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OBJECTIVE - Problem solving is a critical diabetes self-management skill. Because of a lack of clinically feasible measures, our aim was to develop and validate a self-report self-management problem solving questionnaire for adolescents with type 1 diabetes (T1D).
METHODS - A multidisciplinary team of diabetes experts generated questionnaire items that addressed diabetes self-management problem solving. Iterative feedback from parents and adolescents resulted in 27 items. Adolescents from two studies (N=156) aged 13-17 were recruited through a pediatric diabetes clinic and completed measures through an online survey. Glycemic control was measured by HbA1c recorded in the medical record.
RESULTS - Empirical elimination of items using principal components analyses resulted in a 13-item unidimensional measure, the diabetes adolescent problem solving questionnaire (DAPSQ) that explained 56% of the variance. The DAPSQ demonstrated internal consistency (Cronbach's alpha=0.92) and was correlated with diabetes self-management (r=0.53, p<.001), self-efficacy (r=0.54, p<.001), and glycemic control (r=-0.24, p<.01).
CONCLUSION - The DAPSQ is a brief instrument for assessment of diabetes self-management problem solving in youth with T1D and is associated with better self-management behaviors and glycemic control.
PRACTICE IMPLICATIONS - The DAPSQ is a clinically feasible self-report measure that can provide valuable information regarding level of self-management problem solving and guide patient education.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
This study utilized structural equation modeling to examine the associations among parental guilt induction (a form of psychological control), youth cognitive style, and youth internalizing symptoms, with parents and youth participating in a randomized controlled trial of a family-based group cognitive-behavioral preventive intervention targeting families with a history of caregiver depression. The authors present separate models utilizing parent report and youth report of internalizing symptoms. Findings suggest that families in the active condition (family-based group cognitive-behavioral group) relative to the comparison condition showed a significant decline in parent use of guilt induction at the conclusion of the intervention (6 months postbaseline). Furthermore, reductions in parental guilt induction at 6 months were associated with significantly lower levels of youth negative cognitive style at 12 months. Finally, reductions in parental use of guilt induction were associated with lower youth internalizing symptoms 1 year following the conclusion of the intervention (18 months postbaseline).
PURPOSE - The voiding cystourethrogram (VCUG) is a common imaging test in pediatric urology that can be associated with anxiety in the child and parent. We hypothesized that education by mailed brochure would decrease pre-procedure parental anxiety.
METHODS - Families of children scheduled for VCUG were randomized into an experimental group that was mailed an educational brochure about the VCUG and a control group. Immediately prior to the procedure, parental anxiety was assessed with the self-administered State-Trait Anxiety Inventory (STAI). The parent repeated the STAI at home after the VCUG and answered brief questions about educational resources used to prepare for the VUCG.
RESULTS - We enrolled 105 families (47 experimental, 58 control). Parental state anxiety was higher before the procedure than after the procedure (p < 0.001). Younger parents had greater pre-procedure state anxiety (p = 0.007). Contrary to our expectations, pre-procedure state anxiety did not differ between control and experimental groups. However, parents in the experimental group demonstrated less anxiety with some individual items in the questionnaire.
CONCLUSION - An educational brochure mailed to families prior to VCUG did not decrease pre-procedure parental state anxiety. However, the educational brochure can ensure accurate dissemination of information to help families prepare for this potentially distressing procedure.
Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
The purpose of this study was to describe coping in mothers of adolescents with type 1 diabetes and to examine the association among mothers' diabetes-related stress and coping strategies and maternal psychological distress (e.g., symptoms of anxiety and depression), adolescent adjustment (e.g., symptoms of depression, quality of life), diabetes-related family conflict, and glycemic control. One hundred and eighteen mother-adolescent dyads completed measures of diabetes-related stress, coping, symptoms of anxiety and depression, quality of life, and family conflict. Data on glycemic control were collected from adolescents' medical charts. Single/divorced mothers and mothers of color were significantly more likely to use disengagement coping strategies (e.g., avoidance) than White and married/partnered mothers. Mothers' use of primary control coping (e.g., problem solving) and secondary control coping (e.g., acceptance) strategies was related to fewer symptoms of anxiety (r = - .51, -.39) and depression (r = - .32, -.37) and less family conflict (r = - .22, -.30, all p < .05). Mothers' use of disengagement coping strategies was related to greater symptoms of anxiety (r = .30) and depression (r = .27, both p < .01). Further, secondary control coping was found to mediate the relationship between diabetes-related stress and maternal symptoms of anxiety and depression. Maternal coping was not significantly associated with adolescent outcomes. The ways in which mothers of adolescents with type 1 diabetes cope with diabetes-related stress are associated with psychological distress and family conflict. By identifying and improving mothers' coping through screening and targeted interventions, we may have the potential to improve both maternal and adolescent outcomes.
BACKGROUND - Research has suggested the importance of pregnancy desire in explaining pregnancy risk behavior among adolescent females. Much of the literature, however, uses cross-sectional study designs to examine this relationship. Because bias may strongly influence these results, more prospective studies are needed to confirm the relationship between pregnancy desire and pregnancy incidence over time.
METHODS - Nonpregnant adolescents aged 14- to 19 years (n = 208) completed baseline interviews and interviews every 6 months thereafter for 18 months. Logistic regression was used to examine demographic and psychosocial correlates of pregnancy desire. Cox regression analysis was used to determine whether pregnancy desire predicted pregnancy incidence over time after controlling for potential confounders.
RESULTS - Twenty-four percent of participants either desired pregnancy or were ambivalent toward pregnancy in the next year. Pregnancy desire was associated with older age, relationship duration of <6 months, and greater perceived stress. After accounting for potential confounders, pregnancy desire doubled the risk of becoming pregnant over the 18-month follow-up period (relative risk, 2.00; 95% confidence interval [CI], 0.99-4.02). Additionally, a heightened risk for pregnancy was found among those who expressed some desire for pregnancy and who were not in school compared with those who expressed no desire for pregnancy and who were in school (relative risk, 4.84; 95% CI, 1.21-19.31).
CONCLUSION - Our analysis reinforces the importance of evaluating pregnancy desire among sexually active adolescent females. Interventions should target young women in new romantic relationships and who are not in school to improve pregnancy prevention efforts. Additionally, improving coping abilities may help to reduce feelings of pregnancy desire among adolescent females.
Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
OBJECTIVE - Describe intervention processes associated with an Internet self-management problem solving program for adolescents with type 1 diabetes, and relate participant characteristics to program use.
METHODS - Forty-one adolescents with type 1 diabetes, aged 13-17, participated in an Internet intervention.
RESULTS - Participants reported psychosocial self-management barriers related to social issues (45%), time pressures (22%), and emotions (25%). Most adolescents (76%) completed the two guided problem solving cycles, and most (97%) problems were appropriate and specific to diabetes. Of the 61 diabetes problems reported, 92% were mostly or completely solved. Baseline hemoglobin A1c, diabetes duration, and age were not related to online activities, however females posted more often to the forum (U=130.0, Z=2.13, p=.033). The majority of parents (87%) interacted with their child about the website.
CONCLUSION - Adolescents experience psychosocial barriers to self-management that can be addressed by teaching problem solving via the Internet.
PRACTICE IMPLICATIONS - An Internet self-management problem solving program with minimal external support provides a viable option for diabetes clinics to improve pediatric diabetes outcomes.
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
The purpose of this study was to develop an Internet coping skills training program and to evaluate its feasibility and acceptability compared with an Internet education intervention for teenagers with type 1 diabetes. A multiphase mixed-methods design with focus groups, a randomized pilot study, and a program evaluation was used. Teenagers with type 1 diabetes, parents, and health professionals were included in the development and evaluative phases along with the research and information technology team. The pilot study included 12 teenagers with type 1 diabetes (mean [SD] age, 14.4 [.90] years; 58% female; mean [SD] duration of diabetes, 5.9 [3.0] years). Psychosocial data and HbA1c levels were collected at baseline and at 3 and 6 months. Results indicate that the development of a psychosocial Internet intervention was complex and required multiple iterations of development and evaluation. Results of this study also indicate the feasibility and acceptability of translating a group-based intervention for teenagers with type 1 diabetes to the Internet. Thus, this study demonstrates a systematic approach to Internet intervention development. Including teenagers with type 1 diabetes and a multidisciplinary professional team into the intervention design was critical to the success of this project.
Although it has been suggested that individuals with an Autism spectrum disorder (ASD) process faces less holistically than typically developing controls, there are few direct investigations of this hypothesis. This question was addressed before using the composite paradigm (Teunisse, J. P., & de Gelder, B. (2003). Face processing in adolescents with autistic disorder: The inversion and composite effects. Brain Cognition, 52(3), 285-294.). The results had revealed that adolescents with ASDs were less sensitive than controls to the misalignment of face parts and it was concluded their face processing was less holistic. However, because of shortcomings of the design, it was not possible to distinguish whether individuals with Autism processed both aligned and misaligned composites in a part-based fashion, or both in a holistic fashion. We compared adolescents with ASDs to controls matched on sex, age and IQ on a more complete version of the composite paradigm. The results indicate that individuals with ASDs, like controls, experience interference from facial features that they are told to ignore. However, while such interference is released for controls if parts of face composites are misaligned, individuals with ASDs show comparable interference from irrelevant parts regardless of alignment. Two different interpretations are discussed, both compatible with the idea that perceptual and or attentional abnormalities in ASDs result in a diminished level of expertise for faces.
PURPOSE - The purpose of this study was to document barriers and facilitators of self-management as perceived by adolescents with type 2 diabetes.
METHODS - Focus groups were conducted with adolescents diagnosed with type 2 diabetes. Adolescents aged 13 to 19 years were recruited from an academic medical center diabetes clinic. Between 2003 and 2005, 6 focus groups were used to elicit responses from the adolescents related to self-management of their diabetes. Questions were asked by trained group facilitators. Transcripts were coded by 3 reviewers. Qualitative analyses were conducted using NVIVO software.
RESULTS - A total of 24 adolescents participated in 6 focus groups. Coding resulted in 4 common domains affecting self-management: adolescent psychosocial development; the role of others with diabetes; environmental influences; and adolescents' problem-solving/coping skills. Adolescents identified both barriers to and facilitators of self-management within each domain. Barriers often related to social situations, embarrassment, seeking acceptance or perceived normalcy, and balancing competing interests. Adolescents viewed having another family member with diabetes as both a positive and a negative influence. Environmental influences, including school and family situations, had a large impact on self-management behaviors. Making sensible food choices was a common challenge. Descriptions of problem-solving or coping skills were limited, but cognitive techniques, such as reframing, were described.
CONCLUSION - Adolescents with type 2 diabetes identified many barriers to self-management, particularly related to interpersonal interactions, the influence of others with diabetes, and environmental influences. Results suggest that improving self-management in adolescents may require multimodal interventions to address individual, family, and social processes.
OBJECTIVE - No studies have been performed to examine parent perceptions of caring for adolescents with type 2 diabetes. In this qualitative study, we examined parent perceptions of barriers and strategies to address barriers to self-care in adolescents with type 2 diabetes.
RESEARCH DESIGN AND METHODS - Families of adolescents with type 2 diabetes were recruited from a pediatric diabetes clinic. Focus groups were used to elicit parent experiences and perceptions of diabetes management of their adolescents with type 2 diabetes. Questions concerning barriers to self-care behaviors were asked by trained group facilitators. Transcripts were coded into themes by three reviewers. Qualitative analyses were conducted using NVIVO software.
RESULTS - Between 2003 and 2005, six focus groups were conducted with a total of 27 parents or guardians. Parents identified many barriers to and practical strategies for positive adolescent self-management. Five domains that influence self-management were identified: the role of others with diabetes, parenting skills, perceived lack of normalcy, environment, and adolescent development. Parents identified many barriers to dietary and exercise habits that were unique to the circumstances of adolescents with type 2 diabetes.
CONCLUSIONS - Parents identified many barriers to self-management that may be unique to adolescents with type 2 diabetes. The importance of others and environmental influences in the self-management behavior of adolescents with type 2 was evident. Interventions that are designed to improve self-management should include components that address multiple influences such as peers, school professionals, parents, siblings, and/or family systems.