title: Qualitative observation instrument to measure the quality of parent-child interactions in young children with type 1 diabetes mellitus.
abstract: BACKGROUND
  In young children with type 1 diabetes mellitus (T1DM), parents have complete responsibility for the diabetes-management. In toddlers and (pre)schoolers, the tasks needed to achieve optimal blood glucose control may interfere with normal developmental processes and could negatively affect the quality of parent-child interaction. Several observational instruments are available to measure the quality of the parent-child interaction. However, no observational instrument for diabetes-specific situations is available. Therefore, the aim of the present study was to develop a qualitative observation instrument, to be able to assess parent-child interaction during diabetes-specific situations.
  
  
  METHODS
  First, in a pilot study (n = 15), the observation instrument was developed in four steps: (a) defining relevant diabetes-specific situations; (b) videotaping these situations; (c) describing all behaviors in a qualitative observation instrument; (d) evaluating usability and reliability. Next, we examined preliminary validity (total n = 77) by testing hypotheses about correlations between the observation instrument for diabetes-specific situations, a generic observation instrument and a behavioral questionnaire.
  
  
  RESULTS
  The observation instrument to assess parent-child interaction during diabetes-specific situations, which consists of ten domains: "emotional involvement", "limit setting", "respect for autonomy", "quality of instruction", "negative behavior", "avoidance", "cooperative behavior", "child's response to injection", "emphasis on diabetes", and "mealtime structure", was developed for use during a mealtime situation (including glucose monitoring and insulin administration).
  
  
  CONCLUSIONS
  The present study showed encouraging indications for the usability and inter-rater reliability (weighted kappa was 0.73) of the qualitative observation instrument. Furthermore, promising indications for the preliminary validity of the observation instrument for diabetes-specific situations were found (r ranged between |.24| and |.45| for significant correlations and between |.10| and |.23| for non-significant trends). This observation instrument could be used in future research to (a) test whether parent-child interactions are associated with outcomes (like HbA1c levels and psychosocial functioning), and (b) evaluate interventions, aimed at optimizing the quality of parent-child interactions in families with a young child with T1DM.
authors.forename: Anke
authors.initials: A
authors.lastname: Nieuwesteeg
authors.affiliation: Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, Tilburg LE 5000, The Netherlands. e.e.hartman@tilburguniversity.edu.
authors.forename: Esther
authors.initials: E
authors.lastname: Hartman
authors.forename: Frans
authors.initials: F
authors.lastname: Pouwer
authors.forename: Wilco
authors.initials: W
authors.lastname: Emons
authors.forename: Henk-Jan
authors.initials: HJ
authors.lastname: Aanstoot
authors.forename: Edgar
authors.initials: E
authors.lastname: Van Mil
authors.forename: Hedwig
authors.initials: H
authors.lastname: Van Bakel
mesh_terms: D015190:Blood Glucose Self-Monitoring; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D062407:Meals; D010287:Parent-Child Relations; D026684:Personal Autonomy; D010865:Pilot Projects
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin