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Social support for diabetes prevention

Social support for diabetes prevention

Effects of public—private real Social support for diabetes prevention investment on local sales prices, rental dizbetes, and Nut butter energy bars rates. Sup;ort sample was For example, Whitaker et al. Fod with type 2 diabetes had worse dietary habits than men with type 1 diabetes, and associations were not influenced by education level, social network contacts or social support. Higher scores indicate better conditions. Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: a systematic review.

Social support for diabetes prevention -

These processes continued until saturation ie, when the analysis yielded no further categories. Some messages involved users sharing their positive diabetes health outcomes and other members expressing joy about these achievements.

Therefore, 2 new categories were added to the coding scheme: these were achievement and congratulations. To promote clarity between the esteem support category from SSBC and the new congratulations category, the compliment subcategory under the esteem support category was removed.

There were no instances of tangible assistance in the analyzed posts, so this category was removed. Previous research on OHCs reported that this was restricted by the geographic distance between community members [ 47 , 51 ] and that this exchange and arrangement may happen via private or offline communication channels.

Finally, the concepts of seeking and providing network support were not distinguished because the nature of this category involved users seeking and providing support in their posts simultaneously.

After these changes, the coding scheme contained 7 categories, including a description and examples for each category Multimedia Appendix 1 : Social support classification guide used for the coding procedure.

Textbox 1 lists the categories and their definitions. The following approaches were adopted to assess the applicability of the coding scheme. First, 3 researchers independently coded and analyzed a subset of the data, which included 40 messages with initial threads and corresponding first replies.

They iteratively discussed and revised the coding scheme until they reached consensus. Finally, 2 domain experts from Diabetes. uk annotated 40 randomly selected messages with what they regarded as the dominant category.

They also reviewed the scheme to determine whether changes were required to provide greater specificity in the diabetes context.

Interrater reliability Cohen κ [ 52 ] was used to estimate the consistency of coding the categories among the annotators using the SPSS software package version 25; IBM Corp.

A κ value of 0. This experience was also useful for developing clear and unambiguous instructions for annotators in the next phase. A sample of 20 randomly selected messages that were agreed to and previously labeled by domain experts was extracted and used as quality control to select suitable annotators for the coding procedure.

A total of 4 researchers referred to as annotators were selected for the coding procedure based on their consistency with the domain experts. Each annotator agreed to a minimum of 18 posts classified by domain experts.

The messages used for developing the coding scheme were excluded from the coding procedure. For the coding procedure, randomly selected posts were extracted from the data set to ensure that they had a higher probability of being selected for inclusion and that they were not subjectively selected.

Each annotator was assigned to classify posts, including the first posts within each thread and first replies to these posts. The annotators classified each post into a social support category using a web-based form that included the same instructions and information as the selection stage.

The annotators were advised to code each message with the dominant category that appeared to best reflect the nature of the post. Interannotator agreement was calculated to assess the reliability and degree of homogeneity of annotations conducted independently by the researcher against annotations distributed among the 4 annotators.

Accordingly, the researcher who had domain expertise and awareness of the dynamics of OHCs annotated all posts and compared these with the corresponding posts classified by the annotators.

A Cohen κ score of 0. A quantitative content analysis using the previously coded messages was applied to produce descriptive statistical data to assess the frequencies of the social support categories.

In addition, statistical analyses were conducted using chi-square tests for independence to assess whether there were overall significant differences between the frequencies of social support categories for each diabetes stage.

The study has been approved by the University of Sheffield Research Ethics Committee application A total of messages Table 1 presents the frequency counts of each social support category for each stage of diabetes.

To further understand where the significant differences between social support categories and diabetes stages existed, post hoc comparisons were conducted. The significance level α was set at. The qualitative content analysis for each social support category is described in the following sections.

Any identifying information eg, date of birth was removed, and forum posts were paraphrased in such a way that they retained their meaning while ensuring that they could not be tracked through search engines.

For example:. Users also sought advice from peers by seeking actionable thoughts and directions about how to cope with their diabetes challenges.

For example, 1 user described her issue of self-disclosed information about her blood glucose readings before requesting advice:. Other messages involved requests for factual information or clarification of information that health care professionals would typically address.

Topics included information regarding diabetes, blood test results, and medications. Messages in this category mostly offered advice or suggestions for coping with the difficulties of diabetes eg, illness management. Other messages referred users to other sources of information, including seeking input from health care professionals, textbooks, and predominantly relevant websites.

Some messages provided to new users or newly diagnosed individuals had an educational role. These included sharing factual and technical information or teaching users about various aspects of diabetes management. For instance, new users who were often recently diagnosed introduced themselves and explicitly expressed the intention to meet and to get to know people.

Forum members often responded to new members by welcoming them, and reminding them that they were always there to help and support people:.

Furthermore, they encouraged new members to continue using the forum and keep everyone informed of any progress or difficulties. Members also participated in companionship activities by posting off-topic messages eg, television programs that promoted social interactions and enjoyment among users.

Finally, several users discussed the specific technical features of the forum and how to use them. Most of the messages in this category included users writing about their negative feelings and emotions eg, sadness regarding their experiences with the condition without making direct questions:.

These messages normally involved users sharing their health achievements eg, weight loss for peers to read. Such achievements even included the improvement of other health-related problems eg, macular degeneration.

By posting messages, users shared self-reflection on their illness journey by providing periodic updates of their progress and blood test results.

From these achievements, users recognized and acknowledged the helpfulness and support provided by peers for making progress on their health goals:. These messages were often provided to users who were struggling to contend with distressing feelings associated with diabetes and required affirmation.

Finally, in some messages, emotional support was offered by sending web-based physical affection messages through contact gestures, including hugs, kisses, and use of emojis:. To the best of our knowledge, this is the first study to assess the types and frequency of social support categories exchanged on a DOC, taking into consideration the different stages of diabetes.

The DOC addressed 3 categories from the SSBC model [ 18 ]: informational, emotional, and network support, which have been found to be the main categories in OHCs [ 47 ].

In addition, the results enriched this model by adding 2 new unique categories that did not necessarily express direct support but facilitated online social support exchanges, namely, achievement and congratulations.

Here, many users announced personal victories associated with diabetes, while their peers typically congratulated them and often encouraged them to go further. These categories have previously been reported to be present in online forums for people recovering from alcohol-related problems [ 54 ] and communities for people seeking weight loss [ 55 ], where they promoted a sense of belonging and self-confidence among users.

This suggests that the platform may be a valuable outlet for users to celebrate their successes and provide positive reinforcement for the challenging behavioral modifications required for diabetes management.

Overall, the content analysis of posts indicated that this community was mostly used by individuals to seek and provide informational support.

These findings are consistent with those of previous studies, suggesting that a significant number of people with diabetes use OHCs to find and provide health-related information [ 7 , 23 , 56 , 57 ].

Moreover, these results appeared to support the Optimal Matching Model [ 50 ], which proposes that the nature and controllability of a stressor determine the type of social support that will most likely be beneficial for an individual.

This indicates that individuals with controllable stressors benefit the most from informational support, which helps them to solve, manage, or eliminate the stressor. In contrast, individuals with uncontrollable stressors should benefit from emotional support, which helps them cope with the stressor without direct efforts to eliminate it, but rather to make them feel cared for [ 50 ].

Accordingly, informational support was requested and provided more often than emotional support in this DOC.

Previous studies investigating social support in OHCs like HIV [ 20 , 57 ], cancer [ 58 - 60 ], eating disorders [ 61 ], infertility [ 62 , 63 ], and complex regional pain syndrome [ 64 ] have supported the Optimal Matching Theory.

When analyzing the different stages of diabetes, informational support was the most frequently sought social support and was provided less in users with prediabetes than users in other diabetes stages. Although there is scarce evidence regarding the use of OHCs by users with prediabetes, previous studies suggest that these patients have less understanding of the disease than people with T2D [ 65 ] and require tailored information about diabetes, nutrition, and exercise [ 66 ].

Therefore, these individuals may have unmet informational support needs and thus are likely to seek these via other sources, such as OHCs. The results also showed that users with prediabetes provided less information support than users in other diabetes stages.

For example, at first, users with prediabetes may be very active in the community asking for informational support, but once their information needs are met, they are more likely to leave the OHC.

Conversely, the distributions of all social support categories in users with T2D were not significantly different when compared with other stages of diabetes. These categories may be equally important for users with T2D to use and establish effective foundations for future interactions and relationship development in the community.

Providing informational support may be the first step in this process, whereas by seeking informational support, they may communicate on a more personal level with their peers and engage further in community relationships by exchanging network support.

The provision of support, including informational and emotional support, was posted more frequently by users with T2D under insulin treatment than those in other stages. These users offered factual information aligned with professional knowledge and advice, referred members to external sources of information, shared personal experiences, and also expressed positive and uplifting messages to other members.

Interestingly, these users tended to play the role of experienced members with diabetes, whose regimens were settled. Accordingly, as these users had experienced diabetes over a long time, they could potentially feel more comfortable or inclined to share their knowledge and experience more widely to support seekers and feel more sympathy toward the emotional burdens experienced by people with diabetes eg, anxiety derived from treatment [ 67 ].

They might also feel compelled to reciprocate and give support out of gratitude to the community that helped them [ 68 ].

Finally, when discussing topics requiring professional knowledge, these users would often refer peers to seek medical advice from doctors to ensure safety. This highlights the need for further research to consider the quality, accuracy, and trustworthiness of the information and any hyperlinks to other sources provided by users.

This may help to determine the extent of misinformation and alleviate the uncertainty that individuals may experience when using OHCs. Finally, people who were in remission from T2D were more likely to exchange more achievement and network support and were less likely to seek informational support than those in other stages.

These users gained knowledge about diabetes over time and shared their successful personal achievements in gratitude for the help that they received from the community.

Reciprocating and sharing these achievements may work as a knowledge-sharing process that may motivate others to achieve similar health goals or behaviors [ 69 , 70 ].

Consequently, it may enable others to learn safer and more efficient strategies to manage their diabetes rather than trying and failing, suggesting that sharing achievements could be used as a strategy to motivate participation in health-related interventions.

These users also played a central role in welcoming and reinforcing the availability of similar users to new members, offered access to other users for further support, and chatted about off-topic content unrelated to diabetes. This suggests that network support may contribute to high community commitment for these users over time, and they may play an important role in sustaining the longevity of the community.

The findings of this study have important theoretical, research, and practical implications for online social support in OHCs. This is the first study to analyze web-based messages exchanged between users with different stages of diabetes, whereas previous studies have typically examined social support exclusively in people with type 1 diabetes or T2D in offline settings and applied methods such as surveys, focus groups, and interviews [ 71 - 73 ].

The use of a validated theoretical framework and subsequent modifications ensured that the categories were well defined in the online diabetes context and included a comprehensive coding system that yielded a high level of agreement between 2 independent annotators.

Therefore, this study provides further evidence for the generalizability of this model to assess online social support exchanges in a diabetes community. As the first content analysis on this topic, our research provided empirical evidence on the distribution of social support categories in a DOC and how these are expressed.

This finding may serve as a basis for future research. In particular, the data may be used to develop automated machine learning classifiers capable of coding data on a larger scale to support or discover new relationships that could not really be assessed through hand-coding messages.

Our findings also have practical implications for multiple stakeholders. Health care providers might be supported with information about how to maximize the full effectiveness of social support and the stages of the condition that these types of support may be beneficial.

The findings can help administrators to create dynamic recommendation services, including information about frequently asked questions that concern members the most and access to more experienced members. Consequently, users may receive targeted support at different stages of diabetes, which may prevent them from posting similar questions, reduce information redundancy, and improve accessibility of useful information.

This study has potential limitations that may require further research. First, messages posted in a single DOC were analyzed and the extent to which the observed patterns of social support categories are generalizable to other DOCs warrants further research. Second, the annotators were advised to select 1 main category per message.

Future research may need to incorporate a multilabel scheme that expands the annotation task at the sentence level. Nevertheless, it is worth mentioning that the single-label approach in this study produced a high level of agreement among annotators. Finally, the amount of data analyzed alone does not allow us to ascertain the distribution of social support categories in this community.

However, this study provides a good basis for building a more comprehensive evaluation in the future, which will be improved in future research.

Overall, most posts in this DOC involved users seeking and providing informational support. In particular, users with prediabetes were more likely to seek informational support than those in other diabetes stages, whereas there were no significant differences between the social support categories posted by the users with T2D.

Users with T2D and under insulin treatment provided more informational and emotional support, and users with T2D remission exchanged more achievement and network support compared with those in other stages. This study supported the idea that different social support categories are more prominent in different types of diabetes.

Findings from this study await further insights into these exchanges by using a larger sample size and supervised machine learning approaches.

The authors would like to thank Diabetes. uk who helped provide the data for this study and the domain experts who helped with the development of the code scheme. They would also like to thank the 4 researchers for their kind assistance with the coding procedure.

Edited by A Sharma; submitted org , Skip to Main Content Skip to Footer. Social Support in a Diabetes Online Community: Mixed Methods Content Analysis Social Support in a Diabetes Online Community: Mixed Methods Content Analysis Authors of this article: Cidila Da Moura Semedo 1 ; Peter A Bath 1 ; Ziqi Zhang 2.

Article Authors Cited by 1 Tweetations 3 Metrics. Original Paper. Corresponding Author: Cidila Da Moura Semedo, BSc, MSc Health Informatics Research Group Information School University of Sheffield Regent Court Portobello Sheffield, S1 4DP United Kingdom Phone: 44 Email: cidiladamourasemedo gmail.

diabetes online community ; social support ; health communication ; mixed methods ; content analysis ; prediabetes ; type 2 diabetes ; type 2 diabetes insulin ; type 2 diabetes remission.

Definition of social support categories. Achievement Users share details about their own health achievements. Congratulations Users express of joy or acknowledgment for their achievement. This also consists of users talking about everyday offline events eg, travel , humor or teasing, and chatting about topics not related to their condition.

Seeking emotional support Expression of need for emotional support and reassurance from peers to feel less afraid or doubtful about their disease or condition. They normally provide mood descriptions. Seeking informational support Expression of specific questions when trying to obtain factual information, advice, recommendations, personal experiences from peers, and knowledge related to their disease, treatment, or symptoms.

Providing emotional support Users provide affection, relief of blame, validation, caring, concern, empathy, sympathy, or encouragement to the thread initiator. Providing informational support Users provide information and guidance to the thread initiator through advice, referrals, feedback on actions, factual input, and personal experiences with treatment or symptoms.

Textbox 1. Table 1. Multimedia Appendix 1 Social support classification guide. DOCX File , 18 KB. References American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care Jan;37 Suppl 1:SS Global and regional diabetes prevalence estimates for and projections for and results from the International Diabetes Federation Diabetes Atlas, 9th edition.

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The relationship between clinical indicators, coping styles, perceived support and diabetes-related distress among adults with type 2 diabetes. J Adv Nurs Feb;68 2 Self-efficacy mediates the associations of diabetes distress and depressive symptoms with type 2 diabetes management and glycemic control.

Gen Hosp Psychiatry ; Health information seeking and social media use on the internet among people with diabetes. Online J Public Health Inform ;3 1 :ojphi. Should patients with diabetes be encouraged to integrate social media into their care plan?

Future Sci OA Jul;4 7 :FSO [ FREE Full text ] [ CrossRef ] [ Medline ] Litchman ML, Edelman LS, Donaldson GW. Effect of diabetes online community engagement on health indicators: cross-sectional study. JMIR Diabetes Apr 24;3 2 :e8 [ FREE Full text ] [ CrossRef ] [ Medline ] Toma T, Athanasiou T, Harling L, Darzi A, Ashrafian H.

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Adherence was assessed using a structured interview developed by Hanson et al. Test-retest reliabilities over 3 and 6 months have been reported to be.

Hanson et al. have provided data on the validity of this measure for adolescents with diabetes; in particular, higher levels of adherence have been significantly related to metabolic control Hb A1 assays , with correlations in the range of.

The primary study objective was to develop and evaluate the DSSQ-Family. Prior to the main analyses, the 58 items were examined to determine their appropriateness for inclusion on the final questionnaire. That is, most adolescents did not view these items as supportive.

The remaining 52 items that were retained on the DSSQ-Family appear in Table I. To examine a normative scoring approach, we calculated average frequency scores for the Total DSSQ-Family all 52 items and for the five areas of diabetes care insulin, blood testing, meals, exercise, emotions.

Scores could range from 0 to 5 see Table I. To examine an individualized approach, for each adolescent, the frequency score for each item was multiplied by the corresponding supportiveness score i. Individualized scores averages were calculated for the Total DSSQ-Family and the five areas of diabetes care and could range from -5 not supportive but very frequent to 15 very supportive and very frequent.

An initial study goal was to evaluate the two methods for scoring the DSSQ-Family. Internal consistencies 2 Cronbach's α were calculated. For the frequency ratings, internal consistencies were. Internal consistencies for the individualized ratings were slightly higher:.

For the frequency ratings, retest reliabilities were. For the individualized ratings, retest reliabilities were. Intercorrelations among the DSSQ-Family scores were examined next.

The frequency ratings were highly correlated with the corresponding individualized rating which was a combination of frequency and supportiveness ; these correlations ranged from.

A second study goal pertained to concurrent validity. The associations between perceived family support for diabetes care and demographic variables age, disease duration, gender were examined, but only age-related differences in perceived family support for diabetes care were expected.

Pearson correlations were computed for age and disease duration with the frequency and the individualized ratings on the DSSQ-Family see Table II. As expected, for the Total score, younger adolescents reported receiving more frequent support from family members for their diabetes care.

In addition, for all five areas of diabetes management, the frequency of family support was significantly related to age, with younger adolescents perceiving more support than older adolescents. Identical findings were obtained for the individualized ratings.

As expected, diabetes duration was unrelated to perceived family support. Gender differences were evaluated using one-way analyses of variance ANOVAs for each of the DSSQ-Family scores listed in Table II left side of the table , using an alpha level of. As expected, none of the measures of family support differed significantly for adolescent boys and girls.

The means for the total sample were reported in Table I. DSSQ-Family Frequency and Individualized Ratings: Correlations With Age, Disease Duration, and Other Support Measures.

As another way of evaluating concurrent validity, the associations between the DSSQ-Family and other measures of support from family and friends were examined.

We hypothesized that the DSSQ-Family would be related to the general measures of family support PSS-Family, FES-Cohesion , but not to friends' support PSS-Friends or to family conflict FES-Conflict.

This pattern was identical for the individualized ratings. Similar results were obtained for the five areas of diabetes management. In general, adolescents who reported more frequent family support for the specific areas of diabetes care also viewed their families as more emotionally supportive and more cohesive.

An identical pattern was observed for the individualized ratings. Thus, regardless of whether the frequency or individualized ratings were used, more emotionally supportive and cohesive families were perceived as providing more diabetes-specific family support.

In support of the discriminant validity of the DSSQ-Family, none of the frequency or individualized ratings was related to support from friends PSS-Friends or to family conflict FES-conflict.

The only exception was that perceptions of emotional support for diabetes care were negatively related to family conflict.

A third study goal was to examine the predictive validity of the DSSQ-Family, hypothesizing that greater perceived family support for adolescents' diabetes care would predict better adherence, even when controlling for general levels of families' emotional support.

Two hierarchical regression analyses were conducted see Table III , with adherence as the dependent variable, and using either the Total frequency ratings or the Total individualized ratings as predictors. On the second step, family support and cohesion PSS-Family and FES-Cohesion were entered to control for general levels of family support and cohesion and to determine if more supportive, cohesive families had more adherent adolescents.

In the third step, the diabetes-specific support scores were entered. Perceived Family Support for Diabetes Care as a Predictor of Adolescents' Treatment Adherence. Table III shows that younger adolescents had better adherence Step 1 , as did adolescents who perceived their families as more cohesive Step 2.

Adolescents with greater perceived family support for diabetes care reported better adherence. Partial correlations controlling for age, family support, and cohesion indicated that greater family support for insulin administration. A final study goal was to examine the clinical utility of the DSSQ-Family by identifying the specific family behaviors that adolescents perceived as most supportive for their diabetes care.

These 13 items are marked in Table I with a superscript a. The mean perceived supportiveness of the 13 items was 1. Underrepresented among the most supportive items were those dealing with insulin Across the 13 most supportive items, an average frequency score and an average individualized score were calculated.

Their internal consistencies were. Regression analyses identical to those described were conducted for the 13 most supportive items as predictors of adolescents' adherence.

Little research has examined the specific family behaviors associated with youngsters' disease management Drotar, , even though families play an important role in disease management and adaptation for youths with chronic pediatric conditions.

Thus, information on family behaviors that relate to better treatment adherence for adolescents with diabetes has the potential to inform the next generation of family interventions for youths with diabetes.

In this regard, this study presents a new measure and provides useful information on the family behaviors that adolescents perceived to be supportive for their diabetes care.

This information may be useful for enhancing adolescents' treatment adherence. The primary study objective was to develop and examine the utility of a new measure, the DSSQ-Family, to assess adolescents' perceptions of family support for diabetes care.

The results provided promising support for this measure. In particular, internal consistencies for the various DSSQ-Family scores were high, and the patterns of relationships with other measures were consistent with predictions. The results also provided support for the incremental and predictive validity of the individualized ratings from the DSSQ-Family, which predicted adolescents' adherence above and beyond general levels of family emotional support and cohesion.

One important clinical implication of these findings is that the DSSQ-Family appears to be a useful measure of perceived family support for adolescents' diabetes care. In this regard, the DSSQ-Family may be useful to include in future studies of adaptation and disease management for youths with diabetes.

In the process of evaluating the DSSQ-Family, two different scoring methods were examined: one based on a normative approach that utilizes frequency ratings for supportive behaviors, and one based on an individualized approach that adjusts the frequency ratings for the individual adolescents' perceptions of supportiveness.

Although the findings were very similar for the two methods, the results appeared to favor the individualized ratings. These findings suggest that the individualized approach may be more useful than the normative approach in clinical settings.

In particular, efforts to increase family support for adolescents' diabetes care may be better served by including adolescents' own perspectives on what they view as supportive, rather than relying on what adolescents typically view as supportive. Another key finding from this study, supporting the concurrent validity of the DSSQ-Family, was that older adolescents perceived their family members to provide less diabetes-specific support than did younger adolescents.

Others e. One of the potential benefits of a measure such as the DSSQ-Family is that it may be used to identify family behaviors that adolescents do find to be supportive, so that family members can provide appropriate kinds of support and maintain involvement in diabetes care as adolescents mature.

In contrast to the findings for age, disease duration was not related to perceived family support for diabetes care. Thus, the relationship between age and perceived family support cannot be explained by the fact that younger adolescents typically have had diabetes for a shorter period of time and, therefore, need more assistance with their diabetes care.

In further support of the concurrent validity of the DSSQ-Family, the results revealed that adolescents who perceived their families as providing more diabetes-specific support also viewed their families as more cohesive and emotionally supportive.

In contrast, adolescents' perceptions of family support for diabetes care were not related to adolescents' support from friends or to reports of family conflict, in general. Although further replication of these findings would be desirable, these data do provide good preliminary support for the convergent and discriminant validity of the DSSQ-Family.

Furthermore, from a clinical perspective, it was interesting to note that the correlations between diabetes-specific family support and general family support and cohesion were moderate.

This suggests that even cohesive, emotionally supportive families do not necessarily provide high levels of diabetes-specific support. This was especially true for family support for adolescents' exercise, which was unrelated to family cohesion.

A clinical implication of these findings is that even supportive, cohesive families may need help in identifying specific ways to support adolescents' diabetes care. With respect to the predictive and incremental validity of the DSSQ-Family, a key finding was that the individualized ratings from the DSSQ-Family predicted adherence above and beyond the more generic measures of family support and cohesion.

In fact, the general measure of family support was not significantly related to adherence, when adolescent age was controlled. Pediatric investigators have emphasized that disease-specific measures may be helpful in understanding youngsters' disease management and disease adaptation e.

Furthermore, the specific areas of diabetes-related family support that were most associated with adolescents' adherence involved daily management tasks meals, glucose testing, and insulin administration , rather than exercise or emotions. Although family members' support of management tasks may be important for adherence, their provision of emotional support may also be critical.

In the future, it may be fruitful to examine linkages between families' emotional support for diabetes and other indices of disease adaptation and adjustment. Although our findings were promising, continued study of the DSSQ-Family is desirable. In particular, several study limitations suggest directions for further investigation.

First, in this study it was not possible to obtain retest reliability for the DSSQ-Family, and this will be important in future work. Second, and also important for future research, would be a replication of the study results with a larger sample, especially one that has sufficient power to factor analyze the DSSQ-Family.

Third, this study relied on adolescents' reports of family support and treatment adherence. Nevertheless, in future studies it will be desirable to evaluate support and adherence from multiple perspectives e. Fourth, this study focused on a primarily middle-class sample, with a relatively small number of minority youths, and thus can best be generalized to similar groups of adolescents.

In the future, work on the DSSQ-Family should be extended to multiethnic, low-income adolescents with diabetes. One advantage of a checklist measure, such as the DSSQ-Family, is that it may facilitate comparisons across different ethnic groups because of its standard set of items.

Finally, this study focused on a particular chronic disease, although it is likely that the finding might be applicable to other chronic conditions for which medications, exercise, or meal management play a role. Future studies may wish to adapt the DSSQ-Family for other chronic pediatric conditions.

In conclusion, this study offers the DSSQ-Family as a useful instrument for understanding family members' support of adolescents' diabetes care. An important clinical implication is that continued family involvement in the day-to-day management of diabetes may be critical for youngsters' disease management.

At least when the goal of intervention is to promote treatment adherence, it may be most productive to focus on ways that families can support daily management tasks, taking into account what the individual adolescent perceives to be supportive in these areas.

This may be especially critical for older adolescents, as families are substantially less likely to be supportive of older teens' management tasks, as the data in this study have shown. The key issue is not whether families should be involved and supportive, but how best to do this, especially as adolescents' mature.

Preparation of this paper was supported, in part, by grants from the National Heart, Lung, and Blood Institute HL and the National Institute of Child Health and Development T32 HD We thank the following individuals for their input on the initial development of the DSSQ-Family: Edwin Fisher, Jr.

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Journal Article. The Diabetes Social Support Questionnaire-Family Version: Evaluating Adolescents' Diabetes-Specific Support From Family Members. La Greca, PhD , Annette M. La Greca, PhD.

All correspondence should be sent to Annette M. La Greca, Department of Psychology, P. Box , University of Miami, Coral Gables, Florida E-mail: alagreca umiami. Oxford Academic. Google Scholar. Karen J. Bearman, MS.

Revision received:. PDF Split View Views. Cite Cite Annette M.

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The most important thing is quality of life, yours and theirs. Skip directly to site content Skip directly to search. Español Other Languages. Español Spanish Print. Minus Related Pages. Help them feel the power to manage their diabetes. Better Together The most important thing is quality of life, yours and theirs.

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: Social support for diabetes prevention

Community-based Organizations (CBOs) | Diabetes | CDC Adler ; Nancy E. Previous studies have reported that that psychological factors like self-efficacy, social support, and attitude influence the behaviors and lifestyles of people [ 16 , 17 ]. Venkataraman K, Kannan AT, Kalra OP, Gambhir JK, Sharma AK, Sundaram K, Mohan V. CMS should fully finance independent state waiver evaluations to ensure robust evaluation of social care and health care integration pilot programs and dissemination. Conversely, low or inconsistent food availability can increase risk of hypoglycemia. For example, cohabitation status was assumed to influence contacts with the social network and therefore we adjusted for cohabitation status when we explored the association between diabetes type and social network.
Key Takeaways Google Scholar. Table 5 SDOH and diabetes research recommendations. The remaining 52 items that were retained on the DSSQ-Family appear in Table I. Mean diabetes knowledge, self-management practice and social support scores of the participants by socio-demographic characteristics. The Face of Diabetes in the United States, State of American Well-being,
Social Support and Diabetes: Understanding Its Importance and How To Increase It In Your Daily Life

Español Other Languages. Español Spanish Print. Minus Related Pages. Help them feel the power to manage their diabetes. Better Together The most important thing is quality of life, yours and theirs. Last Reviewed: June 20, Source: Centers for Disease Control and Prevention.

Facebook Twitter LinkedIn Syndicate. home Diabetes Home. To receive updates about diabetes topics, enter your email address: Email Address. What's this. Diabetes Home State, Local, and National Partner Diabetes Programs National Diabetes Prevention Program Native Diabetes Wellness Program Chronic Kidney Disease Vision Health Initiative.

Links with this icon indicate that you are leaving the CDC website. The Centers for Disease Control and Prevention CDC cannot attest to the accuracy of a non-federal website.

Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.

You will be subject to the destination website's privacy policy when you follow the link. To examine a normative scoring approach, we calculated average frequency scores for the Total DSSQ-Family all 52 items and for the five areas of diabetes care insulin, blood testing, meals, exercise, emotions.

Scores could range from 0 to 5 see Table I. To examine an individualized approach, for each adolescent, the frequency score for each item was multiplied by the corresponding supportiveness score i.

Individualized scores averages were calculated for the Total DSSQ-Family and the five areas of diabetes care and could range from -5 not supportive but very frequent to 15 very supportive and very frequent.

An initial study goal was to evaluate the two methods for scoring the DSSQ-Family. Internal consistencies 2 Cronbach's α were calculated. For the frequency ratings, internal consistencies were.

Internal consistencies for the individualized ratings were slightly higher:. For the frequency ratings, retest reliabilities were.

For the individualized ratings, retest reliabilities were. Intercorrelations among the DSSQ-Family scores were examined next. The frequency ratings were highly correlated with the corresponding individualized rating which was a combination of frequency and supportiveness ; these correlations ranged from.

A second study goal pertained to concurrent validity. The associations between perceived family support for diabetes care and demographic variables age, disease duration, gender were examined, but only age-related differences in perceived family support for diabetes care were expected.

Pearson correlations were computed for age and disease duration with the frequency and the individualized ratings on the DSSQ-Family see Table II. As expected, for the Total score, younger adolescents reported receiving more frequent support from family members for their diabetes care.

In addition, for all five areas of diabetes management, the frequency of family support was significantly related to age, with younger adolescents perceiving more support than older adolescents. Identical findings were obtained for the individualized ratings.

As expected, diabetes duration was unrelated to perceived family support. Gender differences were evaluated using one-way analyses of variance ANOVAs for each of the DSSQ-Family scores listed in Table II left side of the table , using an alpha level of. As expected, none of the measures of family support differed significantly for adolescent boys and girls.

The means for the total sample were reported in Table I. DSSQ-Family Frequency and Individualized Ratings: Correlations With Age, Disease Duration, and Other Support Measures. As another way of evaluating concurrent validity, the associations between the DSSQ-Family and other measures of support from family and friends were examined.

We hypothesized that the DSSQ-Family would be related to the general measures of family support PSS-Family, FES-Cohesion , but not to friends' support PSS-Friends or to family conflict FES-Conflict.

This pattern was identical for the individualized ratings. Similar results were obtained for the five areas of diabetes management. In general, adolescents who reported more frequent family support for the specific areas of diabetes care also viewed their families as more emotionally supportive and more cohesive.

An identical pattern was observed for the individualized ratings. Thus, regardless of whether the frequency or individualized ratings were used, more emotionally supportive and cohesive families were perceived as providing more diabetes-specific family support. In support of the discriminant validity of the DSSQ-Family, none of the frequency or individualized ratings was related to support from friends PSS-Friends or to family conflict FES-conflict.

The only exception was that perceptions of emotional support for diabetes care were negatively related to family conflict. A third study goal was to examine the predictive validity of the DSSQ-Family, hypothesizing that greater perceived family support for adolescents' diabetes care would predict better adherence, even when controlling for general levels of families' emotional support.

Two hierarchical regression analyses were conducted see Table III , with adherence as the dependent variable, and using either the Total frequency ratings or the Total individualized ratings as predictors.

On the second step, family support and cohesion PSS-Family and FES-Cohesion were entered to control for general levels of family support and cohesion and to determine if more supportive, cohesive families had more adherent adolescents.

In the third step, the diabetes-specific support scores were entered. Perceived Family Support for Diabetes Care as a Predictor of Adolescents' Treatment Adherence.

Table III shows that younger adolescents had better adherence Step 1 , as did adolescents who perceived their families as more cohesive Step 2. Adolescents with greater perceived family support for diabetes care reported better adherence.

Partial correlations controlling for age, family support, and cohesion indicated that greater family support for insulin administration. A final study goal was to examine the clinical utility of the DSSQ-Family by identifying the specific family behaviors that adolescents perceived as most supportive for their diabetes care.

These 13 items are marked in Table I with a superscript a. The mean perceived supportiveness of the 13 items was 1. Underrepresented among the most supportive items were those dealing with insulin Across the 13 most supportive items, an average frequency score and an average individualized score were calculated.

Their internal consistencies were. Regression analyses identical to those described were conducted for the 13 most supportive items as predictors of adolescents' adherence.

Little research has examined the specific family behaviors associated with youngsters' disease management Drotar, , even though families play an important role in disease management and adaptation for youths with chronic pediatric conditions.

Thus, information on family behaviors that relate to better treatment adherence for adolescents with diabetes has the potential to inform the next generation of family interventions for youths with diabetes.

In this regard, this study presents a new measure and provides useful information on the family behaviors that adolescents perceived to be supportive for their diabetes care. This information may be useful for enhancing adolescents' treatment adherence.

The primary study objective was to develop and examine the utility of a new measure, the DSSQ-Family, to assess adolescents' perceptions of family support for diabetes care. The results provided promising support for this measure. In particular, internal consistencies for the various DSSQ-Family scores were high, and the patterns of relationships with other measures were consistent with predictions.

The results also provided support for the incremental and predictive validity of the individualized ratings from the DSSQ-Family, which predicted adolescents' adherence above and beyond general levels of family emotional support and cohesion.

One important clinical implication of these findings is that the DSSQ-Family appears to be a useful measure of perceived family support for adolescents' diabetes care.

In this regard, the DSSQ-Family may be useful to include in future studies of adaptation and disease management for youths with diabetes. In the process of evaluating the DSSQ-Family, two different scoring methods were examined: one based on a normative approach that utilizes frequency ratings for supportive behaviors, and one based on an individualized approach that adjusts the frequency ratings for the individual adolescents' perceptions of supportiveness.

Although the findings were very similar for the two methods, the results appeared to favor the individualized ratings.

These findings suggest that the individualized approach may be more useful than the normative approach in clinical settings. In particular, efforts to increase family support for adolescents' diabetes care may be better served by including adolescents' own perspectives on what they view as supportive, rather than relying on what adolescents typically view as supportive.

Another key finding from this study, supporting the concurrent validity of the DSSQ-Family, was that older adolescents perceived their family members to provide less diabetes-specific support than did younger adolescents.

Others e. One of the potential benefits of a measure such as the DSSQ-Family is that it may be used to identify family behaviors that adolescents do find to be supportive, so that family members can provide appropriate kinds of support and maintain involvement in diabetes care as adolescents mature.

In contrast to the findings for age, disease duration was not related to perceived family support for diabetes care. Thus, the relationship between age and perceived family support cannot be explained by the fact that younger adolescents typically have had diabetes for a shorter period of time and, therefore, need more assistance with their diabetes care.

In further support of the concurrent validity of the DSSQ-Family, the results revealed that adolescents who perceived their families as providing more diabetes-specific support also viewed their families as more cohesive and emotionally supportive.

In contrast, adolescents' perceptions of family support for diabetes care were not related to adolescents' support from friends or to reports of family conflict, in general.

Although further replication of these findings would be desirable, these data do provide good preliminary support for the convergent and discriminant validity of the DSSQ-Family.

Furthermore, from a clinical perspective, it was interesting to note that the correlations between diabetes-specific family support and general family support and cohesion were moderate. This suggests that even cohesive, emotionally supportive families do not necessarily provide high levels of diabetes-specific support.

This was especially true for family support for adolescents' exercise, which was unrelated to family cohesion. A clinical implication of these findings is that even supportive, cohesive families may need help in identifying specific ways to support adolescents' diabetes care.

With respect to the predictive and incremental validity of the DSSQ-Family, a key finding was that the individualized ratings from the DSSQ-Family predicted adherence above and beyond the more generic measures of family support and cohesion.

In fact, the general measure of family support was not significantly related to adherence, when adolescent age was controlled. Pediatric investigators have emphasized that disease-specific measures may be helpful in understanding youngsters' disease management and disease adaptation e.

Furthermore, the specific areas of diabetes-related family support that were most associated with adolescents' adherence involved daily management tasks meals, glucose testing, and insulin administration , rather than exercise or emotions. Although family members' support of management tasks may be important for adherence, their provision of emotional support may also be critical.

In the future, it may be fruitful to examine linkages between families' emotional support for diabetes and other indices of disease adaptation and adjustment.

Although our findings were promising, continued study of the DSSQ-Family is desirable. In particular, several study limitations suggest directions for further investigation. First, in this study it was not possible to obtain retest reliability for the DSSQ-Family, and this will be important in future work.

Second, and also important for future research, would be a replication of the study results with a larger sample, especially one that has sufficient power to factor analyze the DSSQ-Family.

Third, this study relied on adolescents' reports of family support and treatment adherence. Nevertheless, in future studies it will be desirable to evaluate support and adherence from multiple perspectives e. Fourth, this study focused on a primarily middle-class sample, with a relatively small number of minority youths, and thus can best be generalized to similar groups of adolescents.

In the future, work on the DSSQ-Family should be extended to multiethnic, low-income adolescents with diabetes. One advantage of a checklist measure, such as the DSSQ-Family, is that it may facilitate comparisons across different ethnic groups because of its standard set of items.

Finally, this study focused on a particular chronic disease, although it is likely that the finding might be applicable to other chronic conditions for which medications, exercise, or meal management play a role. Future studies may wish to adapt the DSSQ-Family for other chronic pediatric conditions.

In conclusion, this study offers the DSSQ-Family as a useful instrument for understanding family members' support of adolescents' diabetes care.

An important clinical implication is that continued family involvement in the day-to-day management of diabetes may be critical for youngsters' disease management. At least when the goal of intervention is to promote treatment adherence, it may be most productive to focus on ways that families can support daily management tasks, taking into account what the individual adolescent perceives to be supportive in these areas.

This may be especially critical for older adolescents, as families are substantially less likely to be supportive of older teens' management tasks, as the data in this study have shown.

The key issue is not whether families should be involved and supportive, but how best to do this, especially as adolescents' mature. Preparation of this paper was supported, in part, by grants from the National Heart, Lung, and Blood Institute HL and the National Institute of Child Health and Development T32 HD We thank the following individuals for their input on the initial development of the DSSQ-Family: Edwin Fisher, Jr.

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Social support and self-esteem effects on psychological adjustment in children and adolescents with insulin-dependent diabetes mellitus. Child and Family Behavior Therapy , 11 , 1 Oxford University Press is a department of the University of Oxford.

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Journal Article. The Diabetes Social Support Questionnaire-Family Version: Evaluating Adolescents' Diabetes-Specific Support From Family Members.

La Greca, PhD , Annette M. La Greca, PhD. All correspondence should be sent to Annette M. La Greca, Department of Psychology, P. Box , University of Miami, Coral Gables, Florida E-mail: alagreca umiami. Oxford Academic. Google Scholar.

Karen J. Bearman, MS. Revision received:. PDF Split View Views. Cite Cite Annette M. Select Format Select format. ris Mendeley, Papers, Zotero. enw EndNote. bibtex BibTex. txt Medlars, RefWorks Download citation. Permissions Icon Permissions.

Close Navbar Search Filter Journal of Pediatric Psychology This issue Child and Adolescent Psychiatry Clinical Child and Adolescent Psychology Books Journals Oxford Academic Enter search term Search. Abstract Objective: To develop and evaluate the Diabetes Social Support Questionnaire-Family Version DSSQ-Family for adolescents with type 1 diabetes.

Social support for diabetes prevention

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Johns Hopkins Diabetes Prevention and Education Program Metrics details. Diabetes is Nut butter energy bars Sleep quality illness which requires lifelong self-care behaviors. Nut butter energy bars diabetws of the present research SSocial to investigate the association of self-efficacy, attitude and social support with adherence to diabetes self-care behavior. In this cross-sectional study conducted indiabetic patients of Zarandieh, Iran participated. They were evaluated by valid and reliable questionnaires comprised of items on diabetes self-care, self-efficacy in dealing with problems, social support and attitude towards self-care.

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