Competing Demands of Young Adulthood and Diabetes: A Discussion of Major Life Changes and Strategies for Health Care Providers to Promote Successful Balance

The association between health literacy and unmet medical needs by gender

OBJECTIVES

Understanding the factors influencing unmet medical needs (UMN) is crucial for developing effective interventions. This study aims to investigate the association between health literacy (HL) and UMN by gender.

STUDY DESIGN

Quantitative survey analysis.

METHODS

We used data from the 2021 Korea Health Panel (KHP) with 10,073 participants. Variable of interest was HL, measured using the HLS-EU-Q16, and the dependent variable was an UMN, measured based on respondents' self-reported experiences of unmet medical needs due to financial or non-financial reasons over the past 12 months. First, the UMN experience was investigated, and then the reason for the occurrence was investigate. Multiple logistic regression was used to assess the association between HL and UMN after adjusted.

RESULTS

UMN rates with problematic and inadequate HL were 12.7 % and 12.5 %, respectively, for males; and 14.3 % and 13.2 %, respectively, for females. HL was significantly associated with UMN among both male and female participants, with adjusted odds ratios of 1.37 and 1.85, respectively; and 1.46 and 1.50, respectively, for problematic and inadequate HL. The odds ratio of UMN was associated with low HL in the groups under 30 years of age for both men and women. The UMN odds ratio was also associated with high academic achievement and the non-exercise group with low HL.

CONCLUSION

Low HL is associated with a higher likelihood of UMN. These findings emphasize the importance of improving HL to reduce the occurrence of UMN, warranting further research in this area.

Focused on the Family: Development of a Family-Based Intervention Promoting the Transition to Adult Health Care for Adolescents with Type 1 Diabetes

Background/Objectives: There is minimal evidence for current interventions promoting the transition to adult healthcare for youth with type 1 diabetes (T1D). Few interventions exclusively target modifiable individual and family-based factors that contribute to transition readiness. The purpose of this paper is to describe the development of Behavioral Family Systems Therapy for Diabetes Transition (BFST-DT), a virtual family-based transition readiness intervention for adolescents with T1D. Methods: The development of BFST-DT occurred in three phases. In phase 1, focus groups with adolescents and young adults with T1D, their caregivers, and pediatric and adult diabetes providers were conducted to assess perspectives on common family challenges surrounding diabetes management and the transition to adult healthcare. In phase 2, focus group data were used to create video vignettes to be used as part of the intervention. In phase 3, BFST-DT was created through the adaptation of a previous evidence-based family intervention for families of adolescents with T1D. Results: BFST-DT is a virtual, 6-month family-based intervention involving four multi-family group meetings and six individual family meetings. It targets the modifiable and reciprocal interactions among individual and family transition readiness factors. Conclusions: BFST-DT is the first family-focused intervention promoting transition readiness in adolescents with T1D and is currently being tested. Intervention development benefits from prioritization of engagement with patients, caregivers, and providers, as their perspectives are invaluable for creating interventions that are relevant and acceptable to communities.

Improving transition of care from pediatric to adult endocrinology for adolescents with diabetes

Introduction

Adolescence is a challenging time in a child's life and can be even more stressful for those with a chronic medical condition such as diabetes mellitus. Adolescents and young adults with type 1 and type 2 diabetes experience worsening glycemic levels as they enter adulthood. Data suggest that a formalized health care transition process and beginning transition preparation in early adolescence leads to better transition outcomes.

Methods

The aim of this study was to create a transition of care program for youth with diabetes in a standalone children's hospital by following the Got Transition Six Core Elements of Health Care Transition. First, we implemented a transition of care policy and formalized how we discussed transition of care with patients and families in early adolescence. Further improvements have included assessing readiness to transition, designing a curriculum centered around adolescent-specific issues and how they relate to diabetes management, and forming connections with adult endocrinologists in the area to establish a seamless transition process.

Results

After implementing our program, 90 % (28/31) of our patients indicated they were very or somewhat ready to transition to adult care.

Discussion

We outline our process for developing a transition of care program and provide a practical tool for other pediatric diabetes providers who are interested in implementing a similar program.

"Fear That One Day I May Not Be Able to Afford Insulin": The Emotional Burden of Diabetes Costs During Emerging Adulthood

Emerging adults (EAs) with type 1 diabetes (T1D) often experience challenges in diabetes management, in particular transitioning to financial independence. EAs 18-30 years of age with T1D completed online surveys about diabetes distress and an open-ended query about the most important worry among survey questions. Most of the 287 respondents (89.5%) endorsed "Agree" or "Somewhat agree" to the statement "I worry about the cost of diabetes." Responses did not differ by gender, age, diabetes duration, race/ethnicity, diabetes technology use, student status, income, or insurance status. However, a greater proportion of those not endorsing cost as a substantial burden achieved A1c <7% (92.9%) versus those who were neutral (46.2%) or who endorsed cost as a burden (50.6%) (P = 0.004). Furthermore, in open-ended responses, cost was the most frequently noted worry. Diabetes costs are a major concern for EAs, likely contributing to diabetes distress during this developmental stage, and clinicians should consider discussing diabetes costs with this population.

Diabetes Distress in Emerging Adulthood: Content Validity of the Problem Areas in Diabetes-Emerging Adult Version (PAID-EA) Using Qualitative Analysis

PURPOSE

The purpose of this study was to explore the emotional work of diabetes during emerging adulthood and to explicate the validity of a newly developed measure of diabetes distress (DD) for use with emerging adults living with type 1 diabetes mellitus (T1DM), the Problem Areas in Diabetes-Emerging Adult version (PAID-EA).

METHODS

Young people ages 18 to 30 with T1DM were recruited online to complete a cross-sectional survey including measures of DD, depressive symptomology, and the PAID-EA. To evaluate content validity, 2 open-ended questions asked what was the most significant emotion or worry discussed in the survey items and what feelings were missed in those items. Responses were analyzed using directed qualitative content analysis.

RESULTS

A total of 254 (87%) participants responded to at least 1 of the 2 open-ended questions. Three themes and 1 subtheme were identified: (1) fear of the future with the subtheme of worry about the cost of diabetes, (2) acute worries about living with diabetes, and (3) challenges with finding support. More PAID-EA items corresponded with these themes than items on the original Problem Areas in Diabetes or Center for Epidemiologic Studies Depression Scale, supporting the validity of the PAID-EA and clarifying the developmental-stage-specific aspects of DD.

CONCLUSIONS

Emerging adulthood is a period in which the future should hold infinite possibility, but young people with T1DM describe a staggering fear of the future with markedly limited possibilities, supporting the need to measure the developmental-stage-specific experience of DD as captured on the PAID-EA.