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Karni-Visel Y, Dekel R, Sadeh Y, Sherman L, Katz U. "You Have to Find a Way for This Child to Be at the Center": Pediatric Cardiologists' Views on Triadic Communication in Consultations on Congenital Heart Defects. Health Commun 2024:1-12. [PMID: 38557305 DOI: 10.1080/10410236.2024.2329422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Congenital heart defects (CHDs) are present at birth and require ongoing management of personal, family, and medical aspects of care, including communication between family and medical staff. Effective communication is considered one of the main objectives of patient-centered care. Communication in pediatric medicine is especially challenging because it includes children and their parent(s), and children's cognitive and communication skills are still developing. Based on the model of behavior in pediatric communication , this study focused on pediatric cardiologists' views of the roles of children, parents, and physicians in the triadic encounter and their experiences in communicating information on pediatric CHDs in medical encounters. Semi-structured interviews were conducted with 17 experienced pediatric cardiologists and cardiac surgeons (five women and 12 men) at three medical centers in Israel. The grounded theory approach was used to identify three main categories: (1) the positioning (centrality) of the child in the setting (ideal vs. actual situation), (2) addressing parents' emotional needs, and (3) the physician's role as mediator between parent(s) and child. In each category, three elements are discussed: The physician's agenda, obstacles and challenges, and the physician's practical methods. Physicians strongly support children's involvement in triadic encounters yet face challenges in effectively integrating them into the information exchange process during cardiology consultations. Struggling to balance the principles of patient- and family-centered care, and without clear guidelines, they rely on their personal beliefs and experiences to formulate communication strategies that address parents' and children's needs.
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Affiliation(s)
- Yael Karni-Visel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University
| | - Yaara Sadeh
- School of Social Work, University of Haifa
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
| | - Liat Sherman
- Pediatric Heart Institute, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
| | - Uriel Katz
- Pediatric Heart Institute, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
- Sackler School of Medicine, Tel-Aviv University
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Abstract
Objective: The aim of the study was to identify factors for treatment non-persistence in patients with ADHD. Method: Data for 100 patients with ADHD aged 5 to 16 who completed the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version (K-SADS-PL-K) and Korean Wechsler Intelligence Scale for Children (K-WISC) were obtained between 2008 and 2013. Patients were classified as treatment-persistent and treatment-non-persistent based on 6-month follow-up. Sociodemographic data, comorbidities, intelligence quotient (IQ), severity, and social/school functioning were compared. Results: Adolescence and poor parental spousal relationships significantly predicted treatment non-persistence. Although comorbid major depressive disorder and absence of transient tic disorder were associated with treatment non-persistence, there was no difference in overall psychiatric comorbidity. No differences existed for IQ, Clinical Global Impressions-Severity (CGI-S) score, peer relationships, and academic achievement. Conclusion: Lower treatment persistence was associated with adolescence, comorbid depression, absence of tics, and poor parental spousal relationships, but not with symptom severity or impairment of the disorder.
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Affiliation(s)
- Jiung Park
- Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Bongseog Kim
- Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
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Abstract
This article describes the Diabetes Education/Support Group Program for people with diabetes and visual impairment. It analyzes some of the common problems that participants have reported, and discusses some methods of reducing anxiety and depression related to the two conditions.
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Affiliation(s)
- J. Caditz
- Diabetes Education/Support Group Program, Center for the Partially Sighted, 70 Wilshire Blvd., Suite 200, Santa Monica, CA 90401
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Keppeke LDF, Molina J, Miotto e Silva VB, Terreri MTDSELRA, Keppeke GD, Schoen TH, Len CA. Psychological characteristics of caregivers of pediatric patients with chronic rheumatic disease in relation to treatment adherence. Pediatr Rheumatol Online J 2018; 16:63. [PMID: 30314523 PMCID: PMC6186042 DOI: 10.1186/s12969-018-0280-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adherence to treatment for chronic diseases is lower in children than in adults, less extensively studied in children and is associated with multiple related factors. The aim of this study is to perform a descriptive analysis of psycho-cognitive aspects of primary caregivers of pediatric patients with chronic rheumatic diseases, as well as socioeconomic and clinical factors, family functioning and treatment satisfaction. METHODS Primary caregivers of 90 patients were included. Pairs (caregiver plus patient) were grouped as presenting good adherence (n = 50) or poor adherence (n = 40) according to the Morisky Adherence Test. Psycho-cognitive aspects were evaluated by Adult Self-Report and Wechsler Adult Intelligence Scale tests. For statistical comparisons, quantitative variables with normal distribution were analyzed by Student's t test, and those with non-Gaussian distribution with the Mann Whitney test. Categorical variables were analyzed by Chi square test. A multivariate logistic regression analysis was performed to estimate the contribution of the independent variables to adherence. RESULTS Compared to caregivers in the good adherence group, caregivers in the poor adherence group were more likely to be classified as clinical on the scales for attention problems and externalizing problems, which include impulsiveness and aggressiveness. They also scored higher on the depressive problem scale. In addition, the average number of children per caregiver and the mean age of caregivers and patients were significantly higher in the poor adherence group, while the proportion of caregivers with higher education was lower. The poor adherence group also included a higher incidence of pediatric patients assuming sole responsibility for managing medications. Economic status, clinical factors, treatment satisfaction, family functioning and caregiver cognitive profile were not related to adherence, except for working memory index. CONCLUSION Older patients, patients as the one solely responsible for medication management, and caregivers with externalizing problems, were observed to be the most strongly associated to poor adherence. Interventions aimed at adolescent patients are needed. Also, psychological programs and interventional studies to better determine caregivers' behavioral/emotional status, and parent-child relationships are recommended.
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Affiliation(s)
- Livia de Freitas Keppeke
- 0000 0001 0514 7202grid.411249.bPediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Borges Lagoa Street, 802, Vila Clementino, São Paulo, SP 04083-001 Brazil
| | - Juliana Molina
- 0000 0001 0514 7202grid.411249.bPediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Borges Lagoa Street, 802, Vila Clementino, São Paulo, SP 04083-001 Brazil
| | - Vanessa Bugni Miotto e Silva
- 0000 0001 0514 7202grid.411249.bPediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Borges Lagoa Street, 802, Vila Clementino, São Paulo, SP 04083-001 Brazil
| | - Maria Teresa de Sande e Lemos Ramos Ascensão Terreri
- 0000 0001 0514 7202grid.411249.bPediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Borges Lagoa Street, 802, Vila Clementino, São Paulo, SP 04083-001 Brazil
| | - Gerson Dierley Keppeke
- 0000 0001 0514 7202grid.411249.bRheumatology Division, Department of Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Pedro de Toledo Street, 720, Vila Clementino, São Paulo, SP 04039-002 Brazil
| | - Teresa Helena Schoen
- 0000 0001 0514 7202grid.411249.bAdolescent Medicine Unit, Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Botucatu Street, 715, Vila Clementino, São Paulo, SP 04023-062 Brazil
| | - Claudio Arnaldo Len
- Pediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Borges Lagoa Street, 802, Vila Clementino, São Paulo, SP, 04083-001, Brazil.
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Shaju M, Vinayan K, Abraham S. Knowledge, attitude and practice of parents regarding pediatric antiepileptic drug therapy. ACTA ACUST UNITED AC 2018; 01:057-63. [DOI: 10.1016/j.ijep.2014.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Objectives To evaluate the parental knowledge, attitude and practice (KAP) regarding the antiepileptic medication therapy in childhood.
Methods This study was carried out over a period of 10 months in the division of Pediatric Neurology of Amrita Institute of Medical Sciences. The cohort of patients was selected randomly meeting the inclusion and exclusion criteria. Parents' KAP regarding epilepsy and antiepileptic drug therapy was assessed using a questionnaire prepared by the authors and patient adherence towards antiepileptic drug therapy by using Pediatric Epilepsy Self-Management Questionnaire (PEMSQ).
Results A total of 123 patients were selected and enrolled in the study. Seventy eight percent of the respondents knew that epilepsy is a brain disorder, while only 6% of them were aware about all the treatment options. The scoring in the domain of “Disease and Treatment Knowledge & Expectations of parents” was found to be significantly low (69.07%) when compared to other domains in the PEMSQ. Although socioeconomic status did not correlate with knowledge score of the parents (p = 0.216), it was significantly related to adherence (p = 0.042).
Conclusion In this cohort, even though the parents had a fair knowledge about the nature of epilepsy, they were found to be less aware about its characteristics, causes and prognosis. The awareness about the nature and duration of treatment, its objectives, use of drugs, their side effects and importance of adherence to drug regimen was found to be significantly low with a potential for affecting the therapeutic outcome. Special awareness programs for parents of children with epilepsy may be needed to reduce the knowledge gaps in the management of epilepsy and to ensure compliance and optimal therapeutic outcomes.
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Abstract
PURPOSE This study investigated whether disclosure of diabetes and gender influenced perceptions of eating and self-care behaviors. METHODS A vignette was developed in which a hypothetical friend engaged in diabetes self-care behaviors during a meal. Respondents (231 young adults) read vignettes that varied according to a 2 x 2 design (male vs female, preventative disclosure vs nondisclosure of diabetes). Participants answered 12 questions, which resulted in 2 factors: concern for friend and encourage professional help. RESULTS Significantly higher scores resulted on the concern for friend and encourage professional help factors when diabetes was not disclosed. Female characters also received significantly higher scores on the concern for friend factor. CONCLUSIONS Individuals with diabetes who choose to disclose their illness may prevent negative or incorrect perceptions related to self-care and eating behaviors, and may have a decreased likelihood that a true eating disorder would be identified by others.
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Affiliation(s)
| | - Daniel A Sass
- The Department of Educational Psychology, University of Wisconsin-Milwaukee
| | - W Hobart Davies
- The Department of Psychology, University of Wisconsin-Milwaukee
- The Medical College of Wisconsin, University of Wisconsin-Milwaukee
| | - Anthony A Hains
- The Department of Educational Psychology, University of Wisconsin-Milwaukee
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Abstract
This article reviews the empirical research literature on behavioral assessment and intervention methods in the context of diabetes mellitus in children and adolescents. The review summarizes the pathophysiology, medical management, and monitoring of pediatric type 1 and type 2 diabetes. Next, the article describes common behavioral barriers to acceptable diabetes management and adequate metabolic control and the role of behavior change agents in evaluation and intervention for these problems. Validated approaches to the assessment of diabetes-specific behavioral problems are described for the measurement of treatment adherence, diabetes-related fears and avoidance behaviors, diabetes-specific social skills, and disease-related stressors. Behavioral interventions that have empirical support are discussed, including treatments that target treatment adherence, social skills, coping skills, family communication and problem solving, anxiety and stress management, and weight control. The article concludes with clinical practice recommendations for behavior change specialists who have the opportunity to work with this population.
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Grover S, Bhadada S, Kate N, Sarkar S, Bhansali A, Avasthi A, Sharma S, Goel R. Coping and caregiving experience of parents of children and adolescents with type-1 diabetes: An exploratory study. Perspect Clin Res 2016; 7:32-9. [PMID: 26955574 PMCID: PMC4763515 DOI: 10.4103/2229-3485.173776] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To assess the coping strategies and the relationship of coping with subjective burden and positive caregiving consequences as perceived by the caregivers of children and adolescents with Type-1 diabetes. Design: Cross-sectional assessment. Setting: Outpatient of Endocrinology Department. Participants: Forty-one parents of children and adolescents with Type-1 diabetes Main Outcome Measure: Ways of coping checklist (WCC), involvement evaluation questionnaire (IEQ) and scale for assessment of positive aspects of caregiving experience (scale for positive aspects of caregiving experience) to study the coping, burden and positive aspects of caregiving respectively. Results: On WCC, the highest score was obtained for seeking social support, followed by planful problem-solving. More frequent use of coping strategies of confrontation and escape-avoidance was associated with significantly higher score on the tension domain of IEQ. Those who more frequently used problem-solving and distancing had significantly higher scores on worrying-urging-I domain of IEQ. supervision domain of IEQ was associated with more frequent use of confrontation, self-control, social support, escape-avoidance and positive reappraisal. More frequent use of distancing and problem-solving were associated with lower caregiving personal gains. More frequent use of problem-solving was associated with higher caregiver satisfaction and lower scores in the domain of self-esteem and social aspects of caring. Conclusion: Caregivers of patients with Type-1 diabetes predominantly use adaptive coping strategies. Higher use of certain coping strategies is associated with negative and positive caregiving consequences.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Natasha Kate
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddharth Sarkar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashi Goel
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Harris MA, Freeman KA, Duke DC. Seeing Is Believing: Using Skype to Improve Diabetes Outcomes in Youth. Diabetes Care 2015; 38:1427-34. [PMID: 26033508 DOI: 10.2337/dc14-2469] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/03/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to compare the relative effectiveness of two modes of delivering Behavioral Family Systems Therapy for Diabetes (BFST-D) to improve adherence and glycemic control among adolescents with type 1 diabetes with suboptimal glycemic control (HbA(1c) ≥9.0% [≥74.9 mmol/mol]): face to face in clinic (Clinic) and Internet videoconferencing (Skype) conditions. RESEARCH DESIGN AND METHODS Adolescents aged 12 to 18 years and at least one adult caregiver were randomized to receive BFST-D via the Clinic or Skype condition. Participants completed up to 10 therapy sessions within a 12-week period. Changes in youth- and parent-reported adherence and glycemic control were compared before and after the intervention and at follow-up assessment. RESULTS Using an intent-to-treat analytic approach, no significant between-group differences were identified between the before, after, and follow-up assessments. Groups were collapsed to examine the overall effects of BFST-D on adherence and glycemic control. Results identified that statistically significant improvements in adherence and glycemic control occurred from before to after the intervention; improvements were maintained at 3-month follow-up. CONCLUSIONS Delivery of BFST-D via Internet-based videoconferencing is viable for addressing nonadherence and suboptimal glycemic control in adolescents with type 1 diabetes, potentially reducing important barriers to care for youth and families.
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Affiliation(s)
- Michael A Harris
- Harold Schnitzer Diabetes Health Center, Portland, OR Institute on Development & Disability, Division of Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Kurt A Freeman
- Institute on Development & Disability, Division of Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Danny C Duke
- Harold Schnitzer Diabetes Health Center, Portland, OR Institute on Development & Disability, Division of Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
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Iskander JM, Rohan JM, Pendley JS, Delamater A, Drotar D. A 3-year prospective study of parent-child communication in early adolescents with type 1 diabetes: relationship to adherence and glycemic control. J Pediatr Psychol 2014; 40:109-20. [PMID: 24839292 DOI: 10.1093/jpepsy/jsu027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine changes in parent-child communication patterns and their relation to glycemic control and treatment adherence using observational data in a 3-year prospective multisite study of youth with type 1 diabetes aged 9-11 years at baseline and their families (n = 217). METHODS Adolescents and caregivers participated in a diabetes problem-solving discussion. Families were rated on negative and positive communication and interactions using the Interaction Behavior Code. RESULTS Maternal and paternal negative communication decreased over time, whereas adolescent and maternal positive communication and positive reciprocity increased. Baseline preadolescent youth and maternal positive communication predicted adherence 3 years later. Changes in family communication did not predict changes in glycemic control or adherence. CONCLUSIONS During the transition to adolescence, family communication changed in unexpected and positive ways. Additionally, the relationship of baseline family communication to subsequent adherence suggests the need to assess family communication concerning diabetes-related management during preadolescence.
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Affiliation(s)
- Jeannette M Iskander
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine
| | - Jennifer M Rohan
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine
| | - Jennifer Shroff Pendley
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine
| | - Alan Delamater
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine
| | - Dennis Drotar
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Department of Psychology, University of Cincinnati, Department of Pediatrics, A. I. duPont Hospital for Children, and Department of Pediatrics, University of Miami School of Medicine
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Abstract
BACKGROUND Increasingly various technologies are being tested to deliver behavioral health care. Delivering services via videoconferencing shows promise. Given that the patient-provider relationship is a strong predictor of patient adherence to medical regimens, addressing relationship quality when services are not delivered face-to-face is critical. To that end, we compared the therapeutic alliance when behavioral health care was delivered to youth with poorly controlled type 1 diabetes mellitus (T1DM) and their caregivers in-clinic with the same services delivered via Internet-based videoconferencing (i.e., Skype™). METHODS Seventy-one adolescents with poorly controlled T1DM (hemoglobin A1c ≥9%) and one of their caregivers received up to 10 sessions of a family-based behavioral health intervention previously shown to improve adherence to diabetes regimens and family functioning; 32 were randomized to the Skype condition. Youth and caregivers completed the working alliance inventory (WAI), a 36-item measure of therapeutic alliance, at the end of treatment. Additionally, the number of behavioral health sessions completed was tracked. RESULTS No significant differences in WAI scores were found for those receiving behavioral health care via Skype versus in-clinic. Youth WAI goal and total scores were significantly associated with the number of sessions completed for those in the clinic group. CONCLUSION Behavioral health can be delivered to youth with T1DM via Internet-based videoconferencing without significantly impacting the therapeutic relationship. Thus, for those adolescents with T1DM who require specialized behavioral health care that targets T1DM management, Internet-based teleconferencing represents a viable alternative to clinic-based care.
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Affiliation(s)
- Kurt A Freeman
- Oregon Health & Science University, 707 SW Gaines, Portland, OR 97239, USA.
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Bhadada S, Grover S, Kumar S, Bhansali A, Jaggi S. Psychological impact of type-1 diabetes mellitus on parents: an exploratory study from North India. Int J Diabetes Dev Ctries 2011; 31:174-9. [DOI: 10.1007/s13410-011-0040-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Abstract
OBJECTIVES The purpose of this pilot study was to determine the association of observed parenting behaviors with adjustment in adolescents with type 1 diabetes (T1D) and their mothers. METHODS Adolescents with T1D (n = 30) and their mothers provided data on psychosocial adjustment and engaged in a discussion task about diabetes stress, which was coded for parenting behavior. Clinical data (i.e., HbA1c) was obtained from adolescents' medical records. RESULTS Mothers' symptoms of anxiety and depression were related to lower levels of child-centered parenting. Higher levels of observed child-centered parenting and positive reinforcement and lower levels of maternal hostility and parental influence were related to better psychosocial adjustment in adolescents (i.e., fewer depressive symptoms, better quality of life) and better metabolic control. CONCLUSIONS Results support the use of observational data in this population and provide estimates of effect sizes between parenting variables, maternal and adolescent psychosocial adjustment, and metabolic control.
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Affiliation(s)
- Sarah S Jaser
- Yale University School of Nursing, 100 Church Street South, New Haven, CT 06536, USA.
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Arbuthnott A, Sharpe D. The effect of physician-patient collaboration on patient adherence in non-psychiatric medicine. Patient Educ Couns 2009; 77:60-67. [PMID: 19395222 DOI: 10.1016/j.pec.2009.03.022] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Revised: 02/09/2009] [Accepted: 03/03/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Factors contributing to treatment adherence are poorly understood but the physician-patient interaction is one factor that is known to affect patient adherence. METHODS This meta-analysis systematically reviewed the published literature to determine the magnitude of the relationships between physician-patient collaboration and patient adherence. RESULTS A statistically significant weighted mean effect size of M(d)=0.145 from 48 published studies indicated better physician-patient collaboration is associated with better patient adherence. The relationship between collaboration and adherence was sustained for pediatric and adult populations, chronic and acute conditions, and primary physician and specialists. CONCLUSION These results emphasize the need for physician-patient collaboration within the medical consultation. PRACTICE IMPLICATIONS The inclusion of the patient's perspective during the consultation is essential to obtaining cooperation once the patient has left the physician's office.
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Stenhouse E, Letherby G. Mother/daughter relationships during pregnancy and the transition to motherhood of women with pre-existing diabetes: raising some issues. Midwifery 2009; 27:120-4. [PMID: 19640622 DOI: 10.1016/j.midw.2009.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 05/29/2009] [Accepted: 06/07/2009] [Indexed: 10/20/2022]
Abstract
In pregnancies complicated by pre-existing diabetes, there is a higher incidence of adverse pregnancy outcome. Several reports including the Confidential Enquiry into Maternal and Child Health, Diabetes in Pregnancy--are we providing the best care? (2007) highlighted the need for family involvement before/during pregnancy and in early motherhood with the aim of making pregnancy and the transition to motherhood a positive and fulfilling experience. Exploring the midwifery, sociological and diabetes literature may assist in gaining a better understanding of the complexities surrounding conception, pregnancy, childbirth and motherhood within the context of diabetes.
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Affiliation(s)
- Elizabeth Stenhouse
- School of Health Professions, Faculty of Health and Social Work, Midwifery Department, University of Plymouth, Derriford, Plymouth, UK.
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Lloyd SM, Cantell M, Pacaud D, Crawford S, Dewey D. Brief report: Hope, perceived maternal empathy, medical regimen adherence, and glycemic control in adolescents with type 1 diabetes. J Pediatr Psychol 2009; 34:1025-9. [PMID: 19168503 DOI: 10.1093/jpepsy/jsn141] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The relationships among hope, perceived maternal empathy, medical regimen adherence, and glycemic control in adolescents with type 1 diabetes were examined. METHOD Twenty-nine girls and 21 boys with type 1 diabetes completed measures of hope, perceived maternal empathy, and medical regimen adherence. Each participant's most recent hemoglobin A1c, a measure of glycemic control, was obtained from the diabetes clinic database. RESULTS Significant correlations were found among hope, perceived maternal empathy, and medical regimen adherence. Significant correlations were also found among hope, perceived maternal empathy, and glycemic control. Adolescents' perceptions of maternal empathy were positively correlated with level of hope. Hope appeared to mediate the relationship between perceived maternal empathy and adherence, as well as between perceived maternal empathy and glycemic control. CONCLUSIONS The results of this study affirm the need for longitudinal research that examines the associations among hope, perceived maternal empathy, medical regimen adherence, and glycemic control.
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Affiliation(s)
- Sarah M Lloyd
- Department of Psychology, University of Calgary, Alberta, Canada
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Abstract
BACKGROUND During adolescence diabetes creates a juncture of very complex disease management demands with developmental needs, including the striving of adolescents for greater autonomy. Parents' concerns and fears about the teen's diabetes self-management abilities during this time can heighten parental attachment behaviour and affect the parents' ability to support autonomy development necessary for effective self-care. Maternal parenting processes may be especially important for those adolescents who have Type 1 diabetes because mothers are the primary caregivers. PURPOSE Based on attachment theory, the aim was to test a model of the influence of mother-adolescent developmental conflict, maternal separation anxiety and maternal inhibition of autonomy and relatedness on cognitive autonomy and self-care of adolescents with Type 1 diabetes. METHOD A total of 131 families with an adolescent, aged 11-15 years, contributed data annually across three waves. Mothers and adolescents completed paper-and-pencil measures and two interaction scenarios that were coded by trained staff from audio-tapes. The adolescent also completed a structured interview and questionnaire to assess self-care. RESULTS Maternal separation anxiety when adolescents were 11-15 years of age directly predicted cognitive autonomy at 1-year follow-up, and that cognitive autonomy was directly related to self-care 1 year later, but did not mediate between separation anxiety and self-care. CONCLUSIONS Future investigation of the influence of separation anxiety of parents on adolescent autonomy development is warranted, as well as the contribution of autonomy development to diabetes self-management behaviours of adolescents.
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Affiliation(s)
- Carol Dashiff
- NB 323, School of Nursing, University of Alabama at Birmingham, 1530 3 Ave. South, Birmingham, AL 35294-1210, (205) 996-6110
| | - David Vance
- Hussein Abdullatif, MD, Associate Professor, Jan Wallander, PhD, Professor, University of Alabama at Birmingham
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Ivey JB, Wright A, Dashiff CJ. Finding the balance: adolescents with type 1 diabetes and their parents. J Pediatr Health Care 2009; 23:10-8. [PMID: 19103402 DOI: 10.1016/j.pedhc.2007.12.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 12/07/2007] [Accepted: 12/07/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study was to describe the ways that parents and 11- to 15-year-old teens communicate and the recurrent themes and patterns of behavior that were revealed during brief interactions about issues related to diabetes management. METHOD A secondary qualitative analysis of data, based on a template for analysis developed from the literature, was completed on audiotaped interactions of 28 adolescents and their parents. RESULTS Themes identified were frustration, fear, normalizing, trusting, and discounting. Trusting the adolescent to manage diabetes was difficult for the parents and was associated with frustration, fear, and discounting communication. DISCUSSION Results support the need for clinicians to work with families to facilitate trust and positive parent-adolescent communication about diabetes management.
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Affiliation(s)
- Jean B Ivey
- Pediatric Graduate Options, University of Alabama at Birmingham, AL, USA.
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Abstract
OBJECTIVES Adherence to antiepileptic drug therapy plays an important role in the effectiveness of pharmacologic treatment of epilepsy. The purpose of this study was to use an objective measure of adherence to (1) document patterns of adherence for the first month of therapy for children with new-onset epilepsy, (2) examine differences in adherence by demographic and epilepsy variables, and (3) determine whether treatment adherence improves for a short time before a clinic visit (eg, "white-coat compliance"). METHODS Participants included 35 children with new-onset epilepsy (mean age: 7.2 years; 34% female; 66% white) and their caregivers. Children had a diagnosis of partial (60%), generalized (29%), or unclassified (11%) epilepsy. Adherence to treatment was electronically monitored with Medication Event Monitoring System TrackCap, starting with the first antiepileptic drug dose. Adherence was calculated across a 1-month period and for the 1, 3, and 5 days before and 3 days after the clinic appointment. RESULTS Adherence for the first month of treatment in children with new-onset epilepsy was 79.4%. One-month adherence was higher in children of married parents and those with higher socioeconomic status but did not correlate with child's gender, age, epilepsy type, prescribed medication, seizure frequency, or length of time since seizure onset. Adherence across the entire 1-month period was not different from adherence for the 1, 3, or 5 days before or 3 days after the clinic visit. CONCLUSIONS Poor adherence seen for children with new-onset epilepsy during the first month of antiepileptic drug therapy is a cause for concern. Several demographic variables influence adherence to treatment, whereas the proximity to a clinic visit does not. Additional studies are needed to document whether this trend continues longitudinally and determine the clinical impact of poor adherence.
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Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Adherence and Self Management, MLC-3015, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
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Wysocki T, Harris MA, Buckloh LM, Mertlich D, Lochrie AS, Taylor A, Sadler M, White NH. Randomized, controlled trial of Behavioral Family Systems Therapy for Diabetes: maintenance and generalization of effects on parent-adolescent communication. Behav Ther 2008; 39:33-46. [PMID: 18328868 DOI: 10.1016/j.beth.2007.04.001] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 03/26/2007] [Accepted: 04/08/2007] [Indexed: 11/26/2022]
Abstract
We report a randomized trial of a revised Behavioral Family Systems Therapy for Diabetes (BFST-D) intervention. Families of 104 adolescents with diabetes were randomized to standard care (SC) or to 6 months of an educational support group (ES) or BFST-D. Family communication and problem-solving skills were assessed at 0, 6, 12, and 18 months by independent rating of videotaped family problem-solving discussions. BFST-D improved individual communication of adolescents and mothers, but not fathers. BFST-D significantly improved quality of family interaction compared to SC (10 of 12 comparisons) and ES (6 of 12 comparisons). Changes in family communication were differentially associated with changes in glycemic control, adherence, and family conflict. BFST-D improved family communication and problem solving relative to SC and modestly relative to ES.
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Affiliation(s)
- Tim Wysocki
- Center for Pediatric Psychology Research, Nemours Children's Clinic, 807 Children's Way, Jacksonville, FL 32207, USA.
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Modi AC, Marciel KK, Slater SK, Drotar D, Quittner AL. The Influence of Parental Supervision on Medical Adherence in Adolescents With Cystic Fibrosis: Developmental Shifts From Pre to Late Adolescence. Children's Health Care 2008. [DOI: 10.1080/02739610701766925] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- Alan M Delamater
- Department of Pediatrics, University of Miami, Miami, FL 33101, USA.
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Alderfer MA, Fiese BH, Gold JI, Cutuli JJ, Holmbeck GN, Goldbeck L, Chambers CT, Abad M, Spetter D, Patterson J. Evidence-based assessment in pediatric psychology: family measures. J Pediatr Psychol 2007; 33:1046-61; discussion 1062-4. [PMID: 17905801 PMCID: PMC2639492 DOI: 10.1093/jpepsy/jsm083] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To provide a review of the evidence base of family measures relevant to pediatric psychology. METHOD Twenty-nine family measures were selected based upon endorsement by Division 54 listserv members, expert judgment, and literature review. Spanning observational and self-report methods, the measures fell into three broad assessment categories: Family functioning, Dyadic family relationships, and Family functioning in the context of childhood chronic health conditions. Measures were categorized as: "Well-established", "Approaching well-established", or "Promising." RESULTS Nineteen measures met "well-established" criteria and the remaining ten were "approaching well-established." "Well-established" measures were documented for each of the broad assessment categories named above. CONCLUSIONS Many measures deemed "well-established" in the general population are proving to be reliable and useful in pediatric samples. More evidence of the validity of family measures is needed in this context. This review should prove helpful to clinicians and researchers as they strive to make evidence-based decisions regarding family measures.
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Affiliation(s)
- Melissa A Alderfer
- The Children's Hospital of Philadelphia, Civic Center Blvd, Philadelphia, PA 19104, USA.
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Wysocki T, Harris MA, Buckloh LM, Mertlich D, Lochrie AS, Mauras N, White NH. Randomized trial of behavioral family systems therapy for diabetes: maintenance of effects on diabetes outcomes in adolescents. Diabetes Care 2007; 30:555-60. [PMID: 17327320 DOI: 10.2337/dc06-1613] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Studies showing that family communication and conflict resolution are critical to effective management of type 1 diabetes in adolescents have stimulated interest in evaluating psychological treatments targeting these processes. Previous trials have shown that Behavioral Family Systems Therapy (BFST) improved parent-adolescent relationships but not treatment adherence or glycemic control. This study evaluates a revised intervention, BFST for Diabetes (BFST-D), modified to achieve greater impact on diabetes-related family conflict, treatment adherence, and metabolic control. RESEARCH DESIGN AND METHODS A sample of 104 families of adolescents with inadequate control of type 1 diabetes was randomized to either remain in standard care (SC) or to augmentation of that regimen by 12 sessions of either a multifamily educational support (ES) group or 12 sessions of BFST-D over 6 months. Pertinent measures were collected at baseline and at follow-up evaluations at 6, 12, and 18 months. RESULTS BFST-D was significantly superior to both SC and ES in effects on A1C, while effects on treatment adherence and family conflict were equivocal. Improvement in A1C appeared to be mediated by improvement in treatment adherence. A significantly higher percentage of BFST-D youth achieved moderate or greater improvement (>0.5 SD) in treatment adherence compared with the SC group at each follow-up and the ES group at 6 and 18 months. Change in treatment adherence correlated significantly with change in A1C at each follow-up. CONCLUSIONS These results support the efficacy of BFST-D in improving A1C, but further research is needed to identify the mechanisms of this effect and to achieve cost-effective dissemination of the intervention.
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Affiliation(s)
- Tim Wysocki
- Nemours Childrens Clinic, Department of Biomedical Research, 807 Children's Way, Jacksonville, FL 32207, USA.
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Greening L, Stoppelbein L, Reeves CB. A Model for Promoting Adolescents' Adherence to Treatment for Type 1 Diabetes Mellitus. Children's Health Care 2006. [DOI: 10.1207/s15326888chc3503_4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
This paper reviews the empirical research literature on the role of social support in children and adolescents with diabetes. Studies on the role of parental involvement in diabetes management suggest that premature withdrawal of parental involvement is associated with poor diabetes outcomes, whereas continued parental support and monitoring is associated with better outcomes among adolescents. Research on social support from friends suggests that friends can be a unique source of support that complements parents' involvement and improves adolescents' diabetes management.
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Affiliation(s)
- Tim Wysocki
- Division of Psychology and Psychiatry, Nemours Children's Clinic, 807 Children's Way, Jacksonville, FL 32207, USA.
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Rapoff MA, Belmont JM, Lindsley CB, Olson NY. Electronically monitored adherence to medications by newly diagnosed patients with juvenile rheumatoid arthritis. ACTA ACUST UNITED AC 2006; 53:905-10. [PMID: 16342104 DOI: 10.1002/art.21603] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To describe patterns of adherence to nonsteroidal antiinflammatory drugs (NSAIDs) in newly diagnosed patients with juvenile rheumatoid arthritis (JRA), and to examine demographic and disease-related variables as potential predictors of adherence. METHODS Adherence to NSAIDs was monitored in 48 children with JRA (mean age 8.6 years) over 28 consecutive days using an electronic monitoring device. Measures of disease activity (active joint counts, morning stiffness) and demographics (age, sex, ethnicity, socioeconomic status) were also obtained. RESULTS Using an 80% adherence cut point, 25 (52%) patients were classified as adherent and 23 (48%) as nonadherent. There was considerable variability across patients, with full adherence (taking all doses on time) ranging from 0 to 100% of the monitored days. Logistic regression showed that active joint count and socioeconomic status were the only significant predictors. Both were positively related to adherence. The model correctly classified 70.5% of patients as either adherent or nonadherent (Cox and Snell R(2) = 0.295, P = 0.0005). CONCLUSION Children newly diagnosed with JRA are more likely to adhere to an NSAID regimen if they have a greater number of active joints or their families have higher socioeconomic status. The former finding suggests that children's adherence is symptom-driven, while the latter suggests that families of lower socioeconomic status deserve special attention to address adherence issues.
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Affiliation(s)
- Michael A Rapoff
- University of Kansas Medical Center, Kansas City, KS 66160-7330, USA.
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Wysocki T, Harris MA, Buckloh LM, Mertlich D, Lochrie AS, Taylor A, Sadler M, Mauras N, White NH. Effects of behavioral family systems therapy for diabetes on adolescents' family relationships, treatment adherence, and metabolic control. J Pediatr Psychol 2006; 31:928-38. [PMID: 16401678 DOI: 10.1093/jpepsy/jsj098] [Citation(s) in RCA: 187] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Behavioral family systems therapy (BFST) for adolescents with diabetes has improved family relationships and communication, but effects on adherence and metabolic control were weak. We evaluated a revised intervention, BFST for diabetes (BFST-D). METHODS One hundred and four families were randomized to standard care (SC) or to 12 sessions of either an educational support group (ES) or a BFST-D over 6 months. Family relationships, adherence, glycosylated hemoglobin (HbA1c), and health care utilization were measured at baseline and after treatment. RESULTS BFST-D significantly improved family conflict and adherence compared to SC and ES, especially among those with baseline HbA1c > or = 9.0%. BFST-D and ES significantly improved HbA1c compared to SC among those with baseline HbA1c > or = 9.0%. CONCLUSIONS The revised intervention (BFST-D) improved family conflict and treatment adherence significantly, while both ES and BFST-D reduced HbA1c significantly, particularly among adolescents with poor metabolic control. Clinical translation of BFST-D requires further study.
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Affiliation(s)
- Tim Wysocki
- Center for Pediatric Psychology Research, Nemours Children's Clinic, 807 Children's Way, Jacksonville, Florida 32207, USA.
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Abstract
During the past few decades, there has been an explosion of behavioral science research on family management of pediatric diabetes. This article distills the major conclusions from that literature, emphasizing how primary care providers can apply these findings in clinical practice.
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Affiliation(s)
- Tim Wysocki
- Nemours Children's Clinic, Division of Psychology and Psychiatry, 807 Children's Way, Jacksonville, FL 32207, USA.
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Dashiff C, Bartolucci A, Wallander J, Abdullatif H. The Relationship of Family Structure, Maternal Employment, and Family Conflict With Self-Care Adherence of Adolescents With Type 1 Diabetes. ACTA ACUST UNITED AC 2005. [DOI: 10.1037/1091-7527.23.1.66] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Creedy DK, Ludlow T, Beggs J, Collis D, Irvine D, Price D, Norton L, Cosgrove S, Houston K. Perceptions of psychosocial support groups by parents who have a child with diabetes: a needs analysis. Collegian 2005; 12:28-32. [PMID: 16619910 DOI: 10.1016/s1322-7696(08)60490-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psychosocial support groups play an important role in assisting parents to understand and manage the demands of having a child with diabetes. Actual participation in such groups is marred by problems of poor uptake, irregular attendance and attrition. A survey was conducted with a convenience sample of parents to determine their knowledge needs about preferred program characteristics, the management of diabetes, perceived barriers to program participation, and factors facilitating group attendance. A response rate of 66% (n = 40) was achieved. Parents favoured a program that was only conducted monthly or three to six times a year, held during the evening or weekend and of two or three hours duration. Parents were keen to know more about new developments in the treatment of diabetes, and strategies to assist their child when they refuse medication or treatment. The most commonly reported barriers to group attendance were distance, timing of groups, and employment demands. Participants were more likely to attend a support group in order to learn new information or skills, keep up to date, as well as meet parents in the same situation. Support groups need to address both content and practical issues for enhanced support and empowerment of families.
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Affiliation(s)
- Debra K Creedy
- Research Centre for Clinical Practice Innovation, Griffith University.
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DeLambo KE, Ievers-Landis CE, Drotar D, Quittner AL. Association of Observed Family Relationship Quality and Problem-Solving Skills with Treatment Adherence in Older Children and Adolescents with Cystic Fibrosis. J Pediatr Psychol 2004; 29:343-53. [PMID: 15187173 DOI: 10.1093/jpepsy/jsh038] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine associations between observations of the quality of family relationships and problem-solving skills and reported adherence to medical treatments for older children and adolescents with cystic fibrosis (CF). METHODS Reports of adherence were obtained from 96 youth with CF and their parents recruited from six CF centers in the Midwest and southeastern United States. Videotaped observations of family discussions of high conflict issues were used to assess quality of relationships and problem-solving skills. RESULTS Hierarchical regression analyses indicated that observed family relationship quality (RQ) was related to parent and child reports of adherence to airway clearance and aerosolized medications after controlling for demographic variables and illness severity. Observed family problem solving was not a significant predictor after controlling for RQ. CONCLUSIONS Older children and adolescents who come from families experiencing unhappy and conflicted relationships may be at greater risk for poor adherence to treatments; thus, family relationships are appropriate targets for interventions aimed at improving adherence.
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Affiliation(s)
- Kirsten E DeLambo
- Pacific Graduate School of Psychology, Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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Abstract
PURPOSE The purpose of this preliminary study was to describe and explore the behavioral autonomy (both independent functioning and decision making) of adolescents with type 1 diabetes. METHODS A sample of 34 adolescents with type 1 diabetes completed checklists on independent functioning and decision making for daily and nondaily diabetes management as well as typical adolescent activities/rules. RESULTS Independent functioning in daily diabetes management was greater for older adolescents. Independent functioning and decision making for daily diabetes management, nondaily diabetes management, and typical adolescent activities/rules were strongly correlated. Independent decision making, but not independent functioning for daily diabetes management, was significantly correlated to metabolic control. CONCLUSIONS The strong relationship between independent decision making and functioning suggests that both aspects are important parts of behavioral autonomy to be assessed by healthcare professionals working with adolescents with type 1 diabetes. Healthcare professionals should encourage parental involvement that facilitates adolescents' independent decision making, which was related to better metabolic control in this study.
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Affiliation(s)
| | - Diana Guthrie
- Dr Gurhrie is a professor emeritis from the University of Kansas School of Medicine-Wichita
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Abstract
AIMS Behavioural support around diabetes management tasks is linked to glycaemic outcomes. In this study we investigated the relationship between diabetes-related parental behaviours (conflict around and involvement in treatment tasks), adherence to blood glucose monitoring (BGM), and glycaemic control in youth with short duration Type 1 diabetes mellitus (DM). METHODS In a cross-sectional study, 104 youth (aged 8-17 years, duration of Type 1 DM 0.5-6 years) along with a parent, completed the Diabetes Conflict Scale. Parental involvement in management tasks was assessed with structured interviews and the Diabetes Family Responsibility Questionnaire. Adherence to BGM was evaluated by family report and by independent clinician rating. Glycaemic control was assessed with glycosylated haemoglobin (HbA1c) (ref. range, 4-6%). RESULTS Children (8-12 years; n = 69) and adolescents (13-17 years; n = 35), respectively, had similar durations of diabetes (x +/- sd; 2.7 +/- 1.69, 2.4 +/- 1.32 years) and similar glycaemic control (8.3 +/- 1.1%, 8.4 +/- 1.1%). In both age groups, parental involvement was a significant predictor of adherence to BGM (P = 0.01). Multivariate analyses, controlling for age, sex, disease duration, and BGM adherence, revealed that higher diabetes conflict significantly related to poorer glycaemic control (HbA1c) (R2 = 0.17; P < 0.01). CONCLUSIONS These findings indicate that in this cohort, early in the course of diabetes, diabetes-specific conflict and adherence to BGM became strongly linked to the child's glycaemic control. This suggests that to insure optimal control, it may be beneficial to introduce targeted interventions to build positive family involvement and interaction around diabetes tasks early in the disease course, before negative behaviours become established.
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Affiliation(s)
- Barbara J Anderson
- Behavioural Research and Mental Health Section, Paediatrics Unit, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
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Abstract
OBJECTIVE Personal models of diabetes have been shown to be proximal determinants of self-care behavior in adults with diabetes, both cross-sectionally and prospectively. This study set out to test the predictive utility of this approach in adolescents with diabetes. RESEARCH DESIGN AND METHODS Participants were recruited from four regional hospitals in southern England (n = 54). They completed questionnaires assessing diabetes self-care, well-being, and personal models of diabetes (perceived impact, perceived seriousness, and short- and long-term treatment effectiveness) at baseline and 1-year follow-up. GHb assays performed as part of the patients' usual diabetes care were used to assess glycemic control. RESULTS After controlling for baseline anxiety, change in perceived impact of diabetes prospectively predicted adolescents' anxiety (beta = -0.21; t = -2.65; P < 0.01). After controlling for baseline dietary self-care, change in perceived effectiveness of the diabetes treatment regimen to control diabetes predicted dietary self-care (beta = -0.39; t = -3.28; P < 0.0005). Poorer dietary self-care and being female were predictive of poorer glycemic control (r2 = 0.29; F = 2.74; P < 0.005). CONCLUSIONS This study provides further support for the role of personal models of illness in determining responses to illness. As adolescents take responsibility for the management of their diabetes, parents, clinicians, educators, and interventionists should consider these adolescents' beliefs about their diabetes and its treatment as key factors influencing self-care, emotional well-being. and glycemic control.
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Affiliation(s)
- T C Skinner
- Department of Psychology, University of Bath, UK
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Abstract
OBJECTIVE This study reports 6- and 12-month follow-up for the families of adolescents with diabetes who participated in a trial of Behavioral-Family Systems Therapy (BFST). RESEARCH DESIGN AND METHODS A total of 119 families of adolescents with type 1 diabetes were randomized to 3 months of treatment with either BFST, an education and support (ES) group, or current therapy (CT). Family relationships, adjustment to diabetes, treatment adherence, and diabetic control were assessed at baseline, after 3 months of treatment, and 6 and 12 months later. This report focuses on the latter two evaluations. RESULTS Compared with CT and ES, BFST yielded lasting improvements in parent-adolescent relationships and diabetes-specific conflict. Delayed effects on treatment adherence emerged at 6- and 12-month follow-ups. There were no immediate or delayed effects on adolescents' adjustment to diabetes or diabetic control. CONCLUSIONS BFST yielded lasting improvement in parent-adolescent relationships and delayed improvement in treatment adherence, but it had no effect on adjustment to diabetes or diabetic control. A variety of adaptations to BFST could enhance its impact on diabetes outcomes.
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Affiliation(s)
- T Wysocki
- Division of Psychology and Psychiatry, Nemours Children's Clinic, Jacksonville, FL 32207, USA.
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Abstract
PURPOSE This study examined the relationship between health-compromising behavior, age, gender, and diabetes mismanagement. METHODS A total of 107 adolescents and young adults, 12 to 24 years old, with type 1 diabetes were asked to complete a health-compromising behavior scale and a diabetes mismanagement scale. RESULTS Based upon participants' responses, the study population was divided into 2 different groups: those involved in health-compromising behavior and those not involved in such behavior. A multiple regression analysis was performed using age, gender, and health-compromising behavior as predictor variables and diabetes mismanagement as the outcome variable. Variables that accounted for significant variance in diabetes mismanagement were being female and being involved in health-compromising behavior. CONCLUSIONS Adolescents and young adults with diabetes appear to be either involved or not involved in health-compromising behavior. Being female and being involved in health-compromising behavior were associated with diabetes mismanagement.
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Affiliation(s)
- K M Hanna
- Indiana University School of Nursing, Indianapolis (Dr Hanna)
| | - D W Guthrie
- University of Kansas School of Medicine Wichita (Dr Guthrie)
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Maharaj S, Rodin G, Connolly J, Olmsted M, Daneman D. Eating problems and the observed quality of mother–daughter interactions among girls with type 1 diabetes. J Consult Clin Psychol 2001; 69:950-8. [DOI: 10.1037/0022-006x.69.6.950] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
A literature review was undertaken to identify factors that may influence adherence to health advice amongst chronically ill young people. It emerged from the literature that internal and external factors influenced adherence in this client group. Internal influences were associated with adolescent biopsychosocial development and intra-personal dynamics. External factors were linked to interpersonal dynamics between the young person, family, peers, health care professionals and society as a whole. It is proposed that the difficulties in adherence to health advice were often due to 'adultist' beliefs. The implications of these findings are relevant to all health professionals involved in promoting health and in the development of approaches to promote 'young person-centred adherence.'
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Affiliation(s)
- K S Stewart
- Highfield Adolescent and Family Unit, Child and Adolescent Mental Health Directorate, Warneford Hospital, United Kingdom
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Abstract
OBJECTIVE To investigate side effects, medication compliance, and assumption of medication assignment in adolescents taking imipramine versus placebo in a clinical trial. METHOD Sixty-three anxious-depressed adolescents in an 8-week double-blind study of imipramine versus placebo, each in combination with cognitive-behavioral therapy for school refusal, were evaluated. Measures of side effects, global improvement, family functioning, medication compliance based on pill counts, and guesses of drug assignment (imipramine versus placebo) were analyzed. RESULTS Mean side effects ratings were significantly higher for the imipramine group compared with the placebo group (p = .001). Side effects were not associated with noncompliance or with dropping out. Oppositional defiant disorder (ODD) in the adolescents was significantly associated with medication noncompliance (p = .036). On the Family Adaptability and Cohesion Evaluation Scale II (FACES II), low family adaptability (i.e., rigidity), low family cohesion (i.e., disengagement), and extreme family type were significantly associated with greater noncompliance with medications. Accuracy rates for guessing medication assignment (imipramine versus placebo) were 66% for subjects, 62.5% for mothers, and 79.5% for the psychiatrist. Logistic regression demonstrated that side effects (p = .005) and global improvement scores (p = .06) predicted the psychiatrist's guesses of drug assignment. CONCLUSIONS Side effects were not associated with noncompliance. Nonadherence with taking medications was associated with ODD in the adolescents and problematic family functioning on FACES II. The psychiatrist, who was blind to treatment condition, guessed the subjects' medication assignments with high accuracy. Thus, because of expectancy bias, the data support the use of blind independent evaluators for rating changes in medication trials.
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Affiliation(s)
- G A Bernstein
- Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, Minneapolis 55454-1495, USA
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Fisher L, Gudmundsdottir M, Gilliss C, Skaff M, Mullan J, Kanter R, Chesla C. Resolving disease management problems in European-American and Latino couples with type 2 diabetes: the effects of ethnicity and patient gender. Fam Process 2000; 39:403-416. [PMID: 11143595 DOI: 10.1111/j.1545-5300.2000.39402.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The management of type 2 diabetes requires major life style changes. How patients and family members resolve disagreements about disease management affects how well the disease is managed over time. Our goal was to identify differences in how couples resolved disagreements about diabetes management based on ethnicity and patient gender. We recruited 65 Latino and 110 European-American (EA) couples in which one spouse had type 2 diabetes. Couples participated in a 10-minute videotaped, revealed differences interaction task that was evaluated with 7 reliable observer ratings: warm-engagement, hostility, avoidance, amount of conflict resolution, off-task behavior, patient dominance, and dialogue. A series of 2 x 2, Ethnicity x Sex ANOVAs indicated significant effects for Ethnicity and for the Ethnicity x Sex interaction, but not for Sex. Latino couples were rated as significantly more emotionally close, less avoidant, less hostile toward each other, and had less dominant patients than EA couples; however, Latino couples achieved significantly less problem resolution and were more frequently off-task than EA couples. These findings were qualified by patient gender. The findings highlight important differences
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Affiliation(s)
- L Fisher
- Department of Family & Community Medicine, Box 0900, UCSF, San Francisco, CA 94143, USA.
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Abstract
PURPOSE The purpose of this study was to examine involvement in a broad range of health behaviors among adolescents and young adults with diabetes. METHODS The sample consisted of 107 adolescents and young adults (12 to 24 years old) with Type 1 diabetes mellitus. Participants were asked to report involvement in health-enhancing, health-compromising, and diabetes mismanagement behaviors. RESULTS The participants reported low levels of health-compromising behaviors and high levels of health-enhancing behaviors. Females reported significantly higher levels of diabetes mismanagement than males. Males in late adolescence (18 to 24 years) reported significantly higher levels of health-compromising behaviors than males in early (12 to 14 years) and middle (15 to 17 years) adolescence. Females in late adolescence (18 to 24 years) reported significantly higher levels of health-compromising behaviors than females in early adolescence (12 to 14 years). CONCLUSIONS Diabetes educators who work with youth may want to assess all of these health behaviors, keeping in mind age and gender differences.
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Affiliation(s)
- K M Hanna
- The School of Nursing, University of Wyoming, Laramie, (Dr Hanna)
- Dr. Hanna also is a postdoctoral fellow at Indiana University Schools of Nursing and Medicine, Adolescent Section, Indianapolis
| | - D W Guthrie
- The Department of Pediatrics/Psychiatry, University of Kansas School of Medicine Wichita (Dr Guthrie)
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48
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Affiliation(s)
- D Fielding
- Department of Clinical and Health Psychology, St James's University Hospital, Leeds, UK
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49
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Skinner TC, Hampson SE. Social support and personal models of diabetesin relation to self-care and well-being inadolescents with type I diabetes mellitus. J Adolesc 1998; 21:703-15. [PMID: 9971727 DOI: 10.1006/jado.1998.0190] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study set out to examine whether peer support and illness representation mediates the link between family support, self-management and well-being. Seventy-four participants (12-18-years-old) with type I diabetes mellitus completed questionnaires assessing their self-management, depression, anxiety, perceived social support and personal models of diabetes. Perceived impact of diabetes, but not perceived seriousness, and peer support were significant predictors of depression. Family support was a significant predictor of all self-management measures. However, for dietary self-management this relationship was partially mediated by the perceived efficacy of treatment to control diabetes, but not efficacy of treatment to prevent complications.
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Affiliation(s)
- T C Skinner
- University Hospital Lewisham, Lewisham High Street, London SE13 6LH, UK
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Abstract
The purpose of this study was to examine the issue of quality of life (QOL) of parents with children and adolescents with type 1 diabetes. Parental QOL was measured by the Parents Diabetes Quality of Life Questionnaire. Parental life satisfaction was most affected by the burden the child's diabetes placed on the family. The event having the most impact on parental QOL was the frequency of telling others about the child's diabetes. The greatest worry was that the child would develop complications from diabetes. Parents of school-aged children experienced significantly greater life satisfaction than parents of adolescents. Married parents had higher life satisfaction than those who were divorced. Metabolic control, reflected by HbA1c values, was associated with the life satisfaction of parents.
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Affiliation(s)
- M S Faulkner
- The College of Nursing, University of Tennessee-Memphis, Memphis, Tennessee (Dr Faulkner)
| | - F S Clark
- The Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee (Ms Clark)
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