Twenty-One Years and Still Going Strong: A Qualitative Study Exploring the Contribution of Young Adult, Adolescent,...

Adolescence is a period of rapid transformation when meeting targets for optimal diabetes care is often challenging due to competing life demands. For more than two decades a diabetes transition clinic in Sydney, Australia, has sustained positive outcomes and demonstrated aspects of resilience in the care of individuals living with type 1 diabetes (T1D) who have transitioned from paediatric to adult care. Many studies have focused on resilience in acute care setting showever, studies that examine the factors that support resilience in settings that care for individuals with long-term, chronic conditions such as T1D are lacking.

This study aims to examine the contributions of relationships among stakeholders, including adolescents and young adults living with T1D, their carers and healthcare providers, to the resilience of a T1D transition clinic.

Clinic observations at a paediatric clinic (transition preparation) and a T1D transition clinic located in an adult hospital, and interviews with eight providers comprising endocrinologists, diabetes educators, nurses and an administrator, and 17 adolescents/young adults (aged 16-25 years) living with T1D were conducted. Inductive and deductive analyses were performed using a framework of seven principles for Patient and Stakeholder Involvement in Resilience in Healthcare.

There was evidence for all seven principles though three were strongly expressed in the data: (1) Individual factors, (2) Influence of leadership and (3) Relationships among young adults, carers, and healthcare providers. Overall, key contributions to the clinic's resilience included a stable and cohesive team, continuity of staff, strong leadership sustained over 20 years, presence of a clinic coordinator, open channels of communication, and a positive, supportive culture among clinic stakeholders. There was also evidence of situational resilience and established processes that were adapted to suit an individuals' needs such as transition timing, mode of service (e.g., telehealth) and appointment time (e.g., after hours).

Resilience in transitional care settings such as those that support young adults living with T1D are contingent on person-centred care, relational leadership, and strong and supportive relationships. Similar transitional care clinics could seek to test this model in different contexts to assess the transferability of the findings described here.