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      Enhancing Parental Motivation to Monitor African American Adolescents’ Diabetes Care: Development and Beta Test of a Brief Computer-Delivered Intervention

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          Abstract

          Background

          African American youth are at increased risk for poor diabetes management. Parenting behaviors such as parental monitoring are significant predictors of youth diabetes management and metabolic control, but no intervention has targeted parental monitoring of daily diabetes care.

          Objective

          The purpose of the present study was to develop and pilot test a three-session computer-delivered intervention to enhance parental motivation to monitor African American pre-adolescents’ diabetes management.

          Methods

          The 3 Ms (Medication, Meter, and Meals) intervention was based on the Information-Motivation-Behavioral Skills (IMB) model of health behavior change and Motivational Interviewing approaches. Five caregivers of African American youth aged 10-13 years diagnosed with type 1 diabetes for a minimum of one year (ie, the target population) reviewed the intervention and provided feedback via semi-structured interviews. Interviews were transcribed and analyzed using thematic analysis.

          Results

          Caregivers’ responses to interview questions suggest that The 3 Ms was helpful (minimum rating was 8 out of 10) and they would recommend the program to another parent of a child with diabetes (minimum rating was 9 out of 10). Three of five reported that The 3 Ms program increased the likelihood that they would talk to their child about diabetes. Thematic analysis suggested two primary themes: caregivers found the intervention to be a useful reminder of the importance of supervising their child’s diabetes care and that it evoked a feeling of shared experience with other parents.

          Conclusions

          The 3 Ms computer-delivered intervention for increasing parental monitoring of African-American youth with type 1 diabetes was well-received and highly rated by a small sample of representative caregivers.

          Trial Registration

          ClinicalTrials.gov NCT01515930; http://clinicaltrials.gov/ct2/show/NCT01515930 (Archived by WebCite at http://www.webcitation.org/6Rm0vq9pn).

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          Most cited references63

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          The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials.

          A meta-analysis was conducted on controlled clinical trials investigating adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors. AMIs were equivalent to other active treatments and yielded moderate effects (from .25 to .57) compared with no treatment and/or placebo for problems involving alcohol, drugs, and diet and exercise. Results did not support the efficacy of AMIs for smoking or HIV-risk behaviors. AMIs showed clinical impact, with 51% improvement rates, a 56% reduction in client drinking, and moderate effect sizes on social impact measures (d=0.47). Potential moderators (comparative dose, AMI format, and problem area) were identified using both homogeneity analyses and exploratory multiple regression. Results are compared with other review results and suggestions for future research are offered.
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            Impaired insulin action in puberty. A contributing factor to poor glycemic control in adolescents with diabetes.

            Patients with insulin-dependent diabetes mellitus often have poor metabolic control during puberty. To determine whether puberty is associated with decreased insulin-stimulated glucose metabolism, we compared the results of euglycemic insulin-clamp studies in adults and prepubertal and pubertal children with and without insulin-dependent diabetes. In nondiabetic pubertal children, insulin-stimulated glucose metabolism (201 +/- 12 mg per square meter of body surface area per minute) was sharply reduced, as compared with that of prepubertal children and adults (316 +/- 34 and 290 +/- 21 mg per square meter, respectively; P less than 0.01), despite comparable hyperinsulinemia (insulin levels of 80 to 90 microU per milliliter). Similarly, the response to insulin was 25 to 30 percent lower in the diabetic pubertal children than in the diabetic prepubertal children (P less than 0.05) and adults (P = 0.07). At each stage of development, the stimulating effect of insulin on glucose metabolism was decreased by 33 to 42 percent in the children with diabetes (P less than 0.01). In all the groups of children studied, the response to insulin was inversely correlated with mean 24-hour levels of growth hormone (r = -0.52, P = 0.01). Among the diabetic children, the glycosylated hemoglobin levels were substantially higher in the pubertal children than in the prepubertal children (P less than 0.02), although the daily insulin doses tended to be higher. These data suggest that insulin resistance occurs during puberty in both normal children and children with diabetes. The combined adverse effects of puberty and diabetes on insulin action may help explain why control of glycemia is so difficult to achieve in adolescent patients.
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                Author and article information

                Contributors
                Journal
                JMIR Res Protoc
                JMIR Res Protoc
                ResProt
                JMIR Research Protocols
                JMIR Publications Inc. (Toronto, Canada )
                1929-0748
                Jul-Sep 2014
                18 September 2014
                : 3
                : 3
                : e43
                Affiliations
                [1] 1Prevention Research Center Department of Pediatrics Wayne State University School of Medicine Detroit, MIUnited States
                [2] 2Merrill Palmer Skillman Institute and Department of Psychiatry & Behavioral Neurosciences Wayne State University Detroit, MIUnited States
                [3] 3Children's Hospital of Michigan Department of Endocrinology Wayne State University School of Medicine Detroit, MIUnited States
                [4] 4Beaumont Children’s Hospital & St. John Providence Children’s Hospital Wayne State University and Oakland University Detroit, MIUnited States
                [5] 5Department of Public Health Sciences Henry Ford Health System Detroit, MIUnited States
                Author notes
                Corresponding Author: April Idalski Carcone acarcone@ 123456med.wayne.edu
                Author information
                http://orcid.org/0000-0002-4731-1995
                http://orcid.org/0000-0002-4879-6971
                http://orcid.org/0000-0001-6369-4685
                http://orcid.org/0000-0003-1134-7723
                http://orcid.org/0000-0002-1630-1401
                http://orcid.org/0000-0002-9267-5966
                http://orcid.org/0000-0003-0069-4391
                Article
                v3i3e43
                10.2196/resprot.3220
                4180328
                25236503
                4a5817bd-f6ac-4287-a961-12109b9adef5
                ©April Idalski Carcone, Deborah A Ellis, Sylvie Naar, Steven J Ondersma, Kathleen Moltz, Baseem Dekelbab, Christine LM Joseph. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 18.09.2014.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                : 02 January 2014
                : 15 March 2014
                : 14 May 2014
                : 18 July 2014
                Categories
                Original Paper
                Original Paper

                parenting,diabetes mellitus, type 1,motivational interviewing,health behavior,intervention studies,african americans,computer-assisted instruction

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