Exploring why young people with Type 1 diabetes decline structured education with a view to overcoming barriers

AIMS

To identify factors that influence lack of engagement of young adults with Type 1 diabetes (aged 13-21 years) with structured diabetes education (SDE) to inform and broaden the reach of future SDE.

METHODS

A quantitative, cross-sectional survey was undertaken of 227 young people with Type 1 diabetes drawn from 11 health trusts across Northern Ireland and England, deemed to be representative of the wider population. Participants were asked to complete a questionnaire exploring non-attendance, along with the Diabetes Care Profile, the Diabetes Empowerment Scale (Short Form), the Diabetes Knowledge Test and the 12-item General Health Questionnaire. Demographic, health and diabetes-specific variables including HbA_1c were also collected.

RESULTS

The five most commonly cited reasons for non-attendance were 'Had other things to do' (68.3%), 'No time' (62.2%), 'Could not get time off school/college or work' (60.8%), 'Learnt about diabetes from other sources' (55.5%) and 'Feel able to cope on own' (52.9%).

CONCLUSIONS

Greater emphasis is required on communication with young people about the benefits of SDE. In addition, efforts need to be directed to making diabetes education more accessible without losing the quality of structured programmes.

Diabetes distress: understanding the hidden struggles of living with diabetes and exploring intervention strategies

Diabetes distress is a rational emotional response to the threat of a life-changing illness. Distinct from depression, it is conceptually rooted in the demands of diabetes management and is a product of emotional adjustment. Diabetes distress has been found to be significantly associated with glycated haemoglobin (HbA1c) level and the likelihood of an individual adopting self-care behaviours. The lack of perceived support from family, friends and healthcare professionals significantly contributes to elevated diabetes distress, and this issue tends to be overlooked when designing interventions. Pioneering large-scale research, DAWN2, gives voices to the families of those with diabetes and reaffirms the need to consider psychosocial factors in routine diabetes care. Structured diabetes education programmes are the most widely used in helping individuals cope with diabetes, but they tend not to include the psychological or interpersonal aspects of diabetes management in their curricula. The need for health practitioners, irrespective of background, to demonstrate an understanding of diabetes distress and to actively engage in discussion with individuals struggling to cope with diabetes is emphasised.

A longitudinal qualitative study examining the factors impacting on the ability of persons with T1DM to assimilate the Dose Adjustment for Normal Eating (DAFNE) principles into daily living and how these factors change over time

BACKGROUND

The literature reveals that structured education programmes, such as DAFNE, result in many positive outcomes for people with Type 1 diabetes including a decrease in HbA1c levels and reductions in hypoglycaemia. While there is evidence that some of these outcomes are maintained we do not know at present what factors are most important over time. The study aim was to identify the key factors impacting on persons with Type 1 diabetes ability to assimilate the Dose Adjustment For Normal Eating (DAFNE) DAFNE principles into their daily lives and how these factors change over time.

METHODS

This is a longitudinal descriptive qualitative study. Interviews were undertaken with 40 participants who had attended DAFNE in one of 5 study sites across the Island of Ireland, at 6 weeks, 6 and 12 months after completion of the programme. The interviews lasted from 30 to 60 minutes and were transcribed verbatim. Data were analysed in three ways, a within time analysis, a cross sectional analysis for each participant and a thematic analysis which focused on examining changes over time

RESULTS

Four themes that influenced participants' ability to assimilate DAFNE into their daily lives over time were identified. These were: embedded knowledge, continued responsive support, enduring motivation and being empowered. Support at the 6 month period was found to be crucial to continued motivation.

CONCLUSIONS

Understanding the factors that influence people's ability to assimilate DAFNE principles over time into their daily lives can help health professionals give focused responsive support that helps people with diabetes become more empowered. Understanding that continued support matters, particularly around 6 months, is important as health professionals can influence good management by providing appropriate support and enhancing motivation.

TRIAL REGISTRATION

ISRCTN79759174.

Participants' perceptions of the factors that influence diabetes self-management following a structured education (DAFNE) programme

AIM

The aim of this study was to understand the experience of participants in the Dose Adjustment for Normal Eating programme and to identify factors that influence participants' implementation of the self-management guidelines.

BACKGROUND

The literature revealed that structured education programmes, such as Dose Adjustment for Normal Eating programme, have many positive outcomes for people with Type 1 diabetes including: a decrease in HbA1c levels, reductions in hypoglycaemic events, reduction in hospital admissions and increased and sustained quality of life. Few researchers, however, have gathered participants' perspectives on the impact of participation in a Dose Adjustment for Normal Eating programme on self-management capacity.

DESIGN

A grounded theory design focused on description guided by Corbin and Strauss was used. Data collection and analysis were concurrent using the constant comparative technique.

METHODS

Over 24 months, 2006-2008, interviews were undertaken with 40 participants who had completed a Dose Adjustment for Normal Eating programme in one of five study sites across Ireland. Purposive sampling was used, initially, with theoretical relational sampling towards the end of the interviews as concepts emerged. The interviews lasted from 30-60 minutes and were transcribed verbatim.

RESULTS

Five factors that influenced participants' self-management of their diabetes following dose adjustment for normal eating were identified. These were knowledge, support, motivation, relationship shift and empowerment, and these were all related to the core category, 'Being in Control'.

CONCLUSION

Understanding the factors that influence self-management in Ireland is important as it broadens prior knowledge and confirms the factors that are important to facilitate self-management.

RELEVANCE TO CLINICAL PRACTICE

Understanding the factors that influence the implementation of dose adjustment for normal eating principles can help health professionals give more focused and empowering care to persons with diabetes. Using the persons' experience and expertise is essential as it can help them develop their internal resources.

Empowered to change: evidence from a qualitative exploration of a user-informed psycho-educational programme for people with type 1 diabetes

OBJECTIVES

To evaluate the impact of a user-informed psycho-educational programme for people with type 1 diabetes.

METHODS

Qualitative data derived from repeated interviews and diaries enabled an appraisal of participants' unique, individual experiences.

RESULTS

Thematic analysis elicited a number of themes from each type of data (interview and diaries) which bore similarities in their representation of a process whereby change was desired, solutions were found to bring about that change, and then the process was planned or embarked upon.

DISCUSSION

The acquisition of trustworthy information and a repertoire of coping skills accompanied by regular contact with other people with type 1 diabetes meant that participants achieved an increased sense of control in their lives and were empowered to change.