Facilitating participation and child-centered care: co-designing narrative and play-based communication tools for...

Young children with type 1 diabetes are often marginalized in clinical consultations due to communication practices that favor verbal, adult-centered interaction. Developmentally attuned methods to support young children's meaningful participation in routine diabetes care remain limited. This study aimed to develop and examine Child-Centered Narrative Play Tools (CNPTs) and explore how they support participation, communication, expression of agency, and assess their feasibility in pediatric diabetes consultations.

An iterative participatory qualitative design was conducted across two specialist pediatric diabetes clinics in Denmark. Twenty-nine children aged 3-7 years, 29 caregivers, and 12 healthcare professionals participated in workshops, exploratory testing, video-recorded clinical observations, and semi-structured interviews. Narrative story stems and play materials were co-developed and refined through cycles of testing and feedback. Data were analyzed using thematic analysis, combining inductive coding with theory-informed interpretation.

Narrative play functioned as a primary medium through which young children expressed experiences, demonstrated understanding of diabetes management, and exercised agency during consultations. The tools enabled children to articulate everyday experiences of diabetes management and emotional responses that were often not expressed in standard consultations. Healthcare professionals reported increased confidence in communicating at the child's developmental level, and caregivers observed greater ownership and recall of consultation content. Feasibility testing indicated that the tools were feasible for routine clinical practice, with high acceptability and good usability following appropriate training.

Child-Centered Narrative Play Tools (CNPTs) offer pediatric HCPs a feasible, theory-informed framework to operationalize child-centered care and make young children's perspectives visible and actionable in routine diabetes practice.