A normal lifestyle: parental stress and coping in childhood diabetes

Factors Related to Behavioral Functioning in Mothers of Children with Type 1 Diabetes: Application of Transactional Model of Stress and Coping

BACKGROUND

Having a child with diabetes creates a great deal of stress for mothers. The transactional model of stress and coping is one of the best conceptual frameworks for stressors.

OBJECTIVES

This study aimed to investigate factors related to health promoting behaviors based on transactional model in mothers of children with type 1 diabetes.

METHODS

This study was conducted on 180 mothers of children with type 1 diabetes. The data was collected using a multi-sectional questionnaire including demographic characteristics and questions about the model constructs. Data were analyzed by SPSS software (version 19) and using statistical tests.

RESULTS

The highest mean score was related to interpersonal relationships (13.8 ± 4.5) and the lowest was related to stress management (10.8 ± 4.2). Linear regression model showed that mother's education, information seeking, and social support had a positive effect, and primary appraisal and emotion-focused coping had a negative effect on the mother's health promotion behaviors. In the regression model R-square accounts for 53.7% of the variance.

CONCLUSIONS

The transactional model was an appropriate framework for explaining the coping outcomes in mothers of children with type 1 diabetes. By mothers' attempts to improve attitude about diabetes and reduce their vulnerability, training to use coping strategies, increasing information and inter-sectoral interventions for attracting sufficient support from patients' families can be hopeful in improving mothers' behavioral Functioning.

Coping strategies in Iranian mothers of children with type 1 diabetes

Purpose

Having a child with type 1 diabetes as a stressor causes the use of coping strategies in mothers. The aim of this study was to investigate the coping strategies in mothers of children with type 1 diabetes and their relationship with stress management.

Methods

This study was conducted on mothers of children with type 1 diabetes (N = 180) in Tehran and Karaj (Iran). Data were collected by a multi-sectional questionnaire that its validity and reliability were confirmed. Data were analyzed by SPSS software (v 19) and using statistical tests.

Results

The highest mean score was related to problem-focused coping (22.11) and the lowest was related to emotion-focused coping strategies (12.2). Regression model showed that the variables of mother's age, problem- focused coping, and meaning-based coping had a positive effect, and variables of father's age and emotion-focused coping had a negative effect on stress management in mothers.

Conclusion

Mothers of children with type 1 diabetes can be more successful in their stress management through using problem-focused and meaning-based coping approaches. Hence, the need for continuous education of effective coping strategies to these mothers is felt.

Cost-effectiveness and cost-utility analyses of hospital-based home care compared to hospital-based care for children diagnosed with type 1 diabetes; a randomised controlled trial; results after two years' follow-up

Background

Practices regarding hospitalisation of children at diagnosis of type 1 diabetes vary both within countries and internationally, and high-quality evidence of best practice is scarce. The objective of this study was to close some of the gaps in evidence by comparing two alternative regimens for children diagnosed with type 1 diabetes: hospital-based care and hospital-based home care (HBHC), referring to specialist care in a home-based setting.

Methods

A randomised controlled trial, including 60 children aged 3–15 years, took place at a university hospital in Sweden. When the children were medically stable, they were randomised to either the traditional, hospital-based care or to HBHC.

Results

Two years after diagnosis there were no differences in HbA1c (p = 0.777), in episodes of severe hypoglycaemia (p = 0.167), or in insulin U/kg/24 h (p = 0.269). Over 24 months, there were no statistically significant differences between groups in how parents’ reported the impact of paediatric chronic health condition on family (p = 0.138) or in parents’ self-reported health-related quality of life (p = 0.067). However, there was a statistically significant difference regarding healthcare satisfaction, favouring HBHC (p = 0.002). In total, healthcare costs (direct costs) were significantly lower in the HBHC group but no statistically significant difference between the two groups in estimated lost production (indirect costs) for the family as a whole. Whereas mothers had a significantly lower value of lost production, when their children were treated within the HBHC regime, fathers had a higher, but not a significantly higher value. The results indicate that HBHC might be a cost-effective strategy in a healthcare sector perspective. When using the wider societal perspective, no difference in cost effectiveness or cost utility was found.

Conclusions

Overall, there are only a few, well-designed and controlled studies that compare hospital care to different models of home care. The results of this study provide empirical support for the safety and feasibility of HBHC when a child is diagnosed with type 1 diabetes. Our results further indicate that the model of care may have an impact on families’ daily living, not only during the initial period of care but for a longer period of time.

Trial registration

ClinicalTrials.gov with identity number NCT00804232, December 2008.

Mediating factors of coping process in parents of children with type 1 diabetes

Background

Type 1 diabetes is a lifelong condition for children and their parents, the management for which imposes a vast responsibility. This study explores the mediating factors that affect Iranian parents’ coping processes with their children’s type 1 diabetes.

Methods

Research was conducted using the grounded theory method. Participants were selected purposefully, and we continued with theoretical sampling. Constant comparative analysis was used to analyze the data.

Results

The mediating factors of the parental coping process with their child’s diabetes consist of the child’s cooperation, crises and experiences, economic challenges, and parental participation in care.

Conclusion

Findings highlight the necessity of well-informed nurses with insightful understanding of the mediating factors in parental coping with juvenile diabetes in order to meet the particular needs of this group.

Explicating caregiving by mothers of children with complex needs in ireland: a phenomenological study

This qualitative phenomenological study explored mothers' experiences of caring for a child with complex needs. After ethical approval was obtained, data were collected through 11 diaries and 48 interviews with 17 mothers in Ireland. Caring for a child with complex needs involves the delivery of care in an inside world of the home, the world outside the home, and a "going-between" world. Caregiving, 1 of 8 closely linked dimensions, is presented, including its 4 categories. These are normal mothering, technical caregiving, preemptive caregiving, and individualized caregiving. Professionals require a greater understanding of the experiences of mothers caring for children with complex needs at home.

Middle-aged women and everyday life: implications for health

The aim of this study was to describe middle-aged women's perceptions of lifestyle and how it was experienced in their daily lives. Interviews with 15 women selected using network sampling were analysed using a phenomenographic approach. Lifestyle was perceived as either 'handle life', describing a framework of how everyday life should manifest itself in different areas of life, or 'relate to life' implying accepting life as it is and making the best of it based on previous experiences. In terms of providing preventive and health-promoting guiding, it is essential that nurses have an insight into people's reasoning to support them to improve health or deal with illness.

Perceptions of parenting children with type 1 diabetes diagnosed in early childhood

INTRODUCTION

The purpose of this study was to explore perceptions of psychosocial adaptations in parenting young children with type 1 diabetes (T1DM) from diagnosis through childhood.

METHOD

Fourteen parents of 11 children with T1DM who were diagnosed at age five years or younger participated in semi-structured interviews. Data were analyzed using content analysis.

RESULTS

Three significant themes were identified. In the theme "Diagnostic Experiences: Frustrations, Fears, and Doubts," parents described inadequate diagnostic experiences with pediatricians where concerns were minimized and diagnosis was sometimes delayed. Although hospitalization occurred abruptly, communication with specialists was more satisfactory. In the theme "Adapting to Diabetes," parents described isolation in caring for their child's T1DM. Family and friends had minimal understanding of T1DM care. Support groups lessened mothers' isolation, but fathers were less positive about this experience. Parental adaptation was more effective when responsibility for diabetes decision making was shared. All parents reported never mastering diabetes management. The theme "Negotiating Developmental Transitions" revealed that normative childhood events were stressful, requiring that parents balance concerns to foster their child's participation.

CONCLUSIONS

Pediatric providers can improve diagnostic and treatment experiences for parents of children with T1DM by recognizing feelings of isolation and lack of mastery, providing attentive communication, encouraging parental teamwork, and offering ongoing anticipatory guidance.

Families' lived experience one year after a child was diagnosed with type 1 diabetes

AIM

This paper is a report of a study to elucidate families' lived experience of diabetes one year after a child was diagnosed with type 1 diabetes.

BACKGROUND

The incidence of type 1 diabetes is rapidly increasing worldwide, with a shift towards younger age groups. This illness is treated by means of an intensive management regimen that often disrupts the child's usual activities and requires disease-focused behaviours from the child and his or her family. However, research elucidating families' lived experience from the perspective of all its members is sparse.

METHOD

A hermeneutic phenomenological study was carried out in 2004, based on interviews one year after diagnosis with 11 consecutively chosen Swedish-speaking family members with children aged between 9 and 14 years.

FINDINGS

The families described their one year of lived experience as living an ordinary yet different life. They experienced their lives to be neither particularly difficult nor as easy as they had been before the child was diagnosed with diabetes. Related themes were 'feeling acceptance yet frustration', 'being healthy yet invisibly ill', 'feeling independent yet supervised' and 'feeling confident yet insecure'.

CONCLUSION

It may be helpful if healthcare professionals make use of the knowledge and experience of families living with the illness to meet their specific needs, especially when the affected child is experiencing fluctuating blood sugar levels. Thus, health-promoting collaboration should be tailor-made for every individual and proceed from each family's everyday life.

Predictors of treatment adherence in young children with type 1 diabetes

AIM

This paper reports a study to investigate whether diabetes-specific, demographic and psychosocial variables predict adherence in young children with type 1 diabetes.

BACKGROUND

Paediatric diabetes rates are increasing worldwide; however, young children are neglected in treatment adherence research, despite the importance of adherence for health. Greater understanding of adherence in this group could enhance nurses' ability to provide care tailored to families' needs.

METHOD

A cross-sectional study was carried out between 2001 and 2003 with 65 children aged 2-8 years and their mothers in Britain. Mothers were interviewed about children's diabetes care, nutritional analyses were conducted and mothers completed assessments of diabetes knowledge, parenting stress, family functioning and child psychological adjustment. Demographic and medical information was collected from patient records.

FINDINGS

Consistent with older populations, blood glucose monitoring and dietary regimens showed greater adherence variability than injection frequency and injection time consistency. Better maternal diabetes knowledge correlated with less injection time variability, more frequent blood glucose monitoring, lower percentage energy intake from extrinsic sugars, lower glycosylated haemoglobin levels and fewer relationship difficulties. Longer diabetes duration, greater injection time variability and higher percentage energy intake from extrinsic sugars predicted less frequent blood glucose monitoring. More relationship difficulties and less frequent blood glucose monitoring predicted higher percentage energy intake from extrinsic sugars.

CONCLUSIONS

Nurses can facilitate treatment adherence through provision of educational, practical and socio-emotional support. Nursing interventions should target blood glucose monitoring and dietary regimens in particular, and nurses should be sensitive to the various caretaking challenges presented to parents by different components of the diabetes regimen.

"Living with risk": mothering a child with food-induced anaphylaxis

Food-induced anaphylaxis (FIA) affects an increasing number of children and families encountered in a variety of nursing environments. Sensitive nursing care requires consideration of the psychosocial impact of the condition. The purpose of this phenomenological study was to arrive at an understanding of the mother's lived experience of parenting a child with FIA. Semistructured interviews were conducted with six mothers of children 6 to 12 years old considered at risk for FIA. Data analysis was carried out concurrently with data collection, revealing "Living with Risk" as the essence of the experience, supported by five themes: "Living with Fear," "Worrying About Well-Being," "Looking for Control," "Relying on Resources," and "It Is Hard But It Is Not." These findings should assist nurses in meeting families' education and support needs related to FIA.

Swedish families' lived experience when a child is first diagnosed as having insulin-dependent diabetes mellitus: An ongoing learning process

Sweden has the second highest nationwide incidence of childhood diabetes in Europe, and it is rapidly increasing. The diagnosis of Type 1 insulin-dependent diabetes mellitus has been indicated as a crisis in the life of the individual and family. The purpose of this study was to elucidate the whole family's lived experience when a child in the family is diagnosed as having diabetes. It was designed as a longitudinal, descriptive, inductive study including qualitative interviews. Family members in 12 families were recruited from a children's university hospital in Sweden to participate in a series of three interviews: when first diagnosed, and 1 and 3 years after diagnosis. This article derives from the first interview. All invited families agreed to participate and were interviewed 1 to 3 months after diagnosis using a hermeneutic phenomenological approach. The family's lived experience was identified as an ongoing learning process including learning about the inevitable and learning about the extent. The learning process was experienced as a recurrent phenomenon when the family was exposed to new situations or contexts. Therefore, individualized treatment may reduce the difficulties experienced in coping with the diabetic management regimen after discharge, thus making the transition smoother.

Participants' experiences of being interviewed about an emotive topic

AIM

The aim of this paper was to report the experience of in-depth interviewing about emotive topics from the perspectives of participants.

BACKGROUND

We both undertook qualitative, longitudinal studies investigating emotive topics using repeated in-depth interviews as the data collection method. Recruitment and some of the interviews took place at a potentially distressing time for participants, which raised concerns for us about issues relating to consent and the impact of the interviews on participants' emotional well-being.

METHOD

At the end of the two studies, 55 participants were asked about their experiences of the recruitment and interview processes. The tape-recorded responses were transcribed verbatim. We both independently analysed the data before agreeing on the final thematic framework arising from participants' accounts. The data were collected in 1998 and 1999 (Study 1) and 2003 and 2005 (Study 2).

FINDINGS

Some participants had initial reservations about participating in the studies. The primary reason for consenting was altruism, i.e. a belief that their participation might somehow help other families. Many participants often found it difficult to discuss emotive issues, particularly soon after the actual event, but all found it helpful to be given the opportunity to talk about their experiences to someone interested in what they had to say. None of the participants had concerns about, or regretted, being interviewed.

CONCLUSION

Participants can find in-depth interviewing about emotive topics a helpful, even 'therapeutic', experience. However, the purpose of the research interview is not to intentionally offer any form of therapy and researchers need to recognize and carefully consider this potential outcome at an early stage of the research process. Researchers studying emotive topics should also be aware of the possible impact of participants' experiences on their own emotional well-being.

Newly diagnosed childhood diabetes: a psychosocial transition for parents?

AIM

This paper reports a study to gain a new theoretical understanding of parental grief responses and the process of adaptation to a diagnosis of childhood diabetes.

BACKGROUND

A diagnosis of childhood (type 1) diabetes is an anxious and distressing event for the whole family. Little is known about the experience of parents of newly diagnosed children as they cope with and adapt to their new situation. Parkes' Theory of Psychosocial Transition proposes that life-change events, or 'psychosocial transitions', require people to undertake a major revision of their assumptions about the world. The relevance of this theory to adjusting to a diagnosis of childhood diabetes has not been explored.

METHOD

Forty audio taped in-depth interviews were undertaken with 38 parents of 20 newly-diagnosed children. The data were subsequently examined using the framework of the Theory of Psychosocial Transition.

FINDINGS

Before diagnosis, most parents associated their child's symptoms with normal childhood illnesses. The unexpectedness and speed of the diagnosis left all parents ill-prepared to deal with the situation. Their world suddenly changed, leaving them insecure and uncertain about the future. Diabetes intruded emotionally and practically upon all of their lives. Parents successfully adjusted and adapted their lives and rebuilt a new model of the world to accommodate their child's diabetes. However, this dynamic process has no guaranteed endpoint for parents.

CONCLUSIONS

A diagnosis of childhood diabetes leads to a psychosocial transition for parents. The concept of transition provides a logical explanation of parents' responses to loss, and allows increased understanding of the grieving and adaptation processes experienced by parents of children diagnosed with a chronic condition such as diabetes. This knowledge should help health care professionals to assist parents in the period of transition.

Childhood diabetes: parents' experience of home management and the first year following diagnosis

AIMS

To explore parents' experience of having a child diagnosed with Type 1 diabetes, managed at home, and their first year following diagnosis.

METHODS

A qualitative, longitudinal study based on 40 in-depth interviews with parents of 20 children with newly diagnosed Type 1 diabetes managed at home from diagnosis in South Wales.

RESULTS

Many parents were alarmed by the speed of diagnosis following the gradual progress of their child's symptoms. The provision of timely, adequate information was important to all parents. Although five parents had initial concerns about going home, all parents were subsequently pleased their children had not been hospitalized. Home management enabled parents to integrate diabetes management into the family's normal lifestyle from diagnosis. Professional support, particularly accessible telephone advice, was valued by and reassured parents. Parents experienced a loss of spontaneity, a continuing fear of hypoglycaemia and did not want their child to feel different to other children. Acutely aware of the seriousness of diabetes, they did their utmost to achieve optimal glycaemic control but felt that diabetes could not 'dominate' if they were to lead a 'normal' life.

CONCLUSIONS

The experience of parents in this study suggests that parents of children with newly diagnosed diabetes are able to cope successfully when given the opportunity to start treatment at home. Therefore, if children with diabetes are clinically well at diagnosis, this study supports home management as a system of care from the parents' point of view. These findings are relevant to clinicians, policy makers and health service managers involved in planning and providing paediatric diabetes care.

Parents', nurses', and educators' perceptions of risks and benefits of school attendance by children who are medically fragile/technology-dependent

Few studies have focused on school activities of children who are medically fragile/technology-dependent. This article reports on an exploratory, interpretive study that examined the perceptions of parents, nurses, and educators with regard to their school concerns and strategies for ensuring the safety and health of these students. Informants all believed that attending school provided benefits to most children who are medically fragile/technology-dependent, including opportunities for skill acquisition, socialization, and respite care for families. However, they also perceived that there were real risks involved, including obtaining appropriate care, exposure to infection, and social isolation or teasing.

Long-term goals and normalization strategies of children and families affected by HIV/AIDS

Decreasing morbidity and mortality of HIV/AIDS has created a growing population of parents and children who are long-term survivors. Using symbolic interaction and ethnographic methods, this study explores families' long-term goals and normalization strategies and the relevance of the published attributes of the concept of normalization for families affected by HIV disease. Findings indicate that treatment complexity and the need for stigma management prevent families from defining their lives as normal, but they do deliberately use normalization strategies to achieve the following goals: health maintenance for members with HIV, facilitation of children's school participation, and enhancement of the emotional well-being of all family members.

Chronic sorrow in parents of children with newly diagnosed diabetes: a review of the literature and discussion of the implications for nursing practice

Childhood (type 1) diabetes is a chronic, life-long condition, the diagnosis of which may represent multiple losses for parents. Their emotional responses to the diagnosis have been likened to the grief reactions experienced as a result of bereavement through death. The practice of health professionals who work with these families is informed by two contrasting theoretical views of the progress of grief reactions; the time bound and the chronic sorrow perspectives. This paper provides a critical appraisal of the evidence concerning grief reactions in parents of children with diabetes and evaluates the extent to which this supports the expectations of the time bound theorists, that parents normally reach an end stage of the grieving process, or those of the proponents of chronic sorrow, who anticipate lifelong, recurring sadness. It concludes with a discussion of the implications of the debate for nursing practice.

Your child has diabetes: hospital or home at diagnosis?

Historically, children with diabetes have been hospitalized at diagnosis, but increasingly, newly diagnosed children are being cared for entirely at home. The management of this chronic condition usually involves the whole family, with children often taking responsibility for much of their own care. However, this article focuses specifically on the needs of parents, forming part of an extensive literature review informing a study exploring parents' experience of home management and coping over the first year with childhood diabetes. A search of the literature revealed a scarcity of evidence overall about hospitalization or home management from a parental perspective, and none in relation to childhood diabetes. This article provides a critical appraisal of the appropriateness of these two approaches to care for parents of children with newly diagnosed diabetes. First, a brief introduction to home management in childhood diabetes is followed by an examination of the small amount of research found about home management and hospitalization from the point of view of parents. Then, the possible benefits and disadvantages of both approaches are discussed and subsequently scrutinized in the context of childhood diabetes. Finally, preliminary conclusions are drawn and suggestions made for the direction of future research in this area.