A Conceptual Model for Understanding the Division and Transfer of Diabetes Care Responsibilities Between Parents and Children with Type 1 Diabetes

Abstract

Background/Objectives: For families with a child with type 1 diabetes, it is often complex and challenging to decide how responsibilities for diabetes care should be divided between parents and children, and how and when these responsibilities should be transferred from parent to child. A smooth transfer of responsibilities is assumed to be key for optimal diabetes outcomes and a successful shift from paediatric to adult health care. However, a theoretical framework to conceptualise the division and transfer of diabetes care responsibilities that brings together the scattered literature regarding these topics is still lacking. Methods: This narrative review synthesises insights from (a) prior quantitative and qualitative studies in the context of paediatric diabetes care, (b) prior reviews regarding the transfer of treatment responsibilities for families of children with a chronic condition, and (c) existing theoretical models in paediatrics, child development and parenting. Results: The division of responsibilities appears to be affected by a complex interaction between child, parent and context characteristics. These factors seem to change the division of diabetes care responsibilities by affecting (1) child/parental readiness to assume responsibility, (2) the alignment between the child's and the parent's readiness and (3) context support and demands. The "success" of the division and transfer of diabetes care responsibilities can be defined by biomedical, emotional, behavioural and parent-child interaction outcomes. Conclusions: The presented conceptual framework can guide research and clinical practice in studying and evaluating the division and transfer of diabetes care responsibilities.

Keywords: diabetes; paediatric; responsibility; review; self-care; transfer.

Figure 1

Proposed model to conceptualise the division of diabetes care responsibilities. In order to address the complexity of this process, bidirectional arrows were added between child, parent and context characteristics.