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Teenagers' perception of factors affecting decision-making competence in the management of type 1 diabetes
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
2009 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 23, 3262-3270 p.Article in journal (Refereed) Published
Abstract [en]

Aims.   Decision-making is an important prerequisite for empowerment. The aim   of this study was to explore teenagers' perceptions of factors   affecting decision-making competence in diabetes management.   Background.   A previous study that assessed an empowerment programme for teenagers   with diabetes showed no effects on metabolic control or empowerment   outcomes, which is not in accordance with results from studies on adult   diabetes patients. The definition of empowerment highlights the   patient's own responsibility for decision-making. Earlier studies have   shown that many teenagers' may not be mature in decision-making   competence until late adolescence. To explore the significance of   decision-making competence on the effectiveness of empowerment   education we wanted to explore teenagers' own view on factors affecting   this competence.   Design.   An explorative, qualitative interview study was conducted with 31   teenagers with type 1 diabetes, aged 12-17 years.   Methods.   The teenagers were interviewed two weeks after completing an   empowerment education programme. The interviews were analysed using   qualitative content analysis.   Results.   Five categories stood out as important for decision-making competence:   cognitive maturity, personal qualities, experience, social network and   parent involvement. Based on the content in the interviews and the five   categories, we made an interpretation and formulated an overall theme:   'Teenagers deserve respect and support for their short-comings during   the maturity process'.   Conclusion.   Our conclusion is that teenagers deserve respect for their immature   decision-making competence. Decision-making competence was described as   cognitive abilities, personal qualifications and experience. To   compensate for the deficiencies the teenagers deserve constructive   support from their social network and the essential support is expected   to come from their parents.   Relevance to clinical practice.   These findings can be useful for diabetes team members in supporting   teenagers with diabetes and their parents both in individual meetings   and when planning and delivering group education.

Place, publisher, year, edition, pages
2009. Vol. 18, no 23, 3262-3270 p.
Keyword [en]
adolescence, decision-making, nurses, nursing, parent-involvement, Type 1 diabetes
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-97786DOI: 10.1111/j.1365-2702.2009.02963.xISI: 000271637800007PubMedID: 19930085OAI: oai:DiVA.org:uu-97786DiVA: diva2:172857
Available from: 2008-11-20 Created: 2008-11-20 Last updated: 2010-12-27Bibliographically approved
In thesis
1. Education for Teenagers with Type 1 Diabetes
Open this publication in new window or tab >>Education for Teenagers with Type 1 Diabetes
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Education for teenagers with diabetes has had limited effects to date, especially regarding metabolic control. The development had been towards more patient-centred approaches, like empowerment, motivational interviews and family behavioural programmes. A patient-centred approach means that the patient is expected to take control of the management of the disease. The empowerment approach has been implemented in adults with diabetes, with some positive results.

The aims of this thesis were to evaluate empowerment group education and education in a camp setting, and to validate the “Check your health” instrument which can be used to assess the effects of such education programmes on perceived health and the burden of diabetes.

Thirty-two teenagers between 12 and 17 years of age were randomized to either an intervention group or a wait-listed control group. The intervention consisted of six group sessions with an empowerment approach as the theoretical frame. Thirty-one of the teenagers were interviewed two weeks after the empowerment education programme was completed.

The programme did not have any positive effect on metabolic control between-groups, but within groups HbA1c and readiness to change increased. According to the definition of empowerment, which pinpoints decision-making, the interviews were analysed with that in focus. In the interviews the teenagers described five categories they perceived as important for decision-making competence: cognitive maturity, personal qualities, experience, social network and parent involvement. Parent involvement was described as both constructive and destructive. These categories were interpreted in the overall theme that “teenagers deserve respect and support for their shortcomings during the maturity process”.

Ninety teenagers between 14 and 17 years of age attended education in a camp setting and were compared to a reference group, who had declined participation. The camp did not have any positive effect on metabolic control, but the frequency of insulin pump use after camp education increased. In a cross-sectional comparison, the campers had more positive attitudes towards diabetes and self-care than the non-campers did.

The “Check your health” instrument was tested for reliability and validity in 199 teenagers between 12 and 17 years of age. The instrument was found to be reliable and valid for use on a group level in teenagers with diabetes.

In conclusion, empowerment education programmes should be tailored to suit young people with diabetes, and should preferably be integrated into routine care. Teenagers who prefer individual education may be offered an individual education plan. Parents should be involved in all education of teenagers with diabetes, with the purpose of increasing teamwork and decreasing control and conflict. Continued assessment of teenagers perceived health and perceived burden of diabetes can be carried out using the “Check your health” instrument.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 75 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 398
Type 1 diabetes, empowerment, patient education, adolescence, camp, Quality of Life, health
National Category
urn:nbn:se:uu:diva-9391 (URN)978-91-554-7341-9 (ISBN)
Public defence
2008-12-11, Dillneraulan, Folkhälso- vårdvetenskap, Döbelnsgatan 2, Uppsala, 13:00
Available from: 2008-11-20 Created: 2008-11-20Bibliographically approved

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