Self-management in diabetic children

A therapeutic education programme for diabetic children: recreational, creative methods, and use of puppets

Patient education is an important aspect of care to young diabetic children. The use of playthings and recreational activities is an effective way to help children develop harmoniously by integrating the paradox of having to become compliant with treatment and medication while becoming autonomous in life. This paper presents the evaluation of a therapeutic education programme which was attended by 14 young diabetic patients aged 10-12. In order to take into account the learning capacities and strategies linked to the children's age and development stage, the programme's methods were mainly interactive and recreational. In particular, puppets were used as a means to enable the children to express themselves on different aspects of diabetes-related difficulties in their everyday life. The results of the study show that recreational methods and tools can effectively be implemented into therapeutic patient education programmes so as to enable children to develop various treatment-related skills. As far as the psychosocial skill of expressing one's difficulties and emotions is concerned, the use of puppets was found to be an effective means to facilitate the development of such a skill. Moreover, puppets were found to have a projective and transactional function that allowed children to make decisions and react autonomously, and thus regain control on situations in which they had previously felt disempowered.

Self-management approaches for people with chronic conditions: a review

The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies.

Self-management approaches for people with chronic conditions: a review

The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies.

Family responses to children with diabetes and their influence on self-care

This study describes family responses to school-age children with diabetes and the influence of parents and siblings on self-care. Semistructured interviews of seven families living in a rural area of the Midwest were conducted. Major family responses included reminiscing about the time of diagnosis, changing the diet, scheduling daily routines, coping with and managing the diabetes, and worrying about insulin reactions. Mothers were the primary managers of the diabetes regimen. Blood-testing and self-injections were encouraged during less hurried times, particularly evenings and weekends.

Summer camps for diabetic children: an experience in Campania, Italy

To evaluate the effectiveness of summer camps with objective parameters, the authors examined data relative to nine summer camps organized by the Young Diabetics Association in Campania, Italy. The mean duration of camps was 10 days (range, 8-15) and a total of 256 diabetic children with an average age of 10 (range 8-16) participated in them. The medical personnel consisted of three pediatric endocrinologists, one psychologist, two male nurses and two parents who were directors of the Association. A significant improvement in knowledge and self-management of the disease was noted at the end of the camps. A beneficial effect on mean HbA1c level was also observed in the diabetic children who attended the monthly meetings and follow-up checks with their parents after the camp. On the other hand, a worsening of these values was noted in diabetic children who did not participate in them. No increased incidence of hypoglycaemia or ketoacidosis was found during or after camps, in contrast with previous studies. From a psychological viewpoint, the results suggest that summer camps have an important bearing on achieving acceptance of the disease. Sharing personal experiences with actively involved parents who participated in self-management training together with their children, has favourably influenced the results of this experience in Campania.

Meta-analysis of correlates of diabetes patients' compliance with prescribed medications

This study quantitatively integrated the results of independent research papers containing correlates of objectively measured diabetes patients' compliance with prescribed medications. A total of 183 correlations were extracted from 26 studies. Separate meta-analytic syntheses were conducted to calculate average correlations for different subsets of studies, each of which represented homogeneous results. In general, emotional stability, internal and external motivations, perceived benefit, and supportive structure were positively associated with patients' compliance; perceived barriers and negative social environment were correlated with poor compliance. The directions of relationships of knowledge and age with compliance varied, depending on other study characteristics.

Differences in patient knowledge about diabetes as a function of type of primary care physician

This study examined whether or not patients (n =57) of specialists in diabetes differed from patients (n=211) ofnonspecialists in terms of their knowledge about diabetes before and after a standardized patient education program in diabetes. A specialist was defined as a physician whose practice consisted of 50 % or more diabetic patients. Patient knowledge about diabetes was measured with a 50-item ques tionnaire consisting of seven subscores and a total score. Prior to the program, the two groups did not differ on five of the subscores nor on the total score. There were statistically significant differences on two of the subscores on the pretest: Methods of Control and Pattern Control, with the specialist group scoring better than the nonspecialist group. No differences on any of the scores were found at the end of the program, nor were there differ ences in the amount of knowledge gained during the program. Several interpretations of these findings are suggested and the implications for patient and physician education and the need for further research are discussed.