| 1. |
- Brorsson, Anna Lena, 1964-, et al.
(författare)
-
A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol
- 2013
-
Ingår i: BMC Pediatrics. - : BioMed Central. - 1471-2431. ; 13
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment.Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment.Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family.Trial registration: Current controlled trials: ISRCTN22444034
|
|
| 2. |
- Brorsson, Anna Lena, 1964-, et al.
(författare)
-
Adolescents’ perceptions of participation in group education using the Guided Self-Determination-Young method : a qualitative study
- 2017
-
Ingår i: BMJ Open Diabetes Research & Care. - : BMJ. - 2052-4897. ; 5:1
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Guided Self-Determination (GSD) is a person-centered communication and reflection method. Education in groups may have a greater impact than the content of the education, and constructive communication between parents and adolescents has been shown to be of importance. The purpose of this study was to describe adolescents’ perceptions of participation in group education with the Guided Self-Determination-Young (GSD-Y) method, together with parents, in connection with the introduction of continuous subcutaneous insulin infusion.Research design and methods In the present qualitative interview study, 13 adolescents with type 1 diabetes were included after completing a GSD-Y group education program in connection with the introduction of continuous subcutaneous insulin infusion at three hospitals located in central Sweden. The adolescents were interviewed individually, and qualitative content analysis was applied to the interview transcripts.Results Two categories that emerged from the analysis were the importance of context and growing in power through the group process. An overarching theme that emerged from the interviews was the importance of expert and referent power in growing awareness of the importance of self-management as well as mitigating the loneliness of diabetes.Conclusions GSD-Y has, in various ways, mitigated experiences of loneliness and contributed to conscious reflection about self-management in the group (referent power) together with the group leader (expert power). Overall, this highlights the benefits of group education, and the GSD method emphasizes the person-centered approach.
|
|
| 3. |
- Brorsson, Anna Lena, 1964-, et al.
(författare)
-
Does treatment with an insulin pump improve glycaemic control in children and adolescents with type 1 diabetes? : A retrospective case-control study
- 2015
-
Ingår i: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 16:7, s. 546-553
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate long-term effects on glycaemic control, ketoacidosis, serious hypoglycaemic events, insulin requirements, and body mass index standard deviation scores (BMI-SDS) in children and adolescents with type 1 diabetes starting on continuous subcutaneous insulin infusion (CSII) compared with children and adolescents treated with multiple daily injections (MDI).METHODS: This retrospective case-control study compares 216 patients starting CSII with a control group on MDI (n = 215), matched for glycated hemoglobin (HbA1c), sex, and age during a 2-yr period. Variables collected were gender, age, HbA1c, insulin requirement, BMI, BMI-SDS, ketoacidosis, and serious hypoglycaemic events.RESULTS: In the CSII group there was an improvement in HbA1c after 6 and 12 months compared with the MDI group. For boys and girls separately the same effect was detected after 6 months, but only for boys after 12 months. The incidence of ketoacidosis was higher in the CSII group compared with the MDI group (2.8 vs. 0.5/100 person-yr). The incidences of severe hypoglycaemic episodes per 100 person-yr were three in the CSII group and six in the MDI group (p < 0.05). After 6, 12, and 24 months, the insulin requirement was higher in the MDI group.CONCLUSIONS: This study shows that treatment with CSII resulted in an improvement in HbA1c levels up to 1 yr and decreased the number of severe hypoglycaemic events, but the frequency of ketoacidosis increased. The major challenge is to identify methods to maintain the HbA1c improvement, especially among older children and teenagers, and reduce the frequency of ketoacidosis.
|
|
| 4. |
- Brorsson, Anna Lena, 1964-, et al.
(författare)
-
Parent's perception of their children's health, quality of life and burden of diabetes : testing reliability and validity of 'Check your Health' by proxy.
- 2017
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 31:3, s. 497-504
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: To test the validity and reliability of the 'Check your Health by proxy' instrument in parents to children with diabetes aged 8-17 years.METHODS: One hundred and ninety-one caregivers and their children, aged 8-17 years, were included. All completed the 'Check your Health' questionnaire measuring quality of life and burden of diabetes, DISABKIDS self- or proxy version, and 45 completed the same questionnaires 2 weeks later.RESULTS: Test-retest reliability on the 'Check your Health' questionnaire by proxy was moderate to strong (r = 0.48-0.74), p < 0.002). Convergent validity was weak to moderate (r = 0.15-0.49, p < 0.05). The instrument showed acceptable discriminant validity. Parents reported lower scores than the children on emotional health and social relations and higher scores on physical and emotional burden and higher burden on quality of life. Poorer social relationships and quality of life were associated with higher reported disease severity. The diabetes burden domain of the questionnaire correlated to perceived severity of diabetes and to perceived health. Discriminant validity showed that poorer social relationships and quality of life were associated with higher severity of the disease. The diabetes burden domain of 'Check your Health' by proxy showed discriminant validity on perceived severity of diabetes.CONCLUSIONS: The instrument 'Check your Health' by proxy showed acceptable psychometric characteristics in parents to young people (8-17 years of age) with diabetes. We also concluded that parents reported that their children had lower health and higher burden of diabetes than the children did, and it correlated to reported disease severity.
|
|
| 5. |
|
|
| 6. |
- Leksell, Janeth, et al.
(författare)
-
Psychometric properties of the Swedish Diabetes Empowerment Scale
- 2007
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 21:2, s. 247-252
-
Tidskriftsartikel (refereegranskat)abstract
- This study was conducted to determine the psychometric properties of the Swedish version of the Diabetes Empowerment Scale (Swe-DES-23). Research design and methods: A convenience sample of 195 patients with type 1 and type 2 diabetes completed the Swe-DES-23 questionnaire. To establish discriminant validity, Swe-DES subscales were compared with the Semantic Differential in Diabetes scale (SDD) and a general health scale (EVGFP). Construct validity was tested using factor analyses. To determine unidimensionality of the subscales, inter-item correlations were calculated. Internal consistency was tested by the use of the Crohnbach-α coefficient. Results: The factor analysis resulted in four factors (empowerment subscales) with eigenvalues >1.0, explaining 60% of the variance. The four empowerment subscales: goal achievement, self-awareness, stress management and readiness to change showed Crohnbach-α values ranging from 0.68 to 0.91. Patients with good self-reported health and low burden of diabetes scored significantly higher on almost all empowerment subscales. Only weak correlations were found between metabolic control and the empowerment subscales. Conclusions: The SWE-DES-23 scale had acceptable validity and reliability and, thus, could be a suitable tool in evaluating empowerment-based education programmes. Further testing is needed to shorten the questionnaire.
|
|
| 7. |
|
|
| 8. |
- Viklund, Gunnel, et al.
(författare)
-
Assessment of an empowerment education programme. : A randomized study in teenagers with diabetes
- 2007
-
Ingår i: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 24:5, s. 550-556
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: To determine the effects of an empowerment programme on glycaemic control and empowerment, and to study the role of parental involvement. Methods: The wait-list design is a randomized controlled trial lasting for 6 months, after which the control group participate in the same education programme as the intervention group. After 6 months, data from the two groups are analysed together (pre/post). Thirty-two teenagers with Type 1 diabetes (12-17 years) completed an empowerment group education programme, meeting weekly for 6 weeks. They were also offered an extra meeting together with their parents, which resulted in three groups: together with parents, only parents and no parent involvement at all. HbA1c was measured before intervention and after 6, 12, 18 and 24 months, and empowerment before, and 6 and 12 months after. Results: HbA1c and empowerment were similar in the intervention group and the control group 6 months after intervention. In pre/post analysis, HbA1c was significantly higher 6 and 12 months after intervention in teenagers > 14 years (from 8.4% to 9.3%; P < 0.05 to 9.6%; P < 0.01), but returned to baseline 18 months after the programme. In teenagers ≤ 14 years of age, HbA1c did not change during the study. The teenagers felt more ready for changes after the programme than before (3.9 sd = 0.5 to 4.1 sd = 0.5; P < 0.05). In the teenagers in the group that involved their parents, there was a significant decrease in HbA1c 12 and 24 months after intervention, from 8.9% (sd = 1.1) to 7.6% (sd = 1.3; P < 0.05, confidence interval 0.37, 2.26). Conclusion: This empowerment programme for teenagers with diabetes showed no positive glycaemic or empowerment effects. Empowerment programmes for diabetic teenagers in early and middle adolescence should include parental involvement.
|
|
| 9. |
- Viklund, Gunnel, 1951-
(författare)
-
Education for Teenagers with Type 1 Diabetes
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)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.
|
|
| 10. |
- Viklund, Gunnel, et al.
(författare)
-
Empowerment education programmes for teenagers need parent involvement
- 2007
-
Konferensbidrag (populärvet., debatt m.m.)abstract
- Objectives.A previous study that assessed an empowerment programme for teenagers with diabetes showed no effects on metabolic control or empowerment outcomes. In pre/post measures teenagers >14 years of age significantly increased their HbA1c, and the hole group their readiness for changes. To balance the teenagers’ decision-making competence with parent involvement seems to be important when planning empowerment programmes for teenagers.The aim was to get a deeper understanding of teenagers view on decision-making competence and parent involvement.MethodsThe study is a descriptive, qualitative interview study.Thirty one out of 32 teenagers (19 girls, 13 boys, mean age= 14.2) attending an empowerment programme was interviewed after completing the programme. The interviews were transcribed, and analyzed with qualitative content analysis.ResultsDecision-making competence:We found seven categories that influence decision-making competence:Cognitive maturity: Make abstractions and priorities, understand consequencesPersonal qualities: Flexibility, intuition and having courage.Self-strength: Strong wishes to own decisions and control.Experiencw: Own experiences or experiences from others.Social network can be both promoting and hindering.Safe environment and emotional factors.Parent involvement:We defined three categories of parent involvement:Constructive involvement: Creating safety and teamwork. Parents being there when needed, having trust, sharing responsibility, listening and coaching.Active destructive involvement: Misbelieves, blaming and making too hard demands.Passive destructive involvement: Lack of understanding and engagement, need of control and conflicts.ConclusionsWe have elucidated factors that seem to be important when planning empowerment group education programmes for teenagers with diabetes. To facilitate parent involvement the results can be used in discussing efficient coping strategies with teenagers and parents.
|
|
