The lived experiences of young people living with type 1 diabetes: A hermeneutic study

Aims

The aim of this hermeneutic study was to explore and elucidate the lived experiences of young people living with type 1 diabetes in terms of their everyday life and school in Sweden.

Design

A qualitative interview study with a hermeneutic approach inspired by Gadamer's thinking.

Methods

Interviews were conducted with a purposive sample of seven girls and three boys with type 1 diabetes between January and September 2017 and analysed with a hermeneutic method.

Results

Young peoples' everyday lives were transformed and re‐organized by their illness and they parodically live a double‐edged everyday life. To support young people's healthcare personnel, headmasters and teachers must understand this double‐edged situation.

Leaving foster or residential care: a participatory study of care leavers' experiences of health and social care transitions

BACKGROUND

Young people in residential or foster care experience multiple transitions around their 18^th birthday without the long term and consistent support from their family of origin that most of their peers can expect. We report a mixed methods qualitative study of transitions across health and social care services for children leaving care, providing narratives of what young people described as positive, and what they and professionals think might be improved.

METHODS

Data were collected in participatory meetings and individual interviews between young people and researchers (n = 24) and individual interviews with practitioners (n = 11). In addition to discussion and interview techniques, we used pictorial and other participatory methods. Interviews were coded by three members of the team and differences resolved with a fourth. Our analysis draws on thematic and framework approaches.

RESULTS

Health was rarely at the top of any young person's agenda, although gaps in health care and exceptional care were both described. Housing, financial support and education took priority. Young people and professionals alike emphasized the importance of workers prepared to go the extra mile; of young people being able to contact professionals; and professionals being able to contact one another.

CONCLUSIONS

Policy and practice aspirations for care leavers recommend gradual change but transfer rather than transition continues to be described by care leavers. Our data support the need for transition as a long-term process, with children and young people having early opportunities to prepare for citizenship.

"We Sometimes Hold on to Ours" - Professionals' Views on Factors that both Delay and Facilitate Transition to Adult Care

BACKGROUND

The transition from child to adult services is a crucial time in the health of young people who may potentially fall into a poorly managed "care gap." Health service provision, which fails to meet the needs of young people and families at this time of significant change, may result in deterioration in health or disengagement with services, which can have negative long-term consequences. Developing transitional care packages has become a focus of activity in the United Kingdom and elsewhere. Indeed, policy documents have been trying to guide practice for many years, with some variable success. There is much work still to be done, particularly around how guidance and the sharing of best practice, when combined can result in a change in practice.

OBJECTIVE

This study aimed to explore the views of professionals involved in transitional care, the process of transition in their services, and the barriers and facilitators to transition.

METHODS

This was a qualitative study using focus group methodology. Four focus groups were carried out, attended by 36 health professionals across child and adult services. They had expertise in working with young people with various health conditions and disabilities. Transcripts were analyzed using qualitative content analysis.

RESULTS

Eight key factors that impact on transition emerged from the data. These included factors associated with the patient group (such as age, health condition, having complex needs) as well as factors associated with services (such as the availability of equivalent services within adult care and the links between child and adult team).

CONCLUSION

It is imperative that health professionals consider the population they are working with when planning transitional care and take into account the factors which can lead to delayed transition, so that this can be avoided if possible. Numerous examples of initiatives to facilitate more timely transition were shared: these have been reflected in our "Benchmarks for Transition from Child to Adult Health Services." We offer these benchmarks to inform and guide the practice of others and illustrate their potential for use in the context of the findings shared here.

Building the Bridge From Pediatric to Adult Diabetes Care

Purpose

The purpose of this study was to evaluate the effectiveness of a structured transition program by measuring clinical and psychometric properties related to transition and adherence to follow-up. Transition of emerging adults with type 1 diabetes can be problematic. This natural progression to adult health care is often delayed, leading to transition at less than optimal times. Implementation of a transition program will improve the transition process for emerging adults with type 1 diabetes.

Methods

Mixed-method, prospective longitudinal study involving collaboration between pediatric and adult providers. Subjects age 18 to 28 years were identified for transition. Transition was facilitated via joint appointment with pediatric and adult health care providers. Participants completed pre- and posttransition surveys measuring diabetes-related distress (Diabetes Distress Scale [DDS]), quality of life (Diabetes Quality of Life Youth–Short Form [DQOLY-SF]), and perceived health care provider autonomy support (Health Care Climate Questionnaire [HCCQ]). Primary outcome was adherence to follow-up. Secondary outcomes evaluated correlations in DDS, DQOLY-SF, HCCQ, and A1C. Chart review assessed acute complications, A1C, and adherence to follow-up.

Results

Adherence to follow-up was 100%. This study found that correlations between DQOLY-SF and DDS and correlations between DDS and A1C were highly significant during the pretransition phase. This study also indicated that the same correlations were highly significant following transition. Paired t test indicated a statistically significant reduction in diabetes distress from pre- to posttransition evaluations and an increase in HCCQ. Content comparative analysis of open-ended questions further illustrated issues related to transition.

Conclusion

Use of a structured transition process with joint appointments and transition coordinator improves adherence to follow-up and reduces diabetes-related distress.

Adolescents' concerns as they transition through High School

As adolescents enter and exit high school, they face numerous changes that reflect the process of transitioning from childhood to adulthood. Concerns written by 216 adolescents who were part of a larger longitudinal study were analyzed for manifest content. Twenty-one categories of concerns were identified. The categories endorsed most frequently were education, relationships, expectations, and the future. Three of these differed significantly between the participant's first and fourth years in high school. These concerns reflect both developmental and situational transitions congruent with transition theory and have implications for nursing practice, research, and further theory development.