Type I diabetes has the ability to promote change in the family. In truth, although the child with diabetes is the diagnosed patient, the whole family has diabetes. While the challenges that families have to face are many, families seem to have the ability to “bounce back” (i.e., they have resilience). Research on the construct of resilience, and more specifically, family resilience has surged in recent times. However, South African research on family resilience is limited. This study aimed to explore and describe the factors that facilitate adjustment and adaptation in families that include a child living with Type I diabetes. The Resiliency Model of Stress, Adjustment and Adaptation, developed by McCubbin and McCubbin (2001) served as a framework to conceptualise the families’ adjustment and adaptation process. Non-probability purposive and snowball sampling techniques were employed. Sixteen families participated in this study, providing a total of 31 participants. Participants consisted of the caregivers of a family living with a child between the ages of four and 12 with Type I diabetes. The study was triangular in nature, with an exploratory, descriptive approach. A biographical questionnaire with an open-ended question was used in conjunction with seven other questionnaires to gather data. These questionnaires were: The Family Hardiness Index (FHI), the Family Time and Routine Index (FTRI), the Social Support Index (SSI), the Family Problem-Solving Communication (FPSC) Index, the Family Crises-Oriented Personal Evaluation Scales (F-COPES), the Relative and Friend Support Index, and the Family Attachment and Changeability Index 8 (FACI8). Descriptive statistics were used to describe the biographical information. Quantitative data were analysed by means of correlation and regression analysis, and a content analysis was conducted to analyse the qualitative data. The results of the quantitative analysis indicated three significant positive correlations with the FACI8. These variables were family hardiness (measured by the FHI), family problem-solving communication (measured by the FPSC), and family time and routines (measured by the FTRI). The results of the qualitative analysis revealed that social support, the caregivers’ acceptance of the condition, and spirituality and religion were the most important strength factors that contributed to the families’ adjustment and adaptation. Although the study had a small sample and many limitations, the study could be used as a stepping-stone for future research on resilience in families living with chronic medical conditions and will contribute to family resilience research in the South African context.

No description available.

The present study evaluated the effectiveness of a behavioral family intervention on adherence and metabolic control in insulin dependent diabetic children (IODM). Specifically, assumption of regimen responsibilities between the parent and child were manipulated to facilitate regimen adherence. The intervention delivered was a target-specific behavioral contract extended sequentially across four target behaviors (Le., blood glucose testing, insulin injections, diet, and exercise). Regimen components were targeted in a within subjects, multiple baseline design across behaviors to assess the relationship between adherence and metabolic control. Metabolic control was assessed with a measure of glycosylated hemoglobin (e.g., HbA1C.) Five IDDM children (3 female,2 male), who met study criteria (Le., nonadherence to blood glucose testing defined as oS. 2 tests daily and metabolic status outside the optimal range using standard laboratory reference values) were recruited from physician referrals and media announcements. Subjects were between the ages of 10 and 15 years (M = 12.6); four were Caucasian and one was African-American. Mean duration of diabetes upon entry into the study was 4.3 years. Results revealed that four subjects responded to the intervention and three of those four evidenced clinically significant improvements in metabolic control at mid - and/ or post-study. One subject demonstrated only moderate intervention effects and no improvement in metabolic control while another increased adherence, but decrements in metabolic control were noted. These results suggest that adherence may mediate the relationship between family variables and metabolic status. Two additional subjects demonstrating consistently good metabolic were employed to assess the validity of target behaviors. The results were related to various family and diabetes-specific psychosocial indices. / Master of Science

In the present study we used an empirical validation approach to determine psychosocial variables related to adaptive management of diabetes in two samples of diabetic children and their families. Children from the Kansas University Medical Center (n = 31) and children from the Virginia Diabetes Association (n = 25) provided results of the glycosylated hemoglobin test (a measure of diabetic control); completed self-report measures on variables of anxiety, coping, family adjustment, and health locus of control; and underwent structured interviewing. Parents completed parallel self-report measures, as well as an assessment of child behavior. In addition, a subsample of parent-child dyads participated in a role-play measure of family interactions around the child’s diabetes. All demographic variables and psychosocial measures were not Significantly different across the Kansas and Virginia samples. Children in optimal control of diabetes had more structured and organized family environments, more frequently believed that ''powerful others'' were responsible for their health, and showed lower levels of negative coping with family problems than children in nonoptimal diabetic control. Surprisingly, children in optimal diabetic control showed poorer knowledge of diabetes and its management than children in nonoptimal control. Psychological interventions to promote adaptive diabetic control should incorporate findings related to family environment, locus of control, and the child’s style of coping with family problems. / Ph. D.

Aim: A wealth of quantitative literature exists exploring the adjustment of children and young people with Type 1 Diabetes Mellitus. However, results are often confusing and contradictory, at least partly due to studies using different definitions and measures. Studies have been criticised for over relying on parental reports and failing to consider young people’s own perceptions. Furthermore, they have often conceptualised adjustment as an outcome, rather than exploring the process involved. Additionally, although peers are considered to play an important role in young people’s lives, their role in young people’s adjustment to living with diabetes has rarely been examined. To address this gap, this study attempted to gain a rich understanding of young people’s experiences of adjusting to life with diabetes and explore how they feel their peers have contributed to this process, with the hope of informing clinical practice and improving support to young people and their families. Method: A qualitative approach was chosen and six young females aged 12 – 15 with a diagnosis of Type 1 diabetes were interviewed using semi-structured interviews. Interpretative Phenomenological Analysis was used to analyse the transcripts. Results: Five main themes emerged from participants’ accounts: Developing a balanced relationship with diabetes; the uncomfortable position of difference; grappling with the fall out of diabetes; making diabetes more bearable; and the role of parents and friends. The findings are discussed in relation to the relevant literature. Clinical implications, methodological limitations and directions for future research are presented. Conclusions: This study provided an insight into the complex and dynamic process of young people’s adjustment to life with Type 1 diabetes. It highlighted the challenges and struggles they faced as a result of their diagnosis and the different strategies they employed to manage these. It also emphasised the valuable role both parents and friends provide in supporting young people with their illness.

This study was design to determine the efficacy of intensive individual play therapy as a method of intervention for children diagnosed with insulin-dependent diabetes mellitus. The purpose of this study was designed to study the effectiveness of an intensive play therapy intervention in: a) reducing symptoms of childhood depression in children with IDDM; b) reducing symptoms of anxiety in children with IDDM; c) reducing the overall behavior difficulties in children with IDDM; d) increasing healthy adjustment in children with IDDM; e) increasing diabetic's children's adherence to their diabetic regime; and f) impacting these emotional and behavioral symptoms over time. The 15 children in the experimental group received 12, daily play therapy sessions while attending a summer camp for children with diabetes. The control group, consisting of 15 children who attended the diabetic summer camp, received no play therapy. Children and parents in both groups completed pretest, post-test and three-month follow-up data, consisting of: the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, the Filial Problems Checklist and the Diabetes Adaptation Scale. Analysis of covariance revealed that the children in the experimental group significantly improved their adaptation to their diabetes following intensive play therapy as reflected by the Diabetes Adaptation Scale. No other hypothesis were retained, although statistical trends noted increased improvement in the experimental group in the areas of behavior difficulties and adherence behavior. Possible explanations for these results include a lack of symptoms reported at the time of pretesting and the validity of these instruments for a chronically ill population. The results of this study indicate that intensive play therapy may be an effective intervention for children diagnosed with IDDM. Qualitative observations and progress noted in therapy reveal that young children with IDDM have the capability to address and resolve issues of anxiety, depression and other emotional issues related to their diabetes in play therapy. Preventative approaches such as play therapy for children with IDDM are particularly important for this population as current behavior patterns and treatment adherence are highly correlated with long-term medical and psychological health.

This thesis offers a rethinking of the role for education as critical workplace pedagogy in complex problems of health care. Taking the case of paediatric diabetes, the study explored how health-care professionals learn the work of supporting children, and their parents, to self-manage the condition. By reconceptualising work problems as sociomaterial learning struggles, this research contributes new understandings of informal professional learning in everyday health-care provision. Data were generated through fieldwork in an outpatient clinic. Particular challenges of supporting self-management in this case were the difficulties of balancing policy aspirations for empowerment with biomedical knowledge about risks to immediate and long-term health. Tracing the materialisation of learning as it unfolded in moments of health-care practice showed professionals handling multiple and contradictory flows of information. Particular challenges were posed by insulin-pump technologies, which have specific implications for professional roles and responsibilities, and introduce new risks. A key insight is that professionals were concerned primarily with the highly complicated perpetual discernment of safe parameters within which children and their parents might reasonably be allowed to contribute to self-management. Such discernment does not readily correspond to the notion of empowerment circulating in the policies and guidelines intended to enable professionals to accomplish this work. As a result, this thesis argues that the work of discernment is obscured. Learning strategies evolve, but could be supported and extended by explicit recognition of the important work of learning as it unfolds in everyday practices of supporting self-management in paediatric diabetes. Most importantly, workplace pedagogies could be developed in ways that attune to the profound challenges and uncertainties that are at stake in these practices.

The present study involved the analyses of the Texas Medicaid prescription claims data. The population studied was made up of subjects between 10 and 18 years who had at least 2 prescriptions of the same oral antidiabetic (OAD) medication from January 1, 2006 through December 31, 2009. Twelve months’ data for each subject were analyzed. The main aim of the study was to describe OAD medication use patterns in the study population, assess trends in Medication Possession Ratio (MPR) and persistence in the study population and determine the relationship between age and MPR and between age and persistence while controlling for covariates. Results of the descriptive statistics, multiple and logistic regression analyses are reported. The average age (± SD) of the 3,109 eligible subjects was 14 (± 2) years; minority populations made up the majority (87%) of the population; 67% of the population were females; and 91% were on the OAD metformin. The overall mean MPR (± SD) for the population was 45% (± 27). A significant negative relationship between MPR and age was reported while controlling for covariates (p<0.0001). Among the covariates, white race and male were significantly associated with a higher MPR, holding other variables constant. When adherence was dichotomized (MPR < 80% and MPR >= 80%), logistic regression analysis also found that age was significantly and negatively related to MPR (p < 0.0001). In addition, the white race and male were again significantly related to a higher level of adherence, holding other variables constant. The overall mean days to non-persistence (± SD) was 108 days (± 86). Persistence was significantly and negatively associated with age, holding other variables constant (p < 0.0001). Among the covariates, white race was significantly related to longer persistence. In conclusion, adherence and persistence are generally low in the study population. Age, gender and race were significantly associated with adherence. Being younger, male, and white were significantly associated with a higher level of adherence, while being younger and white were significantly associated with longer persistence. Healthcare providers therefore need to intensify efforts to improve adherence in pediatric patients especially those at the brink of adulthood. / text

This study assessed change in the dietary intake and weight, height and body mass index (BMI. kg/ml) measurements of children (grades 4--6) who have participated in the Kahnawake Schools Diabetes Prevention Program (KSDPP). Children from two independent cross sectional samples were assessed at baseline in 1994 (n = 156) and in 1998 (n = 146). Diet was assessed using a single 24-hour recall. Results showed no overall change in energy, fat and sucrose intake. Food groups were created as indicators of diet quality. Results showed a decrease in the frequency of consumption of foods in the high fat food group (p < 0.05) and an increase in the average amount of white sugar consumed (p < 0.05). A decrease in the number of servings of fruit was shown, but also a trend towards their increased frequency of consumption. No significant changes were found in weight, height or BMI. Dietary and anthropometric data were combined but results showed no significant changes in diet by BMI category. Changes in diet are challenging to both measure and implement. These results could be used to identify more specific future interventions.

Thesis (Ph.D.)--George Washington University, 2005. / Includes bibliographical references (leaves 57-62).