Feasibility Study of a Behavioral Parent Intervention to Support Self-management in Pediatric Typ 1 Diabetes
- Conditions
- Type 1 Diabetes MellitusParent-Child RelationsSelf-managementBehavioral Intervention
- Interventions
- Behavioral: Parent intervention
- Registration Number
- NCT06599840
- Lead Sponsor
- Karolinska Institutet
- Brief Summary
This study investigates feasibility and preliminary effects of a new behavioral parent intervention that aims to support and improve pediatric diabetes self-management
- Detailed Description
Diabetes self-management is extensive, complex and places high demands on the affected individual and his/her family. Today, half of Swedish children and adolescents with type 1 diabetes (T1D) do not reach target levels of glycemic control. Among the various factors that influence glycemic control, family function is of great importance. Parent-child conflicts surrounding self-management tasks have been shown to predict glycemic control deterioration over time. This study will explore feasibility and preliminary effects of a new behavioral parent intervention that aims to strengthen parent-child cooperation and facilitate diabetes routines in every-day-life. The results of the feasibility study will guide further refinement of the intervention, and the design of a future RCT.
Through digital ads and posters at the diabetes clinics in Stockholm, we will recruit parents of children aged 9-14 with T1D experiencing problems in getting diabetes self-management routines to work in every-day-life. The intervention is held at the hospital and includes six weekly group sessions and a booster session one month later. At the end of each session, parents plan to use a new behavioral strategy at home during the upcoming week. This feasibility study will explore participant satisfaction and attendance combined with qualitative assessments of their experiences. Preliminary effects are investigated through repeated assessments of a set of digitalized questionnaires, data from the national diabetes registry and online blood glucose data during the intervention phase, post intervention and at 3- months follow up.
This intervention is believed to be an effective way to target and prevent T1D self-management problems and may come to serve as an important complement to standard diabetes treatment.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 50
- Parents/guardians of children aged 9-14 with type 1 diabetes.
- The child has had type 1 diabetes for at least one year.
- The parent experience difficulties in managing daily life and/or the parent-child collaboration around self-management routines.
- The perceived difficulties should not solely be due to perceived problems in the medical aspects of the diabetes treatment, such as a perceived need for more support in insulin dosing, more diabetes education, or technical/medical support. This criterion is based solely on the subjective judgement of the parent him-/herself.
- The child receives diabetes care at one of the three diabetes clinics in the Stockholm Region.
- The parent speaks, understands, and can read Swedish.
- The parent claims to be motivated and has the practical possibility to participate in the study and attend group meetings.
- The parent reports current and severe psychiatric conditions in themselves or the child that need to be prioritized, such as severe depression, suicidal thoughts/self-harm, psychosis, or mania.
- The parent is involved in another psychological treatment of a behavior-changing nature that is in an active phase, either concerning themselves or a child.
- Major planned changes in diabetes treatment that require learning and behavioral changes, such as transitioning from pen to pump, and that are expected to occur during the first 3.5 months of the study (active intervention phase).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Intervention group Parent intervention CBT-based parent intervention consisting of 7 group sessions.
- Primary Outcome Measures
Name Time Method Diabetes Treatment Satisfaction Questionnaire - parent report Weekly from baseline to 14 weeks This is a 14 item questionnaire that aim to measure parental satisfaction with the diabetes treatment. Parents are asked to rate their satisfaction on a likert scale from 0 = very unsatisfied, to 6 = very satisfied about a range of diabetes treatment domains. The questionnaire is based on the adult version of DTSQ and adapted to pediatric type 1 diabetes. Translated to Swedish and validated in a Swedish cohort.
- Secondary Outcome Measures
Name Time Method Glycaemic control From baseline until 15 weeks. HbA1c values taken during diabetes clinic visits, registered in the national diabetes registry.
DISABKIDS (child QoL) - parent report From baseline until 15 weeks. This is a questionnaire that aims to measure health related quality of life in children living with chronic conditions. The parent version comprises 37 items concerning aspects of how the condition may affect the child in every-day-life, such as whether the child is worried about his/her future, if he/she spends time with friends. It is scored using five ordinal response categories ranging from "never" to "always." The negative oriented items are coded 4 ("never") to 0 ("always") whereas the positive oriented questions are inverted, so that higher score indicates higher quality of life.
Days of physical activity From baseline until 15 weeks. Number of day per week of physical activity. Information taken during diabetes clinic visits, and registered in the national diabetes registry.
PedsQL - Family Impact Measure (parent QoL) From baseline until 15 weeks. This instrument measures quality of life for parents who have children with a chronic disorder. It includes 36 items concerning physical, emotional, social and cognitive functions as well as daily activities, family relations, communication and family worry. Items are answered on a five-grade scale from 0 = never a problem, to 4 = almost always a problem. These result for each item is transformed so that 0 = 100, 1 = 75, 2 = 50, 3 = 25, 4 = 0, and the sum score is divided by the number of items, so that higher score indicates higher quality of life.
Me As Parent From baseline until 15 weeks. This is a 16-item measure that aim to measure aspects of parenting self-regulation, representing the degree to which participants perceive themselves as efficacious and competent in their role as parents. The scale includes 16 items covering the four subdomains of self-efficacy, personal agency, self-sufficiency and self-management. Items are rated on a scale from 1 = strongly disagree, to 5 = strongly agree.
Getting Self-Management Routines Done Weekly from baseline to 14 weeks This 2-item questionnaire is developed by the research group and aims to serve as a parent-reported proxy for the two key self-management behaviors: taking insulin and handling high and low blood glucose values. In percentages from 0-100%, parents are asked to estimate to what extent their child 1) takes insulin and 2) handles high and low blood glucose values, in relation to all the times these behaviors are required.
Parental Challenges in Diabetes Self-Management Weekly from baseline to 14 weeks. This questionnaire is developed by this research group and based on common diabetes-specific themes of parental, behavioral challenges reported by parents in an interview study conducted by the group. In 12 items, parents are asked to rate how often they experience a set of challenges on a Likert scale from 0 = never, to 4 = always. These items cover four domains 1) parent worry and frustration, 2) talking, asking and reminding 3) child resistance to self-management routines, 4) child resistance to communication about self-management. This is a pilot use of the questionnaire, testing the items before deciding on future validation and psychometric evaluation. We will also use it to look at participants responses over time at a qualitative, clinical and explorative level and to investigate how the domains relate to eachother, to glycemic control and how/if responses change over time.
General Anxiety Disorder -7 Weekly from baseline to 14 weeks. This 7-item version of the GAD questionnaire is a short measure of symptoms of anxiety. Participants are asked how often they have been bothered by a set of anxiety symptoms the last 2 weeks ranging from 0=not at all, to 7=daily. The measure will serve as a control variable in mediation analyses.
Diabetes Family Conflict Scale - parent From baseline until 15 weeks. This 15-item questionnaire targets family conflicts about diabetes self-management tasks. Parents are asked how often they argue with their children about a range of different self-management routines on a scale from 0=never, 1=sometimes and 2=almost always. The sum score is multiplied by 50 giving a maximum score of 100. The last update of the English version from 2023 was translated into Swedish by this research team in 2024.
Perceived Stress Scale 10 From baseline until 15 weeks. This is the 10 item version of the standardized measurement of stress, the PSS-10. Participants are asked how often they have experienced a set of stress symptoms during the last month, ranging from 0=never to 4=very often.
Parenting Practices Scale From baseline until 15 weeks. Parents answer six questions about parenting practices over the last two weeks. Items are rated on a seven point Likert scale from 'Never' (coded as 1) to 'Many times a day' (coded 7), resulting in a range of 6-42 with higher scores indicating greater use of parenting skills.
Time in Target (TiT) From baseline until 15 weeks. TiT is the percentage of time that blood glucose levels have been within the target interval 4-8 mmol/mol during the last 2 weeks.
This data will be taken from the national diabetes registry (NDR), and depending on formal approvement from the Glooko company - this measurement will also be gathered repeatedly during the intervention via the Glooko online glucose system.Mean glucose level From baseline until 15 weeks. The mean glucose level during the past 2 weeks. This data will be taken from the national diabetes registry (NDR), and depending on formal approvement from the Glooko company - this measurement will also be gathered via the Glooko online glucose system.
Blood glucose variation From baseline until 15 weeks. Standard deviation of blood glucose levels during the past 2 weeks. This data will be taken from the national diabetes registry (NDR), and depending on formal approvement from the Glooko company - this measurement will also be gathered via the Glooko online glucose system.
Time with low blood glucose - pending approval From baseline until 15 weeks. Percentage of time during the past two weeks when blood glucose values have reached below 3 mmol/mol. This data will - depending on formal approvement from the Glooko company - be gathered via the Glooko online glucose system.
Ketoacidosis From baseline until 15 weeks. Number of incidents of ketoacidosis registered in the national diabetes registry.
Severe hypoglycemia From baseline until 15 weeks. Number of incidents of hypoglycemia as registered in National Diabetes Registry.
Visits at the diabetes clinic From baseline until 15 weeks. Number of visits registered at the National Diabetes Registry.
Client Satisfaction Questionnaire - 8 15 weeks after baseline CSQ is a cross-treatment questionnaire that aims to measure patient-reported satisfaction with the treatment they have received. This version of the CSQ includes 8 items that ask participants to rate their satisfaction on a 4-point scale where higher scores indicates higher satisfaction.
DISABKIDS (child QoL) generic + diabetes module - child report From baseline until 15 weeks. This is a 37 item questionnaire that aims to measure health related quality of life in children living with chronic conditions. Added to this questionnaire is the diabetes module with 10 diabetes-specific items. Questions concern aspects of how often the condition affects different aspects of every-day-life, such as whether the child feels lonely due to his/her condition, or if he/she is bothered by the medical treatment. It is scored using five ordinal response categories ranging from "never" to "always." The negative oriented items are coded 4 ("never") to 0 ("always") whereas the positive oriented questions are inverted, so that higher score indicates higher health related quality of life.
Diabetes Family Conflict Scale - youth report From baseline until 15 weeks. This 15-item questionnaire targets family conflicts about diabetes self-management tasks. Children/adolescents are asked how often they argue with their parents about a range of different self-management routines on a scale from 0=never, 1=sometimes and 2=almost always. The sum score is multiplied by 50 giving a maximum score of 100, with a higher score indicating more conflicts. The last update of the English version from 2023 was translated into Swedish by this research team in 2024.
Time with high blood glucose - pending approval From baseline until 26 weeks. Percentage of time the past 2 weeks when blood glucose levels have reached above 12.9 mmol/mol. This data will - depending on formal approvement from the Glooko company - be gathered via the Glooko online glucose system.
Short Engagement Questionnaire Weekly from baseline until 14 weeks. This questionnaire is newly developed by the research group and is to be piloted in the current study. The length of questionnaire is adapted to individual CBT treatments depending on the number of treatment components that are presented. One week after a new behavioral strategy and an associated assignment have been presented to the participants, they are asked to rate their engagement according to the following three domains:
1. Frequency: how many days they have used the strategy (1 - 7),
2. Intensity: how much effort they have put down in using it (0 = none, to 5 = a lot).
3. Usability: how helpful they perceive the strategy to be for them (0 = not at all, to 5 = very).
The total score for each of the 3 domains are divided by the number of strategies, to reach a mean score for each of the three domains. Results will be examined at a qualitative level to guide further refinement of the intervention.Time with high blood glucose (repeated measures) - pending approval Every second week from baseline until 14 weeks. Percentage of time the past 2 weeks when blood glucose levels have reached above 12.9 mmol/mol. This data will - depending on formal approvement from the Glooko company - be gathered via the Glooko online glucose system.
Blood glucose variation (repeated measures) - pending approval Every second week from baseline until 14 weeks. Standard deviation of blood glucose levels during the past 2 weeks. This data will - depending on formal approvement from the Glooko company - gathered via the Glooko online glucose system.
Mean glucose level (repeated measures) - pending approval Every second week from baseline until 14 weeks. The mean glucose level during the past 2 weeks. This data will - depending on formal approvement from the Glooko company - gathered via the Glooko online glucose system.
Time in Target (TiT) (repeated measures) - pending approval Every second week from baseline until 14 weeks. TiT is the percentage of time that blood glucose levels have been within the target interval 4-8 mmol/mol during the last 2 weeks. This data will - depending on formal approvement from the Glooko company - gathered via the Glooko online glucose system.
Time with low blood glucose (repeated measures) - pending approval Every second week from baseline until 14 weeks. Percentage of time during the past two weeks when blood glucose values have reached below 3 mmol/mol. This data will - depending on formal approvement from the Glooko company - be gathered via the Glooko online glucose system.
Trial Locations
- Locations (1)
Karolinska University Hospital
🇸🇪Stockholm, Sweden