title: 'It makes a difference, coming here': A qualitative exploration of clinic attendance among young adults with type 1 diabetes.
abstract: OBJECTIVE
  Young adulthood is a time of significant challenges and risks for people with type 1 diabetes. Poor outpatient clinic attendance is common among young adults with type 1 diabetes. The aim of this qualitative study was to develop a theory explaining attendance at a hospital-based diabetes clinic.
  
  
  METHODS
  Using a grounded theory methodology, data were collected through semi-structured qualitative interviews.
  
  
  METHODS
  Twenty-nine people (21 young adults with type 1 diabetes and eight service providers) from one hospital-based diabetes clinic were interviewed. Interviews were audio-recorded, transcribed, and analysed according to grounded theory methodology.
  
  
  RESULTS
  Relationships between young adults and service providers is the core category of this theory. Collaborative relationships between young adults and service providers increased the perceived value of attendance and reduced the vulnerability of young adults to the barriers within the existing service, such as meeting unfamiliar service providers. Relationships between young adults and service providers were developed following opportunities for contact (e.g., structured education programme or crisis of diabetes), and facilitated engagement with the service and further attendance. Barriers to clinic attendance included young adults' negative perceptions of their diabetes self-management and a lack of value associated with attending.
  
  
  CONCLUSIONS
  The diabetes clinic was described as an important and valued resource by young adults and service providers. Collaborative relationships between young adults and service providers enhanced service provision in this study. According to the results of this study, clinic attendance may be improved by increasing opportunities for relationship development between service providers and young adults. Statement of contribution What is already known on this subject? Attendance by young adults at hospital-based diabetes clinics is important to support self-management. Young adults with type 1 diabetes are at risk of clinic non-attendance. What does this study add? This study presents an explanatory theory of clinic attendance among young adults with type 1 diabetes. According to this theory: Barriers within existing models of service delivery prevent collaboration and may contribute to non-attendance. Relationships between service users and providers can establish or maintain regular clinic attendance by fostering the engagement of young adults with diabetes clinics.
authors.affiliation: School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hynes
authors.affiliation: School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Molly
authors.initials: M
authors.lastname: Byrne
authors.affiliation: School of Nursing and Midwifery, National University of Ireland, Galway, Ireland.
authors.forename: Dympna
authors.initials: D
authors.lastname: Casey
authors.affiliation: School of Medicine, National University of Ireland, Galway, Ireland.|Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland.
authors.forename: Sean F
authors.initials: SF
authors.lastname: Dinneen
authors.affiliation: School of Medicine, National University of Ireland, Galway, Ireland.|Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland.
authors.forename: Mary Clare
authors.initials: MC
authors.lastname: O'Hara
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology* / Q000628:therapy; D005260:Female; D066296:Grounded Theory; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010349:Patient Compliance / Q000523:psychology; D055815:Young Adult
keywords: clinic attendance; transition; type 1 diabetes; young adults