fifty-three caregivers of children newly diagnosed with IBD (Mage = 14.17 years; Mdays since diagnosis = 26.15) completed parenting stress (Pediatric Inventory for Parents), child anxiety (Screen for Child Anxiety-Related Disorders), and child health-related quality of life (HRQOL; IMPACT) measures within 1 month of diagnosis and 6-month and 1-year follow-ups. Multilevel longitudinal models assessed change and predictors of parenting stress.

RESULTS

Parenting stress was significantly associated with greater child anxiety and lower HRQOL at diagnosis (rs = 0.27 to -0.53). Caregivers of color and caregivers of female youth reported higher parenting stress at diagnosis (ts = 2.02-3.01). Significant variability and declines in parenting stress were observed across time (ts = -2.28 and -3.50). In final models, caregiver race/ethnicity and child HRQOL were significantly related to parenting stress over the first year of diagnosis (ts = -2.98 and -5.97).

CONCLUSION

Caregivers' parenting stress decreases across 1 year of diagnosis. However, caregivers of color and those rating their child's HRQOL as lower may be at risk for greater parenting stress. More research is needed to understand why caregivers of color reported greater parenting stress compared to White caregivers. Results highlight the importance of providing whole-family care when a child is diagnosed with IBD.

Young Children with Type 1 Diabetes: Recent Advances in Behavioral Research

PURPOSE OF REVIEW

This review provides a recent update of behavioral research pertinent to young children with T1D and addresses current priorities and future directions.

RECENT FINDINGS

Rates of type 1 diabetes (T1D) in young children (ages 1-7) are continuing to rise. Since 2014, changes to diabetes care and management have impacted young children and reinforced the need for increased attention and interventions to support diabetes management, especially in caregivers who are primarily responsible for their young child's diabetes management. T1D is associated with unique physiologic challenges in young children, with constant management demands elevating parental diabetes-related stress and fear of hypoglycemia. Diabetes technology use has significantly increased in young children, contributing to improvements in glycemic levels and parent and child psychosocial functioning. Yet despite the positive outcomes demonstrated in select clinical behavioral interventions, research with this young child age group remains limited in scope and quantity.

Online social support and collective empowerment: Serial mediation effect on self-efficacy among mothers of children with type 1 diabetes

AIM

To identify a serial multiple mediation effect of social support in online health communities and collective empowerment on the relationship between diabetes-related burden (DRB) and self-efficacy, among mothers using a continuous glucose monitoring device for children with type 1 diabetes (T1D).

DESIGN

A secondary analysis, cross-sectional, descriptive study.

METHODS

Data were obtained from 198 mothers of children with T1D via a web survey, from August to September 2020. Measures used were the Collective Empowerment in the Online Health Community Scale, a modified version of the Multidimensional Scale of Perceived Social Support, Problem Areas in Diabetes Survey-Parent Revised version and a modified version of the Maternal Self-efficacy for Diabetes Management Scale. Data were analysed using SPSS 25.0, and PROCESS MACRO for SPSS v3.5.

RESULTS

A serial multiple mediation model was used. The indirect effects of both social support in online health communities and collective empowerment were identified in the relationship between DRB and diabetes self-efficacy (DSE). However, there was no indirect effect of social support in online health communities on these relationships.

CONCLUSION

These findings suggest that online social support alone has a limited role in chronic disease management self-efficacy. Collective empowerment should be a strategic component in intervention development using online health communities to strengthen DSE in mothers of children with T1D.

IMPACT

This study provides novel insights into the functional mechanism of online health communities for T1D. Peer mentor coaching by parents of children with T1D effectively helps other children's parents with its recent diagnosis. The findings recognize a need for strategies enhancing collective empowerment among parents of children with T1D. Along with peer coaching, these strategies should strengthen knowledge of resources and methods to impact social change as well as resource mobilization for collective actions.

Long-term Occupational Consequences for Families of Children With Type 1 Diabetes: The Mothers Take the Burden

OBJECTIVE

To investigate the occupational and financial consequences for parents following the onset of type 1 diabetes in their child.

RESEARCH DESIGN AND METHODS

A questionnaire assessing occupational and financial situations before and in the first year after the onset of diabetes was distributed to all families with a child ≤14 years of age at diagnosis with a diabetes duration of at least 12 months in nine German pediatric diabetes centers.

RESULTS

Data of 1,144 children (mean age at diagnosis 6.7 [3.6] years; 46.5% female) and their families were obtained. Mothers' occupational status reflected in paid working hours was significantly reduced in the first year after their child's diabetes diagnosis (P < 0.001). Overall, 15.1% of mothers stopped working, and 11.5% reduced working hours. Mothers of preschool children were particularly affected. Fathers' working status hardly changed (P = 0.75). Nearly half of the families (46.4%) reported moderate to severe financial losses. Compared with an earlier similar study in 2003, significant negative occupational consequences for mothers and financial burden on families remained unchanged in 2018 (P = 0.59 and 0.31, respectively).

CONCLUSIONS

Mothers of young children with newly diagnosed diabetes experienced negative consequences in their occupational situation. This inequality for mothers can have long-term negative consequences for their mental health and future economic situation. There is an urgent need for action to reduce the burden on families and to provide professional, social, and regulatory support, especially for mothers of young children with diabetes.

IMPACT study: measuring the impact of caregiving on families and healthcare professionals of children and adults living with mucopolysaccharidoses in Ireland

Introduction

Disease trajectories are often uncertain among individuals living with mucopolysaccharidoses (MPS) due to the progressive nature of the illness and the goal of care. This study investigated the impact on caregivers and care providers of children and adults living with MPS.

Methods

The study used a cross-sectional design and a convenience sampling strategy which involved two sequential study components. The stage 1 quantitative component included three validated scales: the abbreviated World Health Organization Quality of Life (WHOQOL-BREF), the Paediatric Inventory for Parents (PIP) and the 14-item Resilience Scale (RS-14). The stage 2 qualitative component consisted of two focus groups with healthcare professionals (HCPs) (n = 9) working with children and adults living with MPS across three clinical sites in Ireland. Data were collected between November 2017 and July 2019.

Results

A total of 31 parents identified as caregivers participated in this study. The mean quality of life (QoL) score was 93.81, indicating a significantly high QoL. The PIP frequency total mean was 102.74 and difficulty mean 104.94. The mean score for the RS-14 was notably high, 81.42 out of a maximum of 98. The majority of the results showed high levels of concern for the future, with just under 50% finding themselves very often feeling scared that their child's condition will deteriorate or that their child will die and finding these thoughts very difficult. The healthcare professionals' (HCPs) perceptions were focused on the complexity of MPS, coping strategies, managing expectations and support services.

Conclusion

The overall findings of the study reinforced the need for sustained and enhanced psychological support to ensure both families of children and adults living with MPS and the HCPs are supported in the continued delivery of quality patient care and outcomes. Subjective and objective measures from family caregivers and HCPs yield results that can decrease stress and improve psychological support.

Plain language summary

Impact of caregiving on families and healthcare professionals of children and adults living with mucopolysaccharidoses in Ireland Mucopolysaccharidoses (MPS) is a group of one of the many rare inherited metabolic disorders that come under category three of life-limiting conditions. Children born with this genetic condition show no change at birth, but effects start to show in subsequent years as it is a progressive disease. The severity of the condition varies according to the specific type, ranging from very mild symptoms to, in most cases, multisystemic, restricted growth or mental and physical disabilities. Recent developments in treatments for some forms of MPS have dramatically changed the quality of life (QoL) for patients. Other forms of treatment are currently under investigation and development. This study aimed to provide a detailed and reliable evidence base on the impact of caregiving for patients living with MPS on family caregivers and healthcare providers. Paper questionnaires were completed by the family caregivers of children and adults living with MPS. These three questionnaires focused on measuring QoL, parental stress and anxiety, and resilience among these families. Two focus group interviews were carried out with healthcare professionals working with children and adults living with MPS across three clinical sites in Ireland.A total of 31 parents completed the questionnaires in this study, indicating a significantly high QoL and notably high resilience. The majority of the parental stress results were related to concern for the future, with just half of the families finding themselves very often scared that their child's condition will deteriorate or that their child will die and find these thoughts very difficult. The healthcare providers also spoke about the complexity of MPS, coping strategies, managing expectations and support services for the families of children and adults living with MPS. This study provided evidence for clinicians and policymakers to improve the availability of appropriate healthcare provisions for people living with MPS and their families.

An investigation on parenting stress of children with cystic fibrosis

Background

The management of chronic diseases, particularly in children, requires an integrated physical and psychological approach to both sick children and their family. This is the case of Cystic Fibrosis (CF), a complex genetic chronic disease, where, a comprehensive evaluation of the emotional impact and an effective multidimensional approach are indicated.

Aim

This study investigates on parenting stress in children and adolescents with CF and its determinants related to parents, children and the disease severity.

Methods

The study involved 34.04% adult males and 65.96% adult females (range 21-55 years) and 47 children with CF, 54.35% males and 45.65% females (range 1-17 years). The data were obtained through a Parenting Stress Index – Short Form (PSI-SF) questionnaire. According to the PSI-SF scoring system, three types of stress were detected: a typical stress pattern (normal), a high stress pattern (increased) and a defensive response, which may be considered as a high stress feature in children which requires monitoring and clinical evaluation.

Results

This study shows a significant presence of stress in females (60.23%), of subject married (84.62%), unemployed (69.23%) and with education level such as “middle School” (61.54%). Concerning children of parents with high stress, it resulted most frequent children with one sibling (53.85%). Finally, by univariate analysis, it resulted a significant positive correlation between parenting stress and disease degree of children. Instead by multivariate analysis, we found that the variables: Number of siblings and Birth order were a significant positive and negative predictor of parenting stress respectively.

Conclusion

An increased stress level was detected in less than one third of parents of subjects with CF. These data may be related to the psychological support which is part of the routine management of CF care team. However, as children’s features seem to act as a determinant of stress more than parental ones, the parental-child dysfunction should be the target for further integrated interventions.

An Intervention by a Patient-Designed Do-It-Yourself Mobile Device App Reduces HbA1c in Children and Adolescents with Type 1 Diabetes: A Randomized Double-Crossover Study

BACKGROUND

Prevention of type 1 diabetes mellitus (T1DM)-related complications is dependent on metabolic control. The recommended glycated hemoglobin (HbA1c) values <7.5% (58.5 mmol/mol) are met only by a minority of diabetic children and especially adolescents. The aim of this study was to evaluate the impact of an intervention comprising the use of Webdia, a patient-designed app for smartphones, on metabolic control of T1DM in children.

METHODS

Fifty-five patients with T1DM, 10-18 years of age, were included in this single-center, randomized double-crossover study. We tested an intervention consisting of using Webdia for 3 months with monthly feedback and adaptation of the treatment. Main outcome was modification of HbA1c. Secondary outcomes were the prevalence of hypoglycemia and quality of life (QoL).

RESULTS

Of the 55 included patients, 33 completed the study, 9 dropped out, and 13 were excluded due to insufficient use of the app. The app was well accepted by the users who completed the study (46.4% rated the program as good and 39.3% as excellent). The intervention led to a reduction of HbA1c by 0.33%, compared to the control group in which HbA1c rose by 0.21% (P = 0.048) in patients with HbA1c values >8.0% (63.9 mmol/mol) at inclusion, without increasing the prevalence of hypoglycemia (8.52 ± 9.45 hypoglycemic events during last 2 weeks of intervention vs. 7.62 ± 6.37 observation, P = 0.680). QoL scores were not modified.

CONCLUSIONS

The intervention resulted in a significant decrease in HbA1c, without increasing the prevalence of hypoglycemia in patients with initial HbA1c >8.0% (63.9 mmol/mol).

Avoidant coping moderates the relationship between paternal involvement in the child's type 1 diabetes (T1D) care and parenting stress

Fathers may experience greater parenting stress and anxiety when they are more involved in their child's type 1 diabetes (T1D) care. The present study evaluated whether seeking social support and avoidant coping strategies moderate the relationship between paternal involvement in the child's T1D care and parenting stress in an international sample. Two hundred forty-nine fathers of young children with T1D completed the Parenting Stress Index (PSI), Pediatric Inventory for Parents (PIP), Dads' Active Disease Support scale (DADS), COPE Inventory, Self-Care Inventory (SCI-R), and a demographic questionnaire online. Pearson's product moment correlations were computed, and multiple linear regression analysis was conducted with three separate models in which the PSI Child Domain, PIP Frequency, and PIP Difficulty scores represented different parenting stress outcomes. The interaction between use of denial coping and DADS Involvement was significantly correlated with general parenting stress (p < .05). There were no significant interactions between instrumental social support and DADS Involvement; however, use of instrumental social support coping was significantly correlated with difficulty of pediatric parenting stress (p < .05), DADS Involvement (p < .001), and SCI-R better adherence to the child diabetes treatment regimen (p < .001). Avoidant coping strategies are associated with more general parenting stress, especially when fathers are more involved in T1D management.

The Pediatric Inventory for Parents - Swedish Translation and Psychometric Testing

The Pediatric Inventory for Parents (PIP) measures parental stress related to caring for a child with an illness. However, no Swedish translation is available.

PURPOSE

This study reports a Swedish translation of the PIP and psychometric properties of the instrument.

DESIGN AND METHODS

This is a descriptive/methodological paper. The PIP was translated and culturally adapted to Swedish, and comprehensibility was tested. Data were collected twice from 48 parents of children with different illnesses, and initial psychometric properties of the instrument were examined. The IES-R (Impact of Event Scale-Revised) was used for concurrent validity.

RESULTS

The Swedish version of the PIP demonstrated good correlations with the IES-R, and temporal changes were similar. Endorsement frequencies and test-retest were also satisfactory. When comparing groups of parents, the parents of children with cancer were statistically significantly more distressed, both on total score and for emotional distress and role function. Discriminative validity was demonstrated by comparing parents of children with cancer with parents of children with other diseases.

CONCLUSIONS

The Swedish version of the PIP seems to be a valid and reliable instrument. However, as we used relatively small sample, for the future, we suggest further testing with larger samples.

PRACTICE IMPLICATIONS

Clinicians and researchers seeking to measure parental distress in chronic illness could use the Swedish version of the PIP.

Family adjustment to diabetes diagnosis in children: Can participation in a study on type 1 diabetes genetic risk be helpful?

BACKGROUND

Diagnosis of type 1 diabetes often causes a negative psychological impact on families. We examined whether parents and children enrolled in The Environmental Determinants of Diabetes in the Young (TEDDY) study differ in their psychological adjustment to diabetes diagnosis compared to children diagnosed with diabetes in the community.

METHODS

TEDDY follows 8676 children at genetic risk for type 1 diabetes from birth. Fifty-four TEDDY children diagnosed with diabetes and 54 age-matched community control children diagnosed with diabetes were enrolled. Participants were aged 3 to 10 years and study visits occurred at 3, 6, and 12 months postdiagnosis. Psychological measures included an adapted diabetes-specific State Anxiety Inventory, the Pediatric Quality of Life Inventory-Diabetes Module, and the Pediatric Inventory for Parents, which measures frequency and difficulty of parenting stress.

RESULTS

A generalized estimating equation analysis based on a difference score between TEDDY children and community controls found no significant differences between TEDDY parents and community controls on parent diabetes-specific anxiety (P = .30). However, TEDDY children exhibited better diabetes-specific quality of life (P = .03) and TEDDY parents reported lower frequency (P = .004) and difficulty (P = .008) of parenting stress compared to community controls.

CONCLUSIONS

Children diagnosed with at-risk for type 1 diabetes who have previously enrolled in research monitoring have improved diabetes quality of life and lower parenting stress postdiagnosis compared to children diagnosed in the community. Families in follow-up studies may be more prepared if their child is diagnosed with diabetes.