Le self-care chez l'adolescent ayant un diabète de type 1 un processus complexe soutenu par cinq piliers : gestion de la maladie, cohérence parentale, conciliation identitaire, autonomie de décision et attachement
Year: 2012
Type: dissertation
Study design: Observational Study
Abstract: Type 1 diabetes is one of the most frequent childhood chronic diseases. Appropriate management of treatment is necessary to achieve good glycaemic control and avoid long term incapacitating complications. Adolescence is a period characterized by a risk of fluctuations in glycaemic control, and the developmental task to develop autonomous self-care behaviours. Autonomy may be defined as encompassing a behavioural dimension (performance of self-management techniques) and a psychological dimension (decision-making capacity). Moreover, autonomy extends well beyond disease-related issues, to encompass an equally important psychosocial dimension. In the field of paediatric diabetology, the definition of self-care (ie the capacity to take care of oneself) is often reduced to the performance of independent behaviours related to the management of treatment, and does not take enough into account the young patients’ psychosocial and developmental needs. The concept of self-care in adolescent with type 1 diabetes was never operationalized in the perspective of health promotion. \nThe aim of our research was to better understand how healthcare providers may support the emerging self-care capacity in adolescents with type 1 diabetes. We conducted two successive studies:\n1-A qualitative study to explore the children’s and adolescents’ own perspective regarding the meaning of self-care in the context of type 1 diabetes; \n2-A study using a mixed methods design, with adolescents aged 13 to 15 years, in order to verify the hypothesis of a link between:\nA. the adolescents’ glycaemic control and the self-reported self-care,\nB. the adolescents’ glycaemic control and the coherence of parental practices\nThe results of study 1 show that the adolescents’ self-care behaviours are always supported by their parents and are defined according to the 3 dimensions evidenced in health promotion: take care of (i) one’s psychosocial life, (ii) one’s physical health, and (iii) one’s diabetes. \nThe results of study 2 show that adolescents with an optimal glycaemic control do not only display independent behaviours (behavioural autonomy), but are able to make autonomous decisions (psychological autonomy). Their self-care behaviours regarding the management of diabetes are meant to not only comply with medical demands, but to enable them to pursue meaningful life-goals as well, which is congruent with the broader perspective of health promotion, as opposed to a narrow perspective of disease management. Finally, our results show that coherent parenting practices, that are supportive of self-care in both dimensions of diabetes management and psychosocial life-issues, are significantly associated with a better glycaemic control. , \nBased on our results, self-care in adolescent with type 1 diabetes may be defined as a complex process built upon 5 equally important foundations, all of which need to be taken into consideration when developing self-care support interventions in practice: disease management, parental coherence, integration of conflicting identities, psychological autonomy (decision making) , and secure attachment style.
Author: Pélicand, Julie
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7048255367