Perceptions of Adolescent Patients of the "Lived Experience" of Type 1 Diabetes

Naming hypoglycemia: a narrative tool for young people with type 1 diabetes and their families

Objective

Hypoglycemia constitutes a communication barrier between youth with type 1 diabetes, their family members and health professionals. A narrative tool may contribute to a more effective communication.

Methods

Semi-structured interviews with six open-ended questions using narrative techniques collect and analyze (thematic and comparative analysis) different ways of "naming" the lived experience of hypoglycemia.

Results

103 participants, 40 with type 1 Diabetes aged 10-18 years (17 female), 63 relatives (40 female). Group 1 (G1), 10-14 years old (n = 21), Group 2 (G2), 15-18 years old (n = 19), Group 3 (G3) relatives, 30-59 years old. G3 was divided, G3.1: female (n = 42) and G3.2: male (n = 21).G1 and G2 presents greater attention to symptoms. G1 refers a greater need for help, G2 emphasizes autonomy. G2 and G3 describes better the medical protocol. G1 and G2 refer more topics such as "discomfort", "frustration", "obligation", "difficulty in verbalizing", G3 refers to "gilt", "fear" and "responsibility". G3.1 refer more "symptoms", "responsibility", "fault", "incapacity".

Conclusions

A narrative tool enhances the singularity of a common experience, proving itself useful to adolescents, relatives, and healthcare professionals.

Practice implications

In addition to gathering information that is usually acquired empirically, a narrative tool exposes knowledge gaps and may allow implementing intervention strategies.

Living with type 1 diabetes and schooling among young people in Ghana: a truism of health selection, inadequate support, or artefactual explanation of educational inequalities?

INTRODUCTION

Type 1 diabetes mellitus (T1DM) is mostly diagnosed among young people. Despite the evidence that T1DM is disruptive, and affects individuals' health and cognitive ability, there is dearth of knowledge on the impact of T1DM on schooling in LMICs including Ghana. In this research, we explored the impact of T1DM on the schooling of young people living with the disease, and discussed the results within health selection, social support, and artefactual perspectives of inequality.

METHODS

Data were extracted from a qualitative project on T1DM lived experiences in southern Ghana. The study participants were young persons living with T1DM (n = 28) and their caregivers (n = 12). They were purposively recruited to participate in the study using maximum variation and snowball sampling techniques and interviewed in their support group centres, homes, or healthcare facilities using semi-structured interview guides. A computer-assisted qualitative data analysis was performed using QSR NVivo 14 software, and the results were categorised into themes.

RESULTS

Three themes were identified from the transcripts. These themes were school and classroom attendance, choice of school, and school/academic performance. T1DM was a major reason for patients' limited contact hours with teachers, school drop-out, preference for day schools rather than boarding, opting for vocational training instead of continuation of formal education, limited concentration at school, and delayed educational progression.

CONCLUSION

T1DM impacted the schooling of young people living with the disease. The mechanisms of these impacts, and young peoples lived experiences are not artefactual, but rather support discourses on health selection and inadequate social support for young people living with the disease. The results call for the need to develop educational and social interventions to address these barriers. The full implementation of the Inclusive Education Policy (IEP) may contribute to reducing educational and social inequalities caused by ill-health.

A Systematic Review of the Effects of Provider Bias on Health in Youth and Young Adults with Type 1 Diabetes

PURPOSE OF REVIEW

Although pervasive inequities in the health outcomes of youth and young adults with type 1 diabetes (T1D) exist, the role of provider bias in these inequities is not well-understood. The purpose of this review is to synthesize evidence from existing studies on the associations between patient characteristics, provider bias, and patient health.

RECENT FINDINGS

Fourteen articles were included. Determining the extent of the effects of provider bias on patient health is limited by a lack of consensus on its definition. Experiences of provider bias (e.g., shaming, criticism) negatively affects self-esteem, relationships with medical providers, and depressive symptoms. Provider bias also impacts diabetes technology recommendations, insulin regimen intensity, and risk for life-threatening T1D complications. Future studies are needed to develop questionnaires and interviews that better account for diverse experiences and interpretations of bias in T1D healthcare. More research is also needed to investigate mitigating factors to reduce provider bias as a way to improve psychological and physical health in individuals with T1D.

Trying to be like everybody else: A qualitative study revealing the importance of social contexts and illness representations among adolescents with type 1 diabetes and their parents

OBJECTIVE

Type 1 diabetes is one of the most common chronic conditions in young children and adolescents. During the period of adolescence, young people with diabetes often struggle with self-management and have compromised health-related quality of life. This often leads to familial conflicts affecting all family members negatively. The aim of this study is to provide qualitative insight into the everyday life of families with adolescents with type 1 diabetes.

METHODS

The data consisted of participatory family workshops conducted using interactive dialogue tools. The total number of participants was 33 (adolescents n = 13, parents n = 20). The adolescents were between 15 and 17 years. The data were analyzed using systematic text condensation.

RESULTS

The results showed two main themes. The first theme, Diabetes-friendly and unfriendly social contexts, highlighted how the (dis)comfortability of disclosing diabetes was a significant factor in achieving optimal metabolic control. For parents, it affected their perception of social support. The second theme, incongruent illness representations among family members, dealt with the extended family conflict during the period of adolescence.

DISCUSSION

Insights from our study could help healthcare professionals apply a family-centered approach minimizing family conflict and supporting metabolic control when consulting families with adolescents with type 1 diabetes.

Determinants of adherence to insulin and blood glucose monitoring among adolescents and young adults with type 1 diabetes in Qatar: a qualitative study

Background

Adherence to insulin and blood glucose monitoring (BGM) is insufficient in adolescents and young adults (AYAs) with type 1 diabetes (T1D) worldwide and in Qatar. Little is known about the factors related to being aware of suboptimal adherence and the beliefs related to suboptimal adherence in this group. This qualitative study investigated factors related to awareness of, and beliefs about suboptimal adherence, as well as the existence of specific action plans to combat suboptimal adherence using the I-Change model.

Methods

The target group was comprised of 20 Arab AYAs (17-24 years of age) with T1D living in Qatar. Participants were interviewed via semi-structured, face-to-face individual interviews, which were audio-recorded, transcribed verbatim, and analyzed using the Framework Method.

Results

Suboptimal adherence to insulin, and particularly to BGM, in AYAs with T1D was identified. Some AYAs reported to have little awareness about the consequences of their suboptimal adherence and how this can adversely affect optimal diabetes management. Participants also associated various disadvantages to adherence ( e.g., hypoglycemia, pain, among others) and reported low self-efficacy in being adherent ( e.g., when outside home, in a bad mood, among others). Additionally, goal setting and action-planning often appeared to be lacking. Factors facilitating adherence were receiving support from family and healthcare providers, being motivated, and high self-efficacy.

Conclusions

Interventions that increase awareness concerning the risks of suboptimal adherence of AYAs with T1D are needed, that increase motivation to adhere by stressing the advantages, creating support and increasing self-efficacy, and that address action planning and goal parameters.

Hyperglycaemia aversion in type 1 diabetes: A grounded theory study

OBJECTIVE

Very little is known about the circumstances under which hyperglycaemia aversion develops and is maintained. The present study aimed to identify psychological factors involved in the process of hyperglycaemia aversion and to understand how it affects people's self-management of type 1 diabetes.

DESIGN

Qualitative, in-depth interviews were used.

METHODS

A constructivist grounded theory study, using semi-structured participant interviews, was undertaken to build a theoretical model of the process of hyperglycaemia aversion.

RESULTS

Eighteen participants were interviewed. Fifteen were considered hyperglycaemia averse and included in the analysis. A theoretical model was developed to describe and explain processes involved in hyperglycaemia aversion. Many participants held very high standards for themselves and often had a strong preference for control. While some participants described anxiety associated with higher blood glucose, the most proximal driver of their approach was self-criticism and frustration associated with not meeting their own high standards for blood glucose. A number of attentional processes and beliefs, mostly related to hypoglycaemia, maintained and reinforced their blood glucose preference. Diabetes technology served as an enabler, raiser of standards, and additional critical judge of participants' hyperglycaemia aversion.

CONCLUSIONS

The trans-diagnostic concept of emotional over-control is used to understand the proposed model of processes of hyperglycaemia aversion. The present study offers new insight which will aid clinicians in identifying and supporting those who may be at risk of psychological distress and harm associated with a preference for avoidance of higher blood glucose levels.

Calibrating logics: How adolescents and young adults calibrate often-competing logics in their daily self-management of type 1 diabetes

Adolescents and young adults with type 1 diabetes must manage a demanding chronic condition in their daily lives, but adequate self-management remains a major challenge. In this article, we explore the logics invoked in shaping daily type 1 diabetes self-management among adolescents and young adults and propose an analytical view of self-management as a matter of 'calibrating logics'. Drawing on Annemarie Mol's concept of logic, our analysis of in-depth interviews with 21 adolescents and young adults with type 1 diabetes suggested that three main logics collectively shaped their self-management: biomedical, embodied and social. Biomedical logics appeared in the form of routinised insulin therapy, frequent blood glucose testing, and carbohydrate counting, all of which emphasise controlling blood glucose levels. Embodied logics emerged as refined practices such as 'thinking insulin units' and 'listening' to blood glucose fluctuations. Finally, social logics were at play when discreet or postponed self-management practices were used to adjust to social situations. While these logics may complement each other, study participants invoked how these logics often competed in daily life, generating tensions. We therefore propose viewing self-management as a matter of calibrating logics in which often-competing logics are at play. This can provide nuanced insights into the effort and challenges related to the daily self-management of type 1 diabetes for adolescents and young adults, in contrast to the prevailing dichotomy of adherence versus nonadherence to prescribed treatment regimens.

"It is like a pet in a way": The self-management experiences of people with cystic fibrosis diabetes

BACKGROUND

Cystic fibrosis diabetes (CFD) is a very common co-morbidity affecting the lives of people with cystic fibrosis. Surprisingly, minimal research has been undertaken to understand the experiences of people with CFD and how they self-mange this condition.

METHODS

Using interpretative phenomenological analysis, the present study examined the self-management experiences of people with CFD. In-depth semi-structure interviews were conducted with eight people who had CFD.

RESULTS

The following three superordinate themes were identified: forming a relationship with CFD, balancing the CFD self-management triad, and the unmet need for information and support.

CONCLUSIONS

The findings suggest that the management of CFD is challenging and, although people with CFD experience many adaptation and management processes similar to people with type 1 diabetes, they struggle with the additional complexity of balancing CF and CFD. The provision of appropriate education, support and person-centred care needs to be addressed.

Across and Within- Individual Associations Between Everyday Activities and Quality of Life Relevant Measures, in Workers with Type 1 Diabetes

Relationships between activity engagement and health related quality of life (HRQOL) can differ based on the level of analyses. For instance, greater exercise on average may be linked with lower fatigue across individuals (between-person level), whereas the momentary experience of exercise may be associated with increased fatigue within an individual (within-person level). Disentangling the between- and within-person associations between everyday activities and HRQOL outcomes may provide insights for personalized lifestyle-oriented health promotion efforts for individuals with chronic conditions. The purpose of this paper was to examine the between- and within-person relationships between activity engagement and HRQOL relevant measures in a sample of 92 workers with type 1 diabetes (T1D), from whom we collected ecological momentary assessment (EMA) data 5-6 times daily over 14 days. At each EMA prompt, information was collected on the activity participants just engaged in, and HRQOL relevant metrics (e.g. mental health, blood glucose, fatigue, functioning). Momentary reports of "caring for others", and more frequently "caring for others", were both associated with decreased HRQOL. Reporting napping 10% or more of the time during a person's waking hours, but not the momentary experience of napping, was associated with decreased HRQOL. Momentary reports of sleeping were associated with low activity satisfaction relative to other activities, but higher activity importance. Study results provided a quantitative representation of the lived experience of T1D covering multiple types of activity engagement, which potentially has health promotion implications for workers with T1D.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11482-023-10171-2.

Adolescents' and their parents' experiences of using a closed-loop system to manage type 1 diabetes in everyday life: qualitative study

OBJECTIVES

Type 1 diabetes can have life-shattering consequences for adolescents and parents. A closed-loop system is a cutting-edge technology which automatically regulates glucose to reduce the burden of diabetes management. We explored adolescents' and parents' experiences of using this technology to understand how it affects their biographies and everyday lives.

METHODS

In-depth interviews with 18 adolescents newly diagnosed with type 1 diabetes and 21 parents after ≥12 months experience using closed-loop technology. Data were analysed thematically.

RESULTS

Participants reported very few disruptions to their lives when using a closed-loop. Reports of family conflict were minimal as the closed-loop enabled dietary flexibility and glucose levels to be checked effortlessly. Adolescents described doing 'normal' activities without worrying about high/low glucose, and parents reported allowing them to do so unsupervised because the closed-loop would regulate their glucose and keep them safe. Some adolescents expressed concerns about the visibility of components and, to avoid stigma, described curtailing activities such as swimming. Participants described how the closed-loop enabled adolescents to be in control of, or create distance from, diabetes.

DISCUSSION

The closed-loop has life-enhancing consequences for both adolescents and parents and helps to reduce the biographical disruption of type 1 diabetes in this age group.

Self-care practice, lived experience of type 1 diabetes mellitus patients at Kemisse General Hospital, North Eastern Ethiopia: Phenomenological study

Objectives:

To explore self-care experience of type 1 diabetes mellitus patients at Kemisse General Hospital, North east Ethiopia.

Methods:

A phenomenological study was conducted to explore self-care experience of type 1 diabetes mellitus patients at Kemisse General Hospital from 28 February 2020 to 15 March 2020. Participants were selected using a heterogeneous type of purposive sampling technique. Data were collected using in-depth interviews and observation with the aid of an audio recorder and interview guide by the principal investigator. The thematic analysis approach was used to analyze the data. To facilitate the data analysis process, Atlas. ti software version 7 was used.

Results:

The six interconnected themes that were emerged from the analysis are: (1) physical exercise, (2) dietary practice, (3) medication adherence, (4) self-monitoring of blood sugar, (5) problem-solving skill during hypoglycemia and hyperglycemia, and (6) diabetic foot care.

Conclusion:

The study described that type 1 diabetic patients at Kemisse general hospital faced difficulty in self-care practice, which were difficulty in medication adherence; foot care was neglected diabetes self-care, did not practice diabetes recommended dietary plan and lack of regular physical exercises. In addition to this, self-monitoring of blood sugar was not practiced regularly due to the absence of glucometer machine and financial constraints to buy test strips. In addition to diabetic patient’s role to manage hyperglycemia and hypoglycemic episode, family support was crucial to managing hypoglycemia because most of the respondent’s experience loss of consciousness during a hypoglycemic attack.

Physical Activity and Nutrition Interventions for Type 1 Diabetes: A Meta-analysis

BACKGROUND AND OBJECTIVES

Current evidence is lacking on physical activity and nutrition-based interventions focusing on the management of type 1 diabetes mellitus (T1DM) and health-related quality of life among children. To assess the effects of physical activity interventions and nutrition-based interventions for children with T1DM.

METHODS

Data sources include the Cochrane Central Register of Controlled Trials, Medline, clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, CINAHL through January 2022. Study selection includes randomized controlled trials of children aged 18 years and below with T1DM comparing either a physical activity intervention, a nutrition-based intervention, or hybrid physical activity and nutrition-based intervention with placebo or no-treatment control. Data were pooled using a random-effects model. Primary outcomes were hemoglobin A1c (HbA1c), and health-related quality of life.

RESULTS

Eighteen trials were included. Physical activity compared with the no-treatment group showed a lack of effect on HbA1c (mean difference = -0.58, 95% confidence interval -1.20 to 0.05; P value = .07). Nutrition-based intervention compared with no-treatment control for HbA1c level revealed a lack of effect (mean difference = -0.61, 95% confidence interval -1.48 to 0.26; P value = .17). Limitations include paucity of studies and low quality of evidence caused by the risk of bias.

CONCLUSIONS

Despite the lack of significant evidence, the generally favorable results highlight the potential of such interventions in enhancing glycemic control and health-related quality of life. Additionally, promising results from a single physical activity-nutrition-based hybrid intervention in terms of glycemic control indicate the plausible effectiveness of a mixed intervention.

Socio-cognitive determinants affecting insulin adherence/non-adherence in late adolescents and young adults with type 1 diabetes: a systematic review protocol

Objective

This systematic review aims to investigate the key socio-cognitive determinants associated with adherence/non-adherence to insulin treatment in late adolescents and young adults in the age range of 17–24 years with T1D.

Methods

A pre-specified search strategy will be used to search for studies in the electronic databases and citation indexes: PubMed, EMBASE, Web of Science, and PsycINFO. Two researchers will screen the title and the abstract independently, then will read and critically appraise the full text of each included study. A third independent reviewer will resolve disagreements in data extraction until consensus. Data will be extracted using the Population, Exposure, Outcomes, Study characteristics framework. Study selection will follow the updated guideline for reporting systematic reviews (PRISMA 2020) and will take place from 15 October 2021 to 1 January 2022. The methodological quality and risk of bias of the observational studies will be assessed by the JBI Critical Appraisal Checklist for Cohort and JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies.

Results

A qualitative narrative synthesis will present the characteristics and the quality of studies and the outcomes of concern.

Conclusion

Based on the contemporary literature, this review will synthesize the evidence on the socio-cognitive determinants associated with adherence/non-adherence to insulin treatment in late adolescents and young adults in the age range of 17–24 years with T1D. The findings will help design patient-centered interventions to promote adherence to insulin in this age group, guide patients’ consultations and diabetes self-management education (DSME) programs.

Protocol registration: PROSPERO ID: CRD42021233074.

Developing the Chinese version problem areas in diabetes-teen for measuring diabetes distress in adolescents with type 1 diabetes

PURPOSE

To translate the 26-item English version Problem Areas in Diabetes-Teen (PAID-T) into a Chinese version and then to examine its psychometrical properties for measuring diabetes distress in adolescents with type 1 diabetes (T1D).

DESIGN AND METHODS

The 26-item English version PAID-T was translated into a Chinese version guided by the translation model for cross-cultural research. A cross-sectional design was used and 203 adolescents with T1D were recruited from four hospitals in Taiwan. Content validity, exploratory factor analysis, and item analysis were used to ensure the item quality and build the factor structure of the Chinese version PAID-T. Confirmatory factor analysis, concurrent validity, and reliability testing were also used to examine its psychometric properties.

RESULTS

The three second-order factors of the 18-item Chinese version PAID-T were developed. The correlation coefficients of the three-factor Chinese version PAID-T with self-management and glycosylated hemoglobin levels were all significant and ranged from -0.32 to -0.45 and 0.18 to 0.33 respectively. Cronbach's α and the test-retest reliability of the three-factor Chinese version PAID-T ranged from 0.85 to 0.93 and from 0.89 to 0.94 respectively.

CONCLUSIONS

The Chinese version PAID-T with good translation quality was a reliable and valid scale to screen and assess diabetes distress for adolescents with T1D.

PRACTICE IMPLICATIONS

Nurses could use the Chinese version PAID-T to track diabetes distress and tailor interventions for adolescents with T1D; also, the Chinese version PAID-T could facilitate the conducting of research on diabetes distress for adolescents with T1D.

Type 1 Diabetes Patient Experiences Before and After Transfer from a Paediatric to an Adult Hospital

INTRODUCTION

The management of type 1 diabetes (T1D) is especially complex during adolescence when youths are transferred to adult care centres. The objectives of this qualitative study were to: a) determine the expectations of young T1D patients prior to transfer, b) evaluate the transfer process between the 2 centres, and c) evaluate the therapeutic education and care programme (TECP) in the adult centre from their point of view.

MATERIAL AND METHODS

Opinion sampling of adolescents from 2018-2019 was performed: Phase 1: adolescents with T1D prior to transfer to the adult hospital; Phase 2: adolescents with T1D one or two years after transfer and having undergone TECP. A focus group (1.5h) and semi-structured interviews (45 min) were performed and taped, transcribed, and sent to the participants for confirmation. Date analysis was performed of the transcriptions of the focus group and interviews. Fragments were selected and meta-categories created.

RESULTS

Eleven youths accepted to participate: 7 in Phase 1, 4 repeated in Phase 2 and 4 more transferred 2 years previously were added. The meta-categories obtained were: 1) perception of the quality of care and therapeutic education in the paediatric hospital. 2) transfer to the adult hospital. 3) experience of the youths 1-2 years after transfer and having undergone TECP. The data are presented in narrative form and are supported with text fragments of the participants' discussions.

DISCUSSION AND CONCLUSIONS

Analysis of patients' experience complemented by clinical-educational evaluation of TECP provides understanding of the perspectives of youths on the complexity of living with a chronic disease since childhood. It also provides information regarding the factors favouring quality care and therapeutic education, the complexity of transfer from paediatric to adult care, determination of the strong and weak points and the establishment of strategies to improve the programme.

The Influence of Health Mindset on Perceptions of Illness and Behaviors Among Adolescents

BACKGROUND

Health mindsets can be viewed on a continuum of malleability from fixed (health cannot be altered) to growth (health can be affected by behavior). We propose that mindsets may influence the health perceptions of healthy adolescents as well as the health behaviors of adolescents with a chronic illness.

METHODS

In Study 1, we surveyed healthy adolescents about their health mindsets and their judgments of illness in response to vignettes of fictional others. In Study 2, we measured the health mindsets and health behaviors of adolescents with type 1 diabetes RESULTS: In Study 1, healthy adolescents with a fixed health mindset were more likely to rate fictional others as being less healthy, less likely to recover, and more vulnerable to additional diseases. In Study 2, a growth mindset was associated with a greater frequency of glucose monitoring among younger, but not older, adolescents with type 1 diabetes. Further, growth mindset was associated with lower HbA1c levels for younger adolescents.

CONCLUSIONS

Health mindsets may shape views of the implications of illness or injury for overall health and, in adolescents with a chronic condition, may interact with age to influence health behaviors and outcomes.

An exploratory study of how young people experience and perceive living with type 1 diabetes during late adolescence and emerging adulthood

OBJECTIVE

Suboptimal glycemic control and psychosocial challenges are significant concerns for adolescents and emerging adults (collectively young people) with type 1 diabetes. Knowledge about young peoples' attitudes towards living with type 1 diabetes is inadequate, but the issue is important in the development of strategies to improve glycemic control and psychosocial well-being. This study explored young peoples' perceptions of living with type 1 diabetes.

METHODS

An exploratory, qualitative design was employed. Data were collected through five participatory workshops with 19 young people (age 15-25). Data were thematically analyzed.

RESULTS

The overall depiction of living with type 1 diabetes was paradoxical; it affected everything and nothing. Living with type 1 diabetes was a balancing act between accommodating a "normal" way of living and self-management tasks of the treatment regimen. Participants' perceptions reflected shifting accounts that could be divided into five themes: (1) special rules during youth, (2) striving for autonomy, (3) an uncertain future, (4) social support, and (5) stigma and disclosure.

DISCUSSION

It is important to probe for the multiple and interrelated social contexts that underlie young peoples' motives for adhering to and deviating from treatment regimens. Future studies should focus on relational aspects, including stigma mechanisms, the role of friends, and facilitation of balanced parental involvement.

Prevalence of diabetes distress and depression and their association with glycemic control in adolescents with type 1 diabetes in Dubai, United Arab Emirates

OBJECTIVE

Diabetes distress and depression have been shown to be prevalent among adolescents with type 1 diabetes and screening for these parameters should be a routine part of diabetes care. To assess the prevalence of diabetes distress and depression and their association with glycemic control in a sample of adolescents with type 1 diabetes attending a diabetes center in Dubai, United Arab Emirates. All adolescents aged 13 to 18 years with type 1 diabetes that were seeking treatment at the Dubai Diabetes Center from the period of September 1, 2018 to May 1, 2019. A total of 72 participants completed the study.

RESEARCH DESIGN AND METHODS

Adolescents were asked to fill in questionnaires assessing diabetes distress and depression. Multivariate linear regression analysis was used to assess the relationships between the subsets of socio-demographic and clinical characteristics, and the scores of the questionnaires.

RESULTS

The mean HbA1c of the study sample was 9.61% [82 mmol/mol] with higher levels found in females as compared with males (p<0.05). Females showed significantly greater levels of distress as compared with males. Although adolescents with HbA1c≥7.5% scored higher for diabetes distress and depression, the difference was not statistically significant to those with an HbA1c of <7.5%. Higher levels of diabetes distress were highly correlated with depressive symptoms, with distress and depression both being significant predictors of one another.

CONCLUSIONS

Our results highlight the importance of implementing and sustaining psycho-educational interventions to aid in alleviating diabetes distress and depression in this subgroup of the population.

Progression of self-management learning experiences of young adults following an allogeneic hematopoietic stem cell transplantation: A qualitative study

PURPOSE

Hematological diseases are among the most common forms of cancer that can affect young adults. Hematopoietic stem cell transplantation is a common intervention to treat blood-related cancers such as leukemia and lymphoma. Allogeneic stem cell transplants can provoke many acute and chronic symptoms. Young adult cancer survivors are expected to develop expertise to self-manage these symptoms. However, learning self-management can be quite challenging for young adults. This paper aims to describe the symptoms self-management learning experiences of young adults following an allogeneic stem cell transplant.

METHOD

A qualitative descriptive study was conducted to describe self-management learning experiences of young adults (18-39 years old) following an allogeneic stem cell transplant. Semi-structured interviews were conducted (n = 7, mean age 26 years old, mean time since allogeneic stem cell transplant was 14,71 months). Iterative qualitative content analysis was performed.

RESULTS

Participants who had undergone an allogeneic stem cell transplant described learning self-management as a progressive process, with expertise having to be developed through experience. Certain factors could positively or negatively affect the learning process and hence the development of this self-management expertise. With time, these young adults developed interoceptive ability and body awareness related to their symptoms, which influenced their self-management.

CONCLUSIONS

Following an allogeneic stem cell transplant, young adults need to be supported during their survivorship to develop self-management expertise. Nurses must adapt care according to patients' level of expertise to promote autonomy, development of interoceptive ability, and acquisition of self-management skills.

Defining features of diabetes resilience in emerging adults with type 1 diabetes

BACKGROUND

Emerging adulthood presents unique challenges for type 1 diabetes (T1D) management. Barriers to achieving optimal diabetes outcomes have been studied but less is known about how emerging adults overcome these challenges. Characterizing emerging adults' protective factors may help guide T1D care during this developmental period. We anticipated identifying social, cognitive, and behavioral protective factors and were open to additional themes.

METHODS

We analyzed transcripts from semi-structured qualitative interviews with 62 emerging adults (age 18-24 years) with T1D using hybrid thematic analysis. Interviews queried about participants' perspectives on diabetes management challenges, how they overcome challenges, and diabetes resilience.

RESULTS

We categorized responses into three types of protective factors: (a) Social: Interpersonal strategies such as obtaining tangible support (especially from parents) and emotional support from friends, medical professionals, and community leaders. (b) Cognitive: Believing one can live a "normal" life with T1D, benefit-finding, and viewing diabetes management as an important part of life. (c) Behavioral: Proactively planning for diabetes challenges, maintaining a consistent routine while allowing for flexibility, balancing diabetes and non-diabetes activities, and using diabetes-specific and general technologies to support self-management.

CONCLUSIONS

The adaptive approaches emerging adults with T1D use to handle the challenges of diabetes include seeking interpersonal support, managing their thoughts about T1D, and taking specific actions to prevent or resolve challenges. Helping emerging adults identify and strengthen their protective factors has potential to affect clinical outcomes. Strengths-based assessment and clinical attention to protective factors may prepare adolescents to successfully manage the challenges of transition to adult care.

Disruption, worries and autonomy in the everyday lives of adolescents with type 1 diabetes and their family members: A qualitative study of intrafamilial challenges

AIM

To explore daily life with type 1 diabetes in families with an adolescent with type 1 diabetes.

BACKGROUND

Management of adolescent type 1 diabetes is carried out in the context of everyday life, thus involving and affecting the entire family. Type 1 diabetes causes disruption of family life, but the specific experiences and challenges of adolescents with type 1 diabetes, siblings and parents are not well-explored. Specifically, research is lacking on the siblings' experience of adolescents with type 1 diabetes.

DESIGN

A qualitative design using participatory workshops.

METHODS

A sample of 21 families comprising adolescents with type 1 diabetes (aged 8-18) (N = 20), their parents (N = 29) and siblings (N = 10) participated in four workshops exploring everyday life in families with adolescent diabetes from the perspective of all family members. Data were analysed using systematic text condensation. The COREQ checklist was used preparing the manuscript.

RESULTS

Family life with type 1 diabetes was characterised by three overarching themes: (a) the perpetual challenges and disruptive nature of life with diabetes, (b) different ways of worrying about diabetes and (c) diabetes autonomy and emancipation from parents. All family members' lives were marked by these aspects, however in different ways and to varying degrees.

CONCLUSIONS

Our findings emphasise that type 1 diabetes is indeed a family illness affecting all family members. The study provides insight into the unique experiences of adolescents with diabetes, their parents and siblings, all of whom encounter diabetes-related challenges in their daily lives.

RELEVANCE TO CLINICAL PRACTICE

The findings call for the inclusion of all family members of adolescents with type 1 diabetes in both research and healthcare practice. Family-oriented approaches targeting adolescents with diabetes as well as their parents and siblings will enable provision of nursing care that can meet the needs of the entire family.

Diabetes management experience of middle-aged persons with type 1 diabetes

AIM

For middle-aged persons with type 1 diabetes, diabetes management is essential due to the natural effects of middle age. However, studies investigating how such individuals manage their diabetes are lacking. This study aimed to explore diabetes management experiences of middle-aged individuals with type 1 diabetes.

METHODS

Data were collected through in-depth interviews with six middle-aged persons with diabetes. An interpretative phenomenological analysis was used for the analysis of the data.

RESULTS

The following four themes emerged: "familiarity with but no control over type 1 diabetes", "embodiment of one's unique management of type 1 diabetes", "control of one's mindset regarding diabetes management despite a limited scope of activity", and "accepting ownership of self-management and continued management to the best of one's ability." A core theme was "living silently like robots dreaming of true freedom from type 1 diabetes."

CONCLUSIONS

The findings indicate that nurses should provide education, embracing the experience in diabetes management through trial and error among persons with type 1 diabetes.

The Self-Management Experiences of Adolescents with Type 1 Diabetes: A Descriptive Phenomenology Study

Many adolescents with type 1 diabetes experience challenges in achieving good glycemic control and have insufficient understanding in executing interventions for glycemic control. This study aimed to understand self-management experiences of adolescents with type 1 diabetes in Taiwan. In this descriptive phenomenological study, we conducted in-depth interviews with 18 adolescents with type 1 diabetes from the pediatric outpatient clinic of a medical center. Data were analyzed using the Colaizzi's method. Four themes were identified: (1) misconception regarding self-management of blood glucose; (2) conflict between depending on and breaking away from parental assistance for glycemic control; (3) encounter with disruptions in glycemic control regimen due to the presence of schedule changes; and (4) lack of motivation to achieve good glycemic control. The findings indicated that the misconceptions of adolescents with type 1 diabetes about managing glycemic levels resulted from an insufficient understanding of self-management of diabetes. In Taiwan, the heavy emphasis of academic achievement and changes of schedules during breaks tended to disrupt the regimen for glycemic control. Healthcare professionals are encouraged to provide individualized education focusing on the adolescents' misconceptions regarding self-management of diabetes.

Risk of Disordered Eating Behaviors in Adolescents with Type 1 Diabetes

OBJECTIVE

Management of type 1 diabetes (T1D) may be difficult for adolescents, who often fail to meet glycemic targets. Adolescents are also at an increased risk for negative affect (i.e., anxiety, depressive symptoms) and are prone to disordered eating behaviors (DEB). This study hypothesized that negative affect would be associated with DEB, self-management, and glycemic control, but that this would be moderated by negative urgency (the urge to engage in impulsive behaviors in response to negative affect), such that this relationship would be significant only for those with higher negative urgency.

METHODS

The Eating in Adolescents with T1D Study recruited 100 caregiver-adolescent dyads (55% male youth, 48% Caucasian) to complete questionnaires reporting on the adolescent's negative affect, negative urgency, DEB, and diabetes management. Glycemic control 3-4 months following survey completion was extracted from the medical record.

RESULTS

A total of 61% of adolescents reported elevated symptoms of anxiety or depression and 25% reported elevated disordered eating symptoms. A total of 81% of adolescents had an A1c level above recommended targets. Negative affect was associated with DEB, suboptimal T1D self-management, and suboptimal glycemic outcomes, moderated by higher levels of negative urgency. Negative affect was associated directly with suboptimal self-management and glycemic control, but not DEB, at all levels of negative urgency.

CONCLUSIONS

Adolescents reported high levels of negative affect, DEB, and suboptimal glycemic control. Interventions that target negative affect and negative urgency in adolescents with T1D are needed in order to reduce the risk for DEB and negative diabetes health outcomes.

Psychological correlates of disordered eating in youth with type 1 diabetes: Results from diabetes MILES Youth-Australia

BACKGROUND

This study examined the relationship between disordered eating (DE), body dissatisfaction (BD), and psychological variables; and identified correlates of DE in youth with type 1 diabetes.

METHODS

Data were from the Diabetes Management and Impact for Long-Term Empowerment and Success Youth Study-Australia, an online survey assessing the psychosocial impact of type 1 diabetes. Adolescents (N = 477; mean age 16 ± 2 years) with type 1 diabetes for at least 1 year, completed the Diabetes Eating Problem Survey-Revised, measures of BD, quality of life, well-being, depressive and anxiety symptoms, diabetes distress, and resilience.

RESULTS

DE correlated positively (moderate-large) with depressive and anxiety symptoms, diabetes distress, and BD; and negatively (moderate-large) with well-being, quality of life, and resilience. In contrast, BD correlated (moderately) with all psychological variables in females only. In the stepwise regression, high diabetes distress and BD were the strongest predictors of DE. While the magnitude of BD was almost five times higher in females, the level of DE risk across genders did not differ when BD was added into the model, which overall explained 71% of the variance.

CONCLUSIONS

This study explored potential risk and protective factors associated with DE. The novel finding that diabetes distress is a strong indicator of DE provides preliminary support for its inclusion into future risk models and potential target for intervention. Longitudinal studies are required to map how these factors predict changes over time with greater emphasis needed into understanding the gender-specific risks associated with BD, particularly during more difficult developmental phases, such as adolescence to young adulthood.

Psychosocial morbidity among children with type-1 diabetes mellitus

Background:

Although the psychosocial impact of type-1 diabetes mellitus (T1DM) patients is well recognized, data about its prevalence in India is scant. Hence, this study was undertaken to determine the prevalence and spectrum of psychosocial morbidities among pediatric T1DM patients and factors associated with psychosocial distress.

Methods:

Among 39 pediatric T1DM patients, a cross-sectional questionnaire-based study was carried out. Psychological distress was measured by applying a childhood psychopathological measurement schedule (CPMS) questionnaire. Psychosocial distress was analyzed across various sociodemographic factors and disease-specific variables by applying the Chi-square test using the statistical package for social sciences (SPSS) version 16.

Results:

The mean age of the study sample was 11.59 + 2.65 years (range: 6–16 years). Out of a total 39 patients, 21 (53.85%) were found to be psychologically distressed. The mean CPMS score was 12.74 + 9.54. Mean scores among psychologically distressed and nondistressed patient groups were 19.19 + 8.5 and 5.22 + 2.74, respectively. Anxiety, conduct disorder, and depression were the most common problems identified. Psychosocial distress was more prevalent among those who were postpubertal, males, Muslims, residing in rural areas, living in a nuclear family, having no sibling, and from the upper-lower socioeconomic background. Psychosocial distress was significantly associated with an increased number of insulin injections per day (P = 0.041) and dietary and drug regimen noncompliance (P = 0.001).

Conclusion:

The present study revealed a very high prevalence (53.85%) of psychosocial morbidity among T1DM patients. Psychosocial distress was significantly more among patients taking an increased number of insulin injections per day and patients who were noncompliant with the dietary and drug regimen.

Construção de serious games para adolescentes com diabetes mellitus tipo 1

Resumo Objetivo Construir serious games educativo para adolescentes com diabetes mellitus tipo 1. Métodos Pesquisa metodológica, fundamentado no design centrado no usuário e efetivado em três etapas: revisão de literatura e envolvimento dos sujeitos; concepção e produção do protótipo; avaliação da usabilidade. Resultados a produção do serious games foi pautada em literatura científica e sugestões de adolescentes. O conteúdo educativo foi apresentado pelo personagem Didi sobre hábitos de vida diária: acordar, realizar higiene pessoal, monitorização da glicemia capilar e aplicação de insulina. Neste percurso, o jogador observa ações terapêuticas incluindo escolhas de alimentos saudáveis. Na avaliação de usabilidade, os adolescentes consideraram satisfatórios os requisitos de jogabilidade, conteúdo e design. Conclusão o teste de usabilidade teve validação positiva e as sugestões contribuíram para melhoria da qualidade das funções e interação, favorecendo o alcance das metas do jogo. Assim, a tecnologia apresenta propriedades para melhorar os cuidados dos adolescentes com diabetes mellitus tipo 1.