Theoretical frameworks and psychosocial interventions for caregivers of children with type 1 diabetes: a systematic review
DOI:
https://doi.org/10.35319/ajayu.242385Keywords:
Type 1 Diabetes Mellitus, psychosocial interventions, pediatric caregivers, theoretical frameworks, systematic reviewAbstract
This systematic review identifies, characterizes, and analyzes the effects of psychosocial interventions targeting caregivers of children and adolescents with type 1 diabetes mellitus (T1D), with particular attention to their theoretical frameworks and the correspondence between theoretical models and observed outcomes. Following PRISMA 2020 guidelines, ten eligible randomized controlled trials were identified across six databases. The included interventions clustered into three theoretical families: cognitive-behavioral and positive parenting models, systemic and multifamily therapies, and social support and psychoeducational models. All share an emphasis on observable skills and knowledge transmission, with limited explicit attention to the emotional and relational processes of caregiving. Regarding outcomes, improvements in parenting skills and family functioning were the most consistent findings, while effects on parental psychological distress were heterogeneous and frequently non-significant between groups. Only one study reported significant HbA1c improvements across the full sample. Outcome variability was associated with the diversity of instruments used, limited statistical power and, at a descriptive level, differences in the change mechanisms posited by each theoretical family. These findings highlight the need for greater methodological rigor and for interventions that explicitly incorporate emotional and relational mechanisms of change in pediatric diabetes caregiving.
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References
American Diabetes Association Professional Practice Committee (2025). Diagnosis and classification of diabetes: Standards of care in diabetes-2025. Diabetes Care, 48(Supplement_1), S27–S49. https://doi.org/10.2337/dc25-s002
Brown, S. A., Basu, A., & Kovatchev, B. P. (2019). Beyond HbA1c: using continuous glucose monitoring metrics to enhance interpretation of treatment effect and improve clinical decision-making. Diabetic Medicine, 36(6), 679–687. https://doi.org/10.1111/dme.13944
Chen, Z., Wang, J., Carru, C., Coradduzza, D., & Li, Z. (2023). The prevalence of depression among parents of children/adolescents with type 1 diabetes: A systematic review and meta-analysis. Frontiers in Endocrinology, 14. https://doi.org/10.3389/fendo.2023.1095729
Costa, V., Pereira, B., Patton, S. R., & Brandão, T. (2025). Parental psychosocial variables and glycemic control in T1D pediatric age: A systematic review. Current Diabetes Reports, 25(1). https://doi.org/10.1007/s11892-024-01566-y
Doherty, F. M., Calam, R., & Sanders, M. R. (2013). Positive Parenting Program (Triple P) for families of adolescents with type 1 diabetes: A randomized controlled trial of self-directed teen Triple P. Journal of Pediatric Psychology, 38(8), 847–858. https://doi.org/10.1093/jpepsy/jst023
Ellis, D., Carcone, A. I., Templin, T., Evans, M., Weissberg-Benchell, J., Buggs-Saxton, C., Boucher-Berry, C., Miller, J. L., Drossos, T., & Dekelbab, M. B. (2024). Moderating effect of depression on glycemic control in an eHealth intervention among Black youth with type 1 diabetes. JMIR Diabetes, 9. https://doi.org/10.2196/55165
Ellis, D. A., Templin, T., Naar-King, S., Frey, M. A., Cunningham, P. B., Podolski, C. L., & Cakan, N. (2007). Multisystemic therapy for adolescents with poorly controlled type I diabetes: Stability of treatment effects in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(1), 168–174. https://doi.org/10.1037/0022-006X.75.1.168
Feldman, M. A., Anderson, L. M., Shapiro, J. B., Jedraszko, A. M., Evans, M., Weil, L. E. G., Garza, K. P., & Weissberg-Benchell, J. (2018). Family-based interventions targeting improvements in health outcomes for youth with type 1 diabetes: A systematic review. Current Diabetes Reports, 18(3), 15. https://doi.org/10.1007/s11892-018-0981-9
Grey, M., Jaser, S. S., Whittemore, R., Jeon, S., & Lindemann, E. (2011). Coping skills training for parents of children with type 1 diabetes. Nursing Research, 60(3), 173–181. https://doi.org/10.1097/nnr.0b013e3182159c8f
Hilliard, M. E., Monaghan, M., Cogen, F. R., & Streisand, R. (2011). Parent stress and child behaviour among young children with type 1 diabetes. Child: Care, Health and Development, 37(2), 224–232. https://doi.org/10.1111/j.1365-2214.2010.01162.x
Hilliard, M. E., Powell, P. W., & Anderson, B. J. (2014). Evidence-based behavioral interventions to promote diabetes management in children, adolescents, and families. American Psychologist, 69(4), 463–473. https://doi.org/10.1037/a0040359
International Diabetes Federation. (2021). IDF Diabetes Atlas (10th ed.). https://www.diabetesatlas.org
Jansen, M., Voorhoeve, P. G., Wiltink, L., Prins, J. B., & Nefs, G. (2025). Parenting interventions for parents of children with type 1 diabetes—a systematic review. Journal of Pediatric Psychology, 50(12), 1115–1138. https://doi.org/10.1093/jpepsy/jsaf078
Jaser, S. S., Lord, J. H., Savin, K., Gruhn, M., & Rumburg, T. (2018). Developing and testing an intervention to reduce distress in mothers of adolescents with type 1 diabetes. Clinical Practice in Pediatric Psychology, 6(1), 19–30. https://doi.org/10.1037/cpp0000220
Katz, M. L., Volkening, L. K., Butler, D. A., Anderson, B. J., & Laffel, L. M. (2014). Family-based psychoeducation and care ambassador intervention to improve glycemic control in youth with type 1 diabetes: A randomized trial. Pediatric Diabetes, 15(2), 142–150. https://doi.org/10.1111/pedi.12065
Law, G. U., Kelly, T. P., Huey, D., & Summerbell, C. (2014). Self-management and well-being in children and young people with diabetes mellitus. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD009660.pub4
Lohan, A., Morawska, A., & Mitchell, A. (2015). A systematic review of parenting interventions for parents of children with type 1 diabetes. Child: Care, Health and Development, 41(6), 803–817. https://doi.org/10.1111/cch.12278
Michie, S., & Prestwich, A. (2010). Are interventions theory-based? Development of a theory coding scheme. Health Psychology, 29(1), 1–8. https://doi.org/10.1037/a0016939
Mitchell, A. E., Morawska, A., Lohan, A., Filus, A., & Batch, J. (2024). Randomised controlled trial of the Healthy Living Triple P-Positive Parenting Program for families of children with type 1 diabetes. Journal of Child Health Care, 28(2), 235–255. https://doi.org/10.1177/13674935221116694
National Heart, Lung, and Blood Institute. (2021). Study quality assessment tools. U.S. Department of Health and Human Services. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
Ogle, G. D., James, S., Dabelea, D., Pihoker, C., Svennson, J., Maniam, J., Klatman, E. L., & Patterson, C. C. (2022). Global estimates of incidence of type 1 diabetes in children and adolescents. Diabetes Research and Clinical Practice, 183. https://doi.org/10.1016/j.diabres.2021.109083
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Patton, S. R., Kahhan, N., Pierce, J. S., Benson, M., Fox, L. A., & Clements, M. A. (2023). Parental diabetes distress is a stronger predictor of child HbA1c than diabetes device use in school-age children with type 1 diabetes. BMJ Open Diabetes Research & Care, 11(5). https://doi.org/10.1136/bmjdrc-2023-003607
Popay, J., Roberts, H., Sowden, A., Petticrew, M., Britten, N., Arai, L., Roen, K., & Rodgers, M. (2005). Guidance on the conduct of narrative synthesis in systematic reviews. Journal of Epidemiology and Community Health, 59(Suppl 1).
Russell, L. B., Suh, D. C., & Safford, M. A. (2005). Time requirements for diabetes self-management: Too much for many? Journal of Family Practice, 54(1), 52–56.
Saßmann, H., De Hair, M., Danne, T., & Lange, K. (2012). Reducing stress and supporting positive relations in families of young children with type 1 diabetes: A randomized controlled study for evaluating the effects of the DELFIN parenting program. BMC Pediatrics, 12(1), 152. https://doi.org/10.1186/1471-2431-12-152
Satin, W., La Greca, A. M., Zigo, M. A., & Skyler, J. S. (1989). Diabetes in adolescence: Effects of multifamily group intervention and parent simulation of diabetes. Journal of Pediatric Psychology, 14(2), 259–275. https://doi.org/10.1093/jpepsy/14.2.259
Sullivan-Bolyai, S., Bova, C., Leung, K., Trudeau, A., Lee, M., & Gruppuso, P. (2010). Social Support to Empower Parents (STEP): An intervention for parents of young children newly diagnosed with type 1 diabetes. Diabetes Educator, 36(1), 88–97. https://doi.org/10.1177/0145721709352384
Wakelin, K. E., Read, R. K., Williams, A. Y., Francois-Walcott, R. R., O’Donnell, N., Satherley, R.-M., Harrington, M. P., John, M., & Jones, C. J. (2025). The effectiveness of psychological interventions for families of children with type 1 diabetes on caregiver and child functioning: A systematic review and meta-analysis. Journal of Diabetes, 17(6), e70112. https://doi.org/10.1111/1753-0407.70112
Westrupp, E., Northam, E., Lee, K., Scratch, S., & Cameron, F. (2015). Reducing and preventing internalizing and externalizing behavior problems in children with type 1 diabetes: A randomized controlled trial of the Triple P-Positive Parenting Program. Pediatric Diabetes, 16(7), 554–563. https://doi.org/10.1111/pedi.12205
Zhao, X., Ai, Z., Chen, Y., Wang, J., Zou, S., & Zheng, S. (2019). The effectiveness of parenting interventions on psychosocial adjustment in parents of children and adolescents with type 1 diabetes: A meta-analysis. Worldviews on Evidence-Based Nursing, 16(6), 462–469. https://doi.org/10.1111/wvn.12399
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