Checklists for Assessing Skills of Children With Type 1 Diabetes on Insulin Injection Technique.

BACKGROUND: School-aged children often participate in type 1 diabetes (T1D) self-care tasks. Despite widespread discussion about the importance of developing self-care skills in childhood, few explain how the health care team should assess the skills of children with T1D when performing insulin injections. OBJECTIVE: We sought to assess content validity evidence in two checklists regarding injection technique performed by children. METHODS: Two checklists were designed based on a systematic review of the insulin injection technique. Experts in pediatric diabetes, health literacy, and diabetes education assessed the checklists regarding their clarity, objectivity, and relevance. Content validity was assessed using the content validity ratio (CVR). RESULTS: Eleven providers (72% nurses or physicians, professional experience 19.4 ± 10.1 years, 45% of specialists in endocrinology, and 18% in pediatrics) participated in the assessment. Experts considered items containing the word homogeneity inappropriate. Items related to the needle insertion angle and the skin fold did not reach the CVR critical value. The final version of the checklist for syringe injection comprised 22 items with CVR = 0.91, and the checklist for pen injection comprised 18 items with CVR = 0.87. CONCLUSIONS: The checklists presented clear, objective, and relevant content that assesses the skills of children with T1D for insulin injection. The checklists formally present the order of the technique and all the steps for insulin injection and allow a quantitative assessment of the operational skills of children. The developed instruments offer providers the possibility of continuous assessment of the progress of the pediatric clientele until they reach independence in diabetes self-care.

A Video Game for Brazilian T1D Children about Knowledge of Disease and Self-care: A Methodological Study.

BACKGROUND: Video games are interactive technologies able to support children in health promotion, behavior changes, and chronic disease self-management. The use of health behavior change determinants in video game design can increase its effectiveness. This study describes the process of designing a video game for Brazilian children with T1D clarifying the use of health behavior change determinants that may influence self-management behaviors. METHODS: This was a methodological study based on health behavior change theories and the user-centered design approach. The results of a qualitative study conducted with children aged 7 to 12 years identified learning needs about knowledge on diabetes and self-care tasks which contribute to inappropriate behaviors. A Behavioral Diagnosis presented health behavior change determinants, capable of influencing children's learning needs and behaviors, that were considered to design The Heroes of Diabetes-the power of knowledge. RESULTS: The results presented the process of designing 4 mini games with its description and theory foundation to reach children's lack of understanding about T1D, insulin's role, SMBG requirements, food groups and physical activity's role in glycemic control. Knowledge, goal settings, extrinsic and intrinsic motivation determinants were related with video games design features. CONCLUSIONS: The findings support the use of health behavior change determinants into video game design as a guide to achieve children learning needs and that might influence self-management behaviors.

Blood glucose monitoring (BGM) still matters for many: Associations of BGM frequency and glycemic control in youth with type 1 diabetes.

AIMS: This study aimed to compare three approaches of blood glucose monitoring (BGM) frequency attainment and to examine their associations with glycemic control in youth with type 1 diabetes (T1D). METHODS: Cross-sectional data was derived from the baseline assessment in three clinical trials. Clinical and demographic characteristics of youth with T1D was obtained by chart review. BGM frequency was assessed by parent-youth interview, chart review, and meter downloads. To examine the relationship between A1c and frequency of BGM we performed analysis of variance. RESULTS: In youth with T1D (N = 385, 50% female, age 13.6 ± 2.5 years, 74% pump users), the 3 methods of assessing BGM frequency were significantly correlated. Frequency by self-report (6.4 ± 2.3 times/day) was significantly higher than both meter download (5.6 ± 2.4 times/day, p < 0.0001) and clinician report (5.7 ± 2.4 times/day, p < 0.0001). For all methods, more frequent BGM was associated with lower A1c and lower mean glucose (p < 0.0001). For each additional daily blood glucose check, there was a 0.2% decrease in A1c (p < 0.0001). CONCLUSION: BGM remains a potent predictor of glycemic control, warranting continued targeting in clinical efforts to improve glycemic management in youth with T1D.

How to Talk to Children and Adolescents With Cancer About Spirituality? Establishing a Conversation Model.

Talking to children and adolescents with cancer about spirituality is a challenge. This study aimed to develop and evaluate a conversation model for a spiritual approach with children and adolescents with cancer. It was a methodological study with a systematic approach in three stages: (a) review of the literature for the selection of photographs and guiding questions, (b) using an expert committee to evaluate photographs and preselected questions, and (c) cognitive interview with children and adolescents to test the methodology. The expert committee evaluated and selected 20 photos and their respective guiding questions. Fifteen children and adolescents hospitalized with cancer tested the spirituality conversation model and expressed feelings, values, beliefs, fears, and the meaning they give to life and illness. The implementation of the conversation model can contribute both to the clinical practice, facilitating care for the spiritual dimension of pediatric patients, and to qualitative research on spirituality involving children.

Play-Based Interventions Delivered by Child Life Specialists: Teachable Moments for Youth With Type 1 Diabetes.

INTRODUCTION: Certified child life specialists (CCLSs) are health care team members with advanced knowledge of child development. CCLSs can help establish a trajectory of engagement in diabetes self-management beginning in early childhood. METHOD: This article describes the child life interventions delivered in a pediatric diabetes clinic from 2003 to 2018. RESULTS: Over the 16 years, there were 43,549 child life interventions, grouped into six categories: medical play, developmentally appropriate recreational play, therapeutic activities, health education, coping and coaching support, and procedural support. Child life interventions occurred within the pediatric clinic in either the playroom, laboratory, or examination rooms. The CCLS team also organizes other events throughout each year, such as the Teddy Bear Clinic, to maintain child and family engagement. DISCUSSION: CCLSs may improve the experience of a child living with diabetes, setting the stage for a future that maintains engagement in self-care and encourages good health.

A vivência da criança escolar com diabetes mellitus expressa por meio do Brinquedo Terapêutico Dramático / School experience of children with diabetes mellitus expressed by Dramatic Therapeutic Play / La experiencia del niño escolar con diabetes mellitus expresa por medio del Juego Terapéutico Dramático

Objetivo: compreender a vivência da criança escolar por meio do Brinquedo Terapêutico Dramático. Método: estudo descritivo qualitativo, realizado com oito crianças de 6 a 10 anos com diabetes mellitus tipo 1 em um acampamento educativo e um centro de referência em diabetes. O estudo teve aprovado o projeto de pesquisa pelo Comitê de Ética em Pesquisa, n. 1970/09. Resultados: a análise qualitativa dos dados revelou as categorias temáticas: Sofrendo com o mundo da doença; Vivendo um mundo de procedimentos; Sofrendo com a restrição alimentar; Enfrentando a doença com otimismo; e Sendo importante brincar. Conclusão: por meio do Brinquedo Terapêutico Dramático as crianças tiveram a oportunidade de aliviar as tensões que sofrem em seu cotidiano, obter o domínio da situação e resgatar a sua autonomia. O Brinquedo Terapêutico Dramático mostrou-se um importante instrumento de intervenção para a enfermagem, sendo imprescindível a sua implementação na assistência à criança com diabetes.(AU)

Objective: to understand the experience of school children through Dramatic Therapeutic Play. Method: a qualitative descriptive study, with eight children from 6 to 10 years old with type 1 diabetes mellitus in an educational camp and a center of excellence in diabetes. The research project of the study was approved by the Research Ethics Committee, number 1970/09. Results: qualitative analysis of the data revealed the themes: Suffering from the world of the disease; Living a world of procedures; Suffering with dietary restriction; Facing the disease with optimism; and Playing being important. Conclusion: by the Dramatic Therapeutic Play, children had the opportunity to ease tensions suffering in their daily lives, get control of the situation and rescue their autonomy. The Dramatic Therapeutic Play proved to be an important intervention instrument for nursing, being essential to its implementation in the care of children with diabetes.(AU)

Objetivo: comprender la experiencia del niño escolar por medio del Juego Terapéutico Dramático. Método: estudio descriptivo cualitativo, realizado con ocho niños de 6 a 10 años con diabetes mellitus tipo 1 en un acampamento educativo y un centro de referencia en diabetes. El proyecto de investigación del estudio fue aprobado por el Comité de Ética en Investigación, número 1970/09. Resultados: el análisis cualitativo de los datos reveló las categorías temáticas: Sufriendo con el mundo de la enfermedad; Viviendo un mundo de procedimientos; Sufriendo con la restricción alimentar; Enfrentando la enfermedad con optimismo; y Siendo importante el jugar. Conclusión: por medio del Juego Terapéutico Dramático los niños tuvieron la oportunidad de aliviar las tensiones que sufren en su cotidiano, obtener el dominio de la situación y rescatar su autonomía. El Juego Terapéutico Dramático se mostró un importante instrumento de intervención para la enfermería, siendo imprescindible su implementación en la asistencia al niño con diabetes.(AU)