The purpose of this study was to develop an Internet coping skills training program and to evaluate its feasibility and acceptability compared with an Internet education intervention for teenagers with type 1 diabetes. A multiphase mixed-methods design with focus groups, a randomized pilot study, and a program evaluation was used. Teenagers with type 1 diabetes, parents, and health professionals were included in the development and evaluative phases along with the research and information technology team. The pilot study included 12 teenagers with type 1 diabetes (mean [SD] age, 14.4 [.90] years; 58% female; mean [SD] duration of diabetes, 5.9 [3.0] years). Psychosocial data and HbA 1c levels were collected at baseline and at 3 and 6 months. Results indicate that the development of a psychosocial Internet intervention was complex and required multiple iterations of development and evaluation. Results of this study also indicate the feasibility and acceptability of translating a group-based intervention for teenagers with type 1 diabetes to the Internet. Thus, this study demonstrates a systematic approach to Internet intervention development. Including teenagers with type 1 diabetes and a multidisciplinary professional team into the intervention design was critical to the success of this project. KeywordsAdolescents with type 1 diabetes; Coping skills training program; InternetThe Diabetes Control and Complications Trial demonstrated that in adolescents older than 13 years, intensive management and improved metabolic control reduced complications by 27% to 76%. 1 However, intensive management of type 1 diabetes (T1D) is complex and requires frequent monitoring of blood glucose, frequent insulin injections or use of continuous subcutaneous insulin infusion, and regular visits to healthcare providers. Significant effort on the part of the adolescent and the family is necessary to achieve treatment goals.Normal childhood development can present challenges to T1D management. In adolescence, metabolic control tends to deteriorate as a combined result of insulin resistance that accompanies the hormonal changes of adolescence and lower adherence to the treatment regimen often associated with the desire for autonomy. 2 The shift from parental support to peer support is normal during adolescence; however, it can place an adolescent with T1D at increased risk for poorer health outcomes. Fear of nonacceptance with peers may make an adolescent with T1D reluctant to disclose his/her diagnosis or deliberately miss blood glucose monitoring, insulin injections, or boluses, which can cause a decline in metabolic control. 3 Corresponding author: Robin Whittemore, PhD, APRN, Yale School of Nursing, 100 Church St S, New Haven, CT 06536-0740 (robin.whittemore@yale.edu). NIH Public Access Author ManuscriptComput Inform Nurs. Author manuscript; available in PMC 2010 July 15. Published in final edited form as:Comput Inform Nurs. 2010 ; 28(2): 103-111. doi:10.1097/NCN.0b013e3181cd8199. NIH-PA Author ManuscriptNIH-PA Author Manus...

Maternal depression may negatively affect child adjustment through its influence on quality of life, coping, and family functioning. Implications for interventions to improve psychosocial adjustment in children with T1D are discussed.

Background Although it is recognized that caring for a child with type 1 diabetes (T1D) is stressful for parents, few interventions have been developed and tested for this population. Objectives To compare a group educational intervention for parents of children with T1D to a coping skills training intervention. Method Parents of children with T1D were randomized to the group educational (n = 106) or coping skills training (n = 75) conditions. Parents completed measures of family conflict, responsibility for treatment, coping, and quality of life at baseline and 3 months, 6 months, and 12 months postintervention. Clinical data (i.e., HbA1c) were collected from children’s medical records pre- and postintervention. Results There were no significant treatment effects 12 months postintervention, but parents in both groups reported improved coping (p < .001), less responsibility for treatment management (p < .001), and improved quality of life (p = .005). While children’s metabolic control worsened over time, mean values at 12 months were still within the recommended levels in this well-controlled sample (HbA1c < 8%). Discussion Group-based interventions for parents of children with T1D may lessen the impact of treatment management, improving coping and quality of life.

Children with type 1 diabetes are at risk for negative psychosocial and physiological outcomes, particularly as they enter adolescence. The purpose of this randomized trial (n=82) was to determine the effects, mediators, and moderators of a coping skills training intervention (n=53) for school-aged children compared to general diabetes education (n=29). Both groups improved over time, reporting lower impact of diabetes, better coping with diabetes, better diabetes self-efficacy, fewer depressive symptoms, and less parental control. Treatment modality (pump vs. injections) moderated intervention efficacy on select outcomes. Findings suggest that group-based interventions may be beneficial for this age group. Keywords coping skills training; child; type 1 diabetes Effects of Coping Skills Training in School-age Children with Type 1 DiabetesType 1 diabetes (T1D) is one of the most common severe chronic illnesses in children, affecting 1 in every 400 individuals under the age of 20, over 176,000 American youth Corresponding Author: Robin Whittemore, Yale School of Nursing, 100 Church Street South, New Haven, CT 06536-0740, robin.whittemore@yale.edu. NIH Public Access Author ManuscriptRes Nurs Health. Author manuscript; available in PMC 2010 August 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript(National Institute of Diabetes and Digestive and Kidney Disease, 2002). Diabetes is the seventh leading cause of death in the United States, and adults with T1D are twice as likely to die prematurely from complications compared to adults without T1D National Institute of Diabetes and Digestive and Kidney Disease, 2007). Management of T1D is demanding, requiring frequent monitoring of blood glucose levels, monitoring and controlling carbohydrate intake, daily insulin treatment (3-4 injections/day or infusion from a pump), and adjusting insulin dose to match diet and activity patterns (American Diabetes Association, 2008). Such an intensive treatment regimen and maintenance of near-normal glycemic control may delay or prevent long-term complications of T1D by 27-76% (Diabetes Control and Complications Trial [DCCT] Research Group, 1994). Interventions are needed to assist children and families in coping with the considerable demands of living with T1D. The purpose of this study was to evaluate the efficacy of a coping skills training (CST) intervention, specific to school-aged children and their parents, on metabolic control and psychosocial outcomes, and to examine mediators and moderators of these outcomes.Tasks of childhood development can compromise diabetes management. Metabolic control declines during adolescence (Travis, Brouhard, & Schreiner, 1987). Although the physiological changes of puberty contribute to insulin resistance, a premature transfer of responsibility for diabetes-related tasks from parents to children also may result in poor adherence and metabolic control (Anderson, Ho, Brackett, Finkelstein, & Laffel, 1997;Holmes et al., 2006;Schilling, Knafl, & Grey, 2006). As ch...