Semester

Summer

Date of Graduation

2022

Document Type

Dissertation

Degree Type

PhD

College

Eberly College of Arts and Sciences

Department

Psychology

Committee Chair

Christina Duncan

Committee Member

Cheryl McNeil

Committee Member

Kathryn Kestner

Committee Member

Melissa Olfert

Abstract

Type 1 diabetes (T1D) is a chronic illness, typically diagnosed within childhood, that affects the ability of the pancreas to produce insulin. Significant daily self-management behaviors are required to maintain metabolic control for patients with T1D. Nutritional therapy, including adequate intake of macronutrients, is one self-management behavior necessary to optimize health. Adherence to such nutritional guidelines is associated with improved glycemic control, decreased instances of acute health complications (e.g., hyperglycemia, hypoglycemia), and can also prevent insulin resistance. Despite the critical importance of nutritional therapy, adherence to these guidelines remains low within pediatric populations. Therefore, it is important and necessary to better understand relevant factors related to nutritional adherence. Child feeding behaviors is one factor that may influence nutritional therapy, as some literature has identified childhood selective eating to be related to dietary intake quality. The parent-child dynamic also presents unique challenges for achieving diabetic adherence. Some studies indicate that parents of children with T1D report more mealtime stress. However, it is unknown whether specific parent characteristics, such as parent stress or parenting style, influence child nutritional adherence. The current study investigated variables associated with nutritional adherence and health outcomes in children with T1D. Sixty-three children with T1D and their primary caregiver were recruited from in-person and tele-based endocrinology appointments in a pediatric endocrinology clinic in West Virginia. Participants completed self-report questionnaires remotely and researchers extracted relevant health information (HbA1c, diabetes regimen, date of diagnosis) via chart review. Linear regression modeling was used to determine the extent to which child feeding behaviors predicted (a) nutritional adherence and (b) glycemic control. Moderation analyses were used to identify the extent to which parent factors, including authoritative parenting style and parent stress, moderated the relation of child feeding behaviors to nutritional adherence and glycemic control. Problematic child feeding behavior was negatively associated with nutritional adherence to vegetable and protein intake while no association between child feeding behavior and glycemic control was observed. Caregivers with low degrees of parent stress and high degrees of authoritative parenting moderated the relationship between problematic feeding behavior and nutritional adherence. Increased use of Continuous Glucose Monitor (CGM) therapy was associated with low HbA1c levels. Continuing research on factors influencing health outcomes for pediatric T1D patients is needed, with more objective measures of parenting characteristics. Parent-based behavioral interventions and increased access to diabetes technology are recommended to optimize pediatric health outcomes. Recommendations for clinical-based program development surrounding behavioral health interventions are presented and healthcare policy recommendations are discussed.

Embargo Reason

Publication Pending

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