T1D is a life-long condition resulting in major health and psychosocial complications for the child, their families and the whole community. Diabetes management involves insulin injections, dietary control and adjustment of doses in relation to exercise and insulin sensitivity during the day. Poor management and non-adherence to strict regimens are persistent problems in children. Parenting and Parent-child interactions were identified as crucial points of intervention to support such families to achieve emotional wel-being and better glycemic control. However, only a few parenting interventions have been developed or evaluated for parents of young children [12].
Regarding the glycemic profile, Hilliard et al. found that high levels of family conflict and stress were related to poor glycemic control [10]. Their results suggested that the parental stress level was moderate and primarily due to the child’s misbehavior, which may have affected the glycemic control. It was also reported that the higher the involvement of the family, the better the outcome of disease management [13]. The mothers’ knowledge and socioeconomic status had a major influence on glycemic control in T1D pediatric patients [14]. Several studies indicated that the mother is usually responsible for most of the diabetic care of the child, resulting in the father experiencing a lower level of anxiety and fear of hypoglycemic attacks [15,16,17,18]. In the current study, variables associated with a high level of stress were the frequency of hypoglycemia, the father’s level of education and occupation, marital status and the HbA1c level. Support for some of the variables, the frequency of hypoglycemia, marital status and HbA1C, is found in literature [17,18,19,20,21]. The mean of the frequency and difficulty indices in the current study is lower than reported in a similar study in the United States (102.36 and 93.36, respectively) [12]. We speculate that local factors such as cultural differences and the impact of religion on spirituality, social acceptance of the disease, and family support may play a role.
Our study focused on four major domains, including communication, emotional distress, medical care, and role function. The communication domain consisted of 9 items such as “Arguing with family members”, “Speaking with your child” and “Talking with the doctor”. “Speaking with the child” scored the highest in the frequency index. Clinicians could emphasize this issue by encouraging the parents to adopt new tactics to communicate with the child as communication with children can be challenging. Communication can be improved by spending an appropriate time with the parents during the clinic visits and using simple language especially when explaining specific procedures. The emotional distress domain included 15 items. Some of these items are related to observing their children going through different scenarios such as “Knowing that their child is hurt”, “Seeing their child sad”, and “Thinking about their child being isolated due to his/her disease”. Other items are related to the parents themselves, such as “Waiting for test results”, “Experiencing sleep difficulties”, and “Learning about bad news”. To manage emotional distress, parents should attend educational programs and become knowledgeable about their child’s disease, which will reduce the level of stress. The third domain is medical care with 7 items. This domain focuses on the parents’ perceptions of medical care such as bringing the child to the clinic as well as watching or handling procedures such blood glucose monitoring and insulin injections. The last domain is role function, with 10 items. This domain explored the living restrictions that parents may experience. In the current study, parental job attendance was not affected by their child’s illness compared to 44% of the parents in another study [17].
Although the difficulty index is more informative in reflecting the level of stress, the frequency index can vary due to age and in different families due to psychosocial dynamics, however, if interpreted in conjunction with the difficulty index, it adds valuable insight [22]. As previously described in literature, other important factors that are significantly associated with the difficulty experienced by parents in the current study were the marital status, number of children in the family, and the parental level of education [11, 22].