Elsevier

Journal of Pediatric Nursing

Volume 31, Issue 4, July–August 2016, Pages 390-396
Journal of Pediatric Nursing

Stressors in Teens with Type 1 Diabetes and Their Parents: Immediate and Long-Term Implications for Transition to Self-Management

https://doi.org/10.1016/j.pedn.2015.12.012Get rights and content

Highlights

  • Teens with Type 1 Diabetes and their parents expressed concern about ineffective self-management and its implications for transition to adulthood.

  • Teens and parents both worried about immediate negative outcomes of ineffective self-management; however, only parents discussed long-term implications.

  • Resources for T1DM were identified by both teens and parents, but how these would be accessed or shifted following the transition to adulthood and adult medical care was not addressed.

Purpose

Teens with Type 1 diabetes and their parents experience every day and illness-related stress; however, understanding of how these stressors relate to the transition to adulthood is limited. The purpose of this study was to identify stressors of teens with Type 1 diabetes (T1DM) and their parents related to the impending transition to adulthood.

Design and Methods

This study used open-ended questions to identify every day and illness-related stressors among 15 teens with T1DM and 25 parents seen in one pediatric diabetes clinic. Qualitative descriptive analysis identified themes in interview transcripts.

Results

The primary teen stressor related to impending transition centered on ineffective self-management, often when they were taking over responsibility for T1DM management. Parents' concerns included immediate and long-term negative outcomes of teen self-management as well as financial resources and health insurance for the teen. Teens and parents both expressed specific concerns about outcomes and prevention of nocturnal hypoglycemia, and identified uncertainties related to teen health and diabetes-focused health care when no longer living in the parent's home.

Conclusions

Teens with Type 1 diabetes and their parents understand that independent teen self-management is a component of transition to adulthood, but worry about teen self-management outcomes. Concerns specific to health care transition included health insurance, T1DM resources, and teens' abilities to handle new situations.

Practice Implications

Identifying current and future self-management concerns of individuals and families can facilitate targeted education and interventions to support successful transition to adulthood.

Section snippets

Methods

Data were obtained using one-time semistructured telephone interviews with teens with Type 1 diabetes and their parents. Following ethical approval from the University of Iowa Institutional Review Board, participants provided written consent or assent.

Description of the sample and study procedures is in Table 1. Of 30 families who received information in clinic, 16 participated (one teen-only; one parents-only). Fifteen teens (12 to 18 years; four male) with Type 1 diabetes and 25 parents (15

Results

The major theme for teens focused on ineffective self-management. The two major parental themes were transfer of management responsibility and anticipatory worry, also addressed by some teens. Two themes related to health care transition: changes in health insurance and resources for T1DM management.

Discussion

Teens with T1DM and their parents know that achieving independent teen self-management is essential. However, teens and their parents had significant concerns relating to the developmental transition to adulthood and independent self-management. Teens in this study focused on the difficulty they were having attaining independent self-management. Parents, meanwhile, had concerns about the transfer of management responsibility to the teens and experienced anticipatory worry about negative

Conclusions

The process of shifting self-management responsibilities to AEAs with T1DM was stressful for teens and parents. Teens and parents were more concerned about the immediate ramifications of ineffective self-management. In addition, parents expressed worry about the potential long term consequences of poor glycemic control and the AEA's wellbeing after leaving home. Teens and parents had low confidence in the teen's abilities to transition to self-management of T1DM without parental oversight.

Acknowledgments

This study was supported by a New Investigator Seed Grant to Anne L. Ersig, from the Midwest Nursing Research Society (MNRS).

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