Qualitative Analysis of Caregiver and Patient Experiences with and Barriers to Medical Nutrition Therapy Utilization in Pediatric Type 1 Diabetes
Despite recommendations by major diabetes organizations, medical nutrition therapy (MNT) in pediatric type 1 diabetes (T1D) remains underutilized. Suboptimal prandial practices and limited engagement in nutritional counseling with the diabetes care team may impact health outcomes in these youth. Thi...
Uloženo v:
| Vydáno v: | Endocrine practice |
|---|---|
| Hlavní autoři: | , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
United States
21.11.2025
|
| Témata: | |
| ISSN: | 1530-891X |
| On-line přístup: | Zjistit podrobnosti o přístupu |
| Tagy: |
Přidat tag
Žádné tagy, Buďte první, kdo vytvoří štítek k tomuto záznamu!
|
| Abstract | Despite recommendations by major diabetes organizations, medical nutrition therapy (MNT) in pediatric type 1 diabetes (T1D) remains underutilized. Suboptimal prandial practices and limited engagement in nutritional counseling with the diabetes care team may impact health outcomes in these youth. This study aimed to understand patient and caregiver experiences with and barriers to MNT utilization.
Utilizing the socioecological framework and the phenomenological research design augmented by grounded theory methods, we conducted semi-structured interviews with caregivers of patients with T1D <18 years and youth with T1D 12-17 years with T1D duration ≥1 year. Emergent themes were used to generate a theoretical model of the relationship between the family unit encompassing the child with T1D and suboptimal MNT utilization.
We recruited 9 caregivers and 9 patients. Qualitative analysis yielded important themes highlighting challenges impacting MNT utilization across 5 domains: individual, shared child/caregiver-specific, interpersonal, institutional, and community/societal. The central theme was recognition of the importance of MNT in pediatric T1D management juxtaposed with barriers to its implementation. Factors mediating this paradoxical relationship included the impact of diabetes technologies on prandial practices, balance between caregiver involvement and emerging patient independence, emphasis on normalcy, attempts to match child's way of eating with that of others, school-based considerations, and cultural/sociodemographic influences.
This study generated informative insights on the perceptions and experiences of patients and caregivers regarding barriers to MNT implementation in pediatric T1D. Efforts to enhance MNT appreciation and utilization in this population by targeting the identified barriers through patient-/family-centered strategies are crucial. |
|---|---|
| AbstractList | Despite recommendations by major diabetes organizations, medical nutrition therapy (MNT) in pediatric type 1 diabetes (T1D) remains underutilized. Suboptimal prandial practices and limited engagement in nutritional counseling with the diabetes care team may impact health outcomes in these youth. This study aimed to understand patient and caregiver experiences with and barriers to MNT utilization.
Utilizing the socioecological framework and the phenomenological research design augmented by grounded theory methods, we conducted semi-structured interviews with caregivers of patients with T1D <18 years and youth with T1D 12-17 years with T1D duration ≥1 year. Emergent themes were used to generate a theoretical model of the relationship between the family unit encompassing the child with T1D and suboptimal MNT utilization.
We recruited 9 caregivers and 9 patients. Qualitative analysis yielded important themes highlighting challenges impacting MNT utilization across 5 domains: individual, shared child/caregiver-specific, interpersonal, institutional, and community/societal. The central theme was recognition of the importance of MNT in pediatric T1D management juxtaposed with barriers to its implementation. Factors mediating this paradoxical relationship included the impact of diabetes technologies on prandial practices, balance between caregiver involvement and emerging patient independence, emphasis on normalcy, attempts to match child's way of eating with that of others, school-based considerations, and cultural/sociodemographic influences.
This study generated informative insights on the perceptions and experiences of patients and caregivers regarding barriers to MNT implementation in pediatric T1D. Efforts to enhance MNT appreciation and utilization in this population by targeting the identified barriers through patient-/family-centered strategies are crucial. Despite recommendations by major diabetes organizations, medical nutrition therapy (MNT) in pediatric type 1 diabetes (T1D) remains underutilized. Suboptimal prandial practices and limited engagement in nutritional counseling with the diabetes care team may impact health outcomes in these youth. This study aimed to understand patient and caregiver experiences with and barriers to MNT utilization.OBJECTIVESDespite recommendations by major diabetes organizations, medical nutrition therapy (MNT) in pediatric type 1 diabetes (T1D) remains underutilized. Suboptimal prandial practices and limited engagement in nutritional counseling with the diabetes care team may impact health outcomes in these youth. This study aimed to understand patient and caregiver experiences with and barriers to MNT utilization.Utilizing the socioecological framework and the phenomenological research design augmented by grounded theory methods, we conducted semi-structured interviews with caregivers of patients with T1D <18 years and youth with T1D 12-17 years with T1D duration ≥1 year. Emergent themes were used to generate a theoretical model of the relationship between the family unit encompassing the child with T1D and suboptimal MNT utilization.METHODSUtilizing the socioecological framework and the phenomenological research design augmented by grounded theory methods, we conducted semi-structured interviews with caregivers of patients with T1D <18 years and youth with T1D 12-17 years with T1D duration ≥1 year. Emergent themes were used to generate a theoretical model of the relationship between the family unit encompassing the child with T1D and suboptimal MNT utilization.We recruited 9 caregivers and 9 patients. Qualitative analysis yielded important themes highlighting challenges impacting MNT utilization across 5 domains: individual, shared child/caregiver-specific, interpersonal, institutional, and community/societal. The central theme was recognition of the importance of MNT in pediatric T1D management juxtaposed with barriers to its implementation. Factors mediating this paradoxical relationship included the impact of diabetes technologies on prandial practices, balance between caregiver involvement and emerging patient independence, emphasis on normalcy, attempts to match child's way of eating with that of others, school-based considerations, and cultural/sociodemographic influences.RESULTSWe recruited 9 caregivers and 9 patients. Qualitative analysis yielded important themes highlighting challenges impacting MNT utilization across 5 domains: individual, shared child/caregiver-specific, interpersonal, institutional, and community/societal. The central theme was recognition of the importance of MNT in pediatric T1D management juxtaposed with barriers to its implementation. Factors mediating this paradoxical relationship included the impact of diabetes technologies on prandial practices, balance between caregiver involvement and emerging patient independence, emphasis on normalcy, attempts to match child's way of eating with that of others, school-based considerations, and cultural/sociodemographic influences.This study generated informative insights on the perceptions and experiences of patients and caregivers regarding barriers to MNT implementation in pediatric T1D. Efforts to enhance MNT appreciation and utilization in this population by targeting the identified barriers through patient-/family-centered strategies are crucial.CONCLUSIONSThis study generated informative insights on the perceptions and experiences of patients and caregivers regarding barriers to MNT implementation in pediatric T1D. Efforts to enhance MNT appreciation and utilization in this population by targeting the identified barriers through patient-/family-centered strategies are crucial. |
| Author | Azova, Svetlana Garvey, Katharine Lennerz, Belinda Williams, David Michelson, Hannah |
| Author_xml | – sequence: 1 givenname: Svetlana surname: Azova fullname: Azova, Svetlana email: Svetlana.Azova@childrens.harvard.edu organization: Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts, United States, 02115; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, United States, 02115. Electronic address: Svetlana.Azova@childrens.harvard.edu – sequence: 2 givenname: Hannah surname: Michelson fullname: Michelson, Hannah organization: Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts, United States, 02115 – sequence: 3 givenname: David surname: Williams fullname: Williams, David organization: Biostatistics and Research Design Center, Boston Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts, United States, 02115 – sequence: 4 givenname: Belinda surname: Lennerz fullname: Lennerz, Belinda organization: Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts, United States, 02115; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, United States, 02115 – sequence: 5 givenname: Katharine surname: Garvey fullname: Garvey, Katharine organization: Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts, United States, 02115; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, United States, 02115 |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/41276018$$D View this record in MEDLINE/PubMed |
| BookMark | eNo1kMtOwzAQRb0AQVv4AiTkJZuGsfNwsiylPKTykorErpo6U3CVJsF2gPIX_DFWKasZnXtmFrfP9uqmJsZOBEQCRHa-iqi1qCMJMo2EiADSPdYTaQzDvBAvh6zv3ApAQiHyA3aYCKkyEHmP_Tx1WBmP3nwQH9VYbZxxvFnyMVp6DdByrEv-GASqPZ98tWTDpsnxT-PftuEF2sCs477hd1QajRW_77w13jQ1n72RxXbDn72pzDduman5YxAxOJrPNi1xwS8NLsiTO2L7S6wcHe_mgM2uJrPxzXD6cH07Hk2HWhRFOiQNsRSLZSkRAVSOy1KXJSUK0lwlkvK0yOJSKUxUlhGQlhDudI4hj2EhB-zs721rm_eOnJ-vjdNUVVhT07l5LFVSxJkKVQ3Y6U7tFmsq5601a7Sb-X-L8hexmHds |
| ContentType | Journal Article |
| Copyright | Copyright © 2025 AACE. Published by Elsevier Inc. All rights reserved. |
| Copyright_xml | – notice: Copyright © 2025 AACE. Published by Elsevier Inc. All rights reserved. |
| DBID | NPM 7X8 |
| DOI | 10.1016/j.eprac.2025.11.005 |
| DatabaseName | PubMed MEDLINE - Academic |
| DatabaseTitle | PubMed MEDLINE - Academic |
| DatabaseTitleList | PubMed MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| ExternalDocumentID | 41276018 |
| Genre | Journal Article |
| GroupedDBID | --- 0R~ 4.4 53G 5GY 7RV 7X7 AALRI AAXUO ABJNI ADBBV AENEX AFJKZ AFKRA AHMBA AITUG ALMA_UNASSIGNED_HOLDINGS AMRAJ APXCP AZQEC BENPR EBS EFKBS F5P FDB M0R M0T MAS MCE MET NPM P2P ROL 7X8 |
| ID | FETCH-LOGICAL-c1995-ec0321bfd2aa0078afdcdde47058742e85963d77a4766e0ec20199c8a05830b2 |
| IEDL.DBID | 7X8 |
| ISSN | 1530-891X |
| IngestDate | Mon Nov 24 17:30:55 EST 2025 Tue Nov 25 01:40:48 EST 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Keywords | qualitative study type 1 diabetes semi-structured interviews medical nutrition therapy pediatric |
| Language | English |
| License | Copyright © 2025 AACE. Published by Elsevier Inc. All rights reserved. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c1995-ec0321bfd2aa0078afdcdde47058742e85963d77a4766e0ec20199c8a05830b2 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| OpenAccessLink | https://www.endocrinepractice.org/article/S1530-891X(25)01269-8/pdf |
| PMID | 41276018 |
| PQID | 3274936741 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_3274936741 pubmed_primary_41276018 |
| PublicationCentury | 2000 |
| PublicationDate | 2025-Nov-21 |
| PublicationDateYYYYMMDD | 2025-11-21 |
| PublicationDate_xml | – month: 11 year: 2025 text: 2025-Nov-21 day: 21 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | Endocrine practice |
| PublicationTitleAlternate | Endocr Pract |
| PublicationYear | 2025 |
| SSID | ssj0020918 |
| Score | 2.4324214 |
| SecondaryResourceType | online_first |
| Snippet | Despite recommendations by major diabetes organizations, medical nutrition therapy (MNT) in pediatric type 1 diabetes (T1D) remains underutilized. Suboptimal... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| Title | Qualitative Analysis of Caregiver and Patient Experiences with and Barriers to Medical Nutrition Therapy Utilization in Pediatric Type 1 Diabetes |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/41276018 https://www.proquest.com/docview/3274936741 |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1LS8NAEF7Uinjx_agvRvAazSbZJnsSFYsHG3qokFvZ7m6kIEltqv_Df-xMsqknQfCSyxIIm9mZb3bm-4axK0lEHqkNIjdpvChQwpug2_NMSMwSHuaymVryHKdpkmVy6C7cKtdW2frE2lGbUtMd-U2I6ZMMexgAb2fvHk2NouqqG6GxyjohQhmy6jhbVhECjIVJo5fqe4nkWas6VPd3WaIhYYIYiGuS8fTF7xizjjX97f9-5Q7bcigT7hqz2GUrtthjGwNXR99nX410Ri36Da0uCZQ5EB3plVo1QBUGho3oKvzoIVdAF7f14r2a07S7ChYluHIPpK22P4watQJ4WUzfHNUTpgUsJ4MAJcDAwXXkVAds1H8cPTx5bjiDp2tWt9V-GPBJbgKlCGeo3Gh0lVHsiwTTbZsIPNomjlUU93rWtxqRhpQ6Ubge-pPgkK0VZWGPGcQWYZG2MeehisTEV1wYLhI0FGFypf0uu2z3eoy2TwUNVdjyoxr_7HaXHTU_bDxrRDrGEQ-o3Sc5-cPbp2yT7IAohgE_Y50cT749Z-v6czGt5he1UeEzHQ6-AZGv2Aw |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Qualitative+Analysis+of+Caregiver+and+Patient+Experiences+with+and+Barriers+to+Medical+Nutrition+Therapy+Utilization+in+Pediatric+Type+1+Diabetes&rft.jtitle=Endocrine+practice&rft.au=Azova%2C+Svetlana&rft.au=Michelson%2C+Hannah&rft.au=Williams%2C+David&rft.au=Lennerz%2C+Belinda&rft.date=2025-11-21&rft.issn=1530-891X&rft_id=info:doi/10.1016%2Fj.eprac.2025.11.005&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1530-891X&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1530-891X&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1530-891X&client=summon |