Alissa N, Al Zahrani S. Psychological predictors of diabetic ketoacidosis in children: Health belief model-based case-control study. World J Diabetes 2025; 16(8): 110088 [DOI: 10.4239/wjd.v16.i8.110088]
Corresponding Author of This Article
Nawal Alissa, Associate Professor, Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Prince Turki Ibn Abdulaziz Al Awwal Road, Riyadh 11433, Saudi Arabia. nalissa@ksu.edu.sa
Research Domain of This Article
Pediatrics
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Aug 15, 2025; 16(8): 110088 Published online Aug 15, 2025. doi: 10.4239/wjd.v16.i8.110088
Psychological predictors of diabetic ketoacidosis in children: Health belief model-based case-control study
Nawal Alissa, Sara Al Zahrani
Nawal Alissa, Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
Sara Al Zahrani, Health Promotion and Education Program, Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
Author contributions: Alissa N and Al Zahrani S contributed equally to the study’s conception, design, data collection, analysis, and manuscript preparation; and all authors read and approved the final manuscript.
Supported by the Ongoing Research Funding Program at King Saud University, Riyadh, Saudi Arabia, No. ORF-2025-1315.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Prince Sultan Military Medical City, approval No. IRB 1211.
Informed consent statement: Informed consent was obtained from all the participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nawal Alissa, Associate Professor, Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Prince Turki Ibn Abdulaziz Al Awwal Road, Riyadh 11433, Saudi Arabia. nalissa@ksu.edu.sa
Received: May 29, 2025 Revised: June 18, 2025 Accepted: July 18, 2025 Published online: August 15, 2025 Processing time: 77 Days and 13 Hours
Abstract
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.
Core Tip: This study explores the psychological factors that contribute to diabetic ketoacidosis in children with type 1 diabetes mellitus, focusing on a population in Saudi Arabia. Using the health belief model, the research examines perceived severity and susceptibility, while introducing perceived understanding of diabetes management as a novel cognitive factor. The findings reveal that a caregiver’s understanding of diabetes management plays a more significant role in preventing diabetic ketoacidosis than risk perception alone. These insights suggest that enhancing comprehension through targeted education could improve adherence and reduce complications, offering a more patient-centered approach to pediatric diabetes care.
