title: Adolescents developing life skills for managing type 1 diabetes: a qualitative, realistic evaluation of a guided self-determination-youth intervention.
abstract: OBJECTIVE
  To explore and illustrate how the Guided Self-Determination-Youth method influences the development of life skills in adolescents with type 1 diabetes supported by their parents and healthcare providers.
  
  
  BACKGROUND
  Evidence-based methods that accomplish constructive cooperation between adolescents with poorly controlled type 1 diabetes, their parents and healthcare providers are needed. We adjusted an adult life skills intervention comprising reflection sheets and advanced communication for use by adolescent-parent-professional triads in outpatient visits.
  
  
  METHODS
  A qualitative realistic evaluation design comprising eight context-mechanism-outcome configurations directed the analysis of the Guided Self-Determination-Youth's influence on adolescent-parent-professional triads to evaluate what worked for whom, how and in what circumstances. Thirteen adolescents aged 13-18 years diagnosed with type 1 diabetes for ≥1 year and having poor glycaemic control participated together with 17 parents and eight healthcare providers. Data were collected from December 2009-March 2012 and consisted of digitally recorded outpatient Guide Self-Determination-Youth visits collected during the intervention period (11·5-24·5 months) and semi-structured interviews at 6-month follow-up.
  
  
  RESULTS
  Emerging life skills in adolescents were identified as: (1) developing new relatedness with healthcare providers and parents; (2) becoming decision makers in their own lives with diabetes; and (3) growing personally. Reflection sheets combined with healthcare providers' advanced communication were central to promoting mutual problem-solving.
  
  
  CONCLUSIONS
  A life skills approach turned outpatient visits into person-specific visits with improved cooperation patterns in the triads. Combining reflection sheets and advanced communication skills supported adolescents in beginning a process of developing life skills.
authors.affiliation: The Paediatric Department, Nordsjaellands Hospital Hillerød, University of Copenhagen, Denmark.
authors.forename: Gitte R
authors.initials: GR
authors.lastname: Husted
authors.forename: Bente Appel
authors.initials: BA
authors.lastname: Esbensen
authors.forename: Eva
authors.initials: E
authors.lastname: Hommel
authors.forename: Birger
authors.initials: B
authors.lastname: Thorsteinsson
authors.forename: Vibeke
authors.initials: V
authors.lastname: Zoffmann
mesh_terms: D000293:Adolescent; D000818:Animals; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D006801:Humans; D036301:Qualitative Research; D011817:Rabbits; D012648:Self Care; D020377:Self Efficacy
keywords: adolescents; autonomy-supportive intervention; decision-making; nursing; outpatient clinic; type 1 diabetes