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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.

Edwards D, Noyes J, Lowes L, Haf Spencer L, Gregory JW - BMC Pediatr (2014)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: School of Social Sciences, Bangor University, Bangor LL57 2EF, UK. jane.noyes@bangor.ac.uk.

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.

No MeSH data available.


Related in: MedlinePlus

Mixed-methods review design.
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Fig1: Mixed-methods review design.

Mentions: We conducted a mixed-method systematic review. The design was informed by mixed-method synthesis methods developed by the Evidence for Policy and Practice Information (EPPI) Centre [25, 26] and is shown in Figure 1. We followed Cochrane Effective Practice and Organisation of Care Guidance on the inclusion of more diverse quantitative study designs to determine the effectiveness of interventions as our initial scoping review has identified few randomized controlled trials [27]. The EPPI ‘mixed-methods’ triangulation approach maps evidence from effectiveness studies (Stream1: quantitative data) with evidence from studies reporting the attitudes and experiences of participants (Stream 2: non intervention studies including surveys and qualitative studies). We then conducted an overarching narrative synthesis from streams 1 and 2 to determine the extent to which interventions to optimize T1D care and management in educational settings addressed the barriers, and built on the facilitators, identified by children, parents and teachers. The quantitative component of the review (stream 1) adhered as far as possible to PRISMA reporting guidelines (http://www.prisma-statement.org). We developed a detailed protocol which is not publically available.Figure 1


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.

Edwards D, Noyes J, Lowes L, Haf Spencer L, Gregory JW - BMC Pediatr (2014)

Mixed-methods review design.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4263204&req=5

Fig1: Mixed-methods review design.
Mentions: We conducted a mixed-method systematic review. The design was informed by mixed-method synthesis methods developed by the Evidence for Policy and Practice Information (EPPI) Centre [25, 26] and is shown in Figure 1. We followed Cochrane Effective Practice and Organisation of Care Guidance on the inclusion of more diverse quantitative study designs to determine the effectiveness of interventions as our initial scoping review has identified few randomized controlled trials [27]. The EPPI ‘mixed-methods’ triangulation approach maps evidence from effectiveness studies (Stream1: quantitative data) with evidence from studies reporting the attitudes and experiences of participants (Stream 2: non intervention studies including surveys and qualitative studies). We then conducted an overarching narrative synthesis from streams 1 and 2 to determine the extent to which interventions to optimize T1D care and management in educational settings addressed the barriers, and built on the facilitators, identified by children, parents and teachers. The quantitative component of the review (stream 1) adhered as far as possible to PRISMA reporting guidelines (http://www.prisma-statement.org). We developed a detailed protocol which is not publically available.Figure 1

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: School of Social Sciences, Bangor University, Bangor LL57 2EF, UK. jane.noyes@bangor.ac.uk.

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.

No MeSH data available.


Related in: MedlinePlus