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Objectives: Severe hypoglycemia is more common among young children with type 1 diabetes mellitus (T1DM) than older youth, and parents report significant hypoglycemia fear (HF). Parents experiencing HF describe constant and extreme worry about the occurrence of hypoglycemia and may engage in potentially risky behaviors to avoid hypoglycemia. Our team developed and tested a behavioral intervention, Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP), to decrease HF in parents of young children with T1DM. Here, we qualitatively analyzed parent feedback to refine and optimize future intervention iterations. Methods: The randomized pilot study included parents (n = 73) of young children with T1DM who participated in the 10-session video-based intervention. We qualitatively analyzed 21 recordings of the final intervention session, where parents provided feedback about intervention content. Trained coders independently reviewed each session. The frequency of parent quotes regarding active REDCHiP treatment components were calculated. Results: The coded themes reflected active treatment components [viz., Use of Cognitive Behavioral Therapy (CBT) Skills, Coping, Behavioral Parenting Strategies]. Also, two secondary process codes were identified: Appreciate REDCHiP Content and Challenges in Applying REDCHiP Strategies. Parents provided examples of skills or concepts they applied from REDCHiP, the challenges they encountered, and if they planned to apply these skills in the future. Conclusions: A qualitative analysis provided insight into parent perceptions of the active treatment components within the REDCHiP intervention, their acceptability, and parents’ intention to apply REDCHiP skills/concepts within daily T1DM cares. Future iterations of the intervention that trial alternative formats (i.e., individual vs. group and asynchronous vs. telehealth) may increase accessibility and scalability.

Asthma is one of the most common pediatric conditions affecting millions of US children. Digital health apps may provide children and their caregivers (parents or legal guardians) with ways to manage asthma and improve health and educational outcomes. As digital health technology becomes more prevalent to help manage chronic conditions, like asthma, this study examined the reported benefits and barriers of caregiver interactions with an asthma-specific app. The app, created by physicians and digital health development professionals, was designed to educate, inform, and help caregivers manage the health of their child. We evaluated app logins and feature use (collectively defined as \"app engagement\") for caregivers of children with asthma aged 5-11 years. We examined whether (1) app engagement differed due to children's demographic and asthma health characteristics, (2) themes about app engagement emerged from caregiver-reported app experiences, (3) these themes correlated with demographic and asthma health characteristics, and (4) engagement with the app was associated with reduced school absences. Eighty caregivers and their children with asthma participated between September 2019 and November 2020. Pretest (Time 1) and posttest (Time 2) data were collected over 6 months on caregiver and child demographic and health characteristics, health care usage, app engagement, and app experiences. Additionally, caregiver app engagement data and child health care data were collected retrospectively, 2 years prior to the start of the study. We used a mixed methods design, which included correlation, regression, chi-square, and content analysis to examine caregiver app engagement. Most caregivers were mothers (76/80, 95%) and had a college degree (45/80, 56%). Children's mean age was 8.76 (SD 1.79), and all were English speakers (80/80, 100%). About half of the participants were White children (43/80, 54%), and 26% (21/80) of them had uncontrolled asthma. Logistic regression revealed that caregivers of White children (OR [odds ratio] 8.57, 95% CI 1.68-43.65) with uncontrolled asthma (OR 17.81, 95% CI 2.36-134.24) who earned a college degree (OR 6.94, 95% CI 1.38-34.87) were statistically significantly more likely to use the app than caregivers of children of other races with controlled asthma without a college degree (P<.001). Qualitative findings support and expand on the logistic regression results. Five themes regarding app engagement emerged, including relevancy, acceptability and understandability, technology limitations, educational barriers, and information and communication benefits. Caregivers also identified specific app features that may promote child health and education. Understanding caregiver and child experiences in using digital health technologies for managing asthma may inform ways to support app engagement among caregivers and their children in the effort to improve patient health outcomes.

Decision aids (DAs) are central to shared decision making (SDM) interventions, yet little is known about patients’ actual DA use. Adequate utilization of DAs could optimize SDM effectiveness. Electronic DAs enable more objective tracking and analysis of actual DA utilization than do paper DAs. This report is part of an ongoing randomized controlled SDM trial enrolling adolescents with type 1 diabetes and their caregivers (n = 153) who were considering use of an insulin pump or continuous glucose monitor. Extensive stakeholder engagement guided creation of two online DAs. After completing baseline measures, 133 dyads were randomized to SDM (access to the pertinent DA) or Usual Care (clinic routines for preparing candidates for adopting these devices). Utilization data showed that 80% of caregivers and 66% of youths logged into a DA at least once; youths and caregivers, respectively, dedicated a mean of 44.7 and 55.0 minutes to website use and viewed 72.2% and 77.4% of the DA content. Median total duration from enrollment to last DA logout was 48.2 days for adolescents and 45.6 days for caregivers. Bivariate comparisons showed that non-Hispanic, Caucasian females from households with higher socioeconomic status were significantly more likely to login to the assigned DA at least once. Hierarchical multiple regression showed that adolescent males with lower levels of health literacy demonstrated fewer DA logins (F = 2.59; P < 0.009), but identified no significant predictors of adolescents’ or caregiver’ duration of DA use or proportion of DA content viewed. Future SDM trials should seek to promote DA use, especially by non-White adolescents, perhaps with direct assistance with the initial DA login. Trials employing electronic DAs should routinely report and analyze utilization data.

IntroductionIn a cohort of families of school-age children (8–12.99 years old) with type 1 diabetes, we examined the stability of parent and child diabetes-related distress (DRD) over 6 months and the associations between parent and child DRD and child glycated hemoglobin (HbA1c) over time.Research design and methodsWe recruited families from two large pediatric hospital systems in the USA and used validated measures of parent (Parent Problem Areas in Diabetes-Child, PPAID-C) and child (Problem Areas in Diabetes-Child, PAID-C) DRD and children’s HbA1c. We collected data at baseline and 6 months. We calculated minimal clinically important differences in PPAID-C and PAID-C to examine DRD stability and used a linear regression model to examine associations between PPAID-C and PAID-C scores and child HbA1c over time.ResultsWe recruited n=132 parent–child dyads (mean child age=10.23±1.5 years; 50% male, 86% non-Hispanic white). 60% of children and 55% of parents reported stable DRD levels, 20% of children and 14% of parents reported increasing DRD levels, and 20% of children and 31% of parents reported decreasing DRD levels from baseline to 6 months. In the regression model, child HbA1c and DRD scores at baseline significantly predicted child HbA1c 6 months later, β=0.013, t(157)=2.32, p=0.02.ConclusionsAcross 6 months, DRD remained stable or increased in 80% of school-aged children and 69% of parents. Only child HbA1c and DRD at baseline predicted higher child HbA1c 6 months later. Our results suggest it may be valuable to screen families of school-age children for DRD routinely and to develop treatments to help them reduce DRD.

Diabetes Complications in Youth Qualitative analysis of parents’ perspectives of family learning and knowledge Lisa M. Buckloh , PHD 1 , Amanda S. Lochrie , PHD 1 , Holly Antal , PHD 1 , Amy Milkes , MA 2 , J. Atilio Canas , MD 1 , Sally Hutchinson , RN, PHD 3 and Tim Wysocki , PHD 1 1 Department of Pediatrics, Nemours Children's Clinic, Jacksonville, Florida 2 Department of Biomedical Research, Nemours Children's Clinic, Jacksonville, Florida 3 University of Florida, Gainesville, Florida Corresponding author: Lisa M. Buckloh, lbuckloh{at}nemours.org Abstract OBJECTIVE —Youth with type 1 diabetes face long-term risks of health complications of the disease. Little is known about patients’ and parents’ knowledge, acquisition of information, and family communication regarding these complications. This paper reports qualitative analyses of parental focus-group discussions of this topic. RESEARCH DESIGN AND METHODS —A total of 47 participants (30 mothers, 14 fathers, and 3 others) representing 33 children between the ages of 8 and 18 years with type 1 diabetes participated in 1 of 13 focus groups. Open-ended questions focused on the type and amount of information about long-term complications presented to parents by health care professionals at different time points, as well as the way that information was presented. Questions also elicited details about parent-child communication and exposure to misconceptions about diabetes complications. RESULTS —Qualitative analysis of the transcribed focus groups revealed that participants experienced significant anxiety about diabetes complications, with a shift from concern about daily management tasks to concern about long-term complications over time. Participants desired a flexible, collaborative educational approach, especially regarding the timing and type of information, relative to the child's age and duration of diabetes. Many parents wanted more sensitive communication and emotional support from health care providers. Motivating children appeared to be a particular challenge; family burnout with regard to diabetes care over time was reported. Knowledge was gained in many ways, yet misinformation was uncommon. CONCLUSIONS —Obtaining information about long-term complications is an important process that changes over the course of the disease and with the child's developmental level. More research is needed, especially regarding youth knowledge, learning, and beliefs about diabetes complications. Footnotes Published ahead of print at http://care.diabetesjournals.org on 28 May 2008. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact. Received December 10, 2007. Accepted May 14, 2008. DIABETES CARE

OBJECTIVE:--Youth with type 1 diabetes face long-term risks of health complications of the disease. Little is known about patients' and parents' knowledge, acquisition of information, and family communication regarding these complications. This paper reports qualitative analyses of parental focus-group discussions of this topic. RESEARCH DESIGN AND METHODS--A total of 47 participants (30 mothers, 14 fathers, and 3 others) representing 33 children between the ages of 8 and 18 years with type 1 diabetes participated in 1 of 13 focus groups. Open-ended questions focused on the type and amount of information about long-term complications presented to parents by health care professionals at different time points, as well as the way that information was presented. Questions also elicited details about parent-child communication and exposure to misconceptions about diabetes complications. RESULTS:--Qualitative analysis of the transcribed focus groups revealed that participants experienced significant anxiety about diabetes complications, with a shift from concern about daily management tasks to concern about long-term complications over time. Participants desired a flexible, collaborative educational approach, especially regarding the timing and type of information, relative to the child's age and duration of diabetes. Many parents wanted more sensitive communication and emotional support from health care providers. Motivating children appeared to be a particular challenge; family burnout with regard to diabetes care over time was reported. Knowledge was gained in many ways, yet misinformation was uncommon. CONCLUSIONS:--Obtaining information about long-term complications is an important process that changes over the course of the disease and with the child's developmental level. More research is needed, especially regarding youth knowledge, learning, and beliefs about diabetes complications.