The transition from children's to adult diabetes services: understanding the 'problem'.
OBJECTIVE
The importance of getting transition right for young people with diabetes is increasingly recognized and a strong professional consensus has emerged on best practice in this domain. Research evidence to inform the design of transitional healthcare services is weak, however, and prevailing views about 'the problem of transition' are based on a number of assumptions about adolescence, adulthood and chronic disease management which have been accepted uncritically.


METHODS
Drawing on youth studies and the sociology of chronic disease management, in this paper we describe how 'the problem of transition' has been defined in the professional and UK policy literature and examine the assumptions that underpin it.


RESULTS
We argue that the overwhelming emphasis is on how best to support young people in fitting in with the healthcare system. This has produced an orientation which is more concerned with supporting young people in the process of becoming adults rather than giving attention to their contemporaneous experiences and needs. Two years after the introduction of the UK National Service Framework for diabetes, the challenge of transitional services remains.


CONCLUSIONS
We suggest that the time has come to consider alternative formulations of the 'problem'. Rather than asking how best to manage transition, we might ask how best to meet the needs of young people with diabetes at this stage of the life course. This requires an understanding of their experiences, the social networks in which they are embedded and consideration of how self-management might be supported by the healthcare system.
Allen
D
D
Nursing and Midwifery Studies, Cardiff University, Cardiff, UK. allenda@cf.ac.uk
Gregory
J
J
D000293:Adolescent; D000328:Adult; D002648:Child; D003266:Continuity of Patient Care; D003695:Delivery of Health Care / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000628:therapy*; D006291:Health Policy; D006296:Health Services; D006801:Humans; D020380:Needs Assessment; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D012648:Self Care; D006113:United Kingdom; D055815:Young Adult