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Gardener L, Bourke-Taylor H, Desha L, Gardener M, Turpin M. Developing Self-Management in Type 1 Diabetes at Secondary Schools: Who Is Responsible? A Qualitative Study. Am J Occup Ther 2024; 78:7805205110. [PMID: 39137007 DOI: 10.5014/ajot.2024.050662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
IMPORTANCE Occupational therapists have the proven capacity to improve outcomes for young adults who are self-managing Type 1 diabetes (T1D). There is insufficient understanding of adolescents' experiences of developing responsibility for diabetes self-management (DSM). OBJECTIVE To investigate adolescents' perceptions of sharing responsibility for T1D management at school. DESIGN This study had a descriptive qualitative design and used semistructured interviews and thematic analysis. It is the second phase of a mixed-methods study with a sequential explanatory design that investigated mechanisms of responsibility-sharing at school. SETTING Secondary school in Australia. PARTICIPANTS Purposive sample of adolescents (age 15-16 yr) with T1D (N = 11). RESULTS Adolescents approached the complex occupation of school-based DSM primarily in partnership with their parents, with each adolescent having unique responsibilities while sharing others. Health care professionals and teachers reportedly had minimal involvement. Adolescents described owning most DSM tasks, with their perceptions of building independence limiting the sharing of this responsibility. A heightened sense of risk meant that adolescents were likely to communicate with others in cases of errant blood glucose readings. Current processes commonly resulted in reduced school participation. CONCLUSIONS AND RELEVANCE Adolescents valued working responsively and interdependently with their parents to manage T1D at school, which aligns with the occupational therapy model of co-occupation. Effective responsibility-sharing depends on clear, frequent, autonomy-supportive, team-based communications. Our results showed that patterns of communication for determining school-based DSM processes were fragmented and risk focused, with limited adolescent involvement, resulting in strategies that led to students at times being excluded from school activities. Plain-Language Summary: This is the first study to use an occupational lens to examine the way in which adolescents share their responsibility for diabetes care at school. Diabetes self-management in secondary schools occurs more often when adolescents work interdependently with their parents to manage their diabetes. Adolescent involvement in formal school processes and a clearer allocation of team roles and responsibilities would better support health-promoting habits and school participation.
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Affiliation(s)
- Lisa Gardener
- Lisa Gardener, BOccThy, is PhD Candidate, School of Health and Rehabilitation, The University of Queensland, St. Lucia, Queensland, Australia;
| | - Helen Bourke-Taylor
- Helen Bourke-Taylor, BAppSc OT, MS, PhD, is Professor, Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Laura Desha
- Laura Desha, BOcc Thy (Hons), PhD, is Adjunct Research Fellow, Department of Occupational Therapy, University of Otago, Wellington, New Zealand
| | - Madeline Gardener
- Madeline Gardener, BOccThy (Hons), MTeach, is Research Assistant, School of Education and Professional Studies, Griffith University, Mt. Gravatt, Queensland, Australia
| | - Merrill Turpin
- Merrill Turpin, BOccThy, GradDipCounsel, PhD, is Senior Lecturer, School of Health and Rehabilitation, The University of Queensland, St. Lucia, Queensland, Australia
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Núñez-Baila MÁ, Gómez-Aragón A, Marques-Silva AM, González-López JR. Exploring Determinants of Health-Related Quality of Life in Emerging Adults with Type 1 Diabetes Mellitus: A Cross-Sectional Analysis. Nutrients 2024; 16:2059. [PMID: 38999807 PMCID: PMC11243684 DOI: 10.3390/nu16132059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
(1) Background: Emerging adulthood, from the age of 18 to 29 years, is a crucial phase for individuals with Type 1 Diabetes Mellitus, as it affects their Health-Related Quality of Life. (2) Methods: This cross-sectional study analyzes the influence of the Mediterranean diet, Diabetes duration, Hemoglobin A1c, and sleep disorders on Health-Relate Quality of Life in Type 1 Diabetes Mellitus. In this study, conducted in Andalusia, Spain, 362 emerging adults with Type 1 Diabetes Mellitus completed the Oviedo Sleep Questionnaire, the Adaptation of Mediterranean Diet Adherence Screener, and the Vida con Diabetes Tipo 1 (ViDa1) Health-Related Quality of Life questionnaire between October 2021 and July 2022. Pearson correlation coefficients and a multiple regression analysis were conducted for each Health-Related Quality of Life in Type 1 Diabetes Mellitus dimension (Interference with Life, Well-being, Self-care, and Concern about the Condition) for overall sample and separately for males and females. (3) Results: Different and significant correlations are found among factors such as Age, Body Mass Index, Currently being a student, Hemoglobin A1c, Sleep satisfaction, Insomnia, Hypersomnolence, and Adherence to Mediterranean diet. Notably, Insomnia is a main predictor for Interference with Life, Well-being, and Concern about the Condition, especially for females. (4) Conclusions: Insomnia is the main predictor of Health-Related Quality of Life in Type 1 Diabetes Mellitus among Andalusian emerging adults with this condition. Consequently, a regular assessment of sleep and Health-Related Quality of Life from a gender perspective in this age group is crucial.
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Affiliation(s)
- María-Ángeles Núñez-Baila
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Sevilla, Spain
| | - Anjhara Gómez-Aragón
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Sevilla, Spain
| | - Armando-Manuel Marques-Silva
- Department of Nursing, Escola Superior de Enfermagem de Coimbra, 3004-011 Coimbra, Portugal;
- Unidade de Investigação em Ciências da Saúde: Enfermagem (UICISA: E), 3004-011 Coimbra, Portugal
| | - José Rafael González-López
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Sevilla, Spain
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Pitts L, Patrician PA, Landier W, Kazmerski T, Fleming L, Ivankova N, Ladores S. Parental entrustment of healthcare responsibilities to youth with chronic conditions: A concept analysis. J Pediatr Nurs 2024; 76:1-15. [PMID: 38309191 DOI: 10.1016/j.pedn.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Chronic health conditions impact nearly 40% of children in the United States, necessitating parents/caregivers to entrust healthcare responsibilities to youth aging into adulthood. Understanding the parental entrustment process may lead to tailored transition support; however, the concept lacks conceptual clarity, limiting its research and practical applications. DESIGN AND METHODS Rodgers' evolutionary concept analysis method was used to clarify the parental entrustment of healthcare responsibilities to youth with chronic health conditions. PubMed, CINAHL, and PsycINFO databases were searched without date restrictions, including full-text, English-language, primary source articles related to parent-child healthcare transition preparation. Following title, abstract, and full-text screenings, data were analyzed using a hybrid thematic approach to identify antecedents, attributes, and consequences. RESULTS Forty-three studies from August 1996 to September 2023 were identified. Antecedents encompass social cues and readiness factors, while attributes involve a) responsibility transfer, support, and facilitation, b) a dynamic process, c) balancing trust and fear, d) navigating conflict, and e) parental letting go. Consequences entail shifts in parental and adolescent roles. Parental entrustment is an iterative process wherein parents guide their maturing child through responsibility transfer via facilitation, support, conflict navigation, and trust building. CONCLUSION The clarified concept underscores the role of parents/caregivers in empowering youth to manage their health. Introducing a working definition and conceptual model contributes to understanding the processes families navigate in the larger landscape of healthcare transition. PRACTICE IMPLICATIONS This clarification holds implications for clinicians and policymakers, offering insights to enhance support and guidance for families navigating healthcare transition.
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Affiliation(s)
- Leslie Pitts
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Patricia A Patrician
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Wendy Landier
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama Heersink School of Medicine, Division of Pediatric Hematology/Oncology, 1600 7th Avenue South, Lowder 512, Birmingham, AL 35233, United States.
| | - Traci Kazmerski
- The University of Pittsburg Medical Center Children's Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University Center, 120 Lytton St.-Suite M060, Pittsburgh, PA 15213, United States.
| | - Louise Fleming
- The University of North Carolina at Chapel Hill, School of Nursing, 105 Carrington Hall, Chapel Hill, NC 37599, United States.
| | - Natalyia Ivankova
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama at Birmingham, School of Health Professions, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Sigrid Ladores
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
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Muhammed Elamin S, Muhamad Arshad NF, Md Redzuan A, Abdul Aziz SA, Hong J, Chua XY, Bin-Abbas BS, Alsagheir A, Mohamed Shah N. Information needs on type 1 diabetes mellitus (T1DM) and its management in children and adolescents: a qualitative study. BMJ Open 2024; 14:e079606. [PMID: 38569693 PMCID: PMC10989179 DOI: 10.1136/bmjopen-2023-079606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The objective of this study is to explore the information needs related to insulin therapy in children and adolescents with type 1 diabetes mellitus (T1DM) from the children's perspectives as well as their caregivers. DESIGN Qualitative study; semistructured interviews. To identify emerging themes relating to information needs, open coding and thematic analysis were employed. SETTING Participants were recruited from a tertiary care children's hospital in Kuala Lumpur, Malaysia and a specialist hospital in Riyadh, Saudi Arabia. PARTICIPANTS Thirty one children with a mean age of 11.5 years (SD=1.9) and their caregivers were interviewed. Seventeen participants were from Malaysia and 14 were from Saudi Arabia. RESULTS Four themes of information emerged from the interviews, including information related to (1) hypoglycaemia and hyperglycaemia, (2) insulin therapy, (3) injection technique and (4) other information needs pertaining to continuous glucose monitoring, access to peer groups and future advances in insulin therapy. CONCLUSION This study provided valuable insights into the information needs related to T1DM and insulin therapy among children and adolescents with T1DM that should be considered by stakeholders in the development of age-appropriate education materials. Such materials will assist children and adolescents to better manage their life-long T1DM condition from adolescence until adulthood.
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Affiliation(s)
| | | | - Adyani Md Redzuan
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Joyce Hong
- Department of Pediatric, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Xin Yun Chua
- Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Bassam Saleh Bin-Abbas
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Afaf Alsagheir
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Song J, Shin SY, Kim K, Son YJ, Kim J, Jang I. Self-care Behavior Based on Integrated Behavioral Model in Patients With Atrial Fibrillation: A Structural Equation Modeling Approach. West J Nurs Res 2024; 46:114-124. [PMID: 38124385 DOI: 10.1177/01939459231218949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND There is limited research exploring the behavioral intentions, beliefs, and application of theoretical models in relation to self-care in patients with atrial fibrillation (AF). OBJECTIVE This study aimed to identify the factors that influence self-care behavior in patients with AF. METHODS The study used an integrated behavioral model and collected data from 216 patients diagnosed with AF. Data were analyzed using SPSS 24.0 and AMOS/WIN 24.0 to verify the fit of the hypothesis model, confirm factor analysis, and the validity of the hypothesis itself. RESULTS Self-care behavioral intention (β = 0.433, p < .001) and habit (β = 0.395, p = .005) had a significant direct effect, while instrumental attitude (β = 0.077, p = .045), injunctive norm (β = 0.084, p = .037), and self-efficacy (β = 0.249, p = .011) had a significant indirect effect on self-care behavior, explaining 64.4% of the variance. CONCLUSION The final model validated the factors that impact self-care behavior in patients with AF, highlighting the importance of fostering positive recognition of instrumental attitude, bolstering social influence and self-efficacy through significant individuals to improve self-care behavior. It is recommended to create an intervention program that encourages intentions and motivations for self-care behavior and incorporates tactics to make self-care behavior a habit. The study's path diagram can serve as a conceptual framework for designing strategies to enhance self-care behavior in patients with AF.
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Affiliation(s)
- Juhyun Song
- Chung-Ang University Hospital, Seoul, South Korea
| | - Seung Yong Shin
- Department of Cardiology, Chung-Ang University Hospital, Seoul, South Korea
| | - Kyunghee Kim
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Youn-Jung Son
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Jisu Kim
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Insil Jang
- Department of Nursing, Chung-Ang University, Seoul, South Korea
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Coolen M, Broadley M, Hendrieckx C, Chatwin H, Clowes M, Heller S, de Galan BE, Speight J, Pouwer F. The impact of hypoglycemia on quality of life and related outcomes in children and adolescents with type 1 diabetes: A systematic review. PLoS One 2021; 16:e0260896. [PMID: 34855927 PMCID: PMC8638919 DOI: 10.1371/journal.pone.0260896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To conduct a systematic review to examine associations between hypoglycemia and quality of life (QoL) in children and adolescents with type 1 diabetes. Methods Four databases (Medline, Cochrane Library, CINAHL, PsycINFO) were searched systematically in November 2019 and searches were updated in September 2021. Studies were eligible if they included children and/or adolescents with type 1 diabetes, reported on the association between hypoglycemia and QoL (or related outcomes), had a quantitative design, and were published in a peer-reviewed journal after 2000. A protocol was registered the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020154023). Studies were evaluated using the Joanna Briggs Institute’s critical appraisal tool. A narrative synthesis was conducted by outcome and hypoglycemia severity. Results In total, 27 studies met inclusion criteria. No hypoglycemia-specific measures of QoL were identified. Evidence for an association between SH and (domains) of generic and diabetes-specific QoL was too limited to draw conclusions, due to heterogenous definitions and operationalizations of hypoglycemia and outcomes across studies. SH was associated with greater worry about hypoglycemia, but was not clearly associated with diabetes distress, depression, anxiety, disordered eating or posttraumatic stress disorder. Although limited, some evidence suggests that more recent, more frequent, or more severe episodes of hypoglycemia may be associated with adverse outcomes and that the context in which hypoglycemia takes places might be important in relation to its impact. Conclusions There is insufficient evidence regarding the impact of hypoglycemia on QoL in children and adolescents with type 1 diabetes at this stage. There is a need for further research to examine this relationship, ideally using hypoglycemia-specific QoL measures.
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Affiliation(s)
- Manon Coolen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - Hannah Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mark Clowes
- Information Resources Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Bastiaan E. de Galan
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Steno Diabetes Center Odense, Odense, Denmark
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Aalders J, Hartman E, Pouwer F, Winterdijk P, van Mil E, Roeleveld-Versteegh A, Mommertz-Mestrum E, Aanstoot HJ, Nefs G. The division and transfer of care responsibilities in paediatric type 1 diabetes: A qualitative study on parental perspectives. J Adv Nurs 2021; 77:1968-1979. [PMID: 33591623 PMCID: PMC8048668 DOI: 10.1111/jan.14781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
Aim To determine which factors other than child age play a role in the division and transfer of diabetes care responsibilities between parents and children with type 1 diabetes. Design Qualitative focus group study. Methods Across four sites in the Netherlands, 18 parents (13 mothers) of children (9–14 years) with type 1 diabetes participated in four focus groups in 2015–2016, as part of the research project 'Whose diabetes is it anyway?'. Qualitative content analysis and the constant comparison method were used to analyse the data. Results According to parents, the transfer process included both direct and indirect tasks, had different levels (remembering, deciding, performing), was at times a difficult and stressful process, and showed large variation between families. A large number of child, parent and context factors were identified that affected the division and transfer of diabetes care responsibilities according to parents. Both positive and negative consequences of the transfer process were described for parental and child health, behaviour and well‐being. Parental final evaluations of the division and transfer of diabetes care responsibilities appeared to be dependent on parenting values. Conclusion How families divide and transfer diabetes care tasks appeared to be affected by a complex interplay of child, parent and context characteristics, which had an impact on several parent and child domains. Impact Parents struggle with the right timing of transfer, which calls for more support from diabetes nurses. The identified factors can be used as input for integrating a more family‐based approach into current age‐based guidelines, to improve regular care.
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Affiliation(s)
- Jori Aalders
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders [CoRPS], Tilburg University, Tilburg, The Netherlands.,Department of Psychology, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense, Denmark
| | - Esther Hartman
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders [CoRPS], Tilburg University, Tilburg, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense, Denmark.,School of Psychology, Deakin University, Geelong, Australia
| | - Per Winterdijk
- Diabeter, Center for pediatric and adolescent diabetes care and research, Rotterdam, The Netherlands
| | - Edgar van Mil
- Kidz&Ko, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | | | - Henk-Jan Aanstoot
- Diabeter, Center for pediatric and adolescent diabetes care and research, Rotterdam, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders [CoRPS], Tilburg University, Tilburg, The Netherlands.,Diabeter, Center for pediatric and adolescent diabetes care and research, Rotterdam, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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