The relationships of adolescents with type 1 diabetes with their friends and peers: A qualitative study

Öz

Aim: Adolescents who are in their developmental stages are diagnosed with type 1 diabetes at an early age, so they need to both form life habits and integrate their diseases into their lives. In this process, it is extremely important to investigate adolescents' participation in friendship relationships and how these relationships affect their diabetes management. This study was planned to determine the experiences of adolescents with type 1 diabetes regarding their friendship and peer relationships, how they feel and how it affects their illness. Method: This study was conducted using thematic and descriptive qualitative research design. The population of the study consisted of adolescents with type 1 diabetes diagnosed in Antalya province, and the sample selection was determined according to the purposeful sampling method. Twenty adolescents between the ages of 10-19 were included in the study using the snowball sampling technique. Data were analyzed using an inductive and thematic approach. NVivo 12 program was used to organize the data. Results: The five main themes and the five sub-themes were revealed, reflecting the views of adolescents diagnosed with type 1 diabetes how their friendship and peer relationships affect them. The main themes were: (a) Acceptance, (b) Limitation, (c) Stigma, (d) Support, and (e) Have difficulties. Moreover, in the study, adolescents produced positive and negative metaphors for T1D. Conclusion: Of the five themes that emerged from the opinions of the adolescents in the study, it was understood that friend and peer relations were supportive in two themes, and that they had difficulties in three themes and most of the metaphors they produced. These difficulties can become more complex when combined with the peculiarities of adolescence.

Anahtar Kelimeler

• Adolescent, type 1 diabetes, friend, peer, qualitative study

Tip 1 diyabetli ergenlerin arkadaş ve akranları ile ilişkileri: Nitel bir çalışma

Öz

Amaç: Gelişim evrelerinde olan ergenler erken yaşta tip 1 diyabet tanısı aldıkları için hem yaşam alışkanlıkları oluşturmaları hem de hastalıklarını yaşamlarına entegre etmeleri gerekmektedir. Bu süreçte ergenlerin arkadaşlık ilişkilerine katılımlarını ve bu ilişkilerin diyabet yönetimini nasıl etkilediğini araştırmak son derece önemlidir. Bu çalışma tip 1 diyabetli ergenlerin arkadaşlık ve akran ilişkilerine ait deneyimlerini, neler hissettiklerini ve hastalıklarını nasıl etkilediğini belirlemek amacıyla planlanmıştır. Yöntem: Bu çalışma tematik ve betimsel nitel araştırma deseni kullanılarak yapılmıştır. Araştırmanın evrenini Antalya ilinde, tanı almış tip 1 diyabetli ergenler oluşturmuş, örneklem seçimi amaçlı örnekleme yöntemine göre belirlenmiştir. Çalışmaya, kartopu örnekleme tekniği kullanılarak 10-19 yaş arası 20 ergen alınmıştır. Veriler, tümevarımsal, tematik bir yaklaşım kullanılarak analiz edilmiştir. Verilerin düzenlenmesinde NVivo 12 programı kullanılmıştır. Bulgular: Tip 1 diyabet tanılı ergenlerin arkadaşlık ve akran ilişkilerinin kendilerini nasıl etkilediğine ilişkin görüşlerini yansıtan beş ana tema ve onlara bağlı beş alt tema ortaya çıkarılmıştır. Ana temalar: (a) Kabul görme, (b) Sınırlanma, (c) Damgalanma, (d) Destek ve (e) Zorlanma’dır. Ayrıca çalışmada ergenler T1D’e ilişkin olumlu ve olumsuz metaforlar üretmişlerdir. Sonuç: Çalışmada ergenlerin görüşlerinden ortaya çıkan beş temanın ikisinde arkadaş ve akran ilişkilerinin destekleyici olduğu, üç temada ve ürettikleri metaforların çoğunda zorlandıkları anlaşılmıştır. Bu zorluklar ergenlik döneminin özelikleriyle birleşince daha karmaşık hale gelebilir.

Anahtar Kelimeler

• Ergen
• tip 1 diyabet
• arkadaş
• akran
• nitel çalışma

Kaynakça

1. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014; 383(9911): 69–82. July 26, 2013 doi:10.1016/S0140-6736(13)60591-7.
2. Sun H, Saeedi P, Karuranga S, et al. IDF diabetes atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Prac. 2022; 183: 1-13. doi:10.1016/j.diabres.2021.109119.
3. Barry A, Connelly E. The child with endocrine dysfunction. İçinde: Hockenberry MJ, Wilson D, Rodgers CC, ed. Wong's Essentials of Pediatric Nursing. 10th ed. Canada: Elsevier; 2018: 1830-1853.
4. Núñez-Baila MDLÁ, Gómez-Aragón A, & González-López JR. Social Support and Peer Group Integration of Adolescents with Diabetes. Int J Environ Res Public Health. 2021;18(4): 2064. doi:10.3390/ijerph18042064.
5. World Health Organization (WHO). Adolescent health. https://www.who.int/health-topics/adolescent-health#tab=tab_1. 2023 tarihinde güncellenmiştir. 12 Şubat 2023 tarihinde erişilmiştir.
6. Gaete V. Desarrollo psicosocial del adolescente. Rev Chil Pediatr. 2015; 86 (6):436–443. doi:10.1016/j.rchipe.2015.07.005.
7. Merchán JAA, Miranda IA. Paradoja-Violencia-Adolescencia Comunicación-Conducta-Evolución¿ Cómo se relacionan? Cómo actuar? Redes. Revista de Psicoterapia Relacionale Intervenciones Sociales. 2020; 42: 25-32.
8. Prieler M, Choi J, Lee HE. The Relationships among Self-Worth Contingency on Others' Approval, Appearance Comparisons on Facebook, and Adolescent Girls' Body Esteem: A Cross-Cultural Study. Int J Environ Res Public Health. 2021;18(3): 901. doi:10.3390/ijerph18030901.

9. Flores J, Sánchez EG, Ibáñez EJ. Adolescencia y enfermedades crónicas: una aproximación desde la teoría de la diferenciación. Revista Electrónica de Psicología Iztacala. 2011; 14(1): 174-98.
10. Ferro M, Boyle MH. Self-concept among youth with a chronic illness: A meta-analytic review. Health Psychol. 2013; 32: 839–848. doi:10.1037/a0031861.
11. Trejo LL, Moreno SV, Granell SC, Marín MP, Castilla IM. Enfermedad crónica pediátrica: estudio comparativo de los niveles de ansiedad, depresión y autoestima. Revista de Psicología Clínica con Niños y Adolescentes. 2018; 5(3): 48-53. doi:10.21134/rpcna.2018.05.3.7.
12. Rankin D, Harden J, Barnard K, et al. Barriers and facilitators to taking on diabetes self-management tasks in pre-adolescent children with type 1 diabetes: A qualitative study. BMC Endocr Disord. 2018; 18: 1–9. doi:10.1186/s12902-018-0302-y.
13. Borus JS, Blood E, Volkening LK, Laffel L, Shrier LA. Momentary assessment of social context and glucose monitoring adherence in adolescents with type 1 diabetes. J Adolesc Health. 2013; 52: 578–583. doi:10.1016/j.jadohealth.2012.10.003.
14. Comisariado PV, Kenowitz JR, Trast J, Heptulla RA, González JS. Developing a personal and social identity with type 1 diabetes during adolescence: A hypothesis generative study. Qual Health Res. 2016; 26(5): 672–684. doi:10.1177/1049732316628835.
15. Jones CM, Foli KJ. Maturity in adolescents with type 1 diabetes mellitus: A concept analysis. J Pediatr Nurs. 2018; 42: 73–80. doi:10.1016/j.pedn.2018.07.004.
16. Jespersen LN, Vested MH, Johansen LB, Grabowski D. Mirroring life of adolescents with type 1 diabetes—an outline of key spects. Diabetology, 2021; 2(3): 141-156. doi:10.3390/diabetology2030013.
17. Marshall K, Martin H, Siarkowski Amer K. Exploring perceptions about insulin dependent diabetes mellitus in adolescent patients and peers. Compr Child Adolesc Nurs.2018; 41(1), 25-41. doi:10.1080/24694193.2017.1316788.
18. Bradshaw C, Atkinson S, Doody O. Employing a qualitative description approach in health care research. Glob Qual Nurs Res. 2017; 4: 2333393617742282. doi:10.1177/2333393617742282.
19. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6): 349- 357. doi:10.1093/intqhc/mzm042.
20. Patton MQ. Qualitative research and evaluation methods. 4th ed. Los Angeles, USA: Sage Publication; 2015.
21. Parker C, Scott S, Geddes A. Snowball sampling. İçinde: Atkinson P, Delamont S, Cernat A, Sakshaug JW, Williams RA, ed. Research Design for Qualitative Research. London, UK: Sage Publication; 2019.
22. Grove S, Gray J. Understanding Nursing Research. Building an Evidence-Based Practice. 7th ed. Amsterdam, Netherlands: Elsevier - Health Sciences Division; 2018
23. Mattacola E. “They think it’s helpful, but it’s not”: A qualitative analysis of the experience of social support provided by peers in adolescents with type 1 diabetes. Int J Behav Med. 2020; 27: 444-454. doi:10.1007/s12529-020-09878-5.
24. Lindgren BM, Lundman B, Graneheim UH. Abstraction and interpretation during the qualitative content analysis process. Int J Stud Nurs. 2020; 108(103632): 1-6. doi:10.1016/j.ijnurstu.2020.103632.
25. Maher C, Hadfield M, Hutchings M, de Eyto A. Ensuring rigor in qualitative data analysis: A design research approach to coding combining NVivo with traditional material methods. Int J Qual Method., 2018; 17(1), 1-13. doi:10.1177/1609406918786362.
26. Strand M, Broström A, Haugstvedt A. Adolescents' perceptions of the transition process from parental management to self-management of type 1 diabetes. Scand J Caring Sci. 2019; 33(1):128-135. doi:10.1111/scs.12611.
27. Gómez A, Núñez M, Andrade M. La alimentación como régimen terapéutico: Un análisis de los imaginarios de salud y alimentación saludable en personas que padecen diabetes. İçinde: Vivente T, García MJ, Vizcaíno T, ed. Antropologías en Transformación: Sentidos, Compromisos y Utopias. 1st ed. Institució Alfons El Magnànim Centre Valencià D’estudis Y D’investigació. Valencia, España: 2017: 1335–1348.
28. Brazeau AS, Nakhla M, Wright M, et al. Stigma and its association with glycemic control and hypoglycemia in adolescents and young adults with type 1 diabetes: Cross-sectional study. J Med Internet Res. 2018; 20(4): e151. doi:10.2196/jmir.9432.
29. Andrade CJDN, Alves CAD. Relationship between bullying and type 1 diabetes mellitus in children and adolescents: a systematic review. J Pediatr (Rio J). 2019; 95(5): 509-518. doi:10.1016/j.jped.2018.10.003.
30. Kim JE. Illness experiences of adolescents with type 1 diabetes. J Diabetes Res. 2018; 2022:3117253. doi:10.1155/2022/3117253.