No description available.

No description available.

No description available.

No description available.

No description available.

Type 1 diabetes mellitus is now the third most common chronic illness in children and young people in the United Kingdom, with a twofold increase in incidence in the last decade. Diabetes self-care is integral to the young person's survival, and significantly reduces the risk of cardiovascular disease and microvascular damage associated with the condition. Parental involvement and family support is known to promote adherence to self-care. However adolescence is a period strongly associated with poorer adherence, as young people separate from the influence of their parents and form closer relationships with peers. Young people spend increasing periods of time at school in the company of personnel and peers, but little is known of how the school environment influences self-care. A qualitative study was undertaken, using a grounded theory approach to examine the role of the school environment in the self-care. Nine young people with type 1 diabetes mellitus aged between eleven and sixteen years were interviewed, regarding their experiences of managing their diabetes at school. A core concept of negotiating threats to self-regulation emerged, both to homeostasis and to the self. Threats included stigma in relation to having diabetes and associated self-care, and also the threat of self-exposure through the behaviours associated with hypoglycaemic and hyperglycaemic episodes. Participants sought to manage threats through negotiating the disclosure of their diagnosis, and concealing or omitting self-care. School personnel peers, and school rules played a part in this dynamic and evolving process. Friends acted as advocates, moderating threats to self-regulation and promoting self-care. School personnel and the application of school rules also influenced threats to self-regulation.

Diabetes Mellitus (DM) is a global health problem with a rapidly increasing prevalence. Despite the provision of comprehensive diabetes management programmes, patients are often not able to achieve the desired outcomes. The aims of the study were to investigate factors affecting self-care behaviours of patients with Type 2 DM among Hong Kong Chinese people and to explore barriers to self-care and strategies to overcome barriers from patients' and nurses' perspectives. The conceptual framework was developed from the Health Belief Model and the Theory of Planned Behaviour. A sequential explanatory mixed methods design was adopted. Structured questionnaires were used to investigate key variables for predicting self-care for 183 patients with Type 2 DM. Subsequently, 22 patients and 17 nurses were selected for focus group interviews. The quantitative findings showed that both attitudes and modifying factors (knowledge, demographics, socio-economic factors, insulin therapy) had a significant effect on self- care behaviours. They showed that older patients, those of lower socio-economic status, being treated with insulin, having better knowledge about DM, and with positive attitudes reported better adherence to self-care. The qualitative findings indicated that the patients and nurses perceived barriers to self-care were consistent including physical, psychological, socio-economic, environmental and cultural factors. The focus group interviews revealed that nurses understood most of the barriers to self- care perceived by their patients. The Diabetes Self-care Model was developed in the study to inform and guide healthcare professionals when designing diabetes management programmes by addressing key variables affecting self-care behaviours and patient outcomes. The unique position of nurses and their understanding of patients' needs are essential for improving patient outcomes. Therefore, the roles of nurses should be reinforced and further developed to address the needs of the patients through improving the effectiveness of diabetes management programmes and patient empowerment.

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No description available.

Long-term healthcare for adolescents with type 1 diabetes falls short of government standards (DoH, 2007). Whilst some improvement may be achieved by education, further improvement may be achievable by an improved know.ledge, not only of. the patient's perceptions of their disease, but also of those of the healthcare professionals charged with their care. This study aimed to increase knowledge, concerning the attitudes of patients and healthcare professionals, by eliciting the 'lived experience' of adolescent patients and the views oftheir healthcare professionals. A literature review elicits current knowledge and locates the research within the current healthcare agenda. The aetiology, pathophysiology and management of type 1 diabetes are reviewed, followed by an overview of adolescence and the psycho-sociological and cognitive development of the adolescent. Finally, the review surveys adolescents and diabetes, perceptions of illness and the subjectivity of individuals with chronic illness. A qualitative study, utilising the principles of ground theory (Strauss and Corbin 1998), has been undertaken using patients and healthcare professio~als from the city of Sunderland. Twenty in-depth, interviews were carried out with patients, aged 16 to 21 years, living with type 1 d~abetes. Patients from Sunderland City Hospital were invited to 'tell their story' concerning, their 'lived experience' of diabetes. Interviews were terminated when 'data saturation had been attained. Focus group interviews were carried out with five groups ofhealthcare professionals. All interviews were analysed to allow for the emergence of themes and categories.