Psychological predictors of diabetic ketoacidosis in children: Health belief model-based case-control study.

Background: Diabetic ketoacidosis (DKA) remains a serious and potentially preventable complication among children with type 1 diabetes mellitus (T1DM), particularly in Saudi Arabia. Psychological constructs such as perceived severity and susceptibility influence health behaviour, yet their role in pediatric diabetes management remains underexplored.

Aim: To examine psychological predictors of DKA in children with T1DM using the health belief model, and to assess the role of caregiver-perceived understanding in influencing adherence and DKA occurrence.

Methods: A case-control study was conducted at Prince Sultan Military Medical City in Riyadh, Saudi Arabia, involving 191 caregivers of children with T1DM (96 cases with a history of DKA and 95 controls without). Validated questionnaires measured perceived severity, susceptibility, understanding, and adherence. Statistical analyses included independent t-tests, Pearson and Spearman correlations, and multiple regression.

Results: Perceived understanding was the strongest predictor of adherence (β = 1.03, P < 0.001) and was inversely associated with DKA occurrence (P < 0.001). Children without a DKA history had significantly higher levels of perceived understanding and adherence. Perceived severity had a moderate positive association with adherence, while perceived susceptibility showed a weak negative correlation.

Conclusion: Caregiver-perceived understanding plays a critical role in adherence and DKA prevention. These findings support expanding the health belief model to include perceived understanding as a distinct construct and highlight the importance of integrating comprehension-focused strategies into pediatric diabetes education.