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Journals / Sağlık Akademisyenleri Dergisi / 2026 / Cilt: 13 Sayı: 3

Poverty and deprivation among families of children with type 1 diabetes: scale development and ıts association with metabolic control

Tip 1 diyabetli çocukların ailelerinde yoksulluk ve yoksunluğun ölçülmesi: Ölçek geliştirme ve metabolik kontrolle ilişkisi

Nagihan Çelik(DÜZCE ÜNİVERSİTESİ, SOSYAL BİLİMLER ENSTİTÜSÜ, SAĞLIK YÖNETİMİ (YL) (TEZLİ))0009-0008-6755-5752
Mehmet Nurullah Kurutkan(DÜZCE ÜNİVERSİTESİ, İŞLETME FAKÜLTESİ, SAĞLIK YÖNETİMİ BÖLÜMÜ)0000-0002-3740-4231
Pages
687–702
Publication Date
2026-09-30
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

The weak deprivation–control link may reflect the protective buffering effect of universal health insurance covering the entire sample.

📌 3 Key Takeaways

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Objective & Hypothesis:Introduction and Aim: This study aimed to develop a valid and reliable individual-level scale measuring the poverty and deprivation experienced by families caring for children and adolescents with type 1 diabetes, and to examine the relationship between this deprivation and the child’s metabolic control (HbA1c).
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Key Findings & Data:Material and Methods: In a cross-sectional correlational design, data were collected from 240 family members caring for a child with type 1 diabetes using a 24-item questionnaire.
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Conclusion & Impact:The weak deprivation–control link may reflect the protective buffering effect of universal health insurance covering the entire sample.
🔬Design:Survey & Empirical Study
📍Scope:Comprehensive Sample
⚙️Variables:Tip 1 diyabet · yoksunluk · ölçek geliştirme

Abstract

Introduction and Aim: This study aimed to develop a valid and reliable individual-level scale measuring the poverty and deprivation experienced by families caring for children and adolescents with type 1 diabetes, and to examine the relationship between this deprivation and the child’s metabolic control (HbA1c). Material and Methods: In a cross-sectional correlational design, data were collected from 240 family members caring for a child with type 1 diabetes using a 24-item questionnaire. Construct validity was assessed with exploratory and confirmatory factor analysis; the deprivation–control relationship was tested with log-link Gamma regression, analysis of covariance, logistic regression, ROC analysis, quantile regression, a generalized additive model, and machine learning. Results: After removing three items, the scale reached a two-factor, highly reliable (Cronbach α = .96 and .86) and valid structure (KMO = .951; 61.79% explained variance), comprising Economic-Social Deprivation (18 items) and Environmental Deprivation (3 items). Deprivation strongly discriminated income groups (p < .001) but showed only a weak, largely indirect association with metabolic control; nonlinear and machine-learning methods added no explanatory power. Conclusion: The scale measures the target population’s deprivation more validly than off-the-shelf indices. The weak deprivation–control link may reflect the protective buffering effect of universal health insurance covering the entire sample.

Özet

Giriş ve Amaç: Bu çalışma, Tip 1 diyabetli çocuk ve gençlerin bakımını üstlenen ailelerin yaşadığı yoksulluk ve yoksunluğu birey düzeyinde ölçmek üzere geçerli ve güvenilir bir ölçek geliştirmeyi ve bu yoksunluğun çocuğun metabolik kontrolüyle (HbA1c) ilişkisini incelemeyi amaçlamaktadır. Gereç ve Yöntem: İlişkisel tarama (kesitsel) deseninde, Tip 1 diyabetli bir çocuğun bakımını üstlenen 240 aile üyesinden 24 maddelik bir anketle veri toplanmıştır. Yapı geçerliği açıklayıcı (AFA) ve doğrulayıcı (DFA) faktör analizleriyle; yoksunluğun metabolik kontrolle ilişkisi ise logaritma bağlantılı Gamma regresyonu, kovaryans analizi, lojistik regresyon, ROC analizi, kantil regresyon, genelleştirilmiş toplamsal model ve makine öğrenmesiyle değerlendirilmiştir. Bulgular: Üç maddenin çıkarılmasının ardından ölçek, Ekonomik-Sosyal Yoksunluk (18 madde) ve Çevresel Yoksunluk (3 madde) olmak üzere iki faktörlü, yüksek güvenilirlikli (Cronbach α = .96 ve .86) ve geçerli bir yapıya ulaşmıştır (KMO = .951; açıklanan varyans %61.79). Yoksunluk, ailelerin gelir düzeyini güçlü biçimde ayırt etmekle (p < .001) birlikte metabolik kontrolle yalnızca zayıf ve büyük ölçüde dolaylı bir ilişki göstermiş; doğrusal olmayan ve makine öğrenmesi yöntemleri ek açıklayıcı güç sağlamamıştır. Sonuç: Geliştirilen ölçek, hedef popülasyonun yoksunluğunu literatürdeki hazır endekslerden daha geçerli biçimde ölçmektedir. Yoksunluk ile metabolik kontrol arasındaki ilişkinin zayıflığı, örneklemin tamamının genel sağlık sigortası kapsamında olmasının yarattığı koruyucu tampon etkiyle açıklanabilir. Kaynaklar Allison, P. D. (1990). Change scores as dependent variables in regression analysis. Sociological Methodology, 20, 93-114. Atun, R., Aydın, S., Chakraborty, S., Sümer, S., Aran, M., Gürol, I., Nazlıoğlu, S., Özgülcü, Ş., Aydoğan, Ü., Ayar, B., Dilmen, U., & Akdağ, R. (2013). Universal health coverage in Turkey: Enhancement of equity. The Lancet, 382(9886), 65-99. https://doi.org/10.1016/S0140-6736(13)61051-X Carstairs, V., & Morris, R. (1990). Deprivation and health in Scotland. Health bulletin, 48(4), 162-175. Clark, L. A., & Watson, D. (1995). Constructing validity: Basic issues in objective scale development. Psychological Assessment, 7(3), 309-319. de Bock, M., Codner, E., Craig, M. E., Huynh, T., Maahs, D. M., Mahmud, F. H., Marcovecchio, L., & DiMeglio, L. A. (2022). ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring. Pediatric Diabetes, 23(8), 1270-1276. https://doi.org/10.1111/pedi.13455 DiMeglio, L. A., Evans-Molina, C., & Oram, R. A. (2018). Type 1 diabetes. The Lancet, 391(10138), 2449-2462. https://doi.org/10.1016/S0140-6736(18)31320-5 DiStefano, C., Zhu, M., & Mîndrilă, D. (2009). Understanding and using factor scores: Considerations for the applied researcher. Practical Assessment, Research & Evaluation, 14(20), 1-11. Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39-50.

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Cite This Article

Çelik, N., Kurutkan, M. N. (2026). Poverty and deprivation among families of children with type 1 diabetes: scale development and ıts association with metabolic control. Sağlık Akademisyenleri Dergisi, Cilt: 13 Sayı: 3, 687–702. https://doi.org/10.52880/sagakaderg.1970915

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