Determinants of adherence to insulin and blood glucose monitoring among adolescents and young adults with type 1 diabetes in Qatar: a qualitative study

Abstract

Background: Adherence to insulin and blood glucose monitoring (BGM) is insufficient in adolescents and young adults (AYAs) with type 1 diabetes (T1D) worldwide and in Qatar. Little is known about the factors related to being aware of non-adherence and the beliefs related to non-adherence in this group. This qualitative study investigated factors related to awareness of, and beliefs about non-adherence, as well as the existence of specific action plans to combat non-adherence using the I-Change model. Methods: The target group was comprised of 20 Arab AYAs (17–24 years of age) with T1D living in Qatar. Participants were interviewed via semi-structured, face-to-face individual interviews, which were audio-recorded, transcribed verbatim, and analyzed using the Framework Method. Results: Suboptimal adherence to insulin, and particularly to BGM, in AYAs with T1D was identified. Some AYAs reported to have little awareness about the consequences of their non-adherence and how this can adversely affect optimal diabetes management. Participants also associated various disadvantages to adherence (e.g., hypoglycemia, pain, among others) and reported low self-efficacy in being adherent (e.g., when outside home, in a bad mood, among others). Additionally, goal setting and action-planning often appeared to be lacking. Factors facilitating adherence were receiving support from family and healthcare providers, being motivated, and high self-efficacy. Conclusions: Interventions that increase awareness concerning the risks of non-adherence of AYAs with T1D are needed, that increase motivation to adhere by stressing the advantages, creating support and increasing self-efficacy, and that address action planning and goal parameters.

Challenges and Barriers of Physical Activity Among Pediatric Patients with Type 1 Diabetes Mellitus and Their Parents: A Systematic Review

“…Parallel with this situation, our recent findings indicated that motivation and high self-efficacy among the T1DM pediatric patients mediated their ability to adjust to physical activity practices. We also discovered that a higher parental physical activity profile was associated with a higher level of physical activity among T1DM pediatric patients (Alburno et al, 2022;Michaud et al, 2017). Further, self-efficacy and participation from the patient's family members or peers were also identified as factors that drove the patient's motivation to actively engage in physical exercise practices (Wilkie et al, 2017).…”

“…Four qualitative studies with an average number of 7, 14, and 116 T1DM participants and their parents were employed in this study (Alburno et al, 2022) (Collard et al, 2020;Fried et al, 2021;Morrow et al, 2022). We also enrolled three quantitative studies that involved 96 to 1,129 T1DM patients and their parents (Livny et al, 2020;Michaud et al, 2017;Roberts et al, 2021).…”

“…However, they stated that the average age of the participants was 13.7 (Livny et al, 2020). A study mentioned that their participants were aged between 17 to 18, however, did not state the age of the parents or patient's guardians (Alburno et al, 2022). However, six studies had mentioned the age of the patients and their parents, with the age range of the patient from 9 to 18 years (Collard et al, 2020;Fried et al, 2021;Livny et al, 2020;Michaud et al, 2017;Morrow et al, 2022;Roberts et al, 2021).…”

“…Findings suggested numerous challenges and barriers encountered by pediatric patients and their parents or patient guardians in executing sufficient physical activity level according to the patients' condition. An article mentioned the significant influence of motivation, intention, and high self-efficacy as internal factors on the T1DM management (Alburno et al, 2022). Further, five articles discovered the fear of hypoglycemia while being physically active as the leading factor that commonly impeded the physical activity intensity and frequency among pediatric and adolescents with T1DM (Collard et al, 2020;Fried et al, 2021;Livny et al, 2020;Michaud et al, 2017;Roberts et al, 2021).…”

“…Further, five articles discovered the fear of hypoglycemia while being physically active as the leading factor that commonly impeded the physical activity intensity and frequency among pediatric and adolescents with T1DM (Collard et al, 2020;Fried et al, 2021;Livny et al, 2020;Michaud et al, 2017;Roberts et al, 2021). Findings also highlighted the lack of parental confidence in encouraging their children to be physically active due to the potency of unstable blood glucose level, parental responsibility in preparing adequate diet for their children with T1DM (Fried et al, 2021), the need of physical activity variation to stimulate physical exercise practice for children and adolescents with T1DM (Michaud et al, 2017), the presence of stigma from the surrounding about the physical capability of T1DM patients (Fried et al, 2021), adequate support from the family, school, and peer to adjust with the pace of type and intensity of the physical activity (Alburno et al, 2022;Livny et al, 2020), adequate level of knowledge about the physical activity recommendation and blood glucose level management control (Collard et al, 2020;Fried et al, 2021;Livny et al, 2020), and the unavailability of technology or tools to ensure an adequate level of physical activity practice and safety while being physically active as the perceived challenges and barriers in caring for patients with T1DM (Morrow et al, 2022 The current technology did not address the complex needs of adolescents with T1DM to support their active participation in physical exercise without risking their life and health safety.…”