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Pediatric Diabetes 2014 doi: 10.1111/pedi.12198 All rights reserved
Pediatric Diabetes
Review Article
Barriers and facilitators associated with attendance at hospital diabetes clinics among young adults (15–30 years) with type 1 diabetes mellitus: a systematic review Hynes L, Byrne M, Dinneen SF, McGuire BE, O’Donnell M, Mc Sharry J. Barriers and facilitators associated with attendance at hospital diabetes clinics among young adults (15–30 years) with type 1 diabetes mellitus: a systematic review. Pediatric Diabetes 2014. Regular clinic attendance is recommended to facilitate self-management of diabetes. Poor attendance is common among young adults with type 1 diabetes mellitus (DM). This systematic review aimed to produce a narrative synthesis of the evidence regarding factors which promote or impede regular attendance at adult diabetes clinics among young adults (15–30 years) with type 1 DM. Studies reporting facilitators and barriers to clinic attendance were identified by searching four electronic databases, checking reference lists, and contacting diabetes research networks. A total of 12 studies (8 quantitative and 4 qualitative) met the inclusion criteria. Young adult’s experiences transitioning from paediatric to adult diabetes care can influence attendance at the adult clinic positively if there is a comprehensive transition programme in place, or negatively if the two clinics do not communicate and provide adequate support. Post-transition, relationship development and perceptions of the value of attending the clinic are important for regular attendance. Controlled research is required to better understand decisions to attend or not attend outpatient services among people with chronic conditions. Service delivery must be sensitive to the developmental characteristics of young adults and tailored support may be required by young adults at greatest risk of non-attendance.
The competing distractions of young adulthood, such as attending university or moving away from home, often interfere with the requirements of successful diabetes management, including the establishment and maintenance of consistent contact with the adult diabetes service (1, 2). It is recommended that adults with type 1 diabetes mellitus (DM) attend between two and four medical appointments annually (3). Achievement of this recommendation is particularly important among young adults. Yet considerable variation in attendance rates is regularly reported, for example, attendance across four clinics, 2 years after
Lisa Hynesa , Molly Byrnea , Sean F Dinneenb , Brian E ´ O’Donnellb McGuirec , Maire and Jennifer Mc Sharrya a School of Psychology, Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland; b School of Medicine, National University of Ireland, Galway, Ireland; and c School of Psychology and Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
Key words: clinic attendance – transition – type 1 diabetes mellitus – young adults Corresponding author: Lisa Hynes, School of Psychology, AMBE, National University of Ireland, University Road, Galway, Ireland. Tel: 35391493101; E-mail: [email protected] Submitted 13 March 2014. Accepted for publication 1 July 2014
transition to adult care varied from 29 to 71% in one study (4). Currently, service provision may not reflect an understanding of the complex needs of this group (1, 5, 6). Clinic attendance is important during this developmental stage as behaviours which are commonly associated with young adults may expose individuals with type 1 DM to a greater risk of harm (7). Despite the increased risk, rates of smoking and alcohol consumption are roughly equivalent among young adults with and without type 1 DM (8). The demands of work or college, changes in levels of
1
Hynes et al. physical activity, varying motivation for self-care, and differing dietary patterns have also been reported as barriers to self-care among young adults (8). Thus, in addition to the fundamental considerations of diabetes care, the adult diabetes clinic has an important role to play in risk minimisation, and providing education and support which is developmentally appropriate (1). A minority of adolescents aged 13–19 maintain glycaemic control in line with the American Diabetes Association recommended level of
Pediatric Diabetes 2014 doi: 10.1111/pedi.12198 All rights reserved
Pediatric Diabetes
Review Article
Barriers and facilitators associated with attendance at hospital diabetes clinics among young adults (15–30 years) with type 1 diabetes mellitus: a systematic review Hynes L, Byrne M, Dinneen SF, McGuire BE, O’Donnell M, Mc Sharry J. Barriers and facilitators associated with attendance at hospital diabetes clinics among young adults (15–30 years) with type 1 diabetes mellitus: a systematic review. Pediatric Diabetes 2014. Regular clinic attendance is recommended to facilitate self-management of diabetes. Poor attendance is common among young adults with type 1 diabetes mellitus (DM). This systematic review aimed to produce a narrative synthesis of the evidence regarding factors which promote or impede regular attendance at adult diabetes clinics among young adults (15–30 years) with type 1 DM. Studies reporting facilitators and barriers to clinic attendance were identified by searching four electronic databases, checking reference lists, and contacting diabetes research networks. A total of 12 studies (8 quantitative and 4 qualitative) met the inclusion criteria. Young adult’s experiences transitioning from paediatric to adult diabetes care can influence attendance at the adult clinic positively if there is a comprehensive transition programme in place, or negatively if the two clinics do not communicate and provide adequate support. Post-transition, relationship development and perceptions of the value of attending the clinic are important for regular attendance. Controlled research is required to better understand decisions to attend or not attend outpatient services among people with chronic conditions. Service delivery must be sensitive to the developmental characteristics of young adults and tailored support may be required by young adults at greatest risk of non-attendance.
The competing distractions of young adulthood, such as attending university or moving away from home, often interfere with the requirements of successful diabetes management, including the establishment and maintenance of consistent contact with the adult diabetes service (1, 2). It is recommended that adults with type 1 diabetes mellitus (DM) attend between two and four medical appointments annually (3). Achievement of this recommendation is particularly important among young adults. Yet considerable variation in attendance rates is regularly reported, for example, attendance across four clinics, 2 years after
Lisa Hynesa , Molly Byrnea , Sean F Dinneenb , Brian E ´ O’Donnellb McGuirec , Maire and Jennifer Mc Sharrya a School of Psychology, Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland; b School of Medicine, National University of Ireland, Galway, Ireland; and c School of Psychology and Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
Key words: clinic attendance – transition – type 1 diabetes mellitus – young adults Corresponding author: Lisa Hynes, School of Psychology, AMBE, National University of Ireland, University Road, Galway, Ireland. Tel: 35391493101; E-mail: [email protected] Submitted 13 March 2014. Accepted for publication 1 July 2014
transition to adult care varied from 29 to 71% in one study (4). Currently, service provision may not reflect an understanding of the complex needs of this group (1, 5, 6). Clinic attendance is important during this developmental stage as behaviours which are commonly associated with young adults may expose individuals with type 1 DM to a greater risk of harm (7). Despite the increased risk, rates of smoking and alcohol consumption are roughly equivalent among young adults with and without type 1 DM (8). The demands of work or college, changes in levels of
1
Hynes et al. physical activity, varying motivation for self-care, and differing dietary patterns have also been reported as barriers to self-care among young adults (8). Thus, in addition to the fundamental considerations of diabetes care, the adult diabetes clinic has an important role to play in risk minimisation, and providing education and support which is developmentally appropriate (1). A minority of adolescents aged 13–19 maintain glycaemic control in line with the American Diabetes Association recommended level of
