Teenagers with type 1 diabetes—a phenomenological study of the transition towards autonomy in self-management

https://doi.org/10.1016/j.ijnurstu.2006.08.022Get rights and content

Abstract

Background

Becoming autonomous is an important aspect of teenagers’ psychosocial development, and this is especially true of teenagers with type 1 diabetes. Previous studies exploring the everyday problems of teenagers with diabetes have focused on adherence to self-care management, how self-determination affects metabolic control, and the perception of social support.

Objective

The aim of the study was to elucidate lived experiences, focusing on the transition towards autonomy in diabetes self-management among teenagers with type 1 diabetes.

Design and method

Data were collected using interviews, and a qualitative phenomenological approach was chosen for the analysis.

Participants

Thirty-two teenagers (18 females and 14 males) were interviewed about their individual experiences of self-management of diabetes.

Findings

The lived experiences of the transition towards autonomy in self-management were characterized by the over-riding theme “hovering between individual actions and support of others”. The findings indicate that individual self-reliance and confirmation of others are helpful in the transition process. Growth through individual self-reliance was viewed as a developmental process of making one's own decisions; psychological maturity enabled increased responsibility and freedom; motivation was related to wellbeing and how well the diabetes could be managed. The theme “confirmation of others” showed that parental encouragement increased the certainty of teenagers’ standpoints; peers’ acceptance of diabetes facilitated incorporation of daily self-management activities; support from the diabetes team strengthened teenagers’ self-esteem.

Conclusion

In striving for autonomy, teenagers needed distance from others, but still to retain the support of others. A stable foundation for self-management includes having the knowledge required to practice diabetes management and handle different situations.

Section snippets

What is already known about the topic?

  • The literature defines transition as a life span development in which events produce disequilibrium as well as acquisition of new skills and behaviours.

  • Self-management among teenagers is related to age and the cognitive maturity required to handle self-management. Moreover, the transference of responsibility from parents to teenagers involves shared decision-making.

  • Studies support the benefits of empowerment education in diabetes care, showing that individuals achieve outcomes that are both

What this paper adds

  • A nuanced and deepened understanding of the transition towards autonomy in self-management among teenagers with type 1 diabetes.

  • The stage at which teenagers hover between separating from parents and retaining parental support may result in unclear responsibility in self-management activities; this lack of clarity may complicate the autonomy process.

  • Experiential knowledge and individually adjusted responsibility aids the transition towards autonomy.

The study

The aim of the study was to elucidate lived experiences, focusing on the transition towards autonomy in diabetes self-management among teenagers with type 1 diabetes.

Discussion

The strength of the present study is that it elucidates individual aspects that contribute to a nuanced and deepened understanding of teenagers’ transition towards autonomy in self-management. In phenomenology, the participant is pivotal and the researcher's subjective, intuitive reflection is crucial. The researcher is both an interdependent human being and part of the informant's life world. Because interpretation of the data determines the findings, it may be that the researcher's

Conclusion

The transition towards autonomy in self-management among teenagers with type 1 diabetes was shown to be complex. Findings from the present study show that being allowed to make one's own choices and practice decision-making aids in this transition. Realistic opportunities for a stable foundation of self-management include having the knowledge required to practice and handle different situations.

Acknowledgement

Financial support was provided by The Vardal Foundation—for Health Care Sciences and Allergy Research, The Swedish Diabetes Federation and Federation of European Nurses in Diabetes (FEND). Thanks to diabetes specialist nurse Gunnel Viklund who was helpful in assembling the informants and collecting the background data for the 32 teenagers.

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