Disentangling the Roles of Parental Monitoring and Family Conflict in Adolescents' Management of Type 1 Diabetes
Objective: Less parental monitoring of adolescents' diabetes self-care and more family conflict are each associated with poorer diabetes outcomes. However, little is known about how these two family factors relate with one another in the context of self-care and glycemic control. Diabetes self-care was evaluated as a mediator of the associations among parental monitoring, family conflict, and glycemic control in early adolescents with type 1 diabetes. Methods: Adolescent-parent dyads (n = 257) reported on the frequency of parental monitoring, family conflict, and diabetes self-care. Hemoglobin A1c was abstracted from medical charts. Structural equation modeling was used for mediation analysis. Results: A mediation model linking parental involvement and family conflict with A1c through diabetes self-care fit the data well. Monitoring and conflict were inversely correlated (β = -0.23, p < .05) and each demonstrated indirect associations with A1c (standardized indirect effects -0.13 and 0.07, respectively) through their direct associations with self-care (β = 0.39, p < .001 and β = -0.19, p < .05, respectively). Conflict also was positively associated with higher A1c (β = 0.31, p < .01). Conclusions: Elevated family conflict and less parental monitoring are risk factors for poorer glycemic control, and diabetes self-care is one mediator linking these variables. Interventions to promote parental monitoring of diabetes management during early adolescence may benefit from emphasizing strategies to prevent or reduce family conflict. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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- "Within the structural equation modeling framework, the magnitude of an indirect effect was estimated with an iterative algorithm (e.g., maximum likelihood ), and the significance was tested by dividing the magnitude of the indirect effect by its standard error, producing a standard normally distributed variable Z (e.g., Iacobucci, Saldanha, & Deng, 2007; Kline, 2011; MacKinnon, 2008). Testing indirect effects with structural equation models has been applied in different contexts (e.g., Ahearne, Mathieu, & Rapp, 2005; Hilliard et al., 2013; King, King, Fairbank, Keane, & Adams, 1998; Quilty, Godfrey, Kennedy, & Bagby, 2010). "
ABSTRACT: Statistical tests of indirect effects can hardly distinguish between genuine and spurious mediation effects. The present research demonstrates, however, that mediation analysis can be improved by combining a significance test of the indirect effect with assessing the fit of causal models. Testing only the indirect effect can be misleading, because significant results may also be obtained when the underlying causal model is different from the mediation model. We use simulated data to demonstrate that additionally assessing the fit of causal models with structural equation models can be used to exclude subsets of models that are incompatible with the observed data. The results suggest that combining structural equation modeling with appropriate research design and theoretically stringent mediation analysis can improve scientific insights. Finally, we discuss limitations of the structural equation modeling approach, and we emphasize the importance of non-statistical methods for scientific discovery.European Journal of Social Psychology 05/2015; 45(4). DOI:10.1002/ejsp.2106 · 1.78 Impact Factor
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ABSTRACT: Declining diabetes management and control are common as children progress through adolescence, yet many youths with diabetes do remarkably well. Risk factors for poor diabetes outcomes are well-researched, but fewer data describe processes that lead to positive outcomes such as engaging in effective diabetes self-management, experiencing high quality of life, and achieving in-range glycemic control. Resilience theory posits that protective processes buffer the impact of risk factors on an individual's development and functioning. We review recent conceptualizations of resilience theory in the context of type 1 diabetes management and control and present a theoretical model of pediatric diabetes resilience. Applications to clinical care and research include the development of preventive interventions to build or strengthen protective skills and processes related to diabetes and its management. The ultimate goal is to equip youths with diabetes and their families with the tools to promote both behavioral and health-related resilience in diabetes.Current Diabetes Reports 09/2012; 12(6). DOI:10.1007/s11892-012-0314-3 · 3.08 Impact Factor
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ABSTRACT: Aim: The overall aim of the study was to assess the psychometric properties of the revised Diabetes Family Conflict Scale (DFCS), in a Swedish sample of children, mothers and fathers. A second aim was to analyse maternal and paternal effects separately. Methods: One hundred and fifty-nine families from two diabetes centres participated in the study. The revised DFCS was administered to children aged 8-18 years and their parents. Internal consistency of the scale was measured with Cronbach's alpha, and its concurrent validity was evaluated using bivariate correlations. Independent t-tests were performed to test for differences between mother- and father reports. Results: The revised DFCS total scale exceeded the criteria for satisfactory internal consistency for the child-, mother- and father reports, as did the subscale direct management, with α-values ranging from 0.72 to 0.81. Furthermore, a higher level of reported conflict on the total scale was associated with poorer metabolic control, thus confirming concurrent validity of the instrument. This was true for mother-, father- and child reports. Conclusion: In summary, the study concludes that the revised DFCS can be utilized as a valuable tool both in a research setting and in clinical practice.Acta Paediatrica 03/2013; 102(6). DOI:10.1111/apa.12228 · 1.67 Impact Factor
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