Children and young people's experiences and perceptions of self-management of type 1 diabetes: A qualitative meta-synthesis

Adolescents' Experiences of Transition to Self-Management of Type 1 Diabetes: Systematic Review and Future Directions

PURPOSE

The purpose of this systematic literature review was to explore studies that report the experiences of adolescents, their families, and health care professionals of adolescents' transition to self-management of type 1 diabetes (T1DM).

METHODS

SocINDEX, PsycInfo, APA PsycArticles, and MEDLINE electronic databases were searched. Studies reporting on experiences of transition to self-management of T1DM for adolescents, their parents, siblings, and health care professionals published between January 2010 amd December 2021 were included. The Mixed Methods Appraisal Tool guided trustworthiness and relevance of selected studies.

RESULTS

A total of 29 studies met the inclusion criteria. Findings indicate that adolescents' experiences of transitioning to self-management of T1DM are interconnected with the supports provided by others (eg, family, teachers, friends). Considering interdependence and collective lived experiences is essential to developing effective and personalized family, peer, and social interventions to facilitate transition and to avoid negative outcomes in later life. The renegotiation of roles within the network of supports that impact adolescents' transition and adolescents' self-negotiation have been neglected.

CONCLUSION

Transition to self-management of T1DM is a dynamic and iterative process comprising of continuous shifts between interdependence and independence, making it challenging for all involved. A number of research gaps and avenues for future research are outlined.

Effects of Parental Involvement on Glycemic Control in Adolescents With Type 1 Diabetes Mellitus: A Scoping Review

Type 1 diabetes mellitus (T1DM) is typically diagnosed in pediatric patients. Transitioning from supported management in childhood to self-management in adolescence is an important step. Parental psychosocial influence is a possible factor in adolescents' disease control. This review summarized the effects of parental involvement on glycemic control in adolescents with T1DM by focusing on hemoglobin A1c (HgbAIc). A scoping review per the Guidance for Systematic Scoping Reviews was conducted with the following inclusion criteria: (a) studies in English, (b) focused on adolescents with T1DM, (c) outcomes included HgbAIc, and (d) focused on parental influence of children with T1DM. Of 476 articles, 14 were included. The study outcomes were classified based on direct or indirect influence. "Parental support for adherence" and "parental conflict" significantly affected HgbAIc control. This study provides current evidence on parental influence on glycemic control in adolescents.

What Are the Various Comprehensive Treatment Models to Improve Self-Efficacy and Self-Management in Adolescents with Diabetes Mellitus? A Scoping Review

Background

This review aimed to synthesize intervention models involving the role of adolescent and family support as part of comprehensive care to improve self-efficacy and self-management among adolescents with Diabetes Mellitus (DM).

Methods

A review was conducted to conform to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) standards. We searched PubMed, Research Gate, Science Direct, Cochrane Library databases, and grey literature. We included articles exploring family intervention models on improving self-efficacy and self-management among adolescents with DM, published from January 1, 2009, to June 30, 2022, and in English. Articles were declared eligible, reviewed critically, and then synthesized narratively.

Results

We identified 487 abstracts and title records from the initial search and excluded 409 irrelevant studies. Sixty-six full-text articles were screened, and nine were included in the synthesis. Five articles presented findings from using models focusing on child and adolescent intervention, while in the remaining four articles, the intervention models involved adolescents and their caregivers or parents. Only two models provide comprehensive care that requires collaboration among healthcare providers, patients, and families. Adolescent self-efficacy and self-management schemes as intermediary variables are closely related to everything that can influence health behavior, metabolic control, and quality of life for adolescents, which requires support from a multidisciplinary collaborative team.

Conclusion

Excellent comprehensive care team collaboration involving family support is essential to increase the self-efficacy and self-management of adolescents with DM.

Parents' perspectives of factors affecting parent-adolescent communication about type 1 diabetes and negotiation of self-management responsibilities

Adolescence is an important time in which young people take on type 1 diabetes (T1D) self-management responsibility. Parents are key facilitators of this process. Little is known about parents' experiences of communicating with their children about T1D during adolescence. Semi-structured interviews were conducted with 32 parents (24 mothers and 8 fathers) of adolescents (11-17 years) living with T1D to explore how parents communicate about T1D and self-management with their adolescent children. Parents were recruited through two national child and adolescent diabetes and endocrine clinics and online advertisement through a national diabetes advocacy organisation. Interviews were transcribed verbatim and thematically analysed. Six themes were identified: parent factors, quality of the parent-adolescent relationship, communication strategies, adolescent factors, communication triggers and family/system factors. Understanding factors that impact communication about self-management between parents and adolescents will enable healthcare professionals to provide support and targeted interventions as parent and adolescent roles change over time.

Instruments Measuring Self-Care in Children and Young Adults With Chronic Conditions: A Systematic Review

Children and young adults (CYAs) with chronic conditions need to engage in self-care to improve their quality of life. This study aimed to retrieve the literature on instruments to assess self-care in CYAs living with chronic conditions and evaluate the psychometric proprieties of the instruments retrieved. A systematic literature review was conducted on six databases to identify peer-reviewed papers that described or used an evaluation instrument of self-care in CYAs with chronic conditions. Twenty-three articles describing 11 instruments of self-care were identified. Five instruments (45.45%) were developed for specific diseases, while six (54.54%) for various chronic illnesses. Most of the instruments were focused on treatment adherence within self-care maintenance (i.e., behaviors to maintain illness stability), excluding the monitoring of clinical parameters or the management of exacerbations. This review provides an overview of available instruments that measure self-care in CYAs with chronic conditions, which health professionals could use for patient education.

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.

The Development of Health Self-Management Among Adolescents With Chronic Conditions: An Application of Self-Determination Theory

PURPOSE

The purpose of the study was to better understand the progressive development of health self-management among adolescents and emerging adults (AEAs) with chronic medical conditions in order to identify opportunities to prepare AEA for transition to adult-based care.

METHODS

Twenty-three AEA aged 17-20 years with renal, inflammatory bowel, or rheumatologic diseases, and their parents, completed individual semistructured interviews describing each AEA's health self-management. Self-Determination Theory was used to frame interview questions, including the constructs of competence, autonomy, and autonomy support. Transcripts were analyzed using directed content analysis.

RESULTS

Four themes emerged: Development of Competence in Self-Management; Autonomy: Motivations to Self-Manage; Ways Important Others Support or Hinder Independence; and Normal Adolescent Development. AEA's competency and autonomy increased as they progressed from lack of knowledge about self-management to having knowledge without doing tasks, and, ultimately, to independent completion of tasks. Motivations to self-manage included avoiding sickness/weakness and wanting to engage in activities. Parents and providers supported AEA's autonomy through teaching and transferring responsibility. Parental fear/lack of trust in AEA's ability to self-manage hindered development of AEA's autonomy, producing anxiety. Normal adolescent development impacted timing of self-management task mastery.

CONCLUSIONS

As AEA gain competence in increasingly complex self-management tasks, they assume greater responsibility for managing their health. Competence and autonomy are facilitated by a feedback loop: AEA successful self-management increased parent trust, enabling the parent to transfer responsibility for more complex tasks. Conversely, parents' fear of the AEA doing wrong hinders transfer of responsibility, limiting competence and autonomy. Health-care providers play an important role in fostering autonomy.

Humanoid robot-assisted interventions among children with diabetes: A systematic scoping review

BACKGROUND

Although the humanoid robot is highly engaging for children, whether humanoid robot-assisted interventions could help in diabetes management is still unclear.

OBJECTIVES

This review aimed to elucidate the roles of humanoid robot in managing diabetes and observe the effects of humanoid robot-assisted interventions among children with type I diabetes mellitus.

METHODS

Arksey and O'Malley's methodological framework was used to conduct this scoping review.

DATA RESOURCE

We conducted a comprehensive search in 10 databases, including IEEE Xplore Digital Library, CINAHL, Cochrane Library, EMBASE, PubMed, Scopus, Web of Science, ProQuest, WanFang, and CNKI, from May 1, 1989 to February 1, 2020. The reference lists of key texts were examined and citation chaining was conducted. In addition, our team searched gray literature and relevant journals to maximise the searching.

REVIEW METHODS

Two independent reviewers examined all full articles for fitness with the eligibility criteria. Items of data extraction included the characteristics of articles, description of intervention, and mechanism of humanoid robot in improving the management of children with diabetes.

RESULTS

A total of 2,755 articles were retrieved, 22 of which were included from five countries across different ethnicities. Five roles of humanoid robots in managing diabetes among children with type I diabetes mellitus were identified: disease manager, educator, advocator, emotional supporter, and communicator. To some extent, effects seem to be related to the positive improvement of affective, experiential, relational, cognitive, and behavioral perspectives from humanoid robot-assisted intervention.

CONCLUSIONS

The roles of humanoids have been designed to perform their multidomain functionality. Although many positive effects were observed, the majority of selected articles have methodological issues. Future studies need an improved methodology for large-scale controlled trials.