Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)

Graduate Group


First Advisor

Terri H. Lipman


Type 1 diabetes (T1D), is the third most common pediatric chronic illness in the United States. Historically more prevalent in White youth, pediatric T1D diagnoses are increasing disproportionately among Black youth. Black youth with T1D also have significant disparities in treatment, management and outcomes, as compared to White and Hispanic youth. Disparities are compounded in Black youth from single parent homes, in comparison to those from two-parent homes. Despite being at high risk, the family voices of Black youth from single parent homes are underrepresented in pediatric T1D research.

Daily family and self-management of T1D is critical to reducing the risk of poor diabetes related outcomes, and the social determinants of health (SDOH) of families can substantially influence their ability to manage a chronic illness. To understand how SDOH contribute to health disparities seen in Black youth from single parent homes, a three-phase sequential exploratory mixed methods study [QUALquan] was conducted with a sample of single parents of Black youth with T1D in Philadelphia. Focus groups and interviews with 20 parents identified influential SDOH components and generated potential solutions for addressing these barriers. Results were used to develop a survey administered to n=105 parents, to clarify resource needs and generate research hypotheses and interventions.

Qualitative findings revealed that not having dependable social supports and school environments, the emotional and physical health of the family, obtaining diabetes supplies, relationships with care teams, employment and financial impacts of T1D, taking time off from work, and neighborhood safety were most problematic for families. Survey results clarified that not having social supports to help, managing family T1D stress, spending more for T1D food needs and camp, difficulties taking time off from work, and having multiple T1D-related school absences, were among the highest ranked issues parents encountered. Most highly endorsed solutions related to increasing social, physical and school supports for families, providing concrete resources, and establishing safe places for play and exercise. Knowledge gained from this study will inform clinical, community, and policy research and interventions to reduce health disparities, addressing the SDOH as drivers of family and self-management outcomes among high risk T1D patients.


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