Family responsibility dynamics for young adults in transition to adult health care


Aim: To explore family responsibility dynamics, metabolic control, clinic attendance, and emergency admissions when young adults (YA) with type 1 diabetes transition to an adult hospital. Method: A longitudinal mixed method design with two study groups (parents, n = 28; YA intervention group, n = 23) and a YA comparison group (n = 20). Sample recruited from an outpatient diabetes centre. Demographic, clinic attendance, emergency admissions, biodata, and the Diabetes Family Responsibility Questionnaire (DFRQ) were completed on entry and sixmonths later as part of an 18-month trial of a diabetes transition coordinator (DTC). The selfreport DFRQ were analyzed using derived parent-child dyadic variables to explore differences at baseline and end of study using Wilcoxon Signed Rank Test. The relationship between metabolic control and the DFRQ patterns was explored using Spearman’s rho. Results: On completion of the study, the change in HBA1Cfor both adolescent groups was not significant but was less than ideal for 25% of adolescents in the study. The YA intervention group had significantly fewer missed appointments between them compared to the comparison group. The DFRQ indicated that the derived parent-child dyadic variable of task-discordance increased during the study. Conclusion: The clinically relevant diabetes-task dissonance between parents and young adults offers a challenge and a diagnostic opportunity for diabetes educators.

Share and Cite:

Rapley, P. , Babel, G. , Kaye, J. and Brown, S. (2013) Family responsibility dynamics for young adults in transition to adult health care. Journal of Diabetes Mellitus, 3, 139-144. doi: 10.4236/jdm.2013.33021.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Johnson, G. (2010) National policy priorities 2010: Towards better management and prevention of diabetes for all Australia. Conquest, Winter, 30-31.
[2] Pacaud, D. (2005) Editorial commentary. Bridge over troubled water: Improving the transition from pediatric to adult care. The pediatric perspective. Canadian Journal of Diabetes, 29, 183-184.,Blumer%20Commentaries--Bridging--Staying.pdf
[3] Reid, G., Irvine, J., McCrindle, B., et al. (2004) Prevalence and correlates of successful transfer from pediatric to adult health care among a cohort of young adults with complex congenital heart defects. Pediatrics, 113, e611-e612. doi:10.1542/peds.113.3.e197
[4] Karlsson, A., Arman, M. and Wikblad, K. (2008) Teenagers with type 1 diabetes—A phenomenological study of the transition towards autonomy in self-management. International Journal of Nursing Studies, 45, 562-570. doi:10.1016/j.ijnurstu.2006.08.022
[5] He, K., Kramer, E., Houser, R., Chomitz, V. and Hacker, K. (2004) Defining and understanding healthy lifestyle choices for adolescents. Journal of Adolescent Health, 35, 26-33. doi:10.1016/j.jado health.2003.09.004
[6] Lancaster, B.M., Pfeffer, B., McElligott, M., et al. (2010) Assessing treatment barriers in young adults with type 1 diabetes. Diabetes Research and Clinical Practice, 90, 243-249. doi:10.1016/j.dia bres.2010.07.003
[7] Anderson, B., Auslander, W., Jung, K., Miller, J.P. and Santiago, J. (1990) Assessing family sharing of diabetes responsibilities. Journal of Pediatric Psychology, 15, 477-492. doi:10.1093/jpepsy/15.4.477
[8] Anderson, B.J., Holmbeck, G., Iannotti, R.J., et al. (2009) Dyadic measures of the parent-child relationship during the transition to adolescence and glycemic control in children with type 1 diabetes. Families, Systems, & Health, 27, 141-152. doi:10.1037/a0015759
[9] Cameron, F., Skinner, T., de Beaufort, C., et al. (2008) Are family factors universally related to metabolic outcomes in adolescents with type 1 diabetes? Diabetic Medicine, 25, 463-468. doi:10.1111/j.1464-5491.2008.02399.x
[10] Vesco, A., Anderson, B., Laffel, L., Dolan, L., Ingerski, L. and Hood, K. (2010) Responsibility sharing between adolescents with type 1 diabetes and their caregivers: Importance of adolescent perceptions on diabetes management and control Journal of Pediatric Psychology, 35, 1168-1177. doi:10.1093/jpepsy/jsq038
[11] Field, A. (2005) Reliability analysis. In: Field, A., Ed., Discovering Statistics Using spss. 2nd Edition, Sage, London, Chapter 15.
[12] Lance, C., Butts, M. and Michels, L. (2006) The sources of four commonly reported cutoff criteria: What did they really say? Organizational Research Methods, 9, 202-220. doi:10.1177/10944 28105284919
[13] Nunnally, J. and Bernstein, I. (1994) Psychometric theory. 3rd Edition, McGraw-Hill, New York.
[14] Rapley, P., Hart, L., Babel, G. and Kaye, J. (2007) Young adults transferring to a young adult diabetes clinic: Hba1c and missed appointments. Australian Diabetes Educator, 10, 8, 10-12, 30.
[15] Gholap, N., Pillai, M., Virmani, S., et al. (2006) The alphabet strategy and standards of care in young adults with type 1 diabetes. The British Journal of Diabetes & Vascular Disease, 6, 168-170. doi:10.1177/14746514060060040401
[16] Holmes-Walker, D., Llewellyn, A. and Farrell, K. (2007) A transition care programme which improves diabetes control and reduces hospital admission rates in young adults with type 1 diabetes aged 15-25 years. Diabetic Medicine, 24, 764-769. doi:10.1111/j.1464-5491.2007.02152.x
[17] Crowley, R., Wolfe, I., Lock, K. and McKee, M. (2011) Improving the transition between paediatric and adult healthcare: A systematic review. Archives of Disease in Childhood, 96, 548-553. doi:10.1136/adc.2010.202473
[18] Farrell, K. and Holmes-Walker, J. (2011) Maintaining outcomes after 10 years of a diabetes transition support program. Australian Diabetes Society & Australian Diabetes Education Association Annual Scientific Meeting, Perth, 31 August-2 September 2011, 2241.
[19] Beskine, D. and Owen, P. (2008) Review of transitional care for young people with diabetes. Journal of Diabetes Nursing, 12, 34-38.
[20] Grey, M., Davidson, M., Boland, E. and Tamborlane, W. (2001) Clinical and psychosocial factors associated with achievement of treatment goals in adolescents with diabetes mellitus. Journal of Adolescent Health, 28, 377-385. doi:10.1016/S1054-139X(00)00211-1
[21] Helgeson, V., Snyder, P., Seltman, H., Escobar, O., Becker, D. and Siminerio, L. (2010) Brief report: Trajectories of glycemic control over early to middle adolescence Journal of Pediatric Psychology, 35, 1161-1167. doi:10.1093/jpepsy/jsq011
[22] Allen, D., Channon, S., Lowes, L., Atwell, C. and Lane, C. (2011) Behind the scenes: The changing roles of parents in the transition from child to adult diabetes service. Diabetic Medicine, 28, 994-1000. doi:10.1111/j.1464-5491.2011.03310.x
[23] Lewin, A.B., Heidgerken, A.D., Geffken, G.R., et al. (2006) The relation between family factors and metabolic control: The role of diabetes adherence. Journal of Pediatric Psychology, 31, 174-183. doi:10.1093/jpepsy/jsj004
[24] Dashiff, C., Hardeman, T. and McLain, R. (2008) Parent-adolescent communication and diabetes: An integrative review. Journal of Advanced Nursing, 62, 140-162. doi:10.1111/j.1365-2648.2007.04549.x
[25] Ingerski, L., Anderson, B., Dolan, L. and Hood, K. (2010) Blood glucose monitoring and glycaemic control in adolescence: Contribution of diabetes-specific responsibility and family conflict. Journal of Adolescent Health, 47, 191-197. doi:10.1016/j.jadohealth.2010.01.012
[26] Beléndez, M., de Wit, M. and Snoek, F.J. (2010) Assessment of parent-adolescent partnership in diabetes care: A review of measures. The Diabetes Educator, 36, 205-215. doi:10.1177/0145721709359205
[27] National Health and Medical Research Council. (2005) Clinical practice guidelines: Type 1 diabetes in children and adolescents. Department of Health and Ageing, Canberra, 315, 2169.
[28] Bryden, K., Dunger, D., Mayou, R., Peveler, R. and Neil, H.A. (2003) Poor prognosis of young adults with type 1 diabetes: A longitudinal study. Diabetes Care, 26, 1052-1057. doi:10.2337/diacare.26.4.1052
[29] Busse, F.P., Hiermann, P., Galler, A., et al. (2007) Evaluation of patients’ opinion and metabolic control after transfer of young adults with type 1 diabetes from a pediatric diabetes clinic to adult care. Hormone Research, 67, 132-138. doi:10.1159/000096583
[30] Kipps, S., Bahu, T., Ong, K., et al. (2002) Current methods of transfer of young people with type 1 diabetes to adult services. Diabetic Medicine, 19, 649-654. doi:10.1046/j.1464-5491.2002.00757.x
[31] Visentin, K., Koch, T. and Kralik, D. (2006) Adolescents with type 1 diabetes: Transition between diabetes services. Journal of Clinical Nursing, 15, 761-769. doi:10.1111/j.1365-2702.2006.01347.x
[32] Diabetes Australia (2007) National review of transitional care. Diabetes Australia and Eli Lilly, Canberra.
[33] Jones, S. and Hamilton, S. (2008) The missing link: Paediatric to adult transition in diabetes services. British Journal of Nursing, 17, 842-847.
[34] Viklund, G. and Wikblad, K. (2009) Teenagers’ perceptions of factors affecting decision-making competence in the management of type 1 diabetes. Journal of Clinical Nursing, 18, 3262-3270. doi:10.1111/j.1365-2702.2009.02963.x
[35] National Collaborating Centre for Women’s and Children’s Health (2004) Type 1 diabetes: Diagnosis and management of type 1 diabetes in children and young people. RCOG Press, London.
[36] Rapley, P. and Davidson, P.M. (2010) Enough of the problem: A review of time for health care transition solutions for young adults with a chronic illness. Journal of Clinical Nursing, 19, 313-323. doi:10.1111/j.1365-2702.2009.03027.x

Copyright © 2021 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.