Family-Centered Interventions Improve Health Outcomes in Children, Adolescents With T1D

Family-centered interventions can help improve health outcomes in children and adolescents with type 1 diabetes (T1D), according to a review published in Child Health Nursing Research.

“In the future, family-centered interventions integrated with other approaches, theories, and models should be developed to achieve the best possible outcomes,” the review authors said.

The authors conducted a literature search according to PRISMA guidelines for studies with children and adolescents aged younger than 18 years with T1D and at least one parent or caregiver, or only parents or caregivers if the children were very young, as well as studies investigating health outcomes of children with T1D and parents or caregivers.

Of 2746 published studies, only 9 met the inclusion criteria for the review. Six of these studies were conducted in the United States, 2 in the United Kingdom, and one in Denmark. Regarding the key interventions of each study, 4 had non-technology-based interventions, 2 had technology-based interventions, and 3 had combined technology– and non-technology- based interventions.

The non-technology-based interventions included skills training and educational interventions. Skills training programs focused on teaching coping, problem-solving, and stress management techniques for children and adolescents with T1D. Meanwhile, educational interventions in this study included the Families and Adolescents Communication and Teamwork Study (FACTS) and the Child and Adolescents Structured Competencies Approach to Diabetes Education (CASCADE) intervention.

The interventions in these studies were linked to glycated hemoglobin (HbA1c), adherence to T1D management, T1D self-management behaviors, and parent-child teamwork in T1D management.

Regarding glycemic control, 3 of the included studies—2 using combined interventions and 1 using technology-based interventions—found significant decreases in HbA1c. Interestingly, one study reported a significant decrease in HbA1c in adolescents aged between 12 and 14 years, but not in children aged between 9 and 11 years, while another reported a significant decrease only in adolescents aged between 13 and 16 years at one of 3 sites. A fourth study found a decrease in HbA1c following intervention, but it was not statistically significant, and the other 5 reported no significant effect on HbA1c.

Three studies assessed T1D management adherence and 2 focused on motivation for adherence. Of these studies, one reported increased adherence, one reported no significant changes in adherence, and one insignificant increase in adherence among both the intervention and control groups. The review authors found significant increases in motivation for T1D management adherence only in adolescents.

Of the 2 studies evaluating T1D self-management behaviors, each had a different outcome. While one study using FACTS reported an increased frequency of adjusting insulin doses for snacks, meals, and recent blood glucose levels, another study using combined interventions reported significantly decreased helplessness or worry among children with T1D and significantly increased efforts by parents to maintain high blood glucose levels.

The 6 studies assessing parent-child teamwork in T1D management looked at family conflict, blood glucose monitoring, and shared responsibility as outcomes. Family conflict decreased significantly in 2 studies, though one of these studies found that significant results were only obtained in parent reports. Additionally, one study saw a significant increase in adolescents' self-monitoring of blood glucose and parents' frequent reviews of the adolescent's glucometer. No significant effects were seen for either children or their parents or caregivers when it came to sharing responsibilities in T1D management.

These 9 studies also noted effects on children’s quality of life (QoL) and problem-solving skills, as well as parents' QoL, coping, and depression.

Only 1 of 4 studies looking at children’s QoL found improvements from the children's reports, while the other 3 found no significant effects, and the one study that evaluated problem-solving skills found a significant increase in adolescents' cognitive, affective, and behavioral abilities to resolve problems in everyday living.

While some changes were seen among parents, these changes were insignificant. One study saw improved parent QoL and another saw considerably improved parent QoL in 1 of 3 study sites. Only one study looked at coping and depression and reported no significant effect, but parents' coping did improve in the treatment group.

According to the authors, with increasing technological developments, future studies should focus on testing the efficacy and cost-effectiveness of such family-centered to improve outcomes for children and adolescents with T1D.

“Additionally, nursing-based family-centered interventions must integrate other approaches, theories, or models in development and testing,” they said. “This will ensure that those interventions address the individual families' cultural, socioeconomic, and geographical characteristics in order to achieve better health outcomes.”

Reference

Ispriantari A, Agustina R, Konlan KD, Lee H. Family-centered interventions for children and adolescents with type 1 diabetes mellitus: an integrative review. Child Health Nurs Res. 2023;29(1):7-23. doi:10.4094/chnr.2023.29.1.7