Psychosocial factors of paediatric type one diabetes management: a Q-methodological study

This thesis research was completed as part of a Doctorate in Clinical Psychology at Staffordshire University by the first author. The topic was developed by the author’s experience of working therapeutically with young people with type one diabetes (T1D) and their families. Many psychosocial barriers to managing diabetes in children became quickly apparent. However, there were also many families who were doing exceptionally well at managing the disease and this sparked an interest in how they did this. Chapter 1 is a literature review of studies exploring the relationship between friendships and T1D in children. It used structured appraisal tools and applies a systematic approach to searching for the relevant research. Findings suggest mixed results regarding whether diabetes gets in the way of forming friendships and whether friends have a positive or negative impact on diabetes management. Individual and gender differences were found. Chapter two is the empirical paper which uses Q-methodology to explore which psychosocial factors are most helpful for families in managing T1D in children. Nineteen participants’ (healthcare professionals, young people with T1D and parents of children with T1D) completed Q-sorts in which they ranked 49 statements regarding things that are helpful in managing diabetes. Two factors emerged 1) relationship with the medical team and practical strategies and 2) friendships and psychological factors. Both factors agreed that involving the whole family and taking a flexible approach to parenting were helpful. The majority of parents and young people in the study loaded onto factor two, suggesting a perspective that values the involvement of the medical team and the practical support they provide. All of the most senior medical professionals and the parent who was a nurse by profession loaded onto factor two, suggesting this group place more emphasis on the resources available to young people outside of the medical team. These results have implications for Clinical Psychologists working within Paediatric Diabetes MDTs, highlighting the importance of psychology being embedded in teams to support both staff and families to navigate what is helpful to them at particular points in their journey with diabetes. Chapters 1 and 2 have been written in APA format and will be edited further to meet journal standards. Chapter 3 is a service user executive summary of the empirical study. It has simplified the technical language and formatted to be appropriate for children aged 12 and over, summarising the main points of the study.