Consideration of Insulin Pumps or Continuous Glucose Monitors by Adolescents With Type 1 Diabetes and Their Parents: Stakeholder Engagement in the Design of Web-Based Decision Aids.

PURPOSE: This article describes the stakeholder-driven design, development, and testing of web-based, multimedia decision aids for youth with type 1 diabetes who are considering the insulin pump or continuous glucose monitoring and their parents. This is the initial phase of work designed to develop and evaluate the efficacy of these decision aids in promoting improved decision-making engagement with use of a selected device. METHODS: Qualitative interviews of 36 parents and adolescents who had previously faced these decisions and 12 health care providers defined the content, format and structure of the decision aids. Experts in children's health media helped the research team to plan, create, and refine multimedia content and its presentation. A web development firm helped organize the content into a user-friendly interface and enabled tracking of decision aid utilization. Throughout, members of the research team, adolescents, parents, and 3 expert consultants offered perspectives about the website content, structure, and function until the design was complete. RESULTS: With the decision aid websites completed, the next phase of the project is a randomized controlled trial of usual clinical practice alone or augmented by use of the decision aid websites. CONCLUSIONS: Stakeholder-driven development of multimedia, web-based decision aids requires meticulous attention to detail but can yield exceptional resources for adolescents and parents contemplating major changes to their diabetes regimens.

Do parents understand growth charts? A national, Internet-based survey.

OBJECTIVE: The objective of this study was to assess parental knowledge and understanding of growth charts. METHODS: An online survey was conducted with 1000 parents selected to be demographically representative of the US population. Questions explored awareness of, knowledge of, and attitudes toward growth monitoring, as well as the ability to interpret growth chart data. RESULTS: Seventy-nine percent of parents surveyed claimed to have seen a growth chart before, with the majority thinking that they understood it well. Sixty-four percent of parents thought it was important to be shown growth charts to see how their child was growing, and 40% expressed the need to see their child's growth chart as confirmation of their health care provider's verbal interpretation. However, when provided with multiple-choice questions and answers, only 64% could identify a child's weight when shown a plotted point on a growth chart. Ninety-six percent had heard of the term "percentile," but only 68% identified the percentile of the plotted point, and only 56% could identify the definition of percentile. Up to 77% interpreted incorrectly charts containing height/weight measurements in tandem. CONCLUSIONS: Although growth charts are used frequently as visual aids to educate parents about their children's growth, many parents cannot comprehend the data. This finding is significant because many parents prefer to be shown growth charts by their health care provider, and many parents report recording their children's measurements on growth charts at home.

Public understanding of growth charts: a review of the literature.

OBJECTIVE: To examine current knowledge about the general public's comprehension of growth charts. METHODS: A literature search was carried out to identify and analyze the findings of studies that have examined the extent to which non-healthcare professionals comprehend the information presented by growth charts. RESULTS: Few studies have examined how well parents understand growth charts. These studies have mostly been conducted in developing countries and have yielded inconclusive results. CONCLUSION: Growth charts can be useful for such purposes as growth monitoring and public health education, but their effectiveness as an educational tool depends on whether parents and caregivers comprehend the information they offer. The literature has not clearly proven that growth charts are easily understood by the general population. PRACTICE IMPLICATIONS: Further studies of the public's understanding of growth charts are needed to help guide health care providers in their use of growth charts as educational tools.

Perceptions of tobacco use in early adolescents.

In an effort to strengthen tobacco use prevention programs, this study explores early (9- to 13-year-old) adolescent motivations for and perceptions of use. Data were collected, via electronic keypads, from students visiting 12 health education centers in the U.S. (N=1433). Multivariate logistic regression showed that perceptions of frequent peer tobacco use and popularity of adolescent smoking, in addition to absence of family discussion of tobacco use, were associated with greater likelihood for smoking and of reporting past smoking. Even though most participants thought adolescents who smoke are very unpopular, more than 60% said the primary reason for adolescent smoking was that smokers believe it will make them popular. Participants thought the best way to prevent use was to give kids "other fun things to do instead." Recommendations are given for customizing curricula or programs.