title: Development and validation of PRISM: a survey tool to identify diabetes self-management barriers.
abstract: OBJECTIVE
  Although most children with type 1 diabetes do not achieve optimal glycemic control, no systematic method exists to identify and address self-management barriers. This study develops and validates PRISM (Problem Recognition in Illness Self-Management), a survey-based tool for efficiently identifying self-management barriers experienced by children/adolescents with diabetes and their parents.
  
  
  METHODS
  Adolescents 13 years and older and parents of children 8 years and older visiting for routine diabetes management (n=425) were surveyed about self-management barriers. HbA1c was abstracted from the electronic health record. To develop PRISM, exploratory and confirmatory factor analyses were used. To assess validity, the association of PRISM scores with HbA1c was examined using linear regression.
  
  
  RESULTS
  Factor analyses of adolescent and parent data yielded well-fitting models of self-management barriers, reflecting the following domains: (1) Understanding and Organizing Care, (2) Regimen Pain and Bother, (3) Denial of Disease and Consequences, and (4) Healthcare Team, (5) Family, or (6) Peer Interactions. All models exhibited good fit, with χ(2) ratios<2.21, root mean square errors of approximation<0.09, Confirmatory Fit Indices and Tucker-Lewis Indices both >0.92, and weighted root mean square residuals<1.71. Greater PRISM barrier scores were significantly associated with higher HbA1cs.
  
  
  CONCLUSIONS
  Our findings suggest at least six different domains exist within self-management barriers, nearly all of which are significantly related to HbA1c. PRISM could be used in clinical practice to identify each child and family's unique self-management barriers, allowing existing self-management resources to be tailored to the family's barriers, ultimately improving effectiveness of such services.
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States. Electronic address: ecox@wisc.edu.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Cox
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States.
authors.forename: Katie A
authors.initials: KA
authors.lastname: Fritz
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States.
authors.forename: Kristofer W
authors.initials: KW
authors.lastname: Hansen
authors.affiliation: Department of Research Design & Statistics, University of Wisconsin School of Nursing, Madison, WI 53792, United States.
authors.forename: Roger L
authors.initials: RL
authors.lastname: Brown
authors.affiliation: Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States.
authors.forename: Victoria
authors.initials: V
authors.lastname: Rajamanickam
authors.affiliation: Department of Sociology, University of Wisconsin, Madison, WI 53792, United States.
authors.forename: Kaelyn E
authors.initials: KE
authors.lastname: Wiles
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States.
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Fate
authors.affiliation: School of Pharmacy, University of Wisconsin, Madison, WI 53792, United States.
authors.forename: Henry N
authors.initials: HN
authors.lastname: Young
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Moreno
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005163:Factor Analysis, Statistical; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D018802:Patient-Centered Care / Q000458:organization & administration*; D012648:Self Care / Q000379:methods*
keywords: Adherence; Factor analysis; Patient-centered care; Self-care; Type 1 diabetes mellitus