Diabetes Problem Solving by Youths with Type 1 Diabetes and their Caregivers: Measurement, Validation, and Longitudinal Associations with Glycemic Control

Center for Pediatric Psychology Research, Nemours Children's Clinic, 807 Children's Way, Jacksonville, FL 32207-8426, USA.
Journal of Pediatric Psychology (Impact Factor: 2.91). 04/2008; 33(8):875-84. DOI: 10.1093/jpepsy/jsn024
Source: PubMed


This article introduces a new measure of problem-solving skills of youths with type 1 diabetes (T1DM) and adult caregivers in correcting glycemic fluctuations.
The Diabetes Problem Solving Interview (DPSI), a structured interview, was validated during a pilot study of a behavioral intervention. DPSI data and measures of diabetes management were obtained at baseline from 114 youths (ages 9-14.5) and 109 caregivers. Glycosylated hemoglobin (HbA(1c)) was measured quarterly over 9 months.
Results confirmed the psychometric adequacy of the DPSI. For caregivers, but not youths, low DPSI scores (indicating poor problem-solving skills) were significantly associated with worse HbA(1c) over 9 months.
The DPSI has clinical and research utility as a measure of diabetes problem-solving skills. Identification and targeted remediation of caregivers' deficient diabetes problem-solving skills or promotion of youths' utilization of these skills could possibly enhance glycemic control in youths with T1DM.

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Available from: Korey Hood, Oct 07, 2014
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    • "[63] Future research in pediatric diabetes should investigate possible paradigms that could improve aspects of a child's problem solving abilities related to diabetes in a clinically feasible manner. Other research has suggested that executive functioning may relate less to adherence in younger youth with diabetes, [63] but this may result from the increased involvement from parents in younger children, which improves glycemic control, [64][65] and therefore future research should investigate the relationship between parental executive functioning and younger children's glycemic control. Parents do play an obviously beneficial role in how a youth manages their diabetes, such as monitoring their adherence to treatment recommendations, [66] however, parents can also negatively impact their child's prognosis as the result of parental accommodation. "

    Full-text · Chapter · Nov 2011
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    • "Other metrics of parental involvement such as psychological control may have been mediated through internalizing behaviors (Butler, Skinner, Gelfand, Berg, & Wiebe, 2007). Furthermore, additional mediational processes that could be examined include how adolescents navigate their peer environment (Drew, Wiebe, & Berg, 2010) or solve diabetes problems when they occur (Wysocki et al., 2008), among others. Finally, our results are restricted in generalizability as our sample of families included predominantly intact white, English-speaking, middle-class participants. "
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    ABSTRACT: To examine mediating processes linking parental involvement to diabetes management (adherence and metabolic control) during adolescence. A total of 252 young adolescents (M age = 12.49 years, SD = 1.53, 53.6% females) with type 1 diabetes reported their parents' involvement in diabetes management (relationship quality, monitoring, and behavioral involvement), their own externalizing and internalizing behaviors, diabetes-self efficacy, and adherence behaviors. HbA1c was drawn from medical records. SEM analyses indicated that the associations of mothers' and fathers' relationship quality with diabetes outcomes were mediated by adolescents' perceptions of self-efficacy and externalizing behaviors, and the associations of fathers' monitoring and behavioral involvement with adherence were partially mediated by adolescents' self-efficacy. There were also direct (non-mediated) associations between mothers' monitoring and adherence, and fathers' monitoring and adherence and metabolic control. Quality of the parent-adolescent relationship and monitoring are important for better adherence and metabolic control among adolescents through higher diabetes self-efficacy.
    Full-text · Article · Oct 2010 · Journal of Pediatric Psychology
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    • "This average was above the 7% level (representing 170 mg/dl mean plasma glucose over the preceding 2–3 months) considered good control (American Diabetes Association, 2007). The level of metabolic control was comparable to other samples of children and adolescents exhibiting adequate control (Wysocki et al., 2008 "
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    ABSTRACT: The authors investigated whether parental perceptions of adolescent efficacy are colored by parental negative affect and are associated with adolescents' self-perceptions of efficacy for diabetes management. Adolescents (n = 183, M age = 12.53) with Type 1 diabetes and their mothers and fathers separately reported perceptions of adolescents' efficacy for diabetes management and parents reported their own negative affect (depressed mood and trait anxiety). glycosolated hemoglobin (HbA1c) levels were obtained from medical records. The results indicated that parental negative affect was associated with parental perceptions of poorer adolescent efficacy beyond the association of HbA1c scores. The relationship between fathers' negative affect and adolescents' self-efficacy was mediated by fathers' perceptions of adolescent efficacy. The results suggest that parental negative affect may negatively color their views of adolescents' efficacy and, in the case of fathers' beliefs, may relate to adolescent self-efficacy. Parental negative affect should be considered when evaluating perceptions of adolescents' efficacy.
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