الفهرس 
Overview about Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
T
here is a range of views about what constitutes pediatric children involvement and participation in health care and a range of interpretations of what constitutes shared decision-making. Shared decision-making (or mutuality, ‘active involvement’, ‘partnership’) has gained a high level of children management specially, who suffered from diabetes which emphasizes children autonomy, informed consent, and empowerment (American Academy of Family Physicians 2010).
This study aimed to study the effect of shared decision making program in management of children suffering from diabetes.
This was implemented through assessing the possible areas (for example dealing with hypoglycemia) in decision making by diabetic children and their care givers, assess factors affecting the decision making in management of children suffering from diabetesand study the effect of the implemented decision making program in management of children suffering from diabetes.
Subjects and Methods
The subjects and methods of the current study are discussed under the following designs:
Technical design
Operational design
Administrative design
Statistical design
I-Technical design:
Technical design includes; the research design, setting, subjects and tools for data collection.
Research Design:
A quasi-experimental study design was utilized in carrying out this study.
Research Setting:
This study was conducted at inpatient and diabetes out patient departments of children’s Hospital affiliated to Ain Shams University Hospitals.
Subjects:
A purposive sample was involved in the study from children suffering from diabetes mellitus who are attending the previously mentioned setting over a period of 6 months, their number was 210 children. The following inclusion criteria was considered in their selection:
1-Children with confirmed diagnosis of diabetes (regardless to type or the duration of their illness)
2-Both genders.
3-Children in the age group of 10 ≤ 18 years.
4-Urban and rural residents
Exclusion criteria: Exclude diabetic children suffering from other chronic physical or mental illness.
Tools of data collection
Tools of the study were developed by the researcher after reviewing the relevant literature and include the following:
I. A pre-designed questionnaire (by interview) (pre/post) that includes data about:
1. Socio-demographic characteristics of the diabetic children (age, gender, educational level etc..).
2. Knowledge of the diabetic children related to the use of information technology (such as internet, mobile phone and SMS, etc..) and its effect on glycemic control. As well as, their knowledge regarding diabetes mellitus (definition, predisposing factors, signs and symptoms etc..).
3. Factors affecting decision making in diabetes management
II. Psychometric assessment scales to assess level of:
1) The depression:
Score from 0 < 27 referred to low depression.
Score from 27 < 54 referred to moderate depression.
Score from 54 ≤ 81 referred to severe depression.
2) For the anxiety:
Score from 0 < 20 referred to low anxiety.
Score from 20 < 40 referred to moderate anxiety.
Score from 40 ≤ 60 referred to severe anxiety.
3) For the self-esteem:
Score from 0 < 8 referred to low self-esteem.
Score from 8 < 16 referred to moderate self-esteem.
Score from 16 ≤24 referred to high self-esteem.
4) For the aggressive behavior:
Score from 0 < 33 referred to verbal aggressive behavior.
Score from 33 ≤66 referred to physical aggressive behavior.
III- Perception scale of decision making for children adopted from Dwyer and Gangster’s, (1992) to assess the following:
1. General perception of decision making for children in relation to management of their diabetes.
2. Unit based perception of decision making for children in relation to management of their diabetes.
IV-Decision making program based on actual need assessment of the studied sample that was designed to cover the possible areas of decision making e.g: dealing with hypoglycemia, (type and amount of intake), number and frequency of testing glucose and acetone in blood and urine (in hypo – and hypoglycaemia…etc).
Scoring System
According to the children’s answers, each correct answer had score 1 degree and both wrong answer and do not know had 0 degree. Also, their practices were assessed and scored 1 degree if done correctly and zero if not done or done incorrectly. Then the total scoring was calculated as level of knowledge and practice satisfactory (>70%) and unsatisfactory level of knowledge and practice (< 70%).
Tools validity and reliability
Tools validity was checked through distribution of the tools to seven experts in the field of the study of diabetes mellitus, content validity was assessed to determine whether the tool covers the appropriate and necessary content, as well as its relevance to the aim of the study, clarity, and its simplicity. The suggested modifications were done (rephrasing of some statements, omission and addition of certain items). Then the final form was stated.
II-Operational design:
The operational design of the study entails three main phases: preparatory phase, exploratory phase (pilot study) and field of the work.
1-Preparatory phase:
A review of past and current, local and international related literature using journal, magazines, scientific periodicals and books was done to develop the study tools and to get acquainted with the various aspects of the research problem.
2-Pilot Study (exploratory phase):
A pilot study was carried out including 10 children suffering from type 1 DM to test the applicability and clarity of the study tools and to determine the needed time for fulfilling the study tools. then necessary modifications of some questions were done based on the findings of the pilot study. the diabetic children who participated in the pilot study were excluded later from the study sample.
3-Field work
Data collection was carried out in the period from the beginning of September 2013 to the end of February 2014. The researcher was available at the study setting two days weekly (Tuesday and Wednesday).
The researcher started by explaining the nature, aim and expected outcomes of the study to the diabetic children and their care givers. Children were assessed individually using the previously mentioned tools twice pre/post IT based intervention.
The decision making based intervention was prepared according to the actual need assessment of the studied children
Ethical and legal issues
Parental agreement was a prerequisite to involve the child in the study sample at the first session. all ethical issues of research were maintained. The purpose, specific objectives, anticipated benefits and methods of the study were carefully explained to each eligible subject. when the subjects agreed to participate in the study, they were assured that they could withdraw at any time and they would not be identified in the report of the study. Also, the researcher informed the studied subject that, the research would be harmless. Confidentiality in gathering and treating subjects information was secured.
III-Administrative design
Approval was obtained from the dean of Faculty of nursing (Ain Shams University) and the directors of the study setting to conduct the study at the previously mentioned settings.
IV-Statistical design
The data collected were revised, coded, tabulated and statistically analyzed using statistical package for the social science (SPSS) version 20. numbers and percentages distribution were done. Chi-square test, t-test and the Pearson correlation coefficient test, one way analysis of variance (ANOVA) test, mean and stander deviation were used to estimate the statistical significant difference between variables of the study. Probability of error (p-value) <0.05 was considered significant.
Results
The main findings of the study were as the following:
• About 61% of the studied diabetic children were male, also half of them were at age group of 10 < 13 years old.
• As regards factors affecting children’s decision making were adolescent, female, urban beliefs and values, type of personality, psychological factors and personal tendencies and ambitious, reported by 55.2%, 52.4%, 57.6%, 57.6%, 61.9%, 62.3%, 63.3% and 68.1% respectively.
• There was statistically significant difference between pre and post decision making program intervention regarding children’s factors affecting their decision making by sharing.
• Stages of taking decision by sharing of the studied sample showed that the studied sample identified the benefits of decision making such as diagnose the problem, data gathering related to illness, follow up the taking decision and evaluation and selection proper solution.
• In relation to areas of decision making by sharing pre and post program implementation, it was found that decision of taking medication (dose/ route of administration) diet selection, Practice sport/exercise, testing blood for glucose and acetone self-care, management of hypo / hyperglycemia and follow-up and health supervision / hygiene were improved post program intervention with statistically significance relation between pre and post program intervention with P-Value <0.001.
• Decision by sharing in relation to management of hypo/ hyperglycemia/ DKA was improved post program intervention.
• There was statistically significant difference between pre and post program intervention related to decision by sharing in insulin administration (insulin preparation & injection, route of insulin injection, modifying dose of insulin and managing problems related to insulin therapy), with P-Value <0.001.
• There was statistically significant difference between pre and post program intervention related to decision making by sharing in diet as regards type of food (quality and quantity) and number meals/day, with P-Value <0.001.
• There was statistically significant between pre and post program intervention related to decision making by sharing in self-care skills as regards degree of dependency in self-care skills and consulting whom in self-care, with P-Value <0.001.
• There was statistically significant relation between pre and post program intervention related to total decision making by sharing with P-value <0.001.
• More than half of the studied children were having severed depression pre program intervention which improved post program intervention
• It was clear that more than half of the studied chilren were having positive aggression behavior pre program intervention compared with nearly one third of them post program intervention.
Conclusion
It can be concluded that, factors affecting decision making included factors related to child (age, gender, education, residence, beliefs and values, type of personality, psychological factors and personal tendencies and ambitious, lack of diabetic children experience) factors related to family (neglection of the family, lack of information about disease, lack of specialized diabetes care, lack of financial support, lack of consultation / supervision and lack of practice self care,) the decision making program was successful in management of children suffering from diabetes, which affects positively in improving psychometric assessment (anxiety, self-esteem, depression and aggressive behavior) of the studied sample and glycemic control
Recommendations
According to the result of the current study, the following recommendations are suggested:
• It is recommended to apply such decision making intervention program in pediatric health car setting caring for diabetic children and their care givers.
• Improve area of decision making to enable the children to share in their management of diabetes.
• More studies are needed to investigate the long-term effect of such decision making intervention program on glycemic control of diabetic children with type 1 diabetes.
• Involve the diabetic child in his\her management plan.
• Encourage self care activities and taking appropriate decisions by diabetic children under adult supervision