A Fun Way to Learn About Diabetes: Using Therapeutic Play in a Brazilian Camp

Therapeutic Nursing Education in Promoting Self-Management of Adolescents with Type 1 Diabetes Mellitus: Integrative Literature Review

Diabetes Mellitus Type I (DM1) is an autoimmune disease, characterized by the total destruction of the beta (β) cells of the islets of Langerhans in the pancreas. This disease can strike people at any age, but it usually develops in children or young adults. Because of the high prevalence of DM1 in the young population, as well as all the difficulties in effective self-management in this population, with very specific characteristics, it is essential to develop therapeutic education interventions, with the aim of acquiring self-management skills. Thus, the main objective of this study is to identify the benefits of therapeutic nursing education interventions in promoting self-management of adolescents with DM1. For this, an Integrative Literature Review was carried out, using the EBSCOhost, PubMed, Scopus and Web of Science platforms. Six articles were eligible. In terms of results, benefits were identified in the health of adolescents, with the use of therapeutic education interventions by nurses, including the control of capillary glycemia, better acceptance of the pathology, improvement in body mass index, increased adherence to the therapeutic regime, a reduction in hospitalizations and complications, contribution to bio-psycho-social well-being and improvement quality of life.

Self-care support of diet and the gut in the routine care of school-age children with long-term conditions: An integrative review

There is policy impetus for provision of self-care support (SCS) for children with long-term conditions (LTCs). However, it is not clear what SCS should consist of and how it can be delivered in routine care. This review aimed to synthesise the literature, specifically on SCS of diet and the gut as these components are essential for optimal growth and development and enhanced quality of life. Using an integrative review methodology, studies conducted between January 1990 and July 2020 were systematically identified and methodological quality assessed using the Mixed Methods Appraisal Tool. Twenty-five studies were included. SCS of diet and the gut consisted of support in developing and applying specific knowledge and skills and practical help with incorporating the demands of self-care into everyday life. Key requisites for models of SCS in the context of delivery and uptake in routine care were starting early, keeping it going, being flexible and choosing appropriate outcomes. This review contributes new understanding on the provision of SCS of diet and the gut for school-age children with LTCs, including identification of gaps in the literature and further research needs.

A Video Game for Brazilian T1D Children about Knowledge of Disease and Self-care: A Methodological Study

BACKGROUND

Video games are interactive technologies able to support children in health promotion, behavior changes, and chronic disease self-management. The use of health behavior change determinants in video game design can increase its effectiveness. This study describes the process of designing a video game for Brazilian children with T1D clarifying the use of health behavior change determinants that may influence self-management behaviors.

METHODS

This was a methodological study based on health behavior change theories and the user-centered design approach. The results of a qualitative study conducted with children aged 7 to 12 years identified learning needs about knowledge on diabetes and self-care tasks which contribute to inappropriate behaviors. A Behavioral Diagnosis presented health behavior change determinants, capable of influencing children's learning needs and behaviors, that were considered to design The Heroes of Diabetes-the power of knowledge.

RESULTS

The results presented the process of designing 4 mini games with its description and theory foundation to reach children's lack of understanding about T1D, insulin's role, SMBG requirements, food groups and physical activity's role in glycemic control. Knowledge, goal settings, extrinsic and intrinsic motivation determinants were related with video games design features.

CONCLUSIONS

The findings support the use of health behavior change determinants into video game design as a guide to achieve children learning needs and that might influence self-management behaviors.

Therapeutic play to teach children with type 1 diabetes insulin self-injection: A pilot trial in a developing country

PURPOSE

Child participation in type 1 diabetes (T1D) self-care is needed in developing countries due to a lack of resources, especially during the school day. This pilot study evaluated the feasibility of a therapeutic play intervention (ITP) versus standard education (SE) on the ability of children with T1D to correctly perform insulin injection technique.

DESIGN AND METHODS

Children with T1D (7-12 years) were recruited at two diabetes clinics in Brazil and randomized to ITP or SE. Registered nurses received protocol training to deliver the intervention and perform data collection. ITP group received an education that included a story about a child with T1D who self-injects insulin at school; SE group received routine clinic-based education. Preintervention, children were video-recorded giving insulin injections to a doll; postintervention, children were rerecorded giving the doll an injection. The research team reviewed the videos and assessed the injection technique using validated checklists. Parents reported children's self-injection practices at baseline and 30 days.

RESULTS

Children (N = 20, 40% male) were 9.6 ± 1.3 years old and had T1D for 3.6 ± 2.3 years; HbA1c was 9.1 ± 2.0%; 20% of ITP and 50% of SE children used syringes (vs. pens) for injections. At baseline, 80% of both groups knew how to self-inject; most were taught by a parent/relative. Injection technique scores were low in both groups; ITP group increased their scores significantly postintervention. Practices of self-injection did not change in either group after 30 days.

PRACTICE IMPLICATIONS

The play-based intervention appeared to improve the injection technique in the short-term. Pilot findings support the development of a larger trial to evaluate the effectiveness of ITP on educating children on insulin injections.