Authors: Lisa Gardener, Helen Bourke-Taylor, Laura Desha, Madeline Gardener, Merrill Turpin  

Purpose: This study is the first to examine adolescents' shared responsibility for diabetes care in schools through an occupational lens. Effective diabetes self-management in secondary schools occurs when adolescents collaborate with their parents. Improved adolescent involvement in school processes and clearer team roles would enhance health-promoting habits and school participation.

Phenomenon of this study show that, just like how managing Type 1 diabetes is talked about in families, 11 adolescents see managing their diabetes at school as a pretty complicated job with a lot going on, and they feel mostly in charge of it. They really appreciate a team effort when it comes to handling Type 1 diabetes at school, but sometimes the way things are currently done can get in the way of them fully joining in. The way they share responsibility at school is shaped by their need to handle risks, want to be independent, and need quick help if their blood sugar levels go off track.

Method used in this study were observations, semi structured interview, and open ended questions.

1. What has to be done to take care of your diabetes when you are at school? 

2.Who takes care of each job? 

3.How was that decided? 

4.What do you/your parents think about how important it is that each job gets done? 

5.How does taking care of diabetes affect your school day? 

6.What do you think about the amount of communication about your diabetes that you have with school now, compared to when you were younger? 

-Credibility of this study includes authors who are Registered Occupational Therapists.

-Transferability to programs in community settings

-Dependability of this study shows that there is a high dependability about self management in adolescents with T1D.

-Confirmability is the findings really show what the participants actually go through with managing their Type 1 diabetes, not what the researchers think..

-Recurring patterns and themes found: self management of Type 1 diabetes in schools

reliability and validity: The study highlights the need for further research on occupational therapists' role in supporting families with adolescents who have T1D. Future investigations could focus on developing occupationally tailored DSM interventions and new methods to enhance adolescents' participation in school activities.

Summary of results: Adolescents primarily managed school-based DSM in partnership with their parents, each taking on unique responsibilities. Involvement from health care professionals and teachers was minimal. Adolescents felt they owned most DSM tasks, but their desire for independence limited shared responsibilities. A heightened sense of risk led them to communicate with others regarding errant blood glucose readings. Current practices often reduced school participation.

How this study can guide OT interventions with T1D: Some areas of occupational performance to focus on would be:

-IADLS such as health mgmt and educating on monitoring blood glucose levels, meal planning a healthy meal to adhere to lifestyle changes, adapting daily routines to accommodate for diabetes needs. Teaching stress mgmt techniques, and exercises.

-group-based interventions can help improve coping skills, self-efficacy, and quality of life in children and adolescents with type 1 diabetes. 

Authors: Raymond Hernandez , Stefan Schneider , Haomiao Jin , Claire Hoogendoorn , Pey-Jiuan Lee , Loree Pham , Elizabeth A Pyatak  

Brief summary of the purpose: To assess the typical level of workload people experience with Type 1 Diabetes (T1D) such as health management responsibilities for T1D, work, caregiving and how the demands of all these experiences can create further issues, such as unhealthy physiological changes and interference with self care 

Hypothesis: This study is all about figuring out if this measure really reflects the workload that comes with handling chronic conditions and how it might affect well-being, especially when it comes to stress and controlling blood sugar levels. 

Methods used: psychometric assessment tool called the daily NASA Task Load Index (TLX), ecological momentary assessments (EMA), daily diaries, and the multilevel confirmatory factor analysis,  

Type of data and the way data was analyzed: This study’s data that was statistically analyzed and consists of 164 adults from the U.S. with T1D in which 42% are Latino and 30% are white. These adults completed cross sectional-measures and 2 weeks of ecological momentary assessments (EMA) and daily diaries. This experiment took place in 3 outpatient endocrinology clinics in the U.S.   

reliability and validity: The reliability of this data was for a sub group: workers and non workers. The validity was evaluated using a statistical method such as multilevel confirmatory factor analysis, along with some tests to see how well it lined up with patient- reported outcomes and blood sugar levels. 

Summary of results: The study found that reliable whole day TLX measurements required participants to track their workload for 2 to 6 days, depending on their group. It also validated TLX, revealing that higher workloads corresponded to increased stress, while lower workloads were linked to better blood sugar control. 

Main results: Number of days required for at least 0.70 reliability of the average whole day TLX ranged between 2 and 6 days depending on the subgroup. Results supported convergent and divergent validity of the average of the whole day TLX, including associations with average stress (r = .63, p < .001) and time in target blood glucose range (r = -.25, p = .002).

How this study can guide OT interventions with T1D: We can intervene on a whole day workload by doing an activity analysis, task adaptation, implement energy conservation techniques for someone with T1D or chronic conditions to feel less stressed and control blood sugar. As well as promoting health and well being for our clients.  

Gardener, L., Bourke-Taylor, H., Desha, L., Gardener, M., & Turpin, M. (2024). Developing Self-Management in Type 1 Diabetes at Secondary Schools: Who Is Responsible? A Qualitative Study. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 78(5), 7805205110. https://doi.org/10.5014/ajot.2024.050662