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Purpose: The purpose of the study was to assess the feasibility and acceptability of a financial stress and health insurance education toolkit developed by a community advisory board for emerging adults, ages 18 to 25, with type 1 diabetes. Methods: This study is a longitudinal, randomized controlled trial that enrolled 39 emerging adults with type 1 diabetes. Participants randomized to the intervention group were given access to the T1D Financial Toolkit, an online financial and health insurance education toolkit, over 30 days. For the present analysis, feasibility was assessed by enrollment and attrition. Optional, qualitative interviews were conducted upon the conclusion of the intervention to evaluate feasibility, acceptability, satisfaction, and key recommendations for improvement. Results: Of the 39 participants who enrolled, 36 completed the study. The intervention period had 100% completion in both the control and intervention groups. Eleven participants from the intervention group completed interviews. Participants described few challenges accessing the toolkit and were highly satisfied with the intervention aesthetics, display, and content. Key recommendations included integrating more applied problem-solving into the experience of watching the videos. Conclusions: The T1D Financial Toolkit is a financial and health insurance education intervention tailored to emerging adults with type 1 diabetes. This resource is feasible, acceptable, and satisfactory. Diabetes care and education specialists can utilize this tool in practice to provide relevant, developmentally tailored education to emerging adults with type 1 diabetes, prompt applied problem-solving, reduce barriers to self-management, and improve psychosocial outcomes.

Background: A 2017 umbrella review defined the technology-enabled self-management (TES) feedback loop associated with a significant reduction in A1C. The purpose of this 2021 review was to develop a taxonomy of intervention attributes in technology-enabled interventions; review recent, high-quality systematic reviews and meta-analyses to determine if the TES framework was described and if elements contribute to improved diabetes outcomes; and to identify gaps in the literature. Methods: We identified key technology attributes needed to describe the active ingredients of TES interventions. We searched multiple databases for English language reviews published between April 2017 and April 2020, focused on PwD (population) receiving diabetes care and education (intervention) using technology-enabled self-management (comparator) in a randomized controlled trial, that impact glycemic, behavioral/psychosocial, and other diabetes self-management outcomes. AMSTAR-2 guidelines were used to assess 50 studies for methodological quality including risk of bias. Results: The TES Taxonomy was developed to standardize the description of technology-enabled interventions; and ensure research uses the taxonomy for replication and evaluation. Of the 26 included reviews, most evaluated smartphones, mobile applications, texting, internet, and telehealth. Twenty-one meta-analyses with the TES feedback loop significantly lowered A1C. Conclusions: Technology-enabled diabetes self-management interventions continue to be associated with improved clinical outcomes. The ongoing rapid adoption and engagement of technology makes it important to focus on uniform measures for behavioral/psychosocial outcomes to highlight healthy coping. Using the TES Taxonomy as a standard approach to describe technology-enabled interventions will support understanding of the impact technology has on diabetes outcomes.

Purpose: It is well documented that chronic conditions, such as diabetes, impact quality of life (QoL). QoL assessment is essential when developing and evaluating diabetes self-management education support interventions. The aim of this systematic review was to evaluate the evidence and gaps in the research and the impact of diabetes self-management education (DSME) on QoL outcomes in persons with type 1 diabetes mellitus (T1DM). Methods A systematic review of English language studies published between January 1, 2007, and March 31, 2020, was conducted using a modified Cochrane review method. Studies were included if they were randomized controlled trials (RCTs), participants had T1DM with or without caregivers, a DSME intervention alone or a component(s) of the ADCES7™ Self-Care Behaviors was described, and QoL was a primary or secondary outcome. A 3-tiered review process was utilized for selecting articles. Retained articles were assessed for risk of bias. Results: Nineteen articles, reporting on 17 RCTs, met inclusion criteria, of which 7 studies reported QoL as the primary outcome and 10 as a secondary outcome. Seven studies detected significant impact of DMSE on QoL outcomes in either the participants or family caregivers, which varied in participant populations, selection of QoL tools (generic vs diabetes-specific), intervention type, intervention length, and type of interventionist. Conclusion: DSME has the potential to influence QoL outcomes in people with T1DM. Research using more standardized methods are needed to delineate impact on a broader range of factors that influence QoL for those living with T1DM across the life span and their caregivers.

Background The purpose of this study is to explore the diabetes self-management education (DSME) needs of emerging adults with type 1 diabetes mellitus (T1DM) because addressing these needs may facilitate optimal glycemic management during this challenging transitional period. Methods A hybrid qualitative design was utilized. Emerging adults and parents of emerging adults were recruited from endocrinology and primary care clinics and through a Utah-specific T1DM online community. Interviews were conducted to asses needs to achieve target A1C. Data were interpreted thematically. Results Emerging adults with T1DM (N = 33) and parents of emerging adults with T1DM (N = 17) were interviewed. Three main themes emerged: (1) mixed desire for personal DSME; (2) I don’t need the education, others do; and (3) health care provider (HCP) attributes that make a difference. Associated subthemes were reported. Conclusions Emerging adults reported that further education for themselves was not needed, although newly diagnosed individuals would benefit from increased training in diabetes management. Although many emerging adults had a supportive social network, they endorsed the need for greater public education to avoid diabetes misinformation. Emerging adults felt more connected with HCPs that had diabetes-specific training (ie, endocrinologist) or those who personally live with T1DM.

OBJECTIVE The aim of this systematic review is to summarize and synthesize existing research on the economic impact of Diabetes Self-Management Education and Support. INTRODUCTION Diabetes Self-Management Education and Support is an essential component of diabetes care, yet it continues to be underutilized. A gap exists regarding the true measured economic impact of this intervention. INCLUSION CRITERIA This review will consider studies that report the measured economic impact and health care utilization of Diabetes Self-Management Education and Support for persons with diabetes or their caregivers. The inclusion criteria are as follows: quantitative studies providing measured data on the economic outcomes and health care utilization of Diabetes Self-Management Education and Support interventions that include at least one of the Association for Diabetes Care and Education Specialists Seven Self-Care Behaviors (ADCES7). METHODS The review will search the following databases: MEDLINE; Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions; Embase; Scopus; CINAHL; ERIC, Cochrane Database of Systematic Reviews; and the Cochrane Register of Controlled Trials. Additionally, a search of the grey literature will be performed using Google Scholar. Date limitations will be from January 2006 to May 2020. Two members of the research team will independently screen abstracts and full texts, and extract data. The screening process will be described using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Articles will be assessed for risk of bias using the JBI critical appraisal tools. Data will be narratively summarized. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42020166743).

PurposeValue-driven outcomes are important because health systems determine sustainability of diabetes self-management education and support (DSMES) programming. Health care utilization and clinical outcomes are critical factors when considering the impact of DSMES programs.ObjectiveThe aim of this systematic review was to describe studies that report on the economic and health care utilization outcomes of diabetes self-management programs.MethodsA systematic literature review was performed in multiple databases. Studies reporting economic and health care utilization outcomes related to DSMES and including 1 or more of the ADCES7 Self-Care BehaviorsTM from January 2006 to May 2020 were included. Eligible articles needed to compare the intervention and comparison group and report on economic impact. The methodological quality was assessed with the Joanna Briggs Institute Critical Appraisal Checklist specific to each individual study design.ResultsA total of 22 of 14 556 articles published between 2007 and 2020 were included. Cost benefits varied, and there were considerable methodological heterogeneity among design, economic measures, population, perspective, intervention, and biophysical outcomes.ConclusionDSMES interventions may positively impact economic outcomes and/or health care utilization, although not all studies showed consistent benefit. This review highlights an evidence gap, and future health economic evaluations are warranted.

Mothers of infants in the neonatal intensive care unit (NICU) face stressors including turbulent emotions from their pregnancy/unexpected preterm delivery and their infant's unpredictable health status. The study purpose was to examine the psychological state of mothers prior to the discharge of their technology-dependent infants (eg, feeding tubes, supplemental oxygen) from the NICU to home. The study sample consisted of mothers (N = 19) of infants dependent on medical technology being discharged from a large Midwest NICU. A descriptive, correlational design using convenience sampling was employed to recruit mothers to examine associations of infant and maternal factors, resourcefulness, and stress with psychological state (depressive symptoms, posttraumatic stress symptoms). Forty-two percent of mothers were at high risk for clinical depression, with 37% in the clinical range for posttraumatic stress disorder. Increased maternal depressive symptoms were significantly associated with the increased frequency and perceived difficulty of their stress and posttraumatic stress symptoms. Increased posttraumatic stress symptoms were significantly associated solely with elevated depressive symptoms. This study identified factors associated with the mothers' increased psychological distress, providing beginning evidence for future interventions to employ prior to their technology-dependent infant's NICU discharge.

OBJECTIVE To describe the relationships among financial stress factors (perceived stress, financial stress, and financial independence) and psychological factors (depressive symptoms, trait anxiety, and diabetes distress) on self-management outcomes (HbA1c and diabetes-related quality of life) in emerging adults with type 1 diabetes. RESEARCH DESIGN AND METHODS A descriptive, correlational, cross-sectional study examined 413 emerging adults, ages 18-25, from the Type 1 Diabetes Exchange Clinic Registry. Data were collected via REDCap surveys using the Personal Financial Well-Being Scale, Willingness to Pay Scale, Financial Independence Visual Analog Scale, Center for Epidemiological Studies-Depression Inventory, State-Trait Anxiety Inventory, The Type 1 Diabetes Distress Scale, and Diabetes Quality of Life Measure. Hierarchical Multiple Regression analyses explored significant barriers to self-management outcomes. RESULTS Hierarchical Multiple Regression analyses revealed that 20.6% of variance in HbA1c (F = 15.555, p

Aim The research purpose was to determine whether exposure to residential diabetes camps affects attitudes toward diabetes care and management in nursing students. Background Summer camp for children with type 1 diabetes mellitus (T1D) provides a unique and engaging clinical environment for nursing students to learn about evolving diabetes care and to help children develop diabetes management skills. Methods This prospective, pretest/posttest study assessed student nurses' attitudes about diabetes, who attended one of four residential summer camps in the United States, using the Diabetes Attitude Survey 3 (DAS3). The survey was administered before and after clinical experience designed to fulfill experiential curricula requirements from various nursing programs. Results After attending diabetes camp, nursing students (N = 73) had a positive change in their attitudes regarding the need for special training and the psychosocial impact of diabetes. Discussion The diabetes camp clinical experience impacted nursing students' attitudes. Diabetes camps are a unique clinical setting that uses learned clinical knowledge and judgment to promote health and prevent disease and disability, supporting the integration of primary care and public health nursing.

Purpose The purpose of the study was to examine the association between 3 lifestyle behaviors (smoking, physical activity, and fruit and vegetable consumption) and health-related quality of life (HRQOL) among older adults diagnosed with diabetes. Methods A sample of the US population 65 years and older who were diagnosed with diabetes from the 2015 Behavioral Risk factor Surveillance System (N = 11 503) was analyzed. The 4 HRQOL measures were self-rated health, physically unhealthy days, mentally unhealthy days, and impaired activity days in the past month. Multiple logistic regression analysis was conducted to predict HRQOL. Results The multiple logistic regression results showed that smoking and lack of physical activity were significant predictors for higher odds of fair or poor self-rated health, more physically unhealthy days, more mentally unhealthy days, and more impaired activity days during past 30 days. No significant relationship was found between fruit and vegetable consumption and any HRQOL measure. Conclusions Findings imply that diabetes education could continue and enhance efforts in smoking cessation and increase physical activity to promote the HRQOL among older adults diagnosed with diabetes. In addition, the measure of fruit and vegetable consumption should be further studied to reflect the needs of older adults with diabetes.

Technology-dependent (TD) children require complex care and are dependent on medical technology. Approximately 75% of families, in the United States, who are caring for a TD child, also care for a well child. Well siblings are likely to be affected by the experience of living with a TD sibling as the process of family normalization is described as a family affair. The experiences of well siblings are not well described. The purpose of this qualitative analysis was to describe the experiences of well siblings who are living in a family with a TD child. Mothers were interviewed about the experiences of their well children and were digitally audio recorded. The interviews were transcribed, and content analysis was conducted. Content analysis from the interviews revealed the major themes of well sibling adjustment within the family unit, upside (altruistic, prosocial behaviors) and downside (negative internal and external processing behaviors). These results can be applied to advance the delivery of family nursing care offered to these families.

PurposeThe transition from the NICU to home is a complicated, challenging process for mothers of infants dependent on lifesaving medical technology, such as feeding tubes, supplemental oxygen, tracheostomies, and mechanical ventilation. The study purpose was to explore how these mothers perceive their transition experiences just prior to and during the first three months after initial NICU discharge.DesignA qualitative, descriptive, longitudinal design was employed.SampleNineteen mothers of infants dependent on lifesaving technology were recruited from a large Midwest NICU.Main Outcome VariableDescription of mothers' transition experience.ResultsThree themes were identified pretransition: negative emotions, positive cognitive-behavioral efforts, and preparation for life at home. Two posttransition themes were negative and positive transition experiences. Throughout the transition, the mothers expressed heightened anxiety, fear, and stress about life-threatening situations that did not abate over time despite the discharge education received.

Resourcefulness, a set of cognitive and behavioral skills used to attain, maintain, or regain health, is a factor related to depressive symptoms in mothers of children with chronic conditions and complex care needs who are dependent on medical technology such as mechanical ventilation or feeding tubes. The purpose of this secondary analysis of a randomized, controlled pilot intervention study was to determine the feasibility, acceptability and fidelity of daily journal writing as a method of reinforcement of resourcefulness training (RT) that teaches the use of social and personal resourcefulness skills. Participants returned their journals to the study office at the end of the four-week journaling exercise. Content analysis from exit interviews and journals supported the feasibility, acceptability and fidelity of daily journaling for reinforcement of RT in this population. Journal writing can be used by pediatric nurses to reinforce and promote resourcefulness skill use in parents of technology-dependent children.

The population of children who are dependent on life-sustaining medical technology in the United States is over 600,000 and continues to grow (U.S. Department of Health and Human Services, 2013). Technology-dependent children have complex, chronic conditions and are dependent on technology such as mechanical ventilation, intravenous nutrition or medication, respiratory support or nutritional support to live (Toly, Musil & Carl, 2012a; Spratling, 2015). Advances in medical technology allow technology-dependent children to live longer. Yet, the care associated with technology significantly impacts individual family members and family life on a daily basis over an indefinite period (Toly et al., 2012a; Caicedo, 2014; Caicedo, 2015). Following the technology-dependent child’s discharge to home, families begin to adjust to the change imposed by caring for a child with these complex care needs by creating a new “normal.” This new normal requires that the parent respond to the situation and adapt their lifestyle to accommodate the healthcare needs of the child (Toly et al., 2012a; Knafl & Deatrick, 2003). This process, referred to as normalization in the literature, begins with accepting the reality of the child’s condition and the potential lifestyle and family changes needed to manage the child’s condition (Deatrick, Knafl, & Murphy-Moore, 1999; Knafl et al., 2013). When normalization is present, parents feel competent in caring for the complex healthcare needs of their children and incorporating the medical management into their family lifestyle and routines (Deatrick et al., 1999; Knafl et al., 2013; Rehm, 2005). These families adopt unique solutions for solving the problems they experience and adjust the environment to provide their children with as many everyday childhood experiences as a typical, normally developing child (Leyenaar, O’Brien, Leslie, Lindenauer, & Mangione-Smith, 2017). Families caring for a technology-dependent child at home must learn to restructure goals based on balancing daily family life with their children’s required medical technology to keep the child stable and healthy while concomitantly maintaining a functioning family (Toly et al., 2012a; Toly, Musil & Carl, 2012b). When parents feel like they fully understand their children’s medical condition, they perceive the condition management as less burdensome and have greater confidence in their parenting skills (Deatrick et al., 1999; Sav et al., 2015; Smith, Cheater, & Bekker, 2015). Other families struggle in their normalization efforts and experience unresolved problems in the day-to-day medical management of their children’s condition (Gonzalez et al., 2017; Knafl & Deatrick, 2003). Parents face challenges in balancing normalcy, family life, household needs, and medical care or treatment needs of their technology-dependent child. The constant change in the care needs of the technology-dependent child and unpredictability of the child’s health status can lead parents to focus on the child’s health schedule and routine to the detriment of other family roles and responsibilities (Leyenaar et al., 2017; Smith et al., 2015). 1.1. Study Purpose The purpose of this study was to identify the day-to-day management problems and solutions employed by mothers of technology-dependent children. At this time, there is little information to assist parent caregivers with the day-to-day management problems they might experience while caring for their technology-dependent children at home (Dybwik, Tollali, Nielsen, & Brinchmann, 2011). Thus, exploring management problems and solutions to these problems is warranted.