Young women with diabetes: using Internet communication to create stability during life transitions

'It's like a never-ending diabetes youth camp': Co-designing a digital social network for young people with type 1 diabetes

INTRODUCTION

Living with a chronic condition such as type 1 diabetes (T1D) affects everyday life and support from others experiencing a similar situation can be helpful. A way to receive such support is to use an online network where people can connect and share experiences. Research has described the benefits of using such tools for connecting patients. The aim of this study was to describe the co-design of a social network for young people with T1D and to describe their experiences when using this network.

METHODS

A co-design approach was used, following three steps adapted from Sanders and Stappers (2008). In all, 36 adolescents with T1D participated. Data in the form of recordings and notes from telephone interviews, workshops and focus groups were collected and then analysed using content analysis. Numerical data from the digital platform were also used.

FINDINGS

For the interpersonal values, supporting, learning and relating to emerge, the framework of the network must be appealing and user-friendly. The limits of time and place are eliminated, and there is a possibility for many more to join in.

CONCLUSION

Co-design ensures that what stakeholders think is important forms the basis for the design. The interpersonal values that are promoted are ones that only the exchange of lived knowledge and experience can generate. It is complementary to the support that healthcare professionals can offer; thus, this kind of social network is important for improved, coproduced care.

PATIENT OR PUBLIC CONTRIBUTION

The participants in the present study were persons living with T1D. They were active co-creators from the start to the end. An adult person with experience of living with T1D was involved as an advisor in the research team when drafting the manuscript.

Feasibility and acceptability of an online guided self-determination program to improve diabetes self-management in young adults

Objective

Evaluate the feasibility and acceptability of an online guided self-determination (GSD) program to improve diabetes self-management skills among young adults with type 1 diabetes (YAD).

Methods

An online program comprising seven structured interactive conversations was designed. A pre- and post- interventional study used a sequential, two-phase multiple method design. Phase one comprised a training program for diabetes educators (DEs). In Phase two YAD participated in program and completed pre- and post-surveys assessing motivation to self-manage, perceived competence in diabetes and communication with DEs. Both YAD and DEs provided a program evaluation.

Results

The online GSD program was acceptable, feasible and effective in improving autonomous motivation in self-management and communication with DEs. Easy access and program flexibility were highly appreciated by both participant groups and perceived to assist YAD to stay motivated.

Conclusion

The program had a significant impact on the diabetes self-management of YAD and was a feasible and acceptable way to engage and communicate with DEs. The GSD platform contributes to age appropriate and person-centred diabetes self-management. It can potentially reach geographically distanced populations, or with social circumstances or other barriers impeding in-person service provision.

"It Got Likes, But I Don't Think People Understood": A Qualitative Study of Adolescent Experiences Discussing Type 1 Diabetes on Social Media

BACKGROUND

The majority of adolescents with type 1 diabetes (T1D) integrate social media engagement into their daily lives. The aim of this study was to explore adolescents' experiences and perspectives discussing their T1D on social media.

METHODS

Semi-structured interviews with adolescents with T1D were conducted in person and via telephone. Questions focused on the participant's experiences utilizing social media to discuss T1D and factors that informed the nature of T1D-related social media engagement. Open coding and thematic content analysis were used to identify emergent themes that aligned with accepted domains of social media affordances.

RESULTS

Participants included 35 adolescents with T1D. Adolescents' experiences related to discussing T1D on social media aligned with four affordances of social media: identity, cognitive, emotional, and social. The identity affordances of social media platforms allowed adolescents to curate online personas that selectively included their diagnosis of T1D, while managing the potential negative emotional and social implications linked to the stigma of T1D. Adolescents who decided to discuss T1D on social media leveraged cognitive affordances by providing and receiving diabetes management advice, emotional affordances by obtaining affirmation from peers, and social affordances by extending their network to include other individuals with T1D.

CONCLUSIONS

Adolescents with T1D flexibly leverage the affordances offered by social media to access emotional support, information, and identity affirmation resources while navigating stigma-based social consequences. Our findings highlight the value of developing tools to support adolescents with T1D in comfortably discussing and receiving appropriate support about T1D on social media.

Overcoming challenges to develop technology for child health

Millions of children and young people (CYP) in the UK are affected by chronic or rare health conditions. Rapid advances in science and technology have resulted in CYP with chronic and rare conditions now surviving well into adulthood. New technologies have the potential to improve short- and long-term health outcomes for CYP with health conditions, prevent adult onset disease and complications, and reduce the burden on health services. There is thus a need for targeted investment and appropriate governance in child health technology development to address the specific needs of this population; health technology must be versatile to meet the social, anatomical, cognitive, psychological, and physiological changes inherent to childhood development. Despite the growing demand for health technology for a sizeable global population, industry still wrongly perceives the market size is relatively small, and health technology development is often localised and fragmented with limited scope for spread and adoption. These challenges can be overcome by validating and prioritising unmet needs, involving CYP and their families throughout the innovation pathway, facilitating effective partnerships with key stakeholders, and utilising national and international infrastructure and networks. This paper outlines five innovations supported by NIHR Children and Young People MedTech Co-operative that illustrate how common challenges in child health technology development can be overcome. It is essential that we continue to address such challenges and invest in the health and wellbeing of CYP.

Moving beyond 'don't ask, don't tell': Mental health needs of adults with type 1 diabetes in rural and remote regions of British Columbia

AIMS

To investigate the mental health needs of adults with type 1 diabetes living in rural and remote regions of Interior, British Columbia (BC) and identify factors associated with accessing support. We also explored perspectives around using peer support and digital health strategies for delivering mental health support.

METHODS

This study recruited 38 adults with type 1 diabetes to complete a self-report survey and participate in focus groups. We conducted six 90-min focus groups that addressed the following: current and past mental health needs, social media use for type 1 diabetes support, peer supporter recruitment and training, and support delivery features for virtual care platforms. Focus groups were recorded, transcribed, quality checked, coded and analysed to develop themes and subthemes.

RESULTS

Four core themes emerged: (1) emotional challenges linked to type 1 diabetes management, (2) unique type 1 diabetes-related concerns in rural and remote communities, (3) previous support experiences and future support needs and (4) diabetes-related mental health support interventions involving peer support and digital health strategies. Existing support services are inadequate in meeting the needs of type 1 diabetes adults in Interior BC. Some have turned towards social media as a way to connect with the type 1 diabetes community for support.

CONCLUSIONS

Though type 1 diabetes adults living in rural and remote settings experience distress associated with the ongoing burdens, frustrations and fears of managing a complex chronic condition, many have not been offered support and do not know how to seek services in the present/future. Peer support and digital health strategies are two potential solutions to address this care gap.

Differential influences of social support on app use for diabetes self-management - a mixed methods approach

Background

Recent studies increasingly examine social support for diabetes self-management delivered via mHealth. In contrast to previous studies examining social support as an outcome of technology use, or technology as a means for delivering social support, this paper argues that social support has an impact on the use of diabetes mHealth apps. Specifically, we postulate differences between the impact of healthcare professional versus non-professional (family/friends) support on mobile app use for diabetes self-management.

Methods

This research employed a triangulation of methods including exploratory semi-structured face-to-face interviews (N = 21, Study 1) and an online survey (N = 65, Study 2) with adult type 1 and type 2 diabetes patients. Thematic analysis (Study 1) was used to explore the relevance of social support (by professionals versus non-professionals) for diabetes app use. Binary logistic regression (Study 2) was applied to compare healthcare decision-making, healthcare-patient communication, and the support by the personal patient network as predictors of diabetes app use, complemented by other predictors from self-management and technology adoption theory.

Results

The interviews (Study 1) demonstrated that (technology-supported) shared decision-making and supportive communication by healthcare professionals depended on their medical specialty. The personal patient network was perceived as either facilitating or hindering the use of mHealth for self-management. Binary logistic regression (Study 2) showed that the physician specialty significantly predicted the use of diabetes apps, with supervision by diabetes specialists increasing the likelihood of app use (as opposed to general practitioners). Additionally, specialist care positively related to a higher chance of shared decision-making and better physician-patient communication. The support by the personal patient network predicted diabetes app use in the opposite direction, with less family/friend support increasing the likelihood of app use.

Conclusion

The results emphasize the relevance of support by healthcare professionals and by the patient network for diabetes app use and disclose differences from the existing literature. In particular, the use of diabetes apps may increase in the absence of social support by family or friends (e.g., compensation for lack of support), and may decrease when such support is high (e.g., no perceived need to use technology).

A mHealth Support Program for Australian Young Adults with Type 1 Diabetes: A Mixed Methods Study

Aims and Objectives

Young adulthood is a life stage comprised of many turning points. For young adults with type 1 diabetes (T1DM), diabetes self-management support is crucial during this period. There is a lack of diabetes education programs and services tailored to this population. This paper presents the findings, according to the STROBE guidelines, on the usability and acceptability of a patient-informed mHealth support program (Diabetes YES) that was developed for young adults with T1DM.

Methods

A total of 34 young adults aged 18-35 years with T1DM participated in the Diabetes YES program over 12 weeks. Google analytics was used to tracked website use, while a website usability survey measured ease of use. Facebook analytics was used to measure peer support engagement. Evaluation of the program was completed using Likert scales and open-ended questions.

Results

Participants rated the website favourably for its ease of navigation and easy to understand information. Web page visits declined sharply while peer support group engagement through Facebook remained consistent throughout the intervention period. Participants utilised weekly discussion topics to generate conversation within the peer support group. Emotional support from peers was the highest regarded benefit reported by participants.

Conclusions

Diabetes YES is an example of an mHealth support program that was readily accepted by young adults living with T1DM. Feasibility studies are an important formative step in the implementation of mHealth programs within mainstream healthcare. Future work should focus on the adaptability of such programs to fit within larger consumer or healthcare organisations.

State of the Science: A Scoping Review and Gap Analysis of Diabetes Online Communities

BACKGROUND

Individuals with diabetes are using online resources to engage in diabetes online communities to find diabetes-related support and information. The benefits and consequences of DOC (diabetes online community) use are unclear. This scoping review aims to map existing research focused on organic DOCs in which individuals affected by diabetes are interacting with peers.

METHOD

A scoping review was conducted to comprehensively report and synthesize relevant literature published prior to 2018. Attention was paid to variations in study design, DOC user and platform characteristics, and potential or actual benefits and consequences.

RESULTS

Of the 14 486 titles identified, 47 articles met the inclusion criteria and were included in this scoping review. No overt definition of the DOC could be identified. Perceived or actual benefits associated with DOC use can be broadly categorized as clinical, behavioral, psychosocial and community outcomes. Perceived, potential, or actual consequences associated with DOC use were categorized as quality of information, risky behavior exploration, acute concerns, psychosocial, privacy, and inactivity.

CONCLUSIONS

The results of this review strongly suggest DOC use is highly beneficial with relatively few negative consequences. DOC use is an emerging area of research and research gaps exist. Future research should seek to identify benefits and consequences to DOC use in experimental trials.

Transitional Needs of Australian Young Adults With Type 1 Diabetes: Mixed Methods Study

BACKGROUND

Young adulthood is marked by transitions that impact diabetes self-management behaviors, which require ongoing diabetes education and support. Traditional diabetes education programs and services currently do not meet the needs of many young adults with type 1 diabetes mellitus (T1DM) as they continue to fall through the cracks of clinical services. Age-centered diabetes education programs and services present an opportunity for young adults to meet in a supportive environment and gain a better understanding about diabetes management.

OBJECTIVE

The aim of the study was to identify the health and well-being needs of Australian young adults aged between 18 and 35 years with T1DM to develop appropriate solutions to keep them engaged with diabetes self-management.

METHODS

In total, 13 semistructured individual interviews and self-reported surveys were obtained to understand participants' experiences with diabetes education programs and services. Together with survey data, transcribed interviews were analyzed into themes and categories using comparative analysis to identify the health and well-being needs of young adults with T1DM during young adulthood.

RESULTS

Diabetes education and service needs for young adults with T1DM related to improving access to existing diabetes education programs and services, having credible informational resources, as well as having personalized diabetes management advice. Participants especially valued relevant and real-time information and opportunities for peer support, mostly sourced from Web-based platforms.

CONCLUSIONS

There is a need for diabetes education programs and services to be age-appropriate and easily accessible, to provide relevant and credible information, and to provide opportunities for peer support to better support young adults with T1DM. These findings also support the use of diabetes education programs or services delivered online through mHealth systems in this population.

Social Media Use by Transplant Recipients for Support and Healing

Transplant recipients use a diverse support network that now includes transplant-related social media support groups. The purpose of this study is to explore the use of social media sites by transplant recipients as a potential source of support and healing and the usefulness of Internet postings as a source of rich qualitative data. A qualitative descriptive design was used for the study. A total of 126 retrospective postings from 58 participants were analyzed as they existed on this open publically available Web site over a 20-month period from the selected discussion threads. Two major themes emerged from the data: sharing overwhelming gratitude and finding sanctuary. Sharing overwhelming gratitude was expressed in emotional postings about feelings and letters to donor families. Finding sanctuary described the recipients' perception of the online community as a safe and nonjudgmental environment to discuss sensitive issues and feelings. This study adds to what is known about the unique psychological and emotional needs of transplant recipients. Transplant-related support Web sites offer the opportunity to learn what matters most to transplant recipients and identify gaps in care related to calls for nursing.

Hospital information technology in home care

The utilization of hospital information technology (HIT) as a tool for home care is a recent trend in health science. Subjects gaining benefits from this new endeavor include middle-aged individuals with serious chronic illness living at home. Published data on the utilization of health care information technology especially for home care in chronic illness patients have increased enormously in recent past. The common chronic illnesses reported in these studies were primarily on heart and lung diseases. Furthermore, health professionals have confirmed in these studies that HIT was beneficial in gaining better access to information regarding their patients and they were also able to save that information easily for future use. On the other hand, some health professional also observed that the use of HIT in home care is not suitable for everyone and that individuals cannot be replaced by HIT. On the whole it is clear that the use of HIT could complement communication in home care. The present review aims to shed light on these latest aspects of the health care information technology in home care.

Health and social correlates of Internet use for diabetes information: findings from Australia’s Living with Diabetes Study

This study investigated the relationship between online information seeking and a broad range of health and social characteristics among a large sample of Australian adults with type 2 diabetes. One in four participants used the Internet for diabetes-related purposes and Internet searching was associated with high patient activation, poor metabolic control, signs of peripheral nerve damage, a recent diagnosis of diabetes and poorer patient-assessed coordination of care. No relationship was found between Internet use and treatment complexity and the presence of comorbid conditions. The findings underline the importance of providing better online health resources and support to diabetes patients, and of targeting potential intervention points where services and information may be particularly beneficial.

Psychosocial issues of women with type 1 diabetes transitioning to motherhood: a structured literature review

BACKGROUND

Life transitions often involve complex decisions, challenges and changes that affect diabetes management. Transition to motherhood is a major life event accompanied by increased risk that the pregnancy will lead to or accelerate existing diabetes-related complications, as well as risk of adverse pregnancy outcomes, all of which inevitably increase anxiety. The frequency of hyperglycaemia and hypoglycaemia often increases during pregnancy, which causes concern for the health and physical well-being of the mother and unborn child. This review aimed to examine the experiences of women with T1DM focusing on the pregnancy and postnatal phases of their transition to motherhood.

METHODS

The structured literature review comprised a comprehensive search strategy identifying primary studies published in English between 1990-2012. Standard literature databases were searched along with the contents of diabetes-specific journals. Reference lists of included studies were checked. Search terms included: 'diabetes', 'type 1', 'pregnancy', 'motherhood', 'transition', 'social support', 'quality of life' and 'psychological well-being'.

RESULT

Of 112 abstracts returned, 62 articles were reviewed in full-text, and 16 met the inclusion criteria. There was a high level of diversity among these studies but three common key themes were identified. They related to physical (maternal and fetal) well-being, psychological well-being and social environment. The results were synthesized narratively.

CONCLUSION

Women with type 1 diabetes experience a variety of psychosocial issues in their transition to motherhood: increased levels of anxiety, diabetes-related distress, guilt, a sense of disconnectedness from health professionals, and a focus on medicalisation of pregnancy rather than the positive transition to motherhood. A trusting relationship with health professionals, sharing experiences with other women with diabetes, active social support, shared decision and responsibilities for diabetes management assisted the women to make a positive transition. Health professionals can promote a positive transition to motherhood by proactively supporting women with T1DM in informed decision-making, by facilitating communication within the healthcare team and co-ordinating care for women with type 1 diabetes transitioning to motherhood.

Person-centred web-based support--development through a Swedish multi-case study

Background

Departing from the widespread use of the internet in modern society and the emerging use of web applications in healthcare this project captures persons’ needs and expectations in order to develop highly usable web recourses. The purpose of this paper is to outline a multi-case research project focused on the development and evaluation of person-centred web-based support for people with long-term illness. To support the underlying idea to move beyond the illness, we approach the development of web support from the perspective of the emergent area of person-centred care. The project aims to contribute to the ongoing development of web-based supports in health care and to the emerging field of person-centred care.

Methods/Design

The research design uses a meta-analytical approach through its focus on synthesizing experiences from four Swedish regional and national cases of design and use of web-based support in long-term illness. The cases include children (bladder dysfunction and urogenital malformation), young adults (living close to persons with mental illness), and two different cases of adults (women with breast cancer and childbearing women with type 1 diabetes). All of the cases are ongoing, though in different stages of design, implementation, and analysis. This, we argue, will lead to a synthesis of results on a meta-level not yet described.

Discussion

To allow valid comparisons between the four cases we explore and problematize them in relation to four main aspects: 1) The use of people’s experiences and needs; 2) The role of use of theories in the design of person-centred web-based supports; 3) The evaluation of the effects of health outcomes for the informants involved and 4) The development of a generic person-centred model for learning and social support for people with long-term illness and their significant others. Person-centred web-based support is a new area and few studies focus on how web-based interventions can contribute to the development of person-centred care. In summary, the main intention of the project outlined here is to contribute with both a synthesis of results on meta-level from four cases and a substantial contribution to the field person-centred care.

Person-centered Web support to women with type 1 diabetes in pregnancy and early motherhood--the development process

BACKGROUND

Pregnancy and early motherhood are extraordinarily demanding periods for women with type 1 diabetes, who therefore need optimal support. This article describes the process of developing person-centered Web-based support for women with type 1 diabetes during the period of pregnancy through early motherhood. Important aspects of person-centeredness are a broader scope of medicine, viewing the patient as a person, shared decision-making to accomplish a therapeutic alliance, and the role of documentation.

MATERIALS AND METHODS

A participatory design was used in the development process to capture the target group's knowledge, experiences, and needs, and a systematic process map for Web-based support was used to describe the process.

RESULTS

Content and layout in the Web support were developed collaboratively by project managers, advisory and scientific reference groups, technical producers, and representatives for the target group. Based on needs assessment and evidence synthesis, three main components of complementary Web-based support were identified: (1) specific information about pregnancy, childbirth, and early motherhood in relation to type 1 diabetes; (2) a self-care diary, including a device for documenting and evaluating blood glucose levels, insulin doses, food intake, physical activities, and overall well-being; and (3) a forum for communication between women with type 1 diabetes in the childbearing period.

CONCLUSIONS

Using a perspective of person-centered care, a participatory design and the process map were fruitful for developing person-centered Web support for self-care and self-learning. The developed Web support product will be evaluated in a randomized controlled trial and further developed based on this result.

Pregnancy planning and diabetes: a qualitative exploration of women's attitudes toward preconception care

INTRODUCTION

Seeking preconception care is recognized as an important health behavior for women with preexisting diabetes. Yet many women with diabetes do not seek care or advice until after they are pregnant, and many enter pregnancy with suboptimal glycemic control. This study explored the attitudes about pregnancy and preconception care seeking in a group of nonpregnant women with type 1 diabetes mellitus.

METHODS

In-depth semistructured interviews were completed with 14 nonpregnant women with type 1 diabetes.

RESULTS

Analysis of the interview data revealed 4 main themes: 1) the emotional complexity of childbearing decisions, 2) preferences for information related to pregnancy, 3) the importance of being known by your health professional, and 4) frustrations with the medical model of care.

DISCUSSION

These findings raise questions about how preconception care should be provided to women with diabetes and highlight the pivotal importance of supportive, familiar relationships between health professionals and women with diabetes in the provision of individualized care and advice. By improving the quality of relationships and communication between health care providers and patients, we will be better able to provide care and advice that is perceived as relevant to the individual, whatever her stage of family planning.

‘Oh dear, should I really be saying that on here?’: Issues of identity and authority in an online diabetes community

We explore peer-to-peer discussions which took place in a UK-based diabetes ‘Virtual Clinic’ online community. In particular, we seek to understand the rhetorical nature and content of exchanges over a period of six months from the community’s inception. Data were captured weekly and analysis based on thematic discourse analysis. Two key issues emerged regarding how the community shaped the nature of the discussion forum. First, the identity of the forum was established, and boundaries drawn about what was, and was not, acceptable. Second, participants sought to present themselves as reliable and authoritative sources of information. Internet discussion communities are shaped in important ways early on by the community of users, including how the character and focus of discussion is formed, and how both information and users can be constructed as authoritative and reliable.

Internet use, needs and expectations of web-based information and communication in childbearing women with type 1 diabetes

BACKGROUND

In the childbearing period women use the internet both to seek information and as an important source of communication. For women with type 1 diabetes, pregnancy and early motherhood constitute a more complex situation than for women in general. This implies need for support from various professionals and a way of bridging any discontinuity in care would be to develop a website providing complementary social support and information. The objective of this study was to explore internet use, needs, and expectations regarding web-based information and communication in childbearing women with type 1 diabetes.

METHODS

Data were collected via a web-based survey with an explorative and descriptive design, in which 105 of 139 eligible mothers with type 1 diabetes and recent childbearing experience participated. The data were analyzed with descriptive and analytical statistics, and open answers with a directed content analysis.

RESULTS

Of the 105 women, 22% never used the internet to search for information concerning pregnancy, childbirth, and parenthood. 12% searched for information every day, 29% one or more times a week, and 38% one or more times a month. Of the women 44% declared themselves to be passive participants on social websites, and 45% to be active participants. 45% had specific expectations of web-based support directed towards childbearing, especially those with higher educational level (P = .01). Expectations of instrumental and informational support included an expert-controlled website with reliable, updated, and information focused on childbearing and diabetes, improved access to diabetes care professionals and alternative ways to communicate and to receive childbearing-related support. The women also asked for online technical devices to manage the frequent monitoring of blood glucose during pregnancy. Informal, emotional, and appraisal support from women in similar situations was suggested as a way to provide an arena for belonging instead of creating feelings of alienation.

CONCLUSIONS

Our results add important knowledge about the web-based needs of women with type 1 diabetes in relation to childbearing. This user directed study indicates specific areas of development for the provision of effective web-based support that includes facilities for reliable information, interactive support and social networking in this population.

Young adults' management of Type 1 diabetes during life transitions

AIM

To identify life transitions likely to impact diabetes self-care among young adults with Type 1 diabetes and their coping strategies during transition events.

BACKGROUND

Relationships among psychosocial stress, adjustment, coping and metabolic control affect clinical outcomes and mental health. Life transitions represent major change and are associated with stress that temporarily affects individuals' problem-solving, coping abilities and blood glucose levels.

DESIGN

A qualitative interpretive inquiry.

METHOD

Semi-structured interviews were conducted with 20 young adults with Type 1 diabetes and a constant comparative analysis method. Data and analysis was managed using QSR NVivo 7 software.

RESULTS

Participants identified two significant transition groups: life development associated with adolescence, going through the education system, entering new relationships, motherhood and the workforce and relocating. Diabetes-related transitions included being diagnosed, developing diabetes complications, commencing insulin pump treatment and going on diabetes camps. Participants managed transitions using 'strategic thinking and planning' with strategies of 'self-negotiation to minimise risks'; 'managing diabetes using previous experiences'; 'connecting with others with diabetes'; 'actively seeing information to 'patch' knowledge gaps'; and 'putting diabetes into perspective'.

CONCLUSIONS

Several strategies are used to manage diabetes during transitions. Thinking and planning strategically was integral to glycaemic control and managing transitions. The impact of transitions on diabetes needs to be explored in larger and longitudinal studies to identify concrete strategies that assist diabetes care during life transitions.

RELEVANCE TO CLINICAL PRACTICE

It is important for health professionals to understand the emotional, social and cognitive factors operating during transitions to assist young adults with Type 1 diabetes to achieve good health outcomes by prioritising goals and plan flexible, timely, individualised and collaborative treatment.

Extraordinary exposed in early motherhood - a qualitative study exploring experiences of mothers with type 1 diabetes

BACKGROUND

Women with type 1 diabetes face several challenges during pregnancy, childbirth and in relation to breastfeeding. It is therefore of utmost importance to consider their need for specific support, early postpartum as well as in daily life after discharge from maternity care. Few studies have investigated these aspects of healthcare. The aim of this study was to explore experiences after childbirth regarding breastfeeding, glycemic control, support and well-being in women with type 1 diabetes.

METHODS

A hermeneutic reflective life world research approach was used in this qualitative study. Data was gathered through audio-recorded focus group discussions and individual interviews with 23 women with type 1 diabetes, 6-24 months after childbirth. After verbatim transcription, the text was analyzed in order to identify themes of meaning and a conclusive interpretation of the explored phenomenon.

RESULTS

Experiences of extraordinary exposure challenged the women with type 1 diabetes in their transition to early motherhood. The exposure included a struggle with breastfeeding, although with a driving force to succeed. Everyday life was filled with uncertainty and unpredictability related to one's own unstable glycemic control and the women down-prioritized their own needs in favor of the child. A feeling of being disconnected from professional care further contributed to the experiences of extraordinary exposure.

CONCLUSION

In early motherhood women with type 1 diabetes have a great need for support in managing daily life postpartum, which requires contemporary approaches to overlap insufficient linkage between health care professionals in maternity and child health care, and diabetes care.

Social networks, social capital and chronic illness self-management: a realist review

BACKGROUND

Existing literature on the design of interventions and health policy about self-management have tended to focus on individual-centred definitions of self-care and there is growing recognition of the need to extend consideration beyond individual factors, which determine self-care, to examine wider influences such as the health service, the family and the wider social context.

AIMS

To explore the theoretical and empirical links between social networks, social capital and the self-care practices associated with chronic illness work and management in the context of people's everyday lives.

METHOD

A realist review method was used to search and appraise relevant quantitative and qualitative literature.

FINDINGS

The review findings indicate that social networks play an important part in the management of long-term conditions. We found that social networks tend to be defined narrowly and are primarily used as a way of acknowledging the significance of context. There is insufficient discussion in the literature of the specific types of networks that support or undermine self-care as well as an understanding of the processes involved. This necessitates shifting the emphasis of self-care towards community and network-centred approaches, which may also prove more appropriate for engaging people in socially and economically deprived contexts.

Healthcare routines of university students with Type 1 diabetes

TITLE

Healthcare routines of university students with Type 1 diabetes.

AIM

This paper is a report of a study examining the benefits that university students with Type 1 diabetes associate with diabetes self-care routines, and the barriers that they experience in enacting self-care routines in the university environment.

BACKGROUND

Many young adults with Type 1 diabetes attend university, and it is thought that these students might experience difficulties with their self-care routines while they are there.

METHOD

A qualitative method was chosen to explore students' own perspectives. Seventeen students with diabetes were interviewed twice, and each kept a research diary for a 2-week period. Interviews and diaries were analyzed using standard qualitative techniques. The study was conducted in 2004-2005.

FINDINGS

Routines had a number of identity-producing benefits for students. However, students often experienced difficulties routinizing their self-care practices at university. These difficulties stemmed both from the irregular nature of university life and from students' desires not to let their diabetes interfere with their student lives. Most participants learned to adjust to university and enact self-care routines, although they could still experience routine difficulties during times of transition and stress.

CONCLUSION

Healthcare professionals need to be aware of the difficulties that university students with Type 1 diabetes experience with their self-care routines. This awareness needs to encompass older students in the second, third and fourth years of their undergraduate degrees and postgraduate students as well as students in their first year at university.

New mothers network: the provision of social support to single, low-income, African American mothers via e-mail messages

Electronic mail (e-mail) is being investigated as a health care intervention for mothers caring for their infants. The purpose of this study is to describe themes representing the content of e-mail messages written by 12 single, low-income, African American mothers to nurses participating in the New Mothers Network Study. Three themes that emerged were (a) life's logistics: day-to-day concerns; (b) relationships of support; and (c) personal reflections about being a new mother. Reported themes support the social support theory based on works by House and Revenson, Schiaffano, Majerovitz, and Gibofski used to develop the nursing intervention. Nurses are in key positions to offer social support to African American mothers adjusting to single parenting. Nurses can provide social support to single, low-income African American mothers via e-mail messages to assist them with caring for themselves and their infants.

An Exploration of the Experiences of Young Women Living with Type 1 Diabetes

The aim of this research was to explore young women's experience of living with type 1 diabetes. Nine young women aged between 18 and 24 took part in semi-structured interviews. Data were analysed using Interpretive Phenomenological Analysis. Four main super-ordinate themes emerged; `the relationship with the body', `personal challenges', `the impact of relationships' and `changing and adapting'. These themes provide a deeper understanding of the issues faced by young women with type 1 diabetes. The implications for clinical practice are discussed.