Maternal reactions to the child’s T1D risk

Maternal anxiety about the child’s T1D risk, the accuracy of the mother’s perception of the child’s T1D risk, and the mother’s belief that something can be done to reduce their child’s T1D risk was assessed using a questionnaire, administered at the child-age 6 months and 15-month visits and annually thereafter. In the current analysis, we used data collected at the first annual (child-age 15 months) visit. If data were missing at the 15-month visit, data from the questionnaire completed at the child-age 6-month visit were used. Maternal anxiety about the child’s T1D risk is measured by a 6-item short form [15] of the state anxiety component of the State Trait Anxiety Inventory (STAI)¹ [16]. The 6-item short form has been used to measure parental anxiety in numerous T1D screening studies [15, 17–19]. Parents are asked to respond to the following question: “When you think about your child’s risk for developing diabetes, you feel”: followed by three anxiety absent and three anxiety present items. The score from the short 6-item State Anxiety Inventory (SAI) was converted into the original 20-item score [15]. The SAI is reliable in this study population (α = 0.90 for the child-age 15-month questionnaire). The measure appears stable between the child-age 6- and 15-month assessments (r = 0.74).

The accuracy of the mother’s perception of her child’s T1D risk was measured by the following question: “Compared to other children, do you think your child’s risk for developing diabetes is: Much lower, somewhat lower, about the same, somewhat higher, or much higher.” Mothers responding much higher or somewhat higher were considered accurate, all others as inaccurate. This measure has been used in previous studies with parents of children at risk for T1D [11, 12, 18, 20].

A mother’s belief that something can be done to reduce the child’s T1D risk was measured by two questions. “I can do something to reduce my child’s risk of developing diabetes” and “Medical professionals can do something to reduce my child’s risk of developing diabetes.” On a five-point (0–4) scale, mothers agreed or disagreed with the two statements and answers were combined, with higher scores indicating stronger belief that something can be done to reduce the risk of the child to developing the disease. Reliability estimates for this study population ranged from α = 0.66 on the child-age 15-month questionnaire to α = 0.71 on the child-age 6-month questionnaire. The measure has been used in previous studies with parents of children at risk for T1D [11, 12, 21].