Facilitation of motivation to self-management in pediatric diabetes health care consultations with adolescents with type 1 diabetes. A qualitative triangulation study

Developmental Process ◽

Self Management ◽

Care Clinic ◽

Qualitative Research Design ◽

Pediatric Diabetes ◽

Abstract Background. The impact of health care professionals on the motivation for self-management in adolescents with type 1 diabetes has been highlighted as important. It is, however, not well understood how pediatric diabetes health care practitioners can help adolescents become more motivated to self-management. The aim of the study was to investigate how practitioners can motivate their patients to self-management in consultation and how adolescents with type 1 diabetes experienced that consultation could facilitate motivation to self-management. Methods. Based on a qualitative research design, the study triangulated participant observations of 11 consultations at a pediatric health care clinic and 10 interviews of the adolescents (15-17 years of age) about their experiences of consultations. Using Giorgi’s phenomenological method, the analysis showed five categories important to consultation-facilitated motivation to self-management: 1. Consultation setting, 2. Consultation conversation, 3. Roles in treatment, 4. Assuming consultation-facilitated responsibility for self-management, and 5. Relationship in treatment. Results from the analysis were compared to fulfilment of the motivational needs for autonomy, competence and relatedness described in Self-Determination Theory. Results. Overall findings showed that the adolescent’s developmental process of becoming autonomous in relation to self-management was influenced by consultations, and that the need for relatedness was experienced as valued by the adolescents. Conclusions. The conclusion of the study was that relatedness and development of autonomy were experienced as important for how consultations could facilitate motivation to self-management in 15-17-year-olds and may be fundamental to adolescents’ experience of competence in relation to self-management.

Consultation-dependent motivation to self-management in adolescents with type 1 diabetes: a qualitative triangulation study

10.21203/rs.2.15261/v1 ◽

2019 ◽

Author(s):

Rose Marie Teyken ◽

Johanne Jeppesen Lomholt ◽

Anders Jørgen Schou

Keyword(s):

Health Care ◽

Type 1 Diabetes ◽

Developmental Process ◽

Self Management ◽

Care Clinic ◽

Pediatric Health Care ◽

Qualitative Research Design ◽

Abstract Background. The impact of health care professionals on the motivation for self-management in adolescents with type 1 diabetes has been highlighted as important. It is, however, not well understood how pediatric diabetes health care practitioners can help adolescents become more motivated to self-management. The aim of the study was to investigate how practitioners can motivate their patients to self-management in consultation and how adolescents with type 1 diabetes experienced consultation-dependent motivation to self-management. Methods. Based on a qualitative research design, the study triangulated participant observations of 11 consultations at a pediatric health care clinic and 10 interviews of the adolescents (15-17 years of age) about their experiences of consultations. Using Giorgi’s phenomenological method, the analysis showed five categories important to consultation-dependent motivation to self-management: 1. Consultation setting, 2. Consultation conversation, 3. Roles in treatment, 4. Assuming consultation-dependent responsibility for self-management, and 5. Relationship in treatment. Results from the analysis were compared to fulfilment of the motivational needs for autonomy, competence and relatedness described in Self-Determination Theory. Results. Overall findings showed that the adolescent’s developmental process of becoming autonomous in relation to self-management was influenced by consultations, and that the need for relatedness was experienced as valued by the adolescents. Conclusions. The conclusion of the study was that relatedness and development of autonomy were experienced as important for consultation-dependent motivation to self-management in 15-17-year-olds and may be fundamental to adolescents’ experience of competence in relation to self-management.

Diabetes Technological Revolution: Winners and Losers?

Journal of Diabetes Science and Technology ◽

10.1177/1932296818788872 ◽

2018 ◽

Vol 12 (6) ◽

pp. 1227-1230 ◽

Cited By ~ 3

Author(s):

Katharine D. Barnard ◽

Marc D. Breton

Keyword(s):

Health Care ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Self Management ◽

Technology Access ◽

Technological Revolution ◽

Insurance Costs ◽

Technology Revolution

Over recent years there has been an explosion in availability of technical devices to support diabetes self-management. But with this technology revolution comes new hurdles. On paper, the available diabetes technologies should mean that the vast majority of people with type 1 diabetes have optimal glycemic control and are using their preferred therapy choices. Yet, it does not appear to be universally the case. In parallel, suboptimal glycemic control remains stubbornly widespread. Barriers to improvement include access to technology, access to expert diabetes health care professionals, and prohibitive insurance costs. Until access can be improved to ensure the technologies are available and usable by those that need them, there are many people with diabetes who are still losing out.

Text Messaging and Type 1 Diabetes Management: Qualitative Study Exploring Interactions Among Patients and Health Care Professionals (Preprint)

10.2196/preprints.11343 ◽

2018 ◽

Author(s):

Francesco Miele ◽

Silvia Clementi ◽

Renzo Gennaro ◽

Ilaria Nicolao ◽

Tiziana Romanelli ◽

...

Keyword(s):

Health Care ◽

Type 1 Diabetes ◽

Pregnant Women ◽

Text Messaging ◽

Text Messages ◽

Adult Patients ◽

Specific Patient ◽

BACKGROUND The diffusion of information and communication technologies (ICTs) in type 1 diabetes (T1D) management has generated a debate on the ways in which ICTs can support the patient-provider relationship. Several studies have focused on text messages. Most of the literature proposes quantitative analysis of the impact of text messaging on the clinical conditions of patients and/or their satisfaction with the technology, while the qualitative studies have focused mainly on patients’ perceptions about strengths and weaknesses of this technology. OBJECTIVE In contrast to past studies, we adopted a qualitative approach for the in-depth examination of patient-health care professionals’ interactions in text messaging. METHODS The study focused on the use of the Trento Cartella Clinica del Cittadino Diabetes System (TreC-DS), a digital platform with a built-in messaging system, in two diabetes centers, integrating message analysis with interviews with patients and health care professionals. Each center focused on a specific patient profile: the first one focused on pregnant women with T1D and the second one focused on adult patients with poorly controlled diabetes. RESULTS The main results of the study were as follows: (1) Health care professionals and patients perceived the messaging system as useful for sharing information (ie, pregnant women for prescriptions and adults with poorly controlled diabetes for advice); (2) The content and communication styles of the two centers differed: in the case of pregnant women, interactions via text messaging were markedly prescriptive, while in the case of adult patients with poorly controlled diabetes, they were conceived as open dialogues; and (3) Conversations were initiated mainly by professionals; in the cases considered, it was mainly the diabetes center that decided whether a messaging conversation was needed. CONCLUSIONS The results show how the features of interactions of text messaging changed based on the patient profiles in two different centers. In addition, in both diabetes centers that were involved, the system seems to have laid a foundation for a closer relationship between patients and health care professionals.

Agent-based modeling for the self-management of chronic diseases: An exploratory study

SIMULATION ◽

10.1177/0037549717712605 ◽

2017 ◽

Vol 93 (9) ◽

pp. 781-793 ◽

Cited By ~ 3

Author(s):

Sara Montagna ◽

Andrea Omicini

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Chronic Diseases ◽

Agent Based Modeling ◽

Self Management ◽

Agent Based ◽

Management Interventions ◽

The impact of mobile technologies on healthcare is particularly evident in the case of self-management of chronic diseases, where they can decrease spending and improve life quality of patients. We propose the adoption of agent-based modeling and simulation techniques as built-in tools to dynamically monitor the state of patient health and provide recommendations for self-management. To demonstrate the feasibility of our proposal we focus on Type 1 diabetes mellitus as our case study, and provide simulation results where the dynamic evolution of signal parameters is shown in the case of healthy and Type 1 diabetes mellitus patients, focussing in particular on the beneficial effects that self-management interventions have on plasma glucose values.

Working Toward an mHealth Platform for Adolescents with Type 1 Diabetes: Focus Groups With Teens, Parents, and Providers

The Diabetes Educator ◽

10.1177/0145721720943123 ◽

2020 ◽

Vol 46 (5) ◽

pp. 444-454

Author(s):

Manuela Sinisterra ◽

Katherine Patterson Kelly ◽

Caitlin Shneider ◽

Ashley El-Zein ◽

Ellen Swartwout ◽

...

Keyword(s):

Health Care ◽

Type 1 Diabetes ◽

Focus Groups ◽

Health Care Providers ◽

Diabetes Management ◽

Self Management ◽

Care Providers ◽

Open Communication ◽

Management Behaviors

Purpose The purpose of the study was to explore facilitators and barriers to self-management behaviors in adolescents with type 1 diabetes (T1D) to inform the development of an mHealth platform. Methods Eight adolescents with T1D, 9 parents, and 13 health care providers participated in separate focus groups that explored teen self-management behaviors. Results Adolescents and their parents have distinct preferences for handling diabetes management and use of mHealth technologies. Health care providers support the use of new technologies yet acknowledge concern meeting the potential increased volume of communication requests from teens and families. Conclusion Stakeholders agreed that an ideal mHealth platform would facilitate open communication between teens and their care network and easily integrate with other diabetes technologies. Future directions include incorporating additional feedback from stakeholders to build and modify the mHealth platform. The use of mHealth platforms could be integrated into clinical practice to optimize self-management and support communication between educators, providers, and families in between clinic visits.

Abstract #200: Suboptimal Glycemic Levels in a Patient with Type 1 Diabetes. The Impact of Diabetes Distress and Psychosocial Factors on Diabetes Self-Management

Endocrine Practice ◽

10.1016/s1530-891x(20)44322-8 ◽

2017 ◽

Vol 23 ◽

pp. 29

Author(s):

Maximilien Rappaport ◽

Mary de Groot

Keyword(s):

Type 1 Diabetes ◽

Psychosocial Factors ◽

Self Management ◽

Diabetes Distress ◽

Experiences of Using Web-Based and Mobile Technologies to Support Self-Management of Type 2 Diabetes: Qualitative Study (Preprint)

10.2196/preprints.9743 ◽

2017 ◽

Author(s):

Laura Kelly ◽

Crispin Jenkinson ◽

David Morley

Keyword(s):

Type 2 Diabetes ◽

Health Care ◽

Well Being ◽

Mobile Technologies ◽

Self Management ◽

Coordinated Care ◽

Web Based ◽

BACKGROUND The prevalence of type 2 diabetes is rising, placing increasing strain on health care services. Web-based and mobile technologies can be an important source of information and support for people with type 2 diabetes and may prove beneficial with respect to reducing complications due to mismanagement. To date, little research has been performed to gain an insight into people’s perspectives of using such technologies in their daily management. OBJECTIVE The purpose of this study was to understand the impact of using Web-based and mobile technologies to support the management of type 2 diabetes. METHODS In-depth interviews were conducted with 15 people with type 2 diabetes to explore experiences of using Web-based and mobile technologies to manage their diabetes. Transcripts were analyzed using the framework method. RESULTS Technology supported the users to maintain individualized and tailored goals when managing their health. A total of 7 themes were identified as important to participants when using technology to support self-management: (1) information, (2) understanding individual health and personal data, (3) reaching and sustaining goals, (4) minimizing disruption to daily life, (5) reassurance, (6) communicating with health care professionals, and (7) coordinated care. CONCLUSIONS Patients need to be supported to manage their condition to improve well-being and prevent diabetes-related complications from arising. Technologies enabled the users to get an in-depth sense of how their body reacted to both lifestyle and medication factors—something that was much more difficult with the use of traditional standardized information alone. It is intended that the results of this study will inform a new questionnaire designed to assess self-management in people using Web-based and mobile technology to manage their health.

The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps

Nutrients ◽

10.3390/nu13103558 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3558

Author(s):

Dieter Furthner ◽

Andreas Lukas ◽

Anna Maria Schneider ◽

Katharina Mörwald ◽

Katharina Maruszczak ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Therapy ◽

Dietary Fat ◽

Scientific Evidence ◽

Observation Time ◽

Bolus Insulin ◽

Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (<18 years old) and a mixed age population (paediatric and adult) with T1DM published in the last 10 years was performed. Conclusion: Only a small number of studies with a very low number of participants and high degree of heterogeneity was identified. While all studies concluded that additional bolus insulin for (high) fat and (high) protein is necessary, no consensus on when dietary fat and/or protein should be taken into calculation and no unified algorithm for insulin therapy in this context exists. A prolonged postprandial observation time is necessary to improve individual metabolic control. Further studies focusing on a stratified paediatric population to create a safe and effective algorithm, taking fat and protein into account, are necessary.

Experience of living with type 1 diabetes in a low-income country: a qualitative study from Liberia

BMJ Open ◽

10.1136/bmjopen-2021-049738 ◽

2021 ◽

Vol 11 (10) ◽

pp. e049738

Author(s):

Alma J Adler ◽

Celina Trujillo ◽

Leah Schwartz ◽

Laura Drown ◽

Jacquelin Pierre ◽

...

Keyword(s):

Type 1 Diabetes ◽

Qualitative Study ◽

Economic Impact ◽

Low Income ◽

Sub Saharan Africa ◽

Self Management ◽

Diabetes Distress ◽

Low Middle Income Countries ◽

IntroductionWhile epidemiological data for type 1 diabetes (T1D) in low/middle-income countries, and particularly low-income countries (LICs) including Liberia is lacking, prevalence in LICs is thought to be increasing. T1D care in LICs is often impacted by challenges in diagnosis and management. These challenges, including misdiagnosis and access to insulin, can affect T1D outcomes and frequency of severe complications. Despite the severe nature of T1D and growing burden in sub-Saharan Africa, little is currently known about the impact of T1D on patients and caregivers in the region.MethodsWe conducted a qualitative study consisting of interviews with patients with T1D, caregivers, providers, civil society members and a policy-maker in Liberia to better understand the psychosocial and economic impact of living with T1D, knowledge of T1D and self-management, and barriers and facilitators for accessing T1D care.ResultsThis study found T1D to have a major psychosocial and economic impact on patients and caregivers, who reported stigma, diabetes distress and food insecurity. Patients, caregivers and providers possessed the knowledge necessary to effectively manage T1D but insufficient community awareness leads to delayed diagnosis, often in an emergency department. Most patients reported receiving free services and materials, though the cost of transportation to clinic visits and recommended foods is a barrier to disease management. Many providers noted the lack of national T1D-specific guidelines and registries. Policy-makers reported a lack of prioritisation of and resources for T1D. These barriers, combined with scarcity and expense of appropriate foods, pose severe barriers for self-management of T1D.ConclusionT1D was found to have a significant impact on patients and caregivers, and informants identified several key individual and systems-level barriers to effective T1D care in Liberia. Addressing these concerns is vital for designing sustainable and effective programmes for treating patients living with T1D.

931-P: Supporting Physical Activity in Children with Type 1 Diabetes: A Survey of Health Care Professionals

Diabetes ◽

10.2337/db21-931-p ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 931-P

Author(s):

EMMA COCKCROFT ◽

PARTH NARENDRAN ◽

EVA WOODING ◽

ROBERT C. ANDREWS

Keyword(s):

Physical Activity ◽

Health Care ◽

Type 1 Diabetes ◽

Health Care Professionals