Publications by authors named "Mary E Keenan"

9 Publications

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Development and initial validation of the diabetes family conflict scale (revised)-short form in a racially and income diverse sample.

Pediatr Diabetes 2021 May 2;22(3):529-539. Epub 2021 Feb 2.

Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.

Objective: The purpose of the study was to develop a short form of the revised diabetes family conflict scale (DFCS) in a racially and income diverse sample while retaining strong psychometric properties.

Methods: One seventy nine youth with type 1 diabetes (ages 12-18 years) and caregivers completed the DFCS-Revised as well as assessments of adherence, psychosocial functioning, and diabetes-related stress. Hemoglobin A1c was also obtained. The sample was split at random into a development sample and validation sample.

Results: Confirmatory factor analyses in the validation sample supported the use of a six-item short form (DFCS-SF) either as a total score (6-items) or a direct (3-item) and indirect (3-item) score. Variations of the DFCS-SF (three items of the 6-item short form) also had acceptable model fit. The short-form questionnaires had acceptable internal consistency and convergent validity (6-item: Cronbach's a = 0.865, full scale DFCS r = 0.954; 3-item: Cronbach's a = 0.757, full scale DFCS r = 0.912). The DFCS-SF showed measurement invariance across both youth and caregiver respondents. Greater report of the DFCS-SF by both youth and caregivers was significantly associated with higher HbA1c, more diabetes-related stress, and more psychosocial concerns.

Conclusions: The DFCS-SF developed in the present study shows psychometric integrity in a diverse population of youth and can be utilized by providers to rapidly assess and potentially implement interventions to reduce diabetes family conflict, a psychosocial concern which is associated with elevated HbA1c, non-optimal adherence, diabetes-related stress, and psychological distress.
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http://dx.doi.org/10.1111/pedi.13182DOI Listing
May 2021

Predictors of HbA1c Trajectories in Predominantly Black Adolescents With Type 1 Diabetes.

J Pediatr Psychol 2021 03;46(3):241-250

Department of Psychology, The University of Memphis.

Objective: Following the Journal of Pediatric Psychology's special edition on health disparities, calling for Phase 2 research exploring mechanisms of racial groups in health disparities, this study aims to explore social information processing predictors of longitudinal hemoglobin A1c (HbA1c) trajectories in a racially diverse group of adolescents. The social information processing model of glycemic control in type 1 diabetes (T1D) posits that adolescents who make negative attributions about reactions of friends are likely to find adherence difficult in social situations, have increased stress, and have suboptimal glycemic control.

Methods: One hundred eighty-four youth with T1D completed self-report measures and HbA1c at three time points within 1 year was extracted from medical records. Growth mixture modeling empirically derived classes of HbA1c trajectories and explored predictive relationships of social information processing variables, demographics, and diabetes characteristics.

Results: Three classes emerged: High Decelerating, Mid-High Accelerating, and Near-Optimal Accelerating. Black/African American participants were highly likely to be in the High and Mid-High groups. Higher anticipated adherence difficulties in social situations predicted increased odds of being in the Mid-High versus Near-Optimal HbA1c group. Increased diabetes stress predicted increased odds of being in the High versus Near-Optimal and Mid-High groups.

Conclusions: Continuing research on mechanisms behind this health disparity is necessary with more representation from varied racial and ethnic groups. Equal access to diabetes technology and psychosocial treatments are recommended and implications for clinical intervention development are discussed.
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http://dx.doi.org/10.1093/jpepsy/jsaa124DOI Listing
March 2021

Empirically Derived Profiles of Health-Related Quality of Life in Youth and Young Adults with Sickle Cell Disease.

J Pediatr Psychol 2021 03;46(3):293-303

Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN.

Objective: Determining how the health-related quality of life (HRQOL) is impacted by living with Sickle Cell Disease (SCD) can inform psychosocial interventions. The purpose of the present study is to determine if demographic and treatment variables predict membership into empirically derived subgroups of HRQOL among youth and young adults with SCD.

Methods: Three hundred and seven youth and young adults with SCD (mean 17.63 years ± 3.74 years, 50.5% female) completed the Pediatric Quality of Life InventoryTM Sickle Cell Disease Module. Latent profile analysis examined subgroups/classes of HRQOL and relationships with demographic and treatment variables.

Results: Three distinct classes emerged: High HRQOL (34% of the sample), Moderate HRQOL (44% of the sample), and Low HRQOL (22% of the sample). Being female was associated with increased odds of being in the moderate or low groups. Living with more severe SCD (genotypes HbSS and HbSβ0 thalassemia) was associated with increased odds of being in the Low HRQOL group. Treatment with chronic red blood cell transfusion therapy was associated with increased odds of being in the High HRQOL group. Older age predicted a small increase in the odds of being in the Low versus High HRQOL group.

Conclusions: The present study adds to the literature on HRQOL in SCD by exploring person-centered, empirically derived groups of HRQOL. Identification of demographic and treatment factors that predict membership into those groups within a large sample assists in tailoring needed psychosocial interventions for youth with SCD.
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http://dx.doi.org/10.1093/jpepsy/jsaa104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977438PMC
March 2021

Measuring psychological flexibility in youth with type 1 diabetes.

Pediatr Diabetes 2020 12 21;21(8):1566-1574. Epub 2020 Sep 21.

Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.

Objective: To determine reliability and validity of the acceptance and action diabetes questionnaire (AADQ) and the diabetes acceptance and action scale for children and adolescents (DAAS), measures of diabetes-specific psychological flexibility.

Methods: One hundred and eight-one youth with type 1 diabetes completed the AADQ, DAAS, and measures of mindfulness, cognitive fusion, and health-related quality of life. HbA1c was extracted from medical records. Confirmatory factor analysis (CFA) was used to cull items and evaluate the factor structures of the AADQ and DAAS. Bivariate correlations were conducted between all measures to explore content validity.

Results: CFAs supported a one-factor structure of the AADQ (for youth and parent report) and a second-order DAAS solution with a total score indicated by avoidance, values impairment, and avoidance subscales. All scales and subscales displayed strong internal consistency (α = .86-.95). The AADQ and DAAS evidence good content validity based on associations with other measures.

Conclusions: The AADQ and DAAS are reliable, valid measures of diabetes-specific psychological flexibility.
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http://dx.doi.org/10.1111/pedi.13110DOI Listing
December 2020

How Peer Conflict Profiles and Socio-Demographic Factors Influence Type 1 Diabetes Adaptation.

J Pediatr Psychol 2020 07;45(6):663-672

Department of Pediatrics-Endocrinology, The University of Tennessee Health Science Center.

Objective: This study aimed to (a) validate the factor structure for a measure of peer conflict in youth with type 1 diabetes (T1D); (b) determine empirical patterns of peer conflict in terms of context (friend vs. nonfriend) and content (diabetes-specific vs. general) within a broader context of socio-demographic factors; and (c) examine how these patterns and socio-demographic factors relate to adolescents' T1D adherence, quality of life, and glycemic control (HbA1c).

Methods: Youth with T1D (N = 178), ages 12-18, reported demographic variables, illness duration, adherence, quality of life, and peer conflict. HbA1c was extracted from medical records. Confirmatory factor analysis validated a factor structure for the Diabetes Peer Conflict Scale (DPCS) and latent profile analysis (LPA) determined profiles of peer conflict.

Results: A four-factor structure emerged for the DPCS: general friend conflict, general nonfriend conflict, T1D friend conflict, and T1D nonfriend conflict. Using these factors as indicators in LPA, four profiles were confirmed: (a) Low Overall Conflict (LOC) and (b) Moderate Overall Conflict (MOC), (c) a Nonfriend Conflict (NFC), and (d) a Friend Conflict (FC) profile. Differences were not identified between diabetes specific versus general conflict. Socio-demographic variables did not predict class membership. The LOC profile reported the highest quality of life and best glycemic control, whereas the FC profile reported the lowest adherence behaviors. Conclusions: Peer conflict uniquely contributes to diabetes adaptation above and beyond socio-demographic and illness factors.
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http://dx.doi.org/10.1093/jpepsy/jsaa036DOI Listing
July 2020

Toward the Development of a Culturally Humble Intervention to Improve Glycemic Control and Quality of Life among Adolescents with Type-1 Diabetes and Their Families.

Behav Med 2019 Oct 3:1-12. Epub 2019 Oct 3.

Department of Psychology, The University of Memphis.

Type-1 Diabetes (T1D) is a prevalent and costly disorder associated with substantial morbidity that differentially impacts low-income and/or minority adolescents and their families. The primary study objective was to develop a guiding model to inform culturally humble interventions for Mid-southern youth with T1D presenting with multiple correlates of suboptimal glycemic control and their families. In order to develop a clinic specific guiding model, conceptualizations of health, the need/type of intervention thought to be most helpful, the optimal structure, and strategies to improve the cultural/regional fit was ascertained from (A) youth with T1D ( = 13) and caregivers ( = 11) via qualitative interviews and, (B) pediatric endocrinologists and nurse practitioners ( = 6), and (C) nurses, diabetes educators, dietitians, and social workers ( = 9) via focus groups. Qualitative themes were synthesized to guide the treatment development model whereby Quality of Life and Glycemic Control would be directly enhanced by interventions to promote Coping, Support, Education, and Improved Psychosocial Functioning and indirectly through improved Adherence and T1D Autonomy delivered in a culturally humble way that affirms youths' T1D identify. These finding suggest that existing evidence-based treatments may provide a great fit for low-income, and/or minority youth with T1D and their families living in the mid-south, provided these interventions are delivered in culturally humble manner.
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http://dx.doi.org/10.1080/08964289.2019.1660299DOI Listing
October 2019

Predictors of diabetic ketoacidosis hospitalizations and hemoglobin A1c among youth with Type 1 diabetes.

Health Psychol 2019 Jul 11;38(7):577-585. Epub 2019 Apr 11.

Department of Pediatrics.

Objective: Diabetic ketoacidosis (DKA) and elevated hemoglobin A1c (HbA1c) in youth with Type 1 diabetes (T1D) can result in significant morbidity and mortality. Elucidating the risk factors for poor glycemic control and DKA hospitalizations is crucial for the refinement and development of prevention and treatment efforts.

Method: Based on a conceptual framework, this study used path analysis to evaluate individual and family characteristics, psychosocial responses, and individual and family responses that prospectively predict the number of DKA hospitalizations and HbA1c approximately 1 year after assessment, accounting for sociodemographics. A total of 174 youth 12-18 years old with T1D ( = 14.68, = 1.77) and their caregivers completed measures assessing demographics, internalizing symptoms, diabetes stress, diabetes-related family conflict, and adherence. Medical records were reviewed to obtain the number of episodes of DKA and the HbA1c at 1-year follow-up.

Results: Thirty-one participants had at least 1 episode of DKA based on chart review. Greater duration of diabetes, higher baseline HbA1c, lower income, identifying as non-Hispanic White, and higher youth report of internalizing symptoms were significant predictors of DKA at follow-up ( < .05). Identifying as Black-African American, a younger age, and higher baseline HbA1c significantly predicted higher HbA1c at follow-up ( < .05).

Conclusions: Future studies should assess the utility and accuracy of using screeners for internalizing symptoms in pediatric endocrinology clinics to identify youth at risk for DKA hospitalizations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000719DOI Listing
July 2019

Validity, Reliability, and Measurement Invariance of the Diabetes Stress Questionnaire-Short Form.

J Pediatr Psychol 2019 05;44(4):442-452

University of Tennessee Health Science Center.

Objective: The purpose of this study was to develop a short form of the Diabetes Stress Questionnaire (DSQ) with adequate psychometric properties (i.e., internal consistency, convergent, criterion, discriminant validity, construct validity, and measurement invariance).

Methods: In total, 181 youth with type 1 diabetes (T1D) completed the 65-item DSQ, and archival data were obtained from 142 youth with T1D to serve as an independent cross-validation sample. Twenty-four items were chosen to retain the original eight scales of the DSQ and to maximize internal consistency and correlations to full subscales. Confirmatory factor analyses were used to evaluate the proposed factor structure of the Diabetes Stress Questionnaire-Short Form (DSQ-SF) and to assess invariance of the DSQ-SF across sex, race, grade level, glycemic control, illness duration, and annual income categories.

Results: The 24-item DSQ-SF was found to have good internal consistency, factor structure and fit, correlated highly to the full scale (r = .98), and was invariant across sex, race, grade level (<9th grade or >9th grade), glycemic control, illness duration, and annual income.

Conclusions: The DSQ-SF appears to be a psychometrically robust measure of diabetes-specific stress in youth with T1D. Present findings suggest that the DSQ-SF has the potential to be a useful, quick, cost-effective, and comprehensive screening tool for identifying youth with T1D who may benefit from T1D-specific stress reduction interventions as a way to improve health behaviors, psychosocial well-being, and glycemic control.
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http://dx.doi.org/10.1093/jpepsy/jsy078DOI Listing
May 2019

Keep dialogue alive.

Authors:
Mary E Keenan

Am J Nurs 2005 Nov;105(11):15

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http://dx.doi.org/10.1097/00000446-200511000-00008DOI Listing
November 2005