Parent Perspectives on Educational and Psychosocial Intervention for Recent-Onset Type 1 Diabetes in Their School-Age Child: A Qualitative Study

Caregiver Burden in Parents of Children With Type 1 Diabetes in Bahrain: A Qualitative Study

PurposeThe purpose of the study was to explore caregiver burden among parents of children with type 1 diabetes (T1D) in Bahrain, focusing on emotional, physical, and social demands.MethodsA qualitative research design using phenomenological approach was used to conduct in-depth interviews with 14 parents of children and adolescents with T1D, selected using purposive sampling. Data were collected through in-depth interviews based on Chou's framework of caregiver burden, covering financial, physical, social, spiritual, and emotional stressors. Interviews were conducted in Arabic, audio-recorded, and transcribed. Thematic analysis was performed using Taguette, with themes validated through peer debriefing and member checking.ResultsFour key themes emerged: managing daily health needs, adapting to a new reality, balancing work and personal life, and the need for caregiver support. Parents reported significant emotional-, physical-, social-, and cost-related demands. Managing daily health needs was accompanied by constant monitoring and insulin administration. Adapting to a new reality required lifestyle adjustments. Balancing work and personal life were challenging due to caregiving duties.ConclusionThe findings highlight the substantial burden faced by parents of children and adolescents with T1D in Bahrain. Parents expressed a need for appropriate support systems addressing both their children's medical needs and their own well-being, which can improve the quality of life for both caregivers and their children.

Parent Feedback on the Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP) Intervention: A Qualitative Analysis

OBJECTIVES

Severe hypoglycemia is more common among young children with type 1 diabetes mellitus (T1DM) than older youth, and parents report significant hypoglycemia fear (HF). Parents experiencing HF describe constant and extreme worry about the occurrence of hypoglycemia and may engage in potentially risky behaviors to avoid hypoglycemia. Our team developed and tested a behavioral intervention, Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP), to decrease HF in parents of young children with T1DM. Here, we qualitatively analyzed parent feedback to refine and optimize future intervention iterations.

METHODS

The randomized pilot study included parents (n = 73) of young children with T1DM who participated in the 10-session video-based intervention. We qualitatively analyzed 21 recordings of the final intervention session, where parents provided feedback about intervention content. Trained coders independently reviewed each session. The frequency of parent quotes regarding active REDCHiP treatment components were calculated.

RESULTS

The coded themes reflected active treatment components [viz., Use of Cognitive Behavioral Therapy (CBT) Skills, Coping, Behavioral Parenting Strategies]. Also, two secondary process codes were identified: Appreciate REDCHiP Content and Challenges in Applying REDCHiP Strategies. Parents provided examples of skills or concepts they applied from REDCHiP, the challenges they encountered, and if they planned to apply these skills in the future.

CONCLUSIONS

A qualitative analysis provided insight into parent perceptions of the active treatment components within the REDCHiP intervention, their acceptability, and parents' intention to apply REDCHiP skills/concepts within daily T1DM cares. Future iterations of the intervention that trial alternative formats (i.e., individual vs. group and asynchronous vs. telehealth) may increase accessibility and scalability.

Psychological Care for Children and Adolescents with Diabetes and Patient Outcomes: Results from the International Pediatric Registry SWEET

Background

Easy accessibility of psychosocial care is recommended for children and adolescents with type 1 diabetes (T1D) and their families.

Objective

The study aimed to evaluate the availability of psychological care and its associations with glycemic control in centers from the multinational SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) registry.

Subjects

Centers participating in SWEET (n = 112) were invited to complete a structured online survey, designed for the study, regarding their psychology service.

Methods

Linear/logistic regression models adjusted for several confounders were used to determine the patient's HbA1c (mmol/mol) and odds ratios (ORs) for diabetic ketoacidosis (DKA) and severe hypoglycemia (SH) related to survey responses.

Results

76 (68%) centers with relevant data in the SWEET database responded to the survey. Psychological services were provided in 89% of the centers. The availability of psychological service in centers was associated with a slightly lower HbA1c of the patients (72 (62-82) vs. 67 (57-78) mmol/mol, p = 0.004) and significantly lower odds for DKA (1.8 (1.1-2.9), p = 0.027).

Conclusions

Most centers from the SWEET registry offered some form of structured psychological care, consistent with the recommendations of easy access to psychosocial care for children and adolescents with T1D and their families. The main benefit of this psychological care appears to be in the incidence of DKA between centers. The study data also continues to emphasize the importance of treatment targets in shaping the outcomes of pediatric diabetes care. These findings should inform health-service planners and the diabetes community of the importance of mental healthcare in multidisciplinary diabetes teams.

Experience and Educational Needs of Arab Parental Caregivers Regarding their Children Newly Diagnosed with Type 1 Diabetes in Saudi Arabia: A Qualitative Study

Type 1 diabetes (T1DM) is a common chronic health condition in children that necessitates close monitoring and care. Parents face numerous challenges when caring for children with T1DM, particularly at home owing to self-care. There is little information available about Arab parents’ experiences and educational needs when caring for children with TIDM. The purpose of this study was to explore the experiences and educational needs of Arab parental caregivers in Saudi Arabia who live with and care for children diagnosed with T1DM. An inductive qualitative descriptive design was used in this study. The data were amassed over a 4 month period through audio-recorded semi-structured interviews with 16 Arab parents of children aged 18 years and under who had been diagnosed with T1DM within the previous 6 months. Data were analyzed through a qualitative content analysis. The results could be classified into 3 categories related to the parents’ experience of caring for a child newly diagnosed with T1DM and their educational needs and can be described as follows: (1) management of uncertainty regarding T1DM; (2) management of new daily life situations; and (3) self-care management within the family. The Arab parents of children with T1DM accentuated the need for continuous professional support to manage uncertainty due to changes in everyday life situations. The findings confirmed the significance of culturally and contextually relevant education regarding T1DM for parents, children, and school personnel. Educational interventions and support in the community are recommended to improve daily life situations for families and children with T1DM.

Psychosocial Needs for Newly Diagnosed Youth with Type 1 Diabetes and Their Families

PURPOSE OF REVIEW

To synthesize findings from studies published within the last 5 to 10 years and recruiting families of children with new-onset type 1 diabetes (T1D).

RECENT FINDINGS

Children can establish glycated hemoglobin (HbA1c) trajectories in the new-onset period that may persist for up to a decade. Demographic factors, family conflict, and diabetic ketoacidosis at the time of diagnosis may be risk factors for sub-optimal child HbA1c, while new immune modulating therapies and a treatment approach that combines advanced technologies and remote patient monitoring may improve child HbA1c. Nonetheless, recent trials in the new-onset period have largely overlooked how treatments may impact families' psychosocial functioning and longitudinal observational studies have been limited. The new-onset period of T1D is an important time for research and clinical intervention, though gaps exist specific to families' psychosocial needs. Filling these gaps is essential to inform clinical management and standard of care guidelines and improve outcomes.

Longitudinal associations between family conflict, parent engagement, and metabolic control in children with recent-onset type 1 diabetes

INTRODUCTION

We prospectively investigated the associations between diabetes-related family conflict, parent engagement in child type 1 diabetes (T1D) care, and child glycated hemoglobin (HbA1c) in 127 families of school-age children who we recruited within the first year of their T1D diagnosis.

RESEARCH DESIGN AND METHODS

Parents completed the Diabetes Family Conflict Scale-Revised (DFCS-R) to assess for diabetes-related family conflict and the Diabetes Self-Management Questionnaire-Brief (DSMQ-Brief) to assess parent engagement in child T1D care at the initial study visit (T1) and at 12 (T2) and 27 (T3) months later. We also collected child HbA1c at these time points. Our analyses included Pearson correlations and repeated measures linear mixed models controlling for child age, sex, and T1D duration at T1.

RESULTS

Parents' DFCS-R scores negatively correlated with DSMQ-Brief scores (r=-0.13, p<0.05) and positively correlated with children's HbA1c (r=0.26, p<0.001). In our linear mixed models, parents' DSMQ-Brief scores were unchanged at T2 (β=-0.71, 95% CI -1.59 to 0.16) and higher at T3 (β=8.01, 95% CI 6.89 to 9.13) compared with T1, and there was an association between increasing DFCS-R and decreasing DSMQ-Brief scores (β=-0.14, 95% CI -0.21 to -0.06). Child HbA1c values were significantly higher at T2 (β=0.66, 95% CI 0.38 to 0.94) and T3 (β=0.95, 95% CI 0.63 to 1.27) compared with T1, and there was an association between increasing DFCS-R scores and increasing child HbA1c (β=0.04, 95% CI 0.02 to 0.06).

CONCLUSIONS

Increasing diabetes-specific family conflict early in T1D may associate with decreasing parent engagement in child T1D care and increasing child HbA1c, suggesting a need to assess and intervene on diabetes-specific family conflict. Trial registration number NCT03698708.