Self-care support in paediatric patients with type 1 diabetes: bridging the gap between patient education and health promotion? A review

Self-care activities in pediatric patients with type 1 diabetes mellitus

INTRODUCTION

Effective diabetes self-management and collaborative responsibility sharing with parents are imperative for pediatric patients with type 1 diabetes mellitus, particularly as they gradually assume more self-care responsibilities. The primary goal of this study was to assess differences in adherence to self-care activities regarding sociodemographics and clinical characteristics in pediatric patients with type 1 diabetes. The secondary goal of this study was to understand the level of parental involvement in diabetes management and to assess the pediatric patients' behaviors (independent or dependent on disease self-management) that relate to sociodemographic and clinical characteristics.

METHODS

This was a comparative cross-sectional and correlational study. The study sample included 182 children and adolescents who had been diagnosed with type 1 diabetes at least 3 months prior. Data collection instruments included a sociodemographic and questionnaire about Adherence to self-care activities and parental involvement in diabetes self-management, as well as a documentation sheet for recording clinical data.

RESULTS

A majority of participants (71%) exhibited non-adherence to self-care tasks, despite 78.0% asserting their independence in diabetes self-management. Notably, insufficient parental involvement in administering insulin therapy significantly predicted severe hypoglycemic episodes.

CONCLUSIONS

Pediatric patients dealing with type 1 diabetes demonstrate a substantial degree of autonomy in managing their condition, paradoxically coupled with self-reported non-adherence to critical self-care responsibilities. Notably, children (aged 8-12) rely more heavily on parental support, especially concerning insulin therapy administration. The study underscores the crucial role of parental engagement in insulin therapy, as its deficiency significantly predicts the likelihood of severe hypoglycemic episodes.

Experiences of transition to adulthood and transfer to adult care in young adults with type 1 diabetes: A qualitative study

AIM

To explore young adults' experiences of living with type 1 diabetes in the transition to adulthood, including experiences of the transfer from paediatric to adult care.

DESIGN

A qualitative approach was used.

METHOD

Ten young adults, six women and four men, aged 19-29 years, participated. Participants were recruited at their regular diabetes clinic from spring 2021 to spring 2022. Semi-structured interviews were transcribed and analysed using qualitative content analysis.

FINDINGS

Dreaming of being nurtured towards self-reliance was the overarching theme. Personal experiences of the transition to adulthood, including the transfer from paediatric to adult care, were described in terms of struggling to find balance in daily life, dealing with feelings of being different, being gradually supported to achieve independence, and wishing to be approached as a unique person in healthcare.

CONCLUSION

In healthcare, it is important to emphasize not only diabetes-related factors but also emotional and psychosocial aspects of life connected to the transition to adulthood, including the transfer to adult care. The young adults wished to be seen as unique persons in healthcare during their emerging adulthood and should therefore be supported to achieve self-reliance through personal preparations for new challenges and for the consequences of transitioning to adulthood. Specialist nurses can provide appropriate knowledge and leadership.

IMPLICATIONS FOR THE PROFESSION

These findings can guide nurse specialists in support for emerging adults to achieve self-reliance and indicate the importance of person-centred care when experiencing transition and transfer.

REPORTING METHOD

The study adhered to EQUATOR guidelines, and the COREQ checklist for qualitative studies was used as the reporting method.

Type 1 Diabetes Management and Health Care Experiences Across Rural Nebraska

INTRODUCTION

This study aimed to explore the unique health care needs of rural Nebraska families with a child with type 1 diabetes mellitus (T1DM).

METHOD

Using a phenomenological approach, the researchers conducted four focus groups across Nebraska. The focus groups gathered input from children, caregivers, and health care providers (n = 23). The researchers coded data and generated themes. Member checking, researcher triangulation, reflexivity, a thick description of the process, and an audit trail established trustworthiness.

RESULTS

Four themes emerged: dramatic family and lifestyle changes following diagnosis, lack of access to specialized care resulting in complications, isolation improved health management resourcefulness, and technology improved health management and flexibility.

DISCUSSION

Lifestyle changes persist after a child's diagnosis with T1DM. Rural families reported unpredictable health status of their child, reduced health care services, and limited information access. Conversely, limited specialty health care access, resources, and community support led to creative self-education, advocacy, and health care management strategies. Diabetes technology offered opportunities for improved provider-patient communication and continuous glucose monitoring.

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.

Use of Salutogenic Approach Among Children and Adolescents with Chronic Illnesses: A Scoping Review

PROBLEM

A pathogenic medical orientation focusing on disease management relies heavily on the skills of healthcare professionals. In contrast, a salutogenic approach focuses on health promotion by encouraging resource strengthening among patients to maintain and support recovery, which could help alleviate healthcare burden and enhance healthcare quality. Considering the increased life expectancies of chronically ill children, this review aimed to consolidate evidence on the use of salutogenesis among children and adolescents with chronic illnesses.

ELIGIBILITY CRITERIA

A scoping review guided by Arksey and O'Malley's five-stage framework was conducted. Studies with samples of children or adolescents aged 19 years and below with chronic disease were included in the review.

SAMPLE

A library search was performed across six electronic databases (PubMed, Embase, CINAHL, PsycInfo, and Web of Science) from each database's inception to March 2020. Twelve studies were included.

RESULTS

Current evidence only highlighted the trend and advantages of high sense of coherence and identify factors that enhance sense of coherence. Boys, younger age, higher cognitive functioning, non-migrants, non-smokers, and available peer and family support contribute to higher levels of sense of coherence, which lead to better perceived health, quality of life, and more positive coping strategies.

CONCLUSIONS

Healthcare professionals should adopt a salutogenic approach to encourage patient involvement, independence, and responsibility in maintaining their own health.

IMPLICATIONS

Further research is needed to provide a holistic view of the sense of coherence and application of salutogenesis (especially other salutogenic concepts) among this sample group, which can also inform future salutogenic intervention studies.

The Effect of Self-Care Education on Emotional Intelligence of Iranian Nursing Students: A Quasi-experimental Study

This study aimed to determine the effect of self-care training on emotional intelligence of nursing students. This quasi-experimental study was conducted on nursing students of Mazandaran University of Medical Sciences in 2016. The subjects (60 students) that were collected with random sampling method were divided into experimental and control groups, and then, self-care behaviors were taught to the experimental group' students in 12 sessions by using a checklist. The subjects of control group were not taught. Emotional intelligence was measured by using Bradberry and Greaves' standard questionnaire before and after the intervention. Emotional intelligence scores of students in the experimental group showed positive and significant change between before (75.33 ± 7.23) and after (125.70 ± 7.79) of training (P < 0.001). Also t test shows a significant change in control (78.73 ± 6.54) and experimental groups (125.70 ± 7.79), after of training (P < 0.001). It is recommended that special programs be organized in order to improve the emotional intelligence of students that improve the likelihood of their success in life.

Moving between ideologies in self-management support-A qualitative study

Background

Reforms in current health policy explicitly endorse health promotion through group‐based self‐management support for people with long‐term conditions. Health promotion and traditional medicine are based on different logics. Accordingly, health professionals in health‐promoting settings demand the adoption of new practices and ways of thinking.

Objectives

The objective of our study was to investigate how health professionals perceive the health‐promoting group‐based self‐management support that is politically initiated for people with long‐term conditions.

Design

This study had a qualitative research design that included focus group interviews and was guided by a social constructivist paradigm in which group‐based self‐management was viewed as a social construction. Different logics at play were analysed through the theoretical lens of institutional logic. Discussions among participants show frames of references seen as logics.

Setting and participants

We recruited health professionals from group‐based health‐promoting measures for people with type 2 diabetes in Norway. Two focus groups comprising four and six participants each were invited to discuss the practices and value of health promotion through group‐based self‐management support.

Results

The analysis resulted in three themes of discussion among participants that contained reflections of logics in movement. Health professionals’ discussions moved between different logics based on the importance of expert‐based knowledge on compliance and on individual lifestyle choices.

Discussion and conclusion

The study indicates that health promotion through self‐management support is still a field “in the making” and that professionals strive to establish new logics and practices that are not considered difficult to manage or do not contain incompatible understandings.

Criança diabética do tipo 1 e o convívio familiar: repercussões no manejo da doença

RESUMO A pesquisa objetivou escrever a repercussão do convívio familiar da criança diabética no manejo da doença. Trata-se de um estudo qualitativo descritivo, tipo estudo de caso, com criança diabética em seguimento ambulatorial de um hospital universitário, por meio de grupo focal. Análise de dados por análise de conteúdo do tipo temática. Observou-se que Adriana (nome fictício), 11 anos, não adere às orientações e tratamentos propostos pela equipe de saúde, resultando em inadequado manejo do diabetes e altos índices glicêmicos, decorrente da relação desarmoniosa com a família e da carência de gestão dos serviços de saúde. Condições crônicas de saúde interferem no cotidiano familiar e dificultam o tratamento, especialmente de crianças. A Atenção Primária à Saúde deve utilizar ferramentas como a gestão de caso e o projeto terapêutico singular para que, em conjunto com a família e com a criança, possa obter melhor adesão ao tratamento.

Internalizing motivation to self-care: a multifaceted challenge for young liver transplant recipients

The transition from parent-controlled care to self-managed care represents an important challenge for adolescents with chronic conditions. We sought to gain a deeper understanding of the factors influencing the internalization of motivation to self-care in adolescent liver transplant recipients. We conducted a qualitative study using in-depth interviews with 18 young patients. We triangulated the data collected from the patients with data from parents and health care providers, and used an inductive approach to analyze the data. Our results illustrate three interrelated challenges that impact on young patients' motivation to self-care: (a) the cognitive challenge of fully understanding one's condition and personal health risks; (b) the behavioral challenge of developing independence regarding self-management issues; and (c) the psychological challenge of building a sense of self-ownership and purpose. The latter involves overcoming the trauma of survival and coming to terms with feelings of obligation, two challenges inherent to transplantation that warrant further investigation.

Utilization of blood glucose data in patient education

Many studies have tested clinical and behavioral approaches for improving glycemic control in people with diabetes. We reviewed studies to identify how blood glucose (BG) values have been used in patient-focused clinical research and interventions. We sought to describe the frequency that BG values have been the focus of patient education research and to characterize the different methods to integrate BG into an intervention, the approaches implemented to support patient education, and behavior change, and the nature of communication about BG values. Thirty-four eligible studies were identified that included patient education using BG values. Information regarding the study and intervention characteristics include: (1) characteristics of the study sample, (2) how BG values were obtained, (3) use of a graphical interface for BG values, (4) use of a BG log, (5) BG interpretation and regimen adjustments, (6) recommended actions to patient, (7) modality of intervention, and (8) intervention communication schedule. The review demonstrated that new BG technologies provide outstanding opportunities for greater access to BG data, and for patient support and intervention. However, it also indicated a need to improve and expand support for people with diabetes in their daily use of BG values to maintain and improve glycemic control. In order to make the most sustainable impact on behavior, generalizable skills such as problem solving need to be integrated into BG education.