Children's Roles in Parents' Diabetes Self-Management

Background

Family support is important in diabetes self-management. However, children as providers of support have received little attention. This study examines the role of children in their parents' diabetes self-management, diet, and exercise.

Methods

This research used community-based participatory research principles. Researchers conducted semi-structured parallel interviews of 24 Latino and African-American adults with diabetes and with a child (aged 10–17 years) in their home (2004–2006). Interviews were transcribed, coded, and analyzed for themes (2004–2007).

Results

Adults and children perceived that children play many roles related to adults' diabetes self-management. Parents described children as monitoring parents' dietary intake and reminding them what they should not be eating. Some children helped with shopping and meal preparation. Families described children reminding parents to exercise and exercising with their parents. Children reminded parents about medications and assisted with tasks such as checking blood sugar. Parents and children perceived that children played a role in tempting parents to stray from their diabetes diet, because children's diets included food that parents desired but tried to avoid.

Conclusions

Children and parents perceived that children have many roles in both supporting and undermining adults' diabetes self-management. There is more to learn about the bi-directional relationships between adults and children in this setting, and the most beneficial roles children can play. Healthcare providers should encourage family lifestyle changes, strengthen social support for families, and direct children toward roles that are beneficial for both parent and child without placing an unreasonable level of responsibility on the child.

Introduction

Diabetes self-management, which includes taking medications, monitoring blood glucose, following a diet, and being physically active, takes place within the family context.¹ Increased social support is related to better diabetes self-management.2, 3, 4 Some self-care, such as food preparation, may be done by others (often a spouse).⁴ Often-forgotten players in this family milieu are children. Research to date has examined the roles of children of parents with severe physical disabilities, cancer, chronic pain, and mental illness, but not diabetes.5, 6, 7, 8, 9, 10 Studies have focused on “youth carers” who are “involved in exaggerated levels or types of caring” and the detrimental effects of extreme caregiving tasks on development.⁵ There is little research on the everyday roles that children may play in families in which a parent has a chronic disease such as diabetes and how these roles affect parents and children, and there has been no study of children's roles in behavior changes around diet and exercise in these families.

This paper begins to address these gaps by describing parent and child perspectives on children's roles in the self-management of their parents' diabetes among Latino and African-American families. This paper addresses the following study questions: (1) What roles do children and parents perceive children to play in adults' diabetes self-management? (2) What messages do children relay to parents regarding their diabetes self-management? (3) What actions do children take that help or hinder parents' diabetes self-management? (4) How do parents perceive their ability to make changes as being helped or hindered by their children?