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

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. 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. 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. 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. 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.