Parent Engagement in School Health Decisions for Type 1 Diabetes: Barriers to and Facilitators of Collaboration and Implications for Intervention Design.

Objective: Parent engagement is a frequently cited barrier to school health interventions. Little is known about what influences parent involvement in school health decisions for children with chronic conditions such as type 1 diabetes. We aimed to explore parent perspectives on the factors they believe affect their engagement in school-based type 1 diabetes management to identify potential targets for intervention design and implementation.

Research design and methods: We conducted semi-structured interviews with 27 parents of 28 school-aged children (6-15 years of age) with type 1 diabetes from a large academic center. Interview guide questions explored parents' experiences, communication, and relationships with school staff; the impact of diabetes technology; and perceptions of direct communication between schools and health systems. Interviews transcripts were analyzed using a consensus coding approach with thematic analysis to align with the social-ecological model.

Results: Parents identified four categories of factors that affected their engagement in school health decisions: 1) child-specific factors, such as proximity to diagnosis, self-management skills, and the use of technology; 2) family-specific factors, including personal motivations for their child's experience in school and external stressors and demands that may compete with their motivations; 3) interpersonal relationships, including parents' trust or mistrust in school health staff and the perceived role of school health staff within the medical team; and 4) school district factors, including health staffing and policies for device use.

Conclusion: Parental engagement in school-based diabetes care is complex and multifaceted. Using well-timed interventions that address parent priorities, foster trust, enhance communication, and engage technology may mitigate barriers.