Show simple item record

dc.contributor.authorSparud Lundin, Carina
dc.date.accessioned2008-04-25T10:58:35Z
dc.date.available2008-04-25T10:58:35Z
dc.date.issued2008-04-25T10:58:35Z
dc.identifier.isbn978-91-628-7503-9
dc.identifier.urihttp://hdl.handle.net/2077/10029
dc.description.abstractThe overall aim of the thesis was to illuminate main concerns related to the transition of adolescents/ emerging adults with Type 1 diabetes to adult life and diabetes care and to gain a deeper understanding of how care providers, patients and their parents handle this situation. In paper I and II, participant observations of visits to physicians, nurses and group sessions (n=51) were conducted in two paediatric (PDC) and two adult (ADC) diabetes clinics as well as interviews with care providers (n=10). Focus was to explore the care culture in the settings and its implications for care of and how care providers handle the transition in relation to adolescent needs. In paper III, 104 emerging adults were followed (18-24 years) through record audit in order to explore glycemic control and its relation to diabetes care utilization. In paper IV, interviews with young adults (n=13) and parents (n=13) were conducted to explore the meaning of interactions with and support of self-management from parents and other significant others. Internet communication between youths with diabetes was also included in the analysis. Qualitative studies (I, II, IV) were analyzed with using a constant comparative method. In paper III, parametric and non-parametric statistical methods were used and a generalized linear mixed model was used for the longitudinal data analyses. This thesis shows that differing care culture in paediatric and adult diabetes care has implications for care providers, emerging adults and their parents’ experiences of caring relationships, and diabetes care. While youths are receiving multidimensional support in paediatric care, they become less visible after transition to adult care due to differences in structural and organisational conditions and strategies. The frequency of visits declined from time in PDC to ADC and females visited ADC more than males. The glycemic control was poor during the whole study period where both males and females exceeded the recommended level. HbA1c levels decreased significantly over time for females but not for males. Findings indicate that more visits in ADC are associated with worse glycemic control. The preparation phase and the transition process were facilitated in the clinic with special transition strategies where logistic problems such as lost referral letters could be prevented. Mutual understanding between care providers can be created in professional meetings which also enables integration of care. The transition to adult life for emerging adults with diabetes was found to be characterized by a relational and reflective process involving reconstruction of supportive relationships with care providers and significant others and a re-consideration of the self. This interactional process implies that an ongoing redefinition of relationships and identity occurs during the transition. In conclusion, the findings reveal that individual trust is hindered by an unsettled relationship to the new care provider and institutional trust by declining accessibility and less continuous care. Interventions at an organizational as well as individual level are required in order to meet the needs of emerging adults with diabetes in a life phase characterized by changing conditions. Patterns of diabetes care utilization are important to take into account and more forums for professional meetings might enable integration of paediatric and adult diabetes care.en
dc.language.isoengen
dc.relation.haspartI. Sparud Lundin, C. Öhrn, I & Danielson, E (2008). From multi-dimensional support to decreasing visibility: a field study on care culture in paediatric and adult diabetes outpatient clinics. International Journal of Nursing Studies 45 (2), 180-190. ::pmid::16979642en
dc.relation.haspartII. Sparud Lundin, C. Danielson, E & Öhrn, I (2007). Handling the transition of adolescents with diabetes: participant observations and interviews with care providers in paediatric and adult diabetes outpatient clinics. International Journal of Integrated Care 2007 Feb 15;7:e05::pmid::17377641en
dc.relation.haspartIII. Sparud Lundin, C. Öhrn, I. Danielson, E & Forsander, G. Glycemic control and diabetes care utilization in young adults with Type 1 diabetes. (Resubmitted for publication).en
dc.relation.haspartIV. Sparud Lundin, C. Öhrn, I & Danielson, E. Redefining relationships and identity in emerging adults with type 1 diabetes (Submitted for publication).en
dc.subjectadolescentsen
dc.subjectyoung adultsen
dc.subjecttype 1 diabetesen
dc.subjectpaediatric diabetes careen
dc.subjectadult diabetes careen
dc.subjectdiabetes care utilizationen
dc.subjecttransitionen
dc.subjectglycemic controlen
dc.subjectgrounded theoryen
dc.titleLiving with diabetes during transition to adult life- Relationships, support of self-management, diabetes control and diabetes careen
dc.typetexteng
dc.type.svepDoctoral thesiseng
dc.gup.mailcarina.s-lundin@fhs.gu.seen
dc.type.degreeDoctor of Philosophy (Health Care Sciences)en
dc.gup.defenceFredagen 16 maj 2008 kl.13.00 i hörsal 2119, Arvid Wallgrens Backe 2, Hus 2en
dc.gup.originUniversity of Gothenburg. Sahlgrenska Academyen
dc.gup.departmentInst of Health and Care Sciencesen
dc.gup.dissdb-fakultetSA


Files in this item

Thumbnail
Thumbnail
Thumbnail

This item appears in the following Collection(s)

Show simple item record