Interviews of 21 adolescents reveal a desire for structured education programme specifically tailored to their needs
- Correspondence to Arlene Smaldone
School of Nursing, Columbia University, 617 West 168th Street, New York, NY 10032, USA;
Implications for practice and research
Nurses need to be mindful of adolescent needs and viewpoints in planning diabetes education programmes for this population.
Further research is needed to determine what education strategies are most effective with this population and provide the balance between promoting adolescent independence while maintaining parental involvement at this critical time.
Adolescence is a time when youth with type 1 diabetes are expected to assume greater responsibility for self-management of their chronic illness, yet, they may have insufficient knowledge, skills and maturity to do this. Their beliefs and need for structured diabetes education (SDE) are important in planning programmes that best support young people with diabetes during this transitional period.
Using a qualitative design, Chaney et al conducted five focus groups with 21 young people with type 1 diabetes between the ages of 13 and 19 years from three acute hospitals in Northern Ireland. Three to six young people participated in each group. Data were analysed using content analysis.
The study demonstrated that participants were interested in SDE programmes that were practical, positively focused and tailored to their needs. Group programmes located outside of the hospital setting, meeting not more than once per week for a maximum of 4 weeks, and without parental involvement were preferred.
This study provides insight from adolescents with type 1 diabetes regarding the content, structure and delivery of targeted SDE. Focus groups enable researchers to learn about the ideas and opinions of homogenous groups and discover participants' views of their world and what is important to them.1 ,2 Thus, it can be useful for planning the design of diabetes education programmes. However, methodological issues in both data collection and analysis raise some concern and must be considered. As considerable ethical and legal ambiguity surrounding the role of adolescents in the decision-making process for research participation exists3 and established practices between and within countries may differ, the nature of informed consent should be explicitly reported.
Demographic characteristics of the sample are not provided making it difficult for the reader to understand whose perspective regarding SDE is being provided in terms of age, gender, glycaemic control, diabetes duration, treatment regimen and previous diabetes education. Although the focus groups were homogeneous in that all participants had the experience of living with type 1 diabetes, the range in participant age poses challenges. It has been recommended that focus groups should be homogenous regarding age and gender2 as, notably during adolescence, there is potential for high interest in the opposite sex which may limit productivity of the group. Adolescents between the ages of 13 and 19 years differ significantly in their cognitive and social development. At least one group was with young people representing this wide age spectrum. The size of each focus group was not reported, but it can be inferred that some included fewer participants than what is recommended (four to six participants)2 for children.
The analysis process is not well described in terms of how data saturation was achieved or whether it was considered. Furthermore, measures to assure scientific adequacy such as member checking, data triangulation and use of an audit trail of study credibility, transferability, dependability and confirmability4 of findings are not reported. These methodological issues limit the utility of study findings. Of note, the majority of adolescents in this study felt that their parents should not be involved in SDE. This finding differs from past research showing that parental involvement during adolescence is associated with improved metabolic control5 ,6 and is needed during the transition to independent self-care.7