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. 2025 Jul 9:8:e66914.
doi: 10.2196/66914.

Empowering Caregiver Well-Being With the Adhera Caring Digital Program for Family Caregivers of Children Living With Type 1 Diabetes: Mixed Methods Feasibility Study

Antonio de Arriba Muñoz  1 , Elisa Civitani Monzon  1 , Maria Pilar Ferrer  1 , Marta Ferrer-Lozano  1 , Silvia Quer-Palomas  2 , Joia Nuñez  2 , Alba Xifra-Porxas  2 , Francesca Aimée Mees Mlatiati  2 , Ioannis Bilionis  2 , Ricardo C Berrios  2 , Luis Fernández-Luque  2
Affiliations

Empowering Caregiver Well-Being With the Adhera Caring Digital Program for Family Caregivers of Children Living With Type 1 Diabetes: Mixed Methods Feasibility Study

Antonio de Arriba Muñoz et al. JMIR Pediatr Parent. .

Abstract

Background: Caregivers of children living with type 1 diabetes (T1D) face multiple challenges that significantly impact their mental health and quality of life. The well-being of caregivers directly affects the management of the child's condition. The Adhera Caring Digital Program (ACDP) is a comprehensive, digitally delivered program, designed to support family caregivers in enhancing self-management and well-being. This study aims to assess how the ACDP influences caregivers' mood, emotional well-being, and health-related quality of life within the context of T1D.

Objective: This study aimed to evaluate the impact of ACDP on caregivers' psychological well-being and caregiving outcomes.

Methods: This was a two-step, prospective, mixed methods study targeting caregivers of children living with T1D who were under the care of a pediatric endocrinologist at Miguel Servet Children's University Hospital in Zaragoza, Spain. In substudy 1 (SS1), qualitative and quantitative data were collected to optimize the ACDP. In substudy 2 (SS2), caregivers used the optimized ACDP for three months. Psychometric assessments were conducted at baseline and follow-up to evaluate positive mood states, general well-being, self-efficacy, and lifestyle behaviors. This paper focuses on SS2.

Results: Ninety caregivers participated in SS2. Positive affect significantly increased (P<.001), and negative affect decreased (P<.001) on the Positive and Negative Affect Schedule (PANAS). Depression, anxiety, and stress scores were reduced (P<.001) on the Depression, Anxiety and Stress Scale-21 Items (DASS-21). General well-being, measured by the Mental Health Continuum-Short Form (MHC-SF) and self-efficacy, assessed using General Self-Efficacy Scale (GSE), improved significantly (P<.001). Health-related quality of life (HrQoL) scores and Mediterranean Diet Quality Index scores increased modestly (P=.03, and P=.04, respectively).

Conclusions: The ACDP intervention improved caregivers' psychological well-being and self-efficacy. These findings highlight the potential of digital solutions to support caregiver mental health and positively influence diabetes management. Future research should explore long-term outcomes and scalability.

Keywords: CGM; T1D; caregiver; caregiver wellbeing; caregiving; carer; children; chronic; coaching; continuous glucose monitoring; diabetes; diabetic; digital health; digital program; endocrinology; family care; glucose; guardian; informal care; parental; parents; pediatrics; type 1 diabetes.

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Conflict of interest statement

Conflicts of Interest: AXP, IB, RCB, SQP, and LFL are current employees at Adhera Health; JN and FAMM are former employees.

Figures

Figure 1.
Figure 1.. Substudy 2 diagram. DASS-21:depression, anxiety and stress scale-21 items; GSE: general self-efficacy scale; MDI/CSII: multiple daily injections and continuous subcutaneous insulin infusion; MHC-SF: mental health continuum-short form; PANAS: positive and negative affect schedule; SUS: system usability scale.
See this image and copyright information in PMC

References

    1. Andrade C do N, Alves C de A. Relationship between bullying and type 1 diabetes mellitus in children and adolescents: a systematic review. J Pediatr (Rio J) 2019;95(5):509–518. doi: 10.1016/j.jped.2018.10.003. doi. Medline. - DOI - PubMed
    1. Nieuwesteeg A, Pouwer F, van der Kamp R, van Bakel H, Aanstoot HJ, Hartman E. Quality of life of children with type 1 diabetes: a systematic review. Curr Diabetes Rev. 2012 Nov;8(6):434–443. doi: 10.2174/157339912803529850. doi. Medline. - DOI - PubMed
    1. Alsaigh R, Coyne I. Mothers’ experiences of caring for children receiving growth hormone treatment. J Pediatr Nurs. 2019;49:e63–e73. doi: 10.1016/j.pedn.2019.09.005. doi. Medline. - DOI - PubMed
    1. Eckshtain D, Ellis DA, Kolmodin K, Naar-King S. The effects of parental depression and parenting practices on depressive symptoms and metabolic control in urban youth with insulin dependent diabetes. J Pediatr Psychol. 2010 May;35(4):426–435. doi: 10.1093/jpepsy/jsp068. doi. Medline. - DOI - PMC - PubMed
    1. Carona C, Silva N, Crespo C, Canavarro MC. Caregiving burden and parent-child quality of life outcomes in neurodevelopmental conditions: the mediating role of behavioral disengagement. J Clin Psychol Med Settings. 2014 Dec;21(4):320–328. doi: 10.1007/s10880-014-9412-5. doi. Medline. - DOI - PubMed

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