Supporting disengaged children and young people living with diabetes to self-care: a qualitative study in a socially disadvantaged and ethnically diverse urban area

Experiences of loneliness and social isolation among young people with chronic physical conditions: A thematic synthesis of qualitative studies

INTRODUCTION

Young people with chronic health conditions are among the most at risk of having poor social connections, however, little is known about their experiences of loneliness and social isolation. We aimed to describe the perspectives and experiences of loneliness and social isolation among young people with chronic physical conditions.

METHODS

We searched MEDLINE, Embase, PsycINFO, CINAHL, and CENTRAL from inception to May 2023 for qualitative studies that described the perspectives of loneliness and social isolation in young people aged 10-24 years with chronic physical conditions. Findings from the included studies were analyzed using thematic synthesis.

RESULTS

We included 35 studies across 12 countries involving 723 participants (56% female). Most studies (63%) were conducted in young people with cancer. Four major themes were identified: suffering from repercussions of disease (struggling with body image and physical changes, intensified disconnection while hospitalized); hindering relationships with peers and friends (missing out on formative experiences, feeling stuck behind, restrictive parental attitudes); grappling with social exclusion (facing concerns alone, bullying and ostracism); seeking social support and self-help (reliance on family, kindness and empathy from friends, developing rapport with healthcare professionals, discovering self in adversity).

CONCLUSIONS

Symptoms, treatments, and hospitalizations limited young people's social participation and ability to maintain friendships, and this was compounded by social exclusion and bullying. Supportive friends, family, and healthcare professionals helped mitigate feelings of isolation. Interventions and strategies are needed to improve social support and foster meaningful connections. This can be achieved through education and awareness initiatives that promote inclusion in schools and the community, as well as efforts to enhance social support and continuity of care in hospitals.

Non-pharmacological management strategies for type 2 diabetes in children and young adults: A systematic review

PURPOSE

The evidence for effective non-pharmacological management of type 2 diabetes in children and young adults is scarce. This systematic review aims to identify the available evidence for non-pharmacological interventions in managing type 2 diabetes in children and young adults.

METHODS

A systematic search of OVID MEDLINE, Ovid Emcare, EMBASE, CINAHL, Cochrane, APA PsycINFO, Joanna Briggs, ACP Journal Club, Global Health, Scopus databases, INFORMIT, Circumpolar Health, Native Health Database, Indigenous Studies Portal, OpenGrey and Clinicaltrials.gov was performed up to March 2024. Information on author, year, study design, setting and population, intervention characteristics, and results were extracted by three reviewers independently.

RESULTS

Seven studies met criteria for inclusion. Very low-energy diet (VLED) was associated with reduction in hemoglobin A1c (HbA1c), weight, and body mass index (BMI). No other interventions (intensive group-based lifestyle program, occupational-therapist conducted support program or peer support program) improved HbA1c. Interventions positively impacted well-being, mental health and cardiometabolic outcomes.

DISCUSSION

Evidence for non-pharmacological management of youth onset type 2 diabetes is scarce. Available evidence demonstrated that VLED is associated with improved glycemia and weight loss. The role of social support from peers, family, and health professionals shows mixed results.

Views of children with diabetes from underserved communities, and their families on diabetes, glycaemic control and healthcare provision: A qualitative evidence synthesis

AIMS

Children and young people with diabetes (CYPD) from socio-economically deprived and/or ethnic minority groups tend to have poorer glucose control and greater risk of diabetes-related complications. In this systematic review of qualitative evidence (qualitative evidence synthesis, QES), we aimed to explore the experiences and views of clinical encounters in diabetes care from the perspectives of CYPD and their family/carers from underserved communities and healthcare professionals in diabetes care.

METHODS

We searched 6 databases to March 2022 with extensive search terms, and used a thematic synthesis following methods of Thomas and Harden.

RESULTS

We identified 7 studies and described 11 descriptive themes based on primary and secondary constructs. From these, three "analytical themes" were developed. (1) "Alienation of CYPD" relates to their social identity and interaction with peers, family and health service practitioners in the context of diabetes self- and family/carer management and is impacted by communication in the clinical encounter. (2) "Empowerment of CYPD and family/carers" explores families' understanding of risks and consequences of diabetes and taking responsibility for self- and family/carer management in the context of their socio-cultural background. (3) "Integration of diabetes (into self and family)" focuses on the ability to integrate diabetes self-management into the daily lives of CYPD and family/carers beyond the clinical consultation.

CONCLUSIONS

The analytical themes are interdependent and provide a conceptual framework from which to explore and strengthen the therapeutic alliance in clinical encounters and to foster greater concordance with treatment plans. Communicating the biomedical aspects of managing diabetes in the clinical encounter is important, but should be balanced with addressing socio-emotional factors important to CYPD and family/carers.