Lisa Gardener, BOccThy, is PhD Candidate, School of Health and Rehabilitation, The University of Queensland, St. Lucia, Queensland, Australia;
Helen Bourke-Taylor, BAppSc OT, MS, PhD, is Professor, Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia.
Am J Occup Ther. 2024 Sep 1;78(5). doi: 10.5014/ajot.2024.050662.
Occupational therapists have the proven capacity to improve outcomes for young adults who are self-managing Type 1 diabetes (T1D). There is insufficient understanding of adolescents' experiences of developing responsibility for diabetes self-management (DSM).
To investigate adolescents' perceptions of sharing responsibility for T1D management at school.
This study had a descriptive qualitative design and used semistructured interviews and thematic analysis. It is the second phase of a mixed-methods study with a sequential explanatory design that investigated mechanisms of responsibility-sharing at school.
Secondary school in Australia.
Purposive sample of adolescents (age 15-16 yr) with T1D (N = 11).
Adolescents approached the complex occupation of school-based DSM primarily in partnership with their parents, with each adolescent having unique responsibilities while sharing others. Health care professionals and teachers reportedly had minimal involvement. Adolescents described owning most DSM tasks, with their perceptions of building independence limiting the sharing of this responsibility. A heightened sense of risk meant that adolescents were likely to communicate with others in cases of errant blood glucose readings. Current processes commonly resulted in reduced school participation.
Adolescents valued working responsively and interdependently with their parents to manage T1D at school, which aligns with the occupational therapy model of co-occupation. Effective responsibility-sharing depends on clear, frequent, autonomy-supportive, team-based communications. Our results showed that patterns of communication for determining school-based DSM processes were fragmented and risk focused, with limited adolescent involvement, resulting in strategies that led to students at times being excluded from school activities. Plain-Language Summary: This is the first study to use an occupational lens to examine the way in which adolescents share their responsibility for diabetes care at school. Diabetes self-management in secondary schools occurs more often when adolescents work interdependently with their parents to manage their diabetes. Adolescent involvement in formal school processes and a clearer allocation of team roles and responsibilities would better support health-promoting habits and school participation.
职业治疗师有能力改善 1 型糖尿病（T1D）自我管理的年轻成年人的结果。对于青少年发展糖尿病自我管理（DSM）责任的经验，了解不足。
调查青少年对在学校分担 T1D 管理责任的看法。
本研究采用描述性定性设计，使用半结构化访谈和主题分析。这是一项混合方法研究的第二阶段，采用顺序解释设计，研究了学校责任分担的机制。
澳大利亚中学。
患有 T1D（年龄 15-16 岁）的青少年（N=11）的目的样本。
青少年主要以与父母合作的方式处理学校的复杂 DSM，每个青少年都有独特的责任，同时分担其他人的责任。据报道，医疗保健专业人员和教师几乎没有参与。青少年描述拥有大多数 DSM 任务，他们对建立独立性的看法限制了这种责任的分担。风险意识增强意味着青少年在出现血糖读数错误时可能会与他人交流。目前的流程通常会导致参与学校活动减少。
青少年重视与父母合作响应和相互依存地管理学校的 T1D，这与职业治疗的共同职业模式一致。有效的责任分担取决于清晰、频繁、支持自主性、基于团队的沟通。我们的研究结果表明，确定学校基于 DSM 流程的沟通模式是零散和风险为导向的，青少年参与有限，导致学生有时被排除在学校活动之外的策略。
