Abstract
Diabetes is a significant public health challenge that affects populations of all ages, ethnicities, and socioeconomic groups. The disease requires daily self-management, and their caregivers’ control frequently influences the related habits developed by the affected individuals in childhood and adolescence. This paper explores if regulating parental involvement can result in better health outcomes such as more consistent conditions maintenance, reduced stress, and improved inter-family relationships. The case-control epidemiologic study design was selected, data was collected through surveys and questionnaires, and the results were measured through follow-ups. The behavioral intervention was chosen to address the challenge and evaluate the outcomes from a health and social impact perspective. The results suggested that the self-management attitudes of adolescents with diabetes influenced their parent’s control, and educational programs were beneficial for correcting the deviations.
Introduction
The health of any population depends on various factors, such as genetics, environment, economy, psychosocial aspects, and overall lifestyle tendencies. Consequently, epidemiological research about diseases must view the issue from several perspectives simultaneously to achieve considerable results. Diabetes, as one of the most significant modern health challenges, is the case where observational studies consider different conditions, their correlations, and consequences. Moreover, disease development and prevention varies for individuals with specific genetic, socioeconomic, and environmental circumstances; therefore, evidence-based research requires narrowing the topic to a particular population (Chow et al., 2018). For instance, diabetes management is commonly performed under parental surveillance, overuse of which can lead to the lack of self-control in adolescence, worsening the chronic conditions (Eva et al., 2018). This paper aims to discuss how epidemiological research can be applied to study how the parents’ intervention influences an adolescent’s self-management with diabetes.
The Problem
Diabetes is a widespread disease for many countries and populations, including the United States, and it severely influences national mortality rates. As the condition is chronic, has a genetic predisposition, and can be triggered by numerous environmental factors, individuals can develop it early on (Chow et al., 2018). Furthermore, diabetes requires continuous control, and adults are involved in supporting their child’s well-being. In a home environment where parental intervention is considerable, a young individual with diabetes might maintain comfortable blood sugar levels, timely receive medication, and stay safe from environmental agents. However, as adolescence begins, parents’ authority decreases and the aspiration to be independent can reveal that a teenager lacks self-management skills and control over their diabetes (Rankin et al., 2018). The issue appears due to the intense parents’ intervention during childhood and the risk-absent home environment.
Person
Diabetes development and exposure are strongly tied to lifestyle, and the increasing incidents’ rate emphasizes the severity of the population health problem. Today people can easily access numerous variations of unhealthy foods, have a sedentary lifestyle, and delay medical checkups due to the costs of healthcare services. Consequently, a modern person lives at a high risk of diabetes, and individuals who already have this chronic illness are in danger of worsening their health. Genetic predisposition contributes approximately 60% of susceptibility by affecting insulin processing and chromosomes, and the deviation is hereditary (Gamboa et al., 2017). Moreover, diabetes development is tied to environmental agents such as air pollution, low-quality water, unhealthy diet, frequent stress, vitamins deficiency, and decreased physical activity (Gamboa et al., 2017). Most individuals have at least two of these external triggers in their lifestyle, increasing the risk of illness occurrence.
Diabetes requires self-management, and adolescents are the population with the most challenging situation around controlling their conditions. Indeed, hormonal changes, desire to socialize, difficulties in relationships with adults can have severe outcomes (Rankin et al., 2018). However, controlling skills taught by the parents during childhood and providing children with sufficient independence to learn self-management can considerably help adolescents deal with diabetes. As the selected age is transformative for a person, the outcomes of poor self-support traits might lead to severe consequences’ appearance in the future.
Place
Diabetes is a national healthcare challenge in the United States due to its economical cost and influence on mortality rates. Indeed, 10% of the US population have diabetes, and 34% have pre-disease conditions (Centers for Disease Control and Prevention [CDC], 2020). Different cultures, ethnicities, and racial groups live in the United States, and this circumstance complicates disease treatment and prevention. A diverse population does not have a unified set of genetic predispositions, people live in dissimilar environments, and although the place is the same country, the external agents and risks vary (Gamboa et al., 2017). Adolescents who live in households with low socioeconomic conditions or have an unhealthy atmosphere in their families can lack the ability to properly self-manage their diabetes.
Time
Modern prevention and treatment technologies continuously improve; however, diabetes remains a significant challenge for healthcare services nationwide. Moreover, the COVID-19 pandemic complicates chronic diseases’ management and limits the resources by forcing facilities to prioritize the infection spread (Cardona‐Hernandez et al., 2021). Adolescents, among other diabetics, must improve their self-management approaches and integrate them with the COVID-19 prevention regulations. The recent times’ circumstances are also challenging to address by the parents whose worries increase and can cause more intense control over their children with diabetes.
The Problem’s Magnitude
Millions of citizens of diverse cultural and racial backgrounds have diabetes or have risks increasing lifestyle and environment. CDC (2020) states that “210,000 children and adolescents younger than age 20 years—or 25 per 10,000 US youths— had diagnosed diabetes” (para. 4). Moreover, the trend of growing incidence in the selected age group exists, specifically among Hispanic and African American populations (CDC, 2020). Considering that adolescents are the country’s future, and the rates of diabetes tend to grow, the magnitude of the problem is immense. Teenagers’ ability to maintain optimal conditions through self-management is crucial for making the next generations healthier.
Research Question
Most health-related habits and conditions maintenance attitudes are developed during childhood, yet the parents of children with diabetes might severely influence the process. Adolescence is the period when self-management is the most challenging due to hormonal and psychological changes; therefore, teenagers without solid disease control habits might worsen their conditions (Rankin et al., 2018). Based on the data research and the problem’s identification, the research question can be “How does the parents’ intervention influence an adolescent’s self-management with diabetes?”
Research Methods
Epidemiologic Study Design
Self-management of adolescent diabetics and their parents’ control can be explored via an epidemiologic study. The observational design would provide a significant scope of data to assess from various perspectives and make a foundation to develop approaches for addressing the selected population health problem. Epidemiologic studies are commonly separated on cohort, cross-sectional, and case-control, and the appropriate format must be identified based on the type of data necessary for achieving results answering the initial question (Friis & Sellers, 2021). The third type of research design is the most appropriate for assessing the challenges of self-management among teenagers with diabetes. Case-control studies require dividing a population into groups, doing experiments, and driving conclusions based on the outcomes of implementations (Friis & Sellers, 2021). Indeed, separating the adolescents according to their parent’s involvement in controlling diabetes is beneficial for admitting or denying the research question.
Adolescents’ ability to properly manage their diabetic conditions is the outcome of past activities of their parents. The case-control epidemiologic study design is suitable for conclusions based on retrospective information (Friis & Sellers, 2021). Experiments on the groups are necessary to admit the parental intervention’s influence on how teenagers deal with self-management. Besides, the observational study design is beneficial for identifying certain distinguishes between attitudes of diabetics, and further studies would use the data for developing the most effective diabetes control strategies for adolescents.
Assessment Strategies
The assessment strategy is crucial for pointing out the study direction, selection of tools, and data collection approaches; therefore, it must comply with the research design and question. Families with identified low levels of past parental intervention to diabetes management for the case-control structure can be selected as a control group. Furthermore, to exclude other factors such as genetic predisposition to specific conditions of the disease and adolescent changes, and cultural backgrounds, no representatives of specific ethnic populations or ages’ must dominate at any group (Belbasis & Bellou, 2018). Tools such as surveys and questionnaires would be used for the selection to help researchers gather sufficient information to divide the participants (Belbasis & Bellou, 2018). Methods, where communication with participants is included are convenient for the case-control study because they allow the data collection process and retrieve crucial details that might influence the entire research.
A case-control study of the interdependence between parental control and adolescents’ diabetes self-management would benefit from including experiments. For instance, the same strategies for communication can be offered to the parents for influencing their relationships with children. On the other hand, teenagers can be provided to learn a new self-management approach to dealing with diabetes. Participants who obtain the novel strategy faster and more effectively would be considered more capable of controlling their conditions (Gamboa et al., 2017). The experimental section of the study would require surveying before and after the activity and observation of the tasks’ performance (Friis & Sellers, 2021). The range and diverse basis of tools might become inconvenient for researchers because such a program is time-consuming. However, the scope of data obtained from communicating with participants and observing them during the experiment is significant for the verification of the results.
Data Collection Activities
Data collection for the case-control study must be performed on different research studies. The initial segmentation, basic information, and identification of parents’ intervention assessment require surveys and interviews. The former can be performed remotely and is necessary to identify participants’ backgrounds and exclude the specific conditions of the children’s diabetes (Parast & Paknahad, 2017). Interviews would benefit from conducting in an in-person format and would help evaluate the level of parents’ involvement in the disease management and understand how adolescents perceive the control approaches of their families. After the experiment part of the research, the questionnaires about the experience can be distributed among participants to reveal the patterns in the reactions and make conclusions (Belbasis & Bellou, 2018). Researchers might require implementing tagging, categorizing, or coding the collected information to optimize further analysis and notice tendencies or changes during the study.
The Intervention
The intervention strategies to address the problem of parents’ influence on diabetes self-management among adolescents depend on the selected epidemiological study design. The observational framework is beneficial because it results in a considerable scope of data crucial to set a foundation for developing population health problem addressing approaches. A case-control format of an epidemiological study is applicable for assessing the challenges of self-management among teenagers with diabetes (Friis & Sellers, 2021). Adolescents’ ability to properly manage their diabetic conditions is the outcome of past activities of their parents.
The results of a case-control study about the parent’s influence on adolescents’ self-management with diabetes suggest that both involved sides need to be affected to make a significant change. Consequently, the interference must address the parental control attitudes and the children’s perception of their conditions. The common types of public health interventions based on the descriptive case-control studies are related to screening, vaccinating recommendations, updates in nutritional patterns, or behavioral changes (Friis & Sellers, 2021). The latter is appropriate for influencing adolescents’ self-management because the activities requiring revision are habitual. Besides, parents’ attitudes towards controlling and assisting their children with diabetes are also tied to routine actions they developed.
Behavioral public health intervention contains promotional and educational programs created to influence individuals’ attitudes towards preventing disease outbreaks or decreasing mortality. For instance, the diabetes-related media campaigns address the scientifically-approved connection between habitual consumption of sugary products and the risk of getting ill by promoting healthier ways of acting (Eva et al., 2018). As the selected health challenge is based on a specific and reachable audience – adolescents and their parents, the educational intervention is more appropriate than the promotional. The consultations, helpful guidelines, and access to professional diabetes-related practitioners would be included in the influential strategy (Eva et al., 2018). Based on the results of the case-control study’s results suggesting that parents’ influence on their children’s self-management attitudes is significant, the most appropriate intervention is to create an educational program. The intervention’s outline must contain methods for evaluating the problem’s significance in a certain family, types and descriptions of activities, their influence on parents and adolescents, and the minimal results to achieve.
The Intervention Outline
Problem Assessment Methods
Families have diverse relationships and values, and the case-control study’s results revealed that the aspect of how parents interact with their children has a significant influence on diabetes self-management attitudes. Consequently, assessing how complex the communication is and how strong the supervision of adolescents is necessary for selecting the proper interventional strategy. The methods must contain the benchmarks to identify if there are severe interaction issues that require psychologists’ interference and understand who primarily needs the intervention – a child or parents (Friis & Sellers, 2021). The first method is reviewing the diabetes history in a family to retrieve the patterns and register when the crisis conditions occurred. The second strategy is to interview the participants separately to reveal if the adolescent has severe self-management issues and if the parents have developed harmful controlling attitudes (Carpenter, DiChiacchio, & Barker, 2019). The last approach is to ask the participants to describe how the diabetes management is performed to understand if they know the proper practices.
Interventional Activities
When performed through educational programs, behavioral public health intervention can contain multiple activities performed separately or simultaneously. The most effective approach is to develop lectures for parents who have pre-adolescent children with diabetes and include them in the required treatment strategy (Felix et al., 2020). For instance, educational meetings can be conducted at local healthcare facilities, and attending them must be necessary. Interventional activities for adolescents should contain educational handouts about self-management standards to follow for maintaining stable conditions. The children need to receive a consultation with a psychologist who would describe them when the personal boundaries can be established and how to improve communication with the parents (Felix et al., 2020). Furthermore, educational intervention requires specialists to develop and distribute materials about the importance of proper diabetes management.
Influence on Parents
How the public health intervention would influence all the individuals involved are included in an outline to help the responsible specialists timely revise and improve the program’s quality. The educational campaign must help the parents develop the correct attitude towards controlling their pre-adolescent and adolescent children (Eva et al., 2018). Consequently, the intervention needs to include several checking activities, such as consultation for parents (Carpenter et al., 2019). Besides, the program can contain brochures developed based on the most frequent questions and crisis situations’ descriptions to help the parents deal with difficulties.
Influence on Adolescents
Adolescents who have already developed severe habits for their diabetes self-management might protest against one’s intervention in their life. Showing the example through role models or tailoring the message about the harmful consequences of self-mistreatment are crucial (Eva et al., 2018). Also, adolescents might experience difficulties at school or be abused; thus, consultations with trustworthy specialists are required for the program (Eva et al., 2018). For instance, local administration can assign psychologists to each pediatric clinic’s diabetes department to address the population health problem.
Minimal Expected Results
The intervention’s expected results must be included in the outline to define and adjust the educational program’s efficiency. Indeed, the minimal outcomes can be divided into three groups: adolescents’ self-management quality, changes in parents’ behaviors, and overall family situation (Carpenter et al., 2019). The first can be considered achieved if a child controls their diabetes without additional stress or parental interference. The changes in parents’ attitudes can be positively evaluated if their lack of influence on self-management does not lead to the diabetes conditions worsening. Lastly, the family situation evaluation can reveal the positive impact if a child’s disease does not influence the relationships. To retrieve and analyze the minimal expected results, a descriptive case-control study is necessary to be conducted, and the intervention is then revised based on the new developments.
Literature Review
The interventions that have already been developed to improve self-management suggest that life with diabetes can become comfortable if individuals learn to control their conditions properly. Indeed, one study reviewed the family-based interventions targeting improvements in health and family outcomes and revealed the positive impact on children’s conditions and management attitudes (Feldman et al., 2018). The research was primarily based on glycemic control-related procedures, and the outcomes of educating the people about proper practices were family-centered (Feldman et al., 2018). Awareness of all members about diabetes management improved the relationships between them and made an affected adolescent feel more confident and comfortable.
Another study explored how the educational intervention targeted to the parents of adolescents with diabetes impacts the latter’s conditions. Felix et al. (2020) claim that “diabetes self-management education (DSME) programs that engage the families of patients with diabetes have shown to be effective in improving diabetes-related outcomes of the patients” (p. 121). The study’s results also revealed that the parents tend to have low attendance to the program’s sections dedicated to their own health and well-being (Felix et al., 2020). Lastly, the interventions aimed to educate the adolescents about proper diabetes self-management were studied based on the patients’ self-care attitudes (Eva et al., 2018). The studies suggested that young people’s habits can be influenced to receive better health outcomes and improve their lifestyle.
The Impact
The way parents comply with their pre-adolescent children’s diabetes control significantly influences the attitudes which will be asserted during adolescence. Chronic disease self-management is crucial for each individual because it impacts their quality of life; thus, the correct habits must be developed (Felix et al., 2020). The intervention outcomes start from the improvement of one’s life and expand to the entire society where families learn how to deal with diabetes, and the affected adolescents do not experience severe issues.
The impact of the behavioral intervention to influence how parents control their adolescents with diabetes self-management can be viewed from the family perspective and from an affected child’s. The latter, if they develop the correct attitudes based on the educational meetings, consultations, and other interferences, will have a more fulfilling life and experience less stress about their conditions (Eva et al., 2018). From a family perspective, the impact of intervention can be considered positive if a child feels more freedom in self-expression and the parents decrease the pressure on managing diabetes.
Health Outcomes
The health outcome of the behavioral intervention based on educational programs for adolescents and their parents is if the former would become independent in their diabetes control. Furthermore, the proper self-management strategies obtained and applied into the daily practice by the affected individuals would be a significant improvement (Carpenter et al., 2019). Lastly, family relationships improvement and the ability for adolescents to set boundaries is an essential mental health outcome expected from the intervention.
Diabetes is a significant public health challenge, and the outcomes of any intervention can improve the overall statistics. Indeed, more than 10% of the United States’ population had diabetes in 2020, and the numbers continue to grow (CDC, 2020). Behavioral intervention helps improve the habits of the affected and increases the awareness of people around them to consider preventative measures. Mental health outcomes can also enhance an individual’s life with diabetes as their habits and overall conditions would not be perceived as a complex or unmanageable challenge.
Social Impact
The social impact of the intervention, which addresses the problem of parental influence diabetes self-management among adolescents, can be viewed from three perspectives. Firstly, the quality of relationships in a family is critical for the overall situation in society, and the improvements in this aspect are beneficial for populations’ well-being (Felix et al., 2020). Secondly, support and proper education are given to adolescents can help raise a mentally and physically healthier generation and profoundly influence the future of a nation (Friis & Sellers, 2021). Lastly, the increased attention to chronic diseases such as diabetes impacts society as it forces the government and healthcare providers to enhance the prevention measures.
The intervention’s impacts on society can also be measured through the prevalence rates decrease, which can be achieved through behavioral shifts. CDC (2020) claims that 210,000 children and adolescents younger than age 20 years—or 25 per 10,000 US youths—had been diagnosed with diabetes in 2018. If adolescents develop a healthy relationship with themselves and perceive their diabetes conditions as normal, they will openly speak about it and encourage others around them to take preventative actions. The positive social change would result in healthier future generations and, consequently, the decreasing prevalence rates in the United States.
Diabetes is a chronic disease that requires daily management, and an affected individual’s well-being must develop correct habits and control conditions’ attitudes. The intervention to influence parental involvement in their children’s perception of illness and approaches to administrate is based on the case-control studies and is dedicated to making behavioral change (Feldman et al., 2018). The selected health challenge can be addressed on a specific audience; therefore, educational strategy is beneficial for achieving the results and measuring the outcomes. This paper aims to discuss the intervention to study the influence of parents’ intervention on adolescents’ self-management with diabetes and to create the outcomes’ evaluation plan.
Healthcare Interventions Outcomes Evaluation
Healthcare interventions must contain measurable variables to make it possible to evaluate the outcomes and adjust the strategies to increase their effectiveness. The process can be performed systematically or empirically, and in the case of addressing parents’ influence on their children’s diabetes self-management, both assessments are applicable (Felix et al., 2020). The interventional activities, such as educational meetings for caregivers, consultations, and handouts about self-management standards to follow for maintaining stable conditions, can be evaluated through the outcomes’ rating and analysis.
The intervention included interactions with adolescents and parents; therefore, assessment systems must separately explore the results and collect the data necessary to make conclusions about the program’s effectiveness. Consequently, the observational design based on communication with participants and complying with the pre-set results is the workable approach for evaluating the outcomes (Villalobos et al., 2020). The plan must address the initial study’s results and the interventions’ expected consequences and provide a considerable basis for further improvement. Primary observations concluded that adolescents’ attitudes are dependent on the range of control their parents have on diabetes management and over-ruling how children’s conditions have a severe influence on correct habits development.
The Outcomes’ Evaluation Plan
Theoretical Basis Review
Theoretical basis suggests that diabetes self-management is developed among children in their pre-adolescent period and then solidates through the teenage years. Consequently, to evaluate the intervention outcomes for adolescents, it is crucial to review the data related to the problem’s urgency and set the benchmarks to assess if the results are achieved (Miyamoto et al., 2019). Theoretical information can be re-assessed through analysis of the recent studies about diabetes self-management and the selection of standards to consider the outcomes as successful.
Influence Evaluation on Parents
The observational approach to evaluate intervention outcomes must be based on direct communication with the parents. Local facilities where educational programs were established can organize additional consultations to identify what bothers parents after the behavioral changes occur. Furthermore, the intervention can be evaluated by measuring if their interest in disease management increased among caregivers and their questions became more specific (Feldman et al., 2018). The quantitative side of the assessment can be performed by calculating the attendance and the number of educational handouts brought home (Villalobos et al., 2020). The expected outcome of the intervention was that parents would decrease their pressure and control on adolescents’ diabetes management. Consequently, behavioral change is beneficial if they mention the increased trust and tranquility in relationships with children.
Influence Evaluation on Adolescents’ Self-Management
Developing proper self-management habits and decreasing the stress of chronic disease are the two primary goals of the intervention; thus, systematic and empirical evaluations must be performed to identify the results. The observational assessment can contain consultations with participants and calculations of overall improvement rating (Miyamoto et al., 2019). For instance, data analysis can be based on how adolescents communicate with their parents, how the control of their condition is maintained, and if they feel any improvements. The collected responses coded and merged into themes’ would suggest if the change has been achieved compared to how the participants responded during the pre-interventional study.
Social Outcomes Assessment
Social outcomes require multiple evaluation approaches, such as assessing the family situation in general and how adolescents feel about themselves with their peers and parents. Moreover, the increased attention to chronic disease conditions’ support can be considered a positive effect (Clarke et al., 2019). For instance, new programs for teenagers, promotional campaigns, increased accessibility of treatment, and changes in parents’ attitudes towards their children’s self-management can be observed after the intervention. These events can be measured by checking local press for a set period, such as one year, and searching the materials that contain “diabetes” as a keyword (Clarke et al., 2019). Social outcomes can also be evaluated long-term as the perception of diabetes changes and self-management practices improve.
Conclusion
Diabetes is a chronic disease that demands daily control and self-management, which cannot be successfully performed without proper habits development. Most conditions maintenance attitudes are developed during childhood, yet the affected children’s parents might severely influence the process, and epidemiologic research can support or deny that statement. Adolescence is the period when self-management is the most challenging due to hormonal and psychological changes; therefore, teenagers without solid diabetes control habits might worsen their conditions. The case-control study design is the most appropriate because it provides a foundation to test a question and achieve objective results. Participants would be surveyed, divided into two groups, and the experiments related to the parents’ communicational approaches and adolescents’ learning capabilities would be performed. Data collection tools would include interviews, questionnaires, surveys, and observations during the experimental activities part of the study. The research results would offer evidence for identifying how the parents’ intervention influences an adolescent’s self-management with diabetes.
Diabetes-related intervention to address the population health problem of parents’ influence on adolescents’ self-management must impact the behaviors and habits of the involved individuals. The most appropriate method is education with the integration of programs, lectures, brochures, and consultations. Addressing the diabetes control problem is impactful for personal health and society. Indeed, the knowledge about proper self-management of a chronic condition improves one’s quality of life, and the changes in family relationships are crucial for making a population healthier mentally and physically.
The challenge of investigating the influence of parents’ control over their adolescent children with diabetes self-management has been discovered through case-control study, and the intervention based on the research results has been developed by making the behavioral change. Consequently, educational programs, handouts, and consultations have been created to address the problem and influence how adolescents and their parents perceive diabetes management. The expected outcomes included the improvement of relationships in families and better-controlling behaviors of the children; thus, the evaluation strategies addressed all participants separately. The assessment plan included observational studies, data collection, and interview analysis, which revealed the trends and themes of diabetes management approaches in the selected families.
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