Parenting and Type 1 Diabetes

描述(由申请人提供)： 我提交这份申请是为了促进我的K23的研究计划和具体目标。在我的K23中，我正在进行一项加强亲子糖尿病教育/咨询计划的随机对照试验(RCT)，以促进1型糖尿病儿童的代谢控制/行为遵守。在干预部门，家庭接受有关父母继续参与孩子糖尿病护理的耐心教育和简短咨询。初步数据表明，这是干预的一个重要组成部分，所传授的信息和技能与我们的父母对象产生了很好的共鸣。然而，临床信息已经曝光，突显了一些父母在糖尿病方面所面临的挑战。这些挑战包括过度使用无效的育儿行为(例如，强迫、监管不力、拒绝、严厉/不一致的惩罚)、过度使用有效的育儿行为(例如，对可预测和成熟的行为进行建模、传达明确的期望、设定限制、表扬/奖励)，以及与其孩子的糖尿病相关的心理压力的存在。这一信息引发了人们对父母养育行为的正常变化以及这些变化如何与孩子的糖尿病控制相关的问题。这也引发了一些问题，即父母的心理压力与孩子的糖尿病控制之间可能存在怎样的联系。因此，该应用程序侧重于解决父母在管理孩子的1型糖尿病中所扮演的社会和行为角色。具体地说，我试图加深我对育儿方式(例如，反应和需求)、儿科育儿压力(即，与照顾患有糖尿病的孩子相关的压力)和糖尿病控制(即，新陈代谢控制和行为遵守)之间的相互关系的理解。我将首先(第一阶段)对这些因素和其他相关因素进行横断面描述性调查，临床样本为N=120名患有1型糖尿病的8-11岁儿童的父母。接下来，我将开发并试行测试正在进行的N=10个父母的RCT的育儿辅助工具(第二阶段)。这项工作将作为一项独立但与我的K23相关的研究，利用不同/不活跃的主题池进行。我在国家儿童医疗中心可获得的机构资源，以及我与导师建立的富有成效的工作关系，都有助于及时实现这些目标的可行性。R03的结果最终将根据正在进行的随机对照试验的结果进行解释。它们将被用来指导和告知家庭管理计划的发展，该计划随后将在有效性试验(R01)中进行测试，以促进受影响的青年中的糖尿病控制。

DESCRIPTION (provided by applicant): I am submitting this application to further the research plan and specific aims of my K23. In my K23, I am conducting a randomized controlled trial (RCT) of an enhanced parent-child diabetes education/counseling program to promote metabolic control/behavioral adherence among children with type 1 diabetes. In the intervention arm, families receive patient education and brief counseling regarding parents staying involved in their child's diabetes care. Preliminary data suggest that this is a salient component of the intervention and the information and skills taught resonate well with our parent subjects. However, clinical information has come to light underscoring the challenges some parents are experiencing with diabetes involvement. These challenges include overuse of ineffective parenting behaviors (e.g., coercion, poor supervision, rejection, harsh/inconsistent punishment), underuse of effective parenting behaviors (e.g., modeling of predictable and mature behavior, communicating clear expectations, limit setting, praise/reward), and the presence of psychological stress related to their child's diabetes. This information has raised questions regarding normal variations in parenting behavior and how these variations might be associated with their child's diabetes control. It has also raised questions about how parent psychological stress might be associated with their child's diabetes control. Thus, this application focuses on addressing the social and behavioral roles that parents play in managing their child's type 1 diabetes. Specifically, I am seeking to deepen my understanding of the interrelationships among parenting style (e.g., responsiveness and demandingness), pediatric parenting stress (i.e., stress associated with caring for a child with diabetes), and diabetes control (i.e., metabolic control and behavioral adherence). I will do this first (Phase I) by conducting a cross-sectional, descriptive investigation of these and other related factors in a clinical sample of N=120 parents of children ages 8-11 years with type 1 diabetes. Next, I will develop and pilot test a parenting adjunct to the ongoing RCT with N=10 parents (Phase II). This work will be conducted as an independent but related study to my K23 utilizing a different/not active pool of subjects. The institutional resources available to me at Children's National Medical Center and my established, productive working relationships with my Mentors all contribute to the feasibility of accomplishing these aims in a timely manner. The results of this R03 will ultimately be interpreted in light of the ongoing RCT's results. They will be used to guide and inform the development of a family management program which will subsequently be tested in an effectiveness trial (R01) to promote diabetes control among affected youth.