Developing Self-Management in Type 1 Diabetes at Secondary Schools: Who Is Responsible? A Qualitative Study

Area of Science:

• Pediatric Endocrinology
• Adolescent Health
• Occupational Therapy

Background:

• Type 1 diabetes (T1D) management requires significant self-management skills.
• Adolescents are transitioning to greater responsibility for their diabetes self-management (DSM).
• Understanding adolescents' experiences of sharing T1D management at school is limited.

Purpose of the Study:

• To investigate adolescents' perceptions of sharing responsibility for T1D management in the school setting.
• To explore the role of occupational therapy in supporting adolescents with T1D at school.

Main Methods:

• Descriptive qualitative design utilizing semistructured interviews.
• Thematic analysis of data from 11 adolescents (ages 15-16) with T1D.
• Second phase of a sequential explanatory mixed-methods study on school-based responsibility-sharing.

Main Results:

• Adolescents primarily partnered with parents for school-based DSM, with limited involvement from healthcare professionals and teachers.
• Adolescents perceived ownership of most DSM tasks, with independence goals sometimes limiting shared responsibility.
• Fragmented, risk-focused communication patterns and limited adolescent involvement led to reduced school participation.

Conclusions:

• Adolescents value interdependent partnerships with parents for T1D management at school, aligning with co-occupation principles.
• Effective responsibility-sharing requires clear, frequent, autonomy-supportive, team-based communication.
• Enhanced adolescent involvement and clearer role allocation can improve health habits and school participation.