3/3/2014. Parenting challenges related to diabetes management and preferences for accessing parenting support. What does management involve?

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1 // Parenting challenges related t diabetes management and preferences fr accessing parenting supprt Diabetes is a chrnic illness in which there are high levels f sugar/ glucse in the bld. Why des this happen? Pancreas Insulin mves glucse int bld cells (t be used as bdy fuel) Aditi Lhan Dr Alina Mrawska Dr Amy Mitchell Parenting and Family Supprt Centre University f Queensland T little insulin (Type diabetes) Resistance t insulin (Type diabetes) What des management invlve? Impact f childhd diabetes n parents and family Insulin intake (via multiple daily injectins r insulin pump) Bld glucse mnitring Diet Exercise Immediate transfer f respnsibility (Cyne & Andersn, 988) Guilt, anxiety, depressin, lw self efficacy and QOL (Betschart, 987; Mednick, 6; Streisand, et al., 8) Impacts every aspect f family life: dietary habits, finances, time spent in management, less time fr recreatinal and scial activities (Auslander, Bubb, Rgge, & Santiag, 99; Banin, Miles, & Carter, 98; Lwes, et al., ) Impact f parenting and family factrs n diabetes Parenting and family factrs have been assciated with prer child wellbeing (Armstrng, et al., ) and increased behaviur prblems (Overstreet, et al., 99) Permissive parenting, parental restrictiveness, and family cnflict linked with pr adherence and glycemic cntrl (Shrer, et al., ; Davis, et al., ; Jacbsn, et al., 99; Hauser, et al., 99) Family chesin and authritative parenting style are linked t gd diabetes cntrl and treatment adherence (Mnaghan, Hrn, Alvarez, Cgen, & Streisand, ; Davis, et al., ) Aims f the present study T understand parental prblems related t child diabetes management and behaviur T investigate the specific tpics and strategies that parents wuld find mst beneficial in a parenting interventin T understand relatinships between child, parent and family factrs, which will aid in the develpment f a parenting interventin fr parents f children with type diabetes 6

2 // Measures used Dmain f Assessment Measure Demgraphic infrmatin Family Backgrund Questinnaire (Sanders & Mrawska, ) Parenting efficacy Self-Efficacy fr Diabetes Scale (Streisand et al., ) Child illness behaviur Diabetes Behaviur Checklist (Mrawska, Mitchell & Pay, ) Child behaviur and adjustment Child Adjustment and Parent Efficacy Scale (Mrawska & Sanders, ) Parenting behaviur Alabama Parenting Questinnaire- Shrt Frm (Sctt, Briskman, & Dadds, ) Family management f child s illness Cnditin Management Effrt subscale f Family Management Measure (Knafl et al., ) Preliminary Results: Demgraphics Child n= 6 Mean child age = 7.6 years 6 bys Median age at diagnsis = years (birth- yrs). hspitalised in past (- times) 6.7 have a chrnic illness ther than diabetes Parent psychlgical health and family envirnment Parenting and Family Adjustment Scale (Sanders & Mrawska, ) Parent attributin f child s behaviur Parental Attributin Questinnaire (Adapted frm PAQ, Whittingham, Sfrnff, Sheffield & Sanders, 8, 9) Parent preferences fr accessing supprt Parent Services Preferences Questinnaire 7 8 Preliminary Results: Demgraphics Parent and Family Mean parent age = 8.7 years 9 mthers 87.6 in tw-parent husehlds 8 8 Educatin 8.9 wrking utside hme University/ Pstgraduate degree Technical cllege/ trade High schl Parent is cmpletely respnsible Mean child age=.9yrs (- years) Child is smewhat respnsible Mean child age=7.6yrs (- years) Parent and child are equally respnsible Mean child age=9.9yrs (6- years) Respnsibility sharing Parent is smewhat respnsible Respnsibility sharing in diabetes management Mean child age=yrs ( years) N Yes Dn't knw Nt met essential expenses Mst f the Sme f the Nt much f things things anything Cmfrtably purchase Diabetes behaviur prblems Mean extent scre =.97; SD =.8 Mean cnfidence scre = 8.87; SD =.6 Tp prblems:. Child cmplains abut having diabetes (Mean =.6, SD=.8). Child cmplains abut having insulin injectin/ insulin blus (Mean =., SD=.8). Cmplains abut checking bld sugar levels (Mean =.7, SD=.6) Family finances 9.9 reprted additinal child behaviur difficulties

3 // Diabetes behaviur prblems Child behaviur difficulties 6. reprted additinal parent behaviur prblems Frequency Mean scre... SD=.9 SD=. SD=. Parent prblems with diabetes management Emtinal prblems Behaviural prblems Ttal CAPES intensity scale Mean cnfidence scre = 8.7; SD =.6 Mean =.; SD =.77 Diabetes efficacy Crrelatins between key utcmes DBC Extent DBC CAPES CAPES SED APQ Cnfidence Intensity Cnfidence DBC Extent ** ** * ** * Tp areas with lw self-efficacy:. Nt able t run life similarly t befre the child was diagnsed with diabetes (Mean =.96, SD=.9). Cannt leave child with smene else/ use a babysitter (Mean =., SD=.). Nt able t g n vacatins with r withut child (Mean =.6, SD=.9) DBC Cnfidence CAPES Intensity CAPES Cnfidence -.6 ** **. **.6.9 ** ** -. **. ** -. *.76 ** -.7 **.6 ** -. SED -.6 **. ** -. **.6 ** -. * APQ.7 *.6. ** * p <. * p <. 6. cncerned abut diabetes management Preferences fr accessing supprt Mean scre Nt at all A little Smewhat Much Extremely Helpfulness f parenting interventins 7 Interventin elements 8

4 // Preliminary cnclusins There is a need fr parenting interventins in this ppulatin. Parents indicated that a parenting interventin wuld be at least smewhat helpful in increasing skills and cnfidence in managing their child s diabetes (Mean=.8, SD=.67). All interventin cmpnents rated between smewhat t extremely helpful-clarifies the specific tpics and strategies that parents may find helpful. Thank yu! Parenting prgrams targeting parent behavir may help t further reduce diabetes and general child behaviur prblems, and imprve family relatins. 9 Measures used i. Family Backgrund Questinnaire (Sanders & Mrawska, ) t cllect demgraphics ii. Cnditin Management Effrt subscale f Family Management Measure (Knafl et al., ) t assess family management f the child s illness Internal cnsistency reliability fund t be.7 fr mthers and.78 fr fathers; testretest reliability is.8) pint scale (Strngly Agree t Strngly Disagree) iii. Self-Efficacy fr Diabetes Scale (Streisand et al., ) t measure parental efficacy in managing diabetes items; Internal cnsistency reliability is.87 Please read the fllwing items. After each statement, circle the number frm t that shws hw much yu believe yu can r cannt d what is asked nw. Very Sure I Maybe Sure I Very sure can t I can sure I can t Can I can Be the ne in charge f drawing up and giving the insulin injectin/insulin blus t my child Checking and keeping track f my child s bld glucse levels Checking my child s urine fr ketnes Recgnize and treat a high bld sugar, with r withut ketnes Prevent my child frm having lw bld glucse levels iv. Parenting and Family Adjustment Scale (Sanders & Mrawska, ) t evaluate parent psychlgical health and family envirnment Parental Adjustment ( items; α=.86), Family Relatinships ( items; α=.79) and Parental Teamwrk ( items; α=.79)subscales pint scale = nt true f me at all = true f me a little, r sme f the time = true f me quite a lt, r a gd part f the time = true f me very much, r mst f the time I feel stressed r wrried I feel happy I feel sad r depressed I feel satisfied with my life I cpe with the emtinal demands f being a parent v. Child Adjustment and Parent Efficacy Scale (Mrawska & Sanders, ) t assess child behaviur and adjustment items Behaviural Prblems Subscale (6 items;α=.9), Emtinal Prblems Subscale ( items;α=.8) and Parental Efficacy Scale (α=.96) Hw true is this f yur child? Nt A Quit Very at little e a muc My child: all lt h Gets upset r angry when they dn t get their wn way Refuses t d jbs arund the huse when asked Wrries Lses their temper Misbehaves at mealtimes Rate yur cnfidence = Certain I can t d it = Certain I can d it

5 // vi. Alabama Parenting Questinnaire - shrt frm (Sctt, Briskman, & Dadds, ) t assess parenting behavir items pint scale -Never -Almst Never - Smetimes Often -Always Yu let yur child knw when he/she is ding a gd jb with smething. Yu praise yur child if he/she behaves well. Yu cmpliment yur child when he/ she des smething well. Yu threaten t punish yur child and then d nt actually punish him/her. Yu let yur child ut f a punishment early (like lift restrictins earlier than yu riginally said). vii. Diabetes Behaviur Checklist (Mrawska, Mitchell & Pay, ) t understand behaviurs that parents f children with diabetes ften have t manage items Extent and Cnfidence scales 7 pint scale (Nt at all t Very much) Cmplains abut checking bld sugar level Cmplains abut having insulin injectin/ insulin blus Des nt crrectly fllw steps fr checking bld sugar level Cmplains abut entering bld sugar levels int diary r insulin pump T what extent has this behaviur been a prblem fr yu with yur child? Nt at all A little Smewhat Much Very much Refuses t g t the dctr/clinic Hw cnfident are yu in dealing with it? (Certain I can t d it) (Certain I can d it). 6 viii. Parental Attributin Questinnaire t evaluate parental beliefs regarding factrs that cntribute t their child s behaviural difficulties situatins (tw general and tw diabetes-specific situatins) 6 pint scale (Strngly Agree t Strngly Disagree) Scres n lcus, stability and cntrllability attributins Imagine yur child has recvered frm an episde f lw bld sugar sme time back. Yu ask him/ her t have sme crackers and cheese. Yur child ignres yur instructin and desn t d as asked. My child s behaviur is due t smething abut my child; fr example, because that s the way s/he is. 6 ix. Parent Services Preferences, which are a series f questins abut current and future service access and preferences fr accessing parenting supprt statements pint scale (Nt at all useful t Extremely useful) If a parenting interventin was develped, with the aim f increasing parents' skills and cnfidence in managing their child's diabetes and behaviur, hw imprtant wuld it be that the interventin includes the fllwing elements? My child s behaviur is due t smething abut this particular situatin. My child wuld nt behave like that in ther situatins. 6 Infrmatin abut what diabetes is An verview f diabetes management My child s behaviur is due t his/ her diabetes. 6 The causes f my child s behaviur are mstly permanent and are unlikely t 6 change in the future. Strategies fr preventing medical emergencies Tips fr identifying barriers t apprpriate diabetes management The causes f my child s behaviur are mstly temprary and will pass with time. 6 Strategies fr develping psitive relatinships with children My child culd cntrl this behaviur if s/he wanted t. 6 Skills fr encuraging desirable behavir My child has n cntrl ver this behaviur. 6 Strategies fr managing misbehavir 7 8