(PS6-C63) Expanding Targets for Stress and Health Interventions: A Qualitative Study of Families Navigating Chronic Disease and Socioeconomic Disadvantage

Background: Many existing cognitive-behavioral therapy (CBT)-based stress management programs are not efficacious for families simultaneously navigating chronic disease and socioeconomic disadvantage. This study aimed to examine the experiences of families navigating type 1 diabetes (T1D) and socioeconomic disadvantage to inform ideas for more inclusive stress and health interventions.

Methods: Eligible families had a teen (aged 13-17) diagnosed with T1D ≥ 12 months receiving diabetes care at Seattle Children’s Hospital and living in Washington state. The area deprivation index (ADI), a 1-10 composite measure of neighborhood-level socioeconomic disadvantage (higher scores indicate more disadvantage), was used for sampling. From the pool of families living in areas of highest disadvantage (ADI=8-10), individual families were randomly selected to be invited to interview. We conducted 1:1 semi-structured interviews with a teen and one parent separately via video-conference or phone (participant preference). Interview questions were derived from theories of stress and chronic disease management and included: 1) stressors related to T1D management, 2) salient factors in managing T1D well and tools for resilience, and 3) a review of existing stress and T1D programs to assess personal utility.  Audio-recordings were transcribed, de-identified, and analyzed using conventional content analysis. We collected self-reported demographic information for all participants and a household material hardship survey from parents.

Results: Eleven families (12 teens, 11 parents) participated in interviews. Teens were a median of 15 years (range 13-17); parents were a median of 42 years (range 37-51). Families identified as White (73%) or Hispanic (27%). 64% of parents indicated household material hardship at the time of interview. Both teen and parents reported common stressors primarily clustered in five domains: T1D Management Behaviors, Communication with Healthcare Providers, Physiological Impact, Emotional Impact, and Social Impact. Parents uniquely reported significant financial stressors associated with T1D, including Fears/Worries (related to losing healthcare, not being able to provide for their family, and the cost of T1D when their teen becomes an adult), Access (to diabetes supplies and technology, healthy food and reliable transportation), and Difficulty Communicating with Insurance Companies. Teens/parents universally indicated that a financial stress/instrumental resources program would aid in T1D management.

Conclusion: Both teens and parents reported significant stressors in multiple psychosocial domains that are typically responsive to CBT (e.g., feeling overwhelmed by T1D management tasks). However, given the pervasive financial stress noted by parents and the high percentage of families experiencing household material hardship, the current findings suggest that stress management interventions for families dually navigating chronic disease and socioeconomic disadvantage may benefit from a financial-stress and/or instrumental resource-enhanced CBT to target their distress.