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Managing the unmanageable through interdependence in adolescents living with type 1 diabetes and their parents: A constructivist grounded theory

Published:August 01, 2022DOI:https://doi.org/10.1016/j.pedn.2022.07.016

      Highlights

      • T1D management demands lifestyle changes for adolescents with T1D and their parents.
      • The substantive theory that emerged from the data suggests how participants cope.
      • Interdependence in care during adolescence may be a critical in T1D management.
      • Interdependence should include support from outside the family.

      Abstract

      Background

      Management of T1D is complex and requires continuous care and monitoring that place many demands on adolescents with T1D and their parents. The purpose of this study was to explore the nature of interdependence with T1D management with adolescents and their parents.

      Methods

      Using a constructivist grounded theory methodology, 32 open-ended interviews were conducted, transcribed, and analyzed from 11 adolescents aged 10–18 years with T1D and eight parents.

      Findings

      The data were coded using three coding phases: initial, focused, and theroetical and this process continued until theroetical saturation was reached. The substantive theory that emerged from the data describing parents’ and adolescents' main concern of Maintaining Optimal Glycemic Control was Managing the Unmanageable through Interdependence. Four related subprocesses were found: Completing T1D Tasks, Attaining Support, Balancing Independence, and Reconciling Reality. These subprocesses occurred within the context of the ever-changing, Nature of the Illness.

      Discussion

      There is a dynamic relationship associated with interdependence between adolescents with T1D and their parents that varied situationally and by age. Participants also indicated interdependence occurs or they would like it to occur, with others beyond themselves and the health-care team to others willing to be involved.

      Application to practice

      Interdependence is a dynamic process and requires ongoing evaluation by health-care professionals of its function in the daily management of T1D by parents and adolescents. Additional research into of the roles of health professionals and others in promoting interdependence is needed.

      Keywords

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      References

        • Alhaidar A.M.
        • Alshehri N.A.
        • Alhussaini M.A.
        Family support and its association with glycemic control in adolescents with type 1 diabetes mellitus in Riyadh, Saudi Arabia.
        Journal of Diabetes Research. 2020; 2020: 5151604
        • American Diabetes Association
        12. Children and Adolescents: Standards of medical care in diabetes—2018.
        Diabetes Care. 2018; 41: S126-S136
        • Anderson B.
        • Ho J.
        • Brackett J.
        • Finkelstein D.
        • Laffel L.
        Parental involvement in diabetes management tasks: Relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus.
        The Journal of Pediatrics. 1997; 130: 257-265
        • Anderson B.
        • Holmbeck G.
        • Iannotti R.
        • McKay S.
        • Lochrie A.
        • Volkening L.
        • Laffel L.
        Dyadic measures of the parent-child relationship during the transition to adolescence and glycemic control in children with type 1 diabetes.
        Families, Systems, & Health. 2009; 27: 141-152
        • Babler E.
        • Strickland C.
        Helping adolescents wiht type 1 diabetes “figure it out”.
        Journal of Pediatric Nursing. 2016; 31: 123-131
        • Cameron F.J.
        • Garvey K.
        • Hood K.K.
        • Acerini C.L.
        • Codner E.
        International Society for Pediatric and Adolescent Diabetes (ISPAD) clinical practice consensus guidelines 2018: Diabetes in adolescence.
        Pediatric Diabetes. 2018; 19: 245-256
        • Canadian Pediatric Society
        New data shows more needs to be done to keep kids with diabetes safe at school.
        • Charmaz K.
        Constructing grounded theory.
        2nd ed. SAGE Publications, 2014
        • Coffen R.
        The 600-step program for type 1 diabetes self-management in youth: The magnitude of the self-management task.
        Postgraduate Medicine. 2009; 121: 119-139
        • Creswell J.
        Qualitative inquiry & research design: Choosing among five approaches.
        2nd ed. SAGE Publications, 2007
      1. Denzin N.K. Lincoln Y.S. The SAGE handbook of qualitative research. 5th ed. SAGE Publications, 2018
        • Di Battista A.
        • Hart T.
        • Greco L.
        • Gloizer J.
        Type 1 diabetes among adolescents: Reduced diabetes self-care caused by social fear and fear of hypoglycemia.
        The Diabetes Educator. 2009; 35: 465-475
      2. Emerson R.M. Fretz R.I. Shaw L.L. Writing ethnographic fieldnotes. 2nd ed. The University of Chicago Press, 2011
        • Foster C.
        • Bellando J.
        • Wang Y.A.
        Diabetes control and adherence in adolescence.
        Pediatric Annals. 2016; 45: e327-e331
        • Glaser B.G.
        • Strauss A.L.
        The discovery of grounded theory: Strategies for qualitative research.
        Aldine Publishing Company, 1967
        • Goldenberg R.
        • Punthakee Z.
        Definition, classification and diagnosis of diabetes, prediabetes, and metabolic syndrome.
        Canadian Journal of Diabetes. 2013; 37: S8-S11
        • Guo J.
        • Whittemore R.
        • Guo-Ping H.
        The relationship between diabetes self-management and metabolic control in youth with type 1 diabetes: An integrative review.
        Journal of Advanced Nursing. 2011; 67: 2294-2310
        • Hall W.A.
        • Callery P.
        Enhancing the rigor of grounded theory: Incorporating reflexivity and relationality.
        Qualitative Health Research. 2001; 11: 257-272
        • Hanna K.
        • Dashiff C.
        • Stump T.
        • Weaver M.
        Parent–adolescent dyads: Association of parental autonomy support and parent–adolescent shared diabetes care responsibility.
        Child: Care, Health, and Development. 2012; 39: 695-702
        • Helgeson V.S.
        • Reynolds K.A.
        • Siminerio L.M.
        • Becker D.J.
        • Escobar O.
        Cognitive adaptation theory as a predictor of adjustment to emerging adulthood for youth with and without type 1 diabetes.
        Journal of Psychosomatic Research. 2014; 77: 484-491
        • Hilliard M.E.
        • Mann K.A.
        • Peugh J.L.
        • Hood K.K.
        How poorer quality of life in adolescence predicts subsequent type 1 diabetes management and control.
        Patient Education and Counselling. 2013; 91: 120-125
        • Hilliard M.E.
        • Perlus J.G.
        • Clark L.M.
        • Haynie D.L.
        • Plotnik L.P.
        • Guttman-Bauman I.
        • Iannotti R.J.
        Perspectives from before and after the pediatric to adult care transition: A mixed-methods study in type 1 diabetes.
        Diabetes Care. 2016; 37: 346-354
        • Hung L.
        • Chu-Yu H.
        • Fu-Sung L.
        The self-management experiences of adolescents with type 1 diabetes: A descriptive phenomenology study.
        International Journal of Environmental Research and Public Health. 2020; 17: 5132
        • Iina A.
        • Mirka J.
        • Laura J.
        • Joona M.
        • Raimo L.
        Adolescents with poorly controlled type 1 diabetes: Psychological flexibility is associated with the glycemic control, quality of life and depressive symptoms.
        Journal of Contextual Behavioral Science. 2021; 19: 50-56
        • International Diabetes Federation
        IDF Diabetes Atlas. 8th ed..
        International Diabetes Federation, 2017
        • Ivey J.B.
        • Wright A.
        • Dashiff C.
        Finding the balance: Adolescents with type 1 diabetes and their parents.
        Journal of Pediatric Health Care. 2007; 23: 10-18
        • Kelley H.H.
        • Holmes J.G.
        • Kerr N.L.
        • Reis H.T.
        • Rusbult C.E.
        • Van Lange P.A.
        An atlas of interpersonal situations.
        Cambridge University Press, 2003
        • Lancaster B.L.
        • Gadaire D.M.
        • Holman K.
        • Leblanc L.A.
        Association between diabetes treatment adherence and parent–child agreement regarding treatment responsibilities.
        Families, Systems, & Health. 2015; 33: 120-125
        • Lee H.
        • Choi E.K.
        • Kim H.
        • Kim H.-S.
        Factors affecting the self-management of adolescents with type 1 diabetes mellitus based on the information-motivation-behavioral skills model.
        Child Health Nursing Research. 2019; 25: 234-243
        • Majumder E.
        • Cogen F.R.
        • Monaghan M.
        Self-management strategies in emerging adults with type 1 diabetes.
        Journal of Pediatric Health Care. 2017; 31: 29-36
        • Mistry B.
        • Blyderveen S.V.
        • Punthakee Z.
        • Grant C.
        Condition-related predictors of successful transition from paediatric to adult care among adolescents with type 1 diabetes.
        Diabetic Medicine. 2015; 32: 881-885
        • Nakamura N.
        • Yakushijin Y.
        • Kanamaru T.
        • Tani H.
        • Ideno K.
        • Nakai A.
        Development and validity testing of the revised diabetes self-care inventory for children and adolescents.
        Diabetology International. 2019; 10: 117-125
        • Ogle J.S.
        • Dabelea D.
        • Pihoker C.
        • Svennson J.
        • Maniam J.
        • Klatman E.L.
        • Patterson C.C.
        Global estimates of incidence of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Atlas, 10th edition.
        Diabetes Research and Clinical Practice. 2022; 183: 109083
        • Rausch J.R.
        • Hood K.K.
        • Delmater A.
        • Pendley J.S.
        • Rohan J.M.
        • Reeves G.
        • Drotar D.
        Changes in treatment adherence and glycemic control during transition to adolescence in type 1 diabetes.
        Diabetes Care. 2012; 35: 1219-1224
        • Shepard J.
        • Vajda K.
        • Nyer M.
        • Clarke W.
        • Gonder-Frederick L.
        Understanding the construct of fear of hypoglycemia in pediatric type 1 diabetes.
        Journal of Pediatric Psychology. 2014; 39: 1115-1125
        • Strand M.
        • Broström A.
        • Haugstvedt A.
        Adolescents' perceptions of the transition process from parental management to self-management of type 1 diabetes.
        Scandinavian Journal of Caring Sciences. 2019; 33: 128-135
        • Trudeau B.
        • Trudeau C.
        • Polfuss M.L.
        • Sullivan-Bolyai S.
        A developmental milestones map of type 1 diabetes self-management transition from parents to adolescents.
        Diabetes Spectrum. 2019; 23: 21-29
        • Viaene A.
        • Van Daele T.
        • Bleys D.
        • Faust K.
        • Massa G.
        Fear of hypoglycemia, parenting stress, and metabolic control for children with type 1 diabetes and their parents.
        Journal of Clinical Psychology in Medical Settings. 2017; 24: 74-81
        • Vloemans A.F.
        • Eilander M.A.
        • Rotteveel J.
        • Bakker-van Waarde W.M.
        • Houdijk E.
        • Nuboer R.
        • De Wit M.
        Youth with type 1 diabetes taking responsibility for self-management: The importance of executive functioning in achieving glycemic control.
        Diabetes Care. 2019; 42: 225-231
        • World Health Organization
        Adolescent health.
        • Young M.
        • Lord T.
        • Patel J.
        • Gruhn H.
        • Jaser N.
        Good cop, bad cop: Quality of parental involvement in type 1 diabetes management in youth.
        Current Diabetes Reports. 2014; 14: 1-12