Education for Teenagers with Type 1 Diabetes

University dissertation from Uppsala : Acta Universitatis Upsaliensis

Abstract: Education for teenagers with diabetes has had limited effects to date, especially regarding metabolic control. The development had been towards more patient-centred approaches, like empowerment, motivational interviews and family behavioural programmes. A patient-centred approach means that the patient is expected to take control of the management of the disease. The empowerment approach has been implemented in adults with diabetes, with some positive results.The aims of this thesis were to evaluate empowerment group education and education in a camp setting, and to validate the “Check your health” instrument which can be used to assess the effects of such education programmes on perceived health and the burden of diabetes.Thirty-two teenagers between 12 and 17 years of age were randomized to either an intervention group or a wait-listed control group. The intervention consisted of six group sessions with an empowerment approach as the theoretical frame. Thirty-one of the teenagers were interviewed two weeks after the empowerment education programme was completed.The programme did not have any positive effect on metabolic control between-groups, but within groups HbA1c and readiness to change increased. According to the definition of empowerment, which pinpoints decision-making, the interviews were analysed with that in focus. In the interviews the teenagers described five categories they perceived as important for decision-making competence: cognitive maturity, personal qualities, experience, social network and parent involvement. Parent involvement was described as both constructive and destructive. These categories were interpreted in the overall theme that “teenagers deserve respect and support for their shortcomings during the maturity process”.Ninety teenagers between 14 and 17 years of age attended education in a camp setting and were compared to a reference group, who had declined participation. The camp did not have any positive effect on metabolic control, but the frequency of insulin pump use after camp education increased. In a cross-sectional comparison, the campers had more positive attitudes towards diabetes and self-care than the non-campers did.The “Check your health” instrument was tested for reliability and validity in 199 teenagers between 12 and 17 years of age. The instrument was found to be reliable and valid for use on a group level in teenagers with diabetes.In conclusion, empowerment education programmes should be tailored to suit young people with diabetes, and should preferably be integrated into routine care. Teenagers who prefer individual education may be offered an individual education plan. Parents should be involved in all education of teenagers with diabetes, with the purpose of increasing teamwork and decreasing control and conflict. Continued assessment of teenagers perceived health and perceived burden of diabetes can be carried out using the “Check your health” instrument.