title: Collaborative involvement of primary and secondary caregivers: associations with youths' diabetes outcomes.
abstract: OBJECTIVE
  Collaboration between youths with type 1 diabetes (T1D) and their adult caregivers may be central to effective management of T1D. This article includes analysis of cross-sectional associations between T1D outcomes (adherence, glycemic control, quality of life, family conflict, depression, and self-efficacy) and scores on the Collaborative Parent Involvement (CPI) Scale obtained from 309 youths with T1D about their primary and secondary caregivers.
  
  
  METHODS
  MANCOVA, controlling for age, evaluated associations of diabetes outcomes with youths' CPI scores for each caregiver.
  
  
  RESULTS
  Diabetes outcomes were poor when both caregivers obtained CPI scores below the median. Diabetes outcomes were more strongly associated with CPI scores of primary, rather than secondary, caregivers. CPI scores at or above the median among primary caregivers were associated with more favorable status on multiple youth outcomes. When both caregivers obtained CPI scores at or above the median, children had significantly lower HbA1C and parents retained more responsibility for diabetes care.
  
  
  CONCLUSIONS
  Higher collaborative involvement, particularly among primary caregivers, was associated with favorable status along a variety of diabetes outcomes. Longitudinal studies could confirm if youth-parent collaboration is a justifiable intervention target.
authors.affiliation: Nemours Children's Clinic, Jacksonville, FL 32207, USA. twysocki@nemours.org
authors.forename: Tim
authors.initials: T
authors.lastname: Wysocki
authors.forename: Tonja R
authors.initials: TR
authors.lastname: Nansel
authors.forename: Grayson N
authors.initials: GN
authors.lastname: Holmbeck
authors.forename: Rusan
authors.initials: R
authors.lastname: Chen
authors.forename: Lori
authors.initials: L
authors.lastname: Laffel
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Anderson
authors.forename: Jill
authors.initials: J
authors.lastname: Weissberg-Benchell
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D001521:Behavior Therapy; D002648:Child; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000628:therapy*; D054541:Family Conflict / Q000523:psychology; D005196:Family Therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D016487:Parenting / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology; D012648:Self Care / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human