NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Diabet Med. 2023 Nov;40(11):e15197. doi: 10.1111/dme.15197. Epub 2023 Aug 27.
Children and young people with diabetes (CYPD) from socio-economically deprived and/or ethnic minority groups tend to have poorer glucose control and greater risk of diabetes-related complications. In this systematic review of qualitative evidence (qualitative evidence synthesis, QES), we aimed to explore the experiences and views of clinical encounters in diabetes care from the perspectives of CYPD and their family/carers from underserved communities and healthcare professionals in diabetes care.
We searched 6 databases to March 2022 with extensive search terms, and used a thematic synthesis following methods of Thomas and Harden.
We identified 7 studies and described 11 descriptive themes based on primary and secondary constructs. From these, three "analytical themes" were developed. (1) "Alienation of CYPD" relates to their social identity and interaction with peers, family and health service practitioners in the context of diabetes self- and family/carer management and is impacted by communication in the clinical encounter. (2) "Empowerment of CYPD and family/carers" explores families' understanding of risks and consequences of diabetes and taking responsibility for self- and family/carer management in the context of their socio-cultural background. (3) "Integration of diabetes (into self and family)" focuses on the ability to integrate diabetes self-management into the daily lives of CYPD and family/carers beyond the clinical consultation.
The analytical themes are interdependent and provide a conceptual framework from which to explore and strengthen the therapeutic alliance in clinical encounters and to foster greater concordance with treatment plans. Communicating the biomedical aspects of managing diabetes in the clinical encounter is important, but should be balanced with addressing socio-emotional factors important to CYPD and family/carers.
来自社会经济贫困和/或少数族裔群体的儿童和青少年糖尿病患者（CYPD）往往血糖控制较差，发生糖尿病相关并发症的风险更高。在这项对定性证据（定性证据综合，QES）的系统评价中，我们旨在从服务不足社区的 CYPD 及其家庭/照顾者和糖尿病护理医疗保健专业人员的角度探讨糖尿病护理中临床接触的经验和观点。
我们搜索了 6 个数据库，直到 2022 年 3 月，使用了广泛的搜索词，并按照托马斯和哈登的方法进行了主题综合。
我们确定了 7 项研究，并根据主要和次要结构描述了 11 个描述性主题。从中，开发了三个“分析主题”。（1）“CYPD 的异化”与他们的社会身份以及在糖尿病自我管理和家庭/照顾者管理的背景下与同龄人、家人和医疗服务从业者的互动有关，并受临床接触中的沟通影响。（2）“CYPD 和家庭/照顾者的赋权”探讨了家庭对糖尿病风险和后果的理解，以及在其社会文化背景下承担自我和家庭/照顾者管理的责任。（3）“糖尿病（融入自我和家庭）的整合”重点关注将糖尿病自我管理融入 CYPD 和家庭/照顾者日常生活的能力，超越临床咨询。
分析主题是相互依存的，为探索和加强临床接触中的治疗联盟以及促进与治疗计划更大的一致性提供了一个概念框架。在临床接触中传达管理糖尿病的生物医学方面很重要，但应平衡解决对 CYPD 和家庭/照顾者重要的社会情感因素。
