ArticleSelf-Care of Young Adolescents With Type 1 Diabetes
Section snippets
Theoretical Framework
Orem (1991) put forth a widely recognized theoretical model, the Self-Care Deficit Theory of Nursing, in which she defined self-care as the care one gives oneself to maintain life, health, and well-being. This self-care activity addresses three areas of self-care needs: universal, developmental, and health deviation. Universal self-care is common to all human beings during all stages of the life cycle and includes obtaining sufficient air, water, and food; fostering processes of elimination;
Literature Review
Although the self-care and self-care deficit theories of Orem (1985) were targeted toward the adult population, the descriptors of universal, developmental, and health deviation self-care needs have applicability to the adolescent population. Although the care that adolescents give themselves has been studied and documented throughout the health literature, research that actually describes the self-care needs of children and adolescents using Orem's theory is sparse. In fact, there are very few
Participants
The present sample was recruited from the outpatient endocrinology clinic of a southeastern children's hospital and enrolled in an ongoing 2-year longitudinal project on family, autonomy, and self-care in adolescents with Type 1 diabetes. Data were available for 161 families who completed the first phase of data collection, and these cross-sectional analyses are based on this young adolescent cohort. Eligible subjects for the project included young adolescents (a) aged between 11 and 15 years,
Findings
The mean duration of Type 1 diabetes in this sample was 4 years (SD = 3 years, range = 1–14.33 years). Adolescents were distributed well across the eligible age range (M = 12.86, SD = 1.48, range = 11–15) and equally by sex (50% males and 50% females). The mean Tanner stage of the adolescents was 3.28 (SD = 1.19, range = 1–5). Two-parent (79%) and Caucasian non-Hispanic (81%) families composed most of the sample. The proportion of African Americans (19%) corresponds to the proportion of African
Discussion
Adolescent scores on the SCAI indicate that adolescents 11–15 years old engage in disease-related self-care with room for improvement in positive health deviation self-care behaviors. The mean score of 27 on the SCAI falls significantly short of the optimal score of 41. The range of scores (14–37) demonstrates that some adolescents in this age group report that they are highly effective in assuming responsibility for self-care related to their diabetes. Although subscale scores indicate that
Summary
This study supports the need for continuing investigation of self-care practices, both universal and health deviation self-care behaviors, in the adolescent population. Although the self-care theory of Orem (1985) was developed from an adult health framework, it supports the premise of developmental self-care, and more research is needed to explore interventions that promote the development of self-care behaviors in the adolescent population. This investigation of adolescents with Type 1
References (61)
- et al.
Stressors and self-care challenges faced by adolescents living with Type 1 diabetes
Applied Nursing Research
(2004) Family responses to children with diabetes and their influence on self-care
Journal of Pediatric Nursing: Nursing Care of Children and Families
(1996)Behavioral correlates of health and illness in youths with chronic illness
Applied Nursing Research
(1996)- et al.
Risky behavior and risk in adolescents with IDDM
Journal of Adolescent Health
(1997) - et al.
The challenge of transferring responsibility for diabetes management from parent to child
Journal of Pediatric Health Care
(1992) - et al.
Father-absent adolescents with insulin-dependent diabetes mellitus: A population at risk?
Journal of Applied Developmental Psychology
(1988) - et al.
Cognitive maturity and self-management among adolescents with insulin-dependent diabetes mellitus
Journal of Pediatrics
(1986) - et al.
Psychologic predictors of compliance in children with recent onset of diabetes mellitus
Journal of Pediatrics
(1987) - et al.
Prevalence and predictors of pervasive noncompliance with medical treatment among youths with insulin-dependent diabetes mellitus
Journal of the American Academy of Child and Adolescent Psychiatry
(1992) - et al.
Sociocultural influences and self-care practices of middle adolescents
Journal of Pediatric Nursing
(2000)
Social support and personal models of diabetes in relation to self-care and well-being in adolescents with Type I diabetes mellitus
Journal of Adolescence
Longitudinal assessment of autonomy and relatedness in adolescent–family interactions as predictors of adolescent ego-development and self-esteem
Child Development
Total prevalence of diabetes and pre-diabetes
Family conflict, adherence, and glycaemic control in youth with short duration Type 1 diabetes
Diabetic Medicine
Coping strategies of school-age children with diabetes mellitus
Diabetes Educator
Problems studying and defining pubertal events
Journal of Youth and Adolescence
The epidemiology of insulin-dependent diabetes mellitus: Etiology and prognosis
Exposure to violence and self-care practices of adolescents
Family and Community Health
Young adolescents with IDDM; Family processes, autonomy and health
Quality Nursing
Self- and dependent-care responsibility of adolescents with IDDM and their parents
Journal of Family Nursing
Measurement of self-care agency in adolescents
Nursing Research
Orem's model used for health promotion: Directions for research
Advances in Nursing Science
Age differences in parent and child responsibilities for management of cystic fibrosis and insulin-dependent diabetes mellitus
Journal of Developmental and Behavioral Pediatrics
Health and illness self-care in adolescents with IDDM: A test of Orem's theory
Advances in Nursing Science
Assessing and teaching self-care to youths with diabetes mellitus
Pediatric Nursing
Psychosocial status of children with diabetes in the first 2 years after diagnosis
Diabetes Care
Coping and adaptation in children with diabetes
Nursing Research
Coping behaviors at diagnosis and in adjustment one year later in children with diabetes
Nursing Research
Cited by (42)
Predicting optimal use of continuous glucose monitors in adolescents with type 1 diabetes: It's about benefit and burden
2022, Journal of Pediatric NursingCitation Excerpt :Self-efficacy has further been associated with perceptions of burden (Rosenstock, 1985), and is suggested to play a larger role in health behavior if the individual perceives high benefit to a behavior (Iannotti et al., 2006). Older age reduced the odds of an adolescent being a CGM Optimizer in the final logistic regression model, which is consistent with literature reporting poorer self-management practices in older adolescents compared to younger (Dashiff et al., 2006; Hilliard et al., 2013). This is likely due to the increased autonomy and decreased parental supervision that occurs in the older adolescent years.
The role of stress in the mosaic of autoimmunity: An overlooked association
2018, Autoimmunity ReviewsCitation Excerpt :T1DM is a chronic disease resulting in distress to not only the patients, but also their families. Parents have a great responsibility in improving self -are in children with diabetes, and they play an important role in controlling their children glycemic levels [228,229]. In a systematic review on the effects of diabetes related family stress on glycemic control in young patients, several studies showed that high levels of family conflict and authoritarian parental style were related to lower treatment adherence and poorer glycemic control.
The effectiveness of cognitive-function stress management training in glycemic control in children and in mental health of mother caring for child with type 1 diabetes mellitus
2017, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :This type of diabetes is one of the most common chronic diseases in children and could be potentially lifelong threatening [9], thereby illustrating malfunction in the body organs, life style, personality and behavior, emotion distress and psychiatric problems in the children and families, especially parents [10,11], and this is a reason the doctors would have to treat not only the child but also the parents, particularly the mothers [12,13]. Hence, parents have an important responsibility to improve self-care in children with diabetes from early diagnosis [14], and also scientific literature show that families play an important role in controlling blood glucose in children [9]. Undoubtedly, the regulation of blood glucose in children with diabetes mellitus will improve the symptoms and reduce treatment costs [15].
Moving the Journey Towards Independence: Adolescents Transitioning to Successful Diabetes Self-Management
2015, Journal of Pediatric NursingCompliance among adolescents with a chronic illness: Review
2012, Archives de PediatrieSelf-management, self-care, and self-help in adolescents with emotional problems: a scoping review
2023, European Child and Adolescent Psychiatry