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An ongoing struggle: a mixed-method systematic review of interventions,
barriers and facilitators to achieving optimal self-care by children and young
people with type 1 diabetes in educational settings.
BMC Pediatr. 2014;14:228
Authors: Edwards D, Noyes J, Lowes L, Haf Spencer L, Gregory JW
Abstract
BACKGROUND: Type 1 diabetes occurs more frequently in younger children who are
often pre-school age and enter the education system with diabetes-related
support needs that evolve over time. It is important that children are
supported to optimally manage their diet, exercise, blood glucose monitoring
and insulin regime at school. Young people self-manage at college/university.
METHOD: Theory-informed mixed-method systematic review to determine
intervention effectiveness and synthesise child/parent/professional views of
barriers and facilitators to achieving optimal diabetes self-care and
management for children and young people age 3-25 years in educational settings.
RESULTS: Eleven intervention and 55 views studies were included. Meta-analysis
was not possible. Study foci broadly matched school diabetes guidance.
Intervention studies were limited to specific contexts with mostly high risk of
bias. Views studies were mostly moderate quality with common transferrable
findings.Health plans, and school nurse support (various types) were effective.
Telemedicine in school was effective for individual case management. Most
educational interventions to increase knowledge and confidence of children or
school staff had significant short-term effects but longer follow-up is
required. Children, parents and staff said they struggled with many common
structural, organisational, educational and attitudinal school barriers.
Aspects of school guidance had not been generally implemented (e.g. individual
health plans). Children recognized and appreciated school staff who were
trained and confident in supporting diabetes management.Research with
college/university
students was lacking. Campus-based college/university student support
significantly improved knowledge, attitudes and diabetes self-care.
Self-management was easier for students who juggled diabetes-management with
student lifestyle, such as adopting strategies to manage alcohol consumption.
CONCLUSION: This novel mixed-method systematic review is the first to integrate
intervention effectiveness with views of children/parents/professionals mapped
against school diabetes guidelines. Diabetes management could be generally
improved by fully implementing and auditing guideline impact. Evidence is
limited by quality and there are gaps in knowledge of what works. Telemedicine
between healthcare providers and schools, and school nurse support for children
is effective in specific contexts, but not all education systems employ onsite
nurses. More innovative and sustainable solutions and robust evaluations are
required. Comprehensive lifestyle approaches for college/university students
warrant further development and evaluation.
PMID: 25213220 [PubMed - indexed for MEDLINE]
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Dette abstract er hentet via PubMed fra National Library of Medicine, USA
(http://www.ncbi.nlm.nih.gov/About/disclaimer.html).
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Se abstractet i PubMed: http://evidens.link/1Vm8D55
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