‘sociocultural’ context in Sri Lanka were hardly found in the literature. An examination of associated characteristics of self-care and metabolic control had not been adequately studied in Sri Lanka.
The sociocultural background which a patient lives is mostly connected with his or her perceptions. An examination on the “illness perceptions of both parents and adolescents and their perceptions on diabetes management are crucial aspects in the management of the disease. Different perceptions between adolescents and parents result in conflicts in the management of diabetes. The adolescents had more positive perceptions related to the illness than their parents (Amer, 2008 Herman, 2006). The nature of cognition among adolescents, according to their development stage might be the reason for the results. The state of the perceptions of the illness between Sri Lankan adolescents and their parents had not been studied. An in-depth assessment on this field is beneficial in planning the nursing care effectively.
Life experience in School is a dynamic learning process related to diabetes management. The interaction between peer groups and school teachers may influence the performance of self-care practices in school. The children and adolescents with T1 DM should exhibit more independent self-care practices and autonomy during the school period than the period they spend at home. The academic and school environment in Sri Lanka seems to be a unique experience in the Sri Lankan culture. The behaviour of the school children seems to have a great effect on the outcome of diabetes. However, scientific studies were hardly found in this area in Sri Lanka. This facet is considered to be a vital view point in the future studies in Sri Lanka.
On the other hand, the children and adolescents are required to spend many hours in the school. The support received from school significantly and directly affects self-care behavior and life satisfaction (Tang et al 2013). The school based live experiences in Thaiwanese adolescents with T1 DM showed multiple factors which threatened the health and wellbeing of children at school including disease identification, social anxiety, ignorance of school personnel, classmates and transition to independent health management (Wang et al, 2013). School health nurses are not recruited in Sri Lanka. The school environment of children and adolescents with T1 DM has not been scientifically studied by any researcher in Sri Lanka. The lack of school health programs and easily approachable regular diabetic health camps are some of the negative aspects in the management of the disease.
Family behaviour makes strong effects towards coping with chronic illnesses. Although the existing literature frequently discusses the self-care practices in relation to family functioning, such practices are rarely seen in Sri Lanka.
None of the available studies have discussed the aspect of self-care and sharing of responsibilities among the adolescents with T1 DM in Sri Lanka. Only two ethnographic studies were found related to ‘diabetes’ and ‘Sri Lankan cultural context’. Both of them were type 2 diabetes oriented studies. One has explored the health care behavior of Sri Lankan Buddhist nuns (Idampitiya et al, 2013) while the other one has examined the health beliefs and practices related to diabetes among Sri Lankan adults (Amerasekera et al, 2014).
Parents and members of the family are the most intimate people to children and adolescents in the Sri Lankan context. They engage greatly in diabetes management activities with children and adolescents. The process of sharing responsibilities in diabetes management from parents to children has occurred in the adolescence period. The scientific evaluation of this area is vital to organize a nursing care plan for children and adolescents with T1 DM.
1:3 Significance of the study
Effective self-management of diabetes can be a significant contributor to long-term, positive health outcomes. American Diabetes Association (ADA) suggested that the self-management of youth with T1DM should be evaluated in the clinical context as it is an important component of diabetes care. (ADA, 2012). More studies are required that would focus on the self-care capabilities of children in the school age, the transition of responsibilities between parents and children, the educational role of the health care teams in diabetes care and the effectiveness of different types of education systems (Kelo et al, 2011). Helgeson et al, 2007 suggested about future research which would investigate the sharing of responsibilities in families that would help in designing interventions to optimize shared responsibility in families of children with diabetes during adolescence. The process of how youth and their parents share responsibilities for the management of the illness is not known clearly. The growing body of literature is not sufficient in this area (Schilling et al, 2006). This study will mainly follow the process of sharing self-care responsibilities among children with T1 DM. It fills an important gap in the literature by examining the sharing of responsibilities from parent to adolescents considering the social and cultural background in Sri Lanka.
Understanding the nature of sharing self –care responsibilities may help nurses to provide more targeted assistance to adolescents with diabetes and their parents. (Schilling et al, 2006) The proposed scientific study attempts to understand the self- care of adolescents and the responsibility sharing process within the Sri Lankan context. This effort facilitates proper direction to play the role of parents effectively. It will identify the strategies to support, educate and facilitate the movement of diabetic self-care activities from the domains of parents to shared (parent – adolescent) domain or the domains of adolescent by appropriately considering the socio- cultural nature of Sri Lanka. The findings of this study will be useful for the effective management of the disease.
Academic contribution of the proposed study is considerably high similar to the contribution of nursing care of the adolescents with T1 DM. This will facilitate further research studies to identify significant study areas in this field. The implication of this study shows the development of academic fields as well as the clinical field related to nursing. As the proposed study utilizes the self-care deficit theory of Orem, the theoretical knowledge in the practice will improve. This theory is based on findings that will be beneficial to clinical practice of nursing and nursing education. This study will be a foundation for research development in the area of self-care in adolescents with T1 DM. Further, the application of Sunrise Model of Leningers provides a foundation for consideration of transcultural nursing. The provision of details related to nursing care considering specific cultural aspects is beneficial to expand the holistic care approach of the patients with chronic conditions.
The implication of the current study will be contributed in several areas such as (a) management of the disease in adolescents with T1 DM; (b) parents and family members to facilitate proper directions to improve self-care considering their specific socio-cultural context; (c) the understanding of sharing self -care process which will facilitate to follow an effective management and caring for diabetes teams/ health care providers; (d) for nurses to identify the nursing diagnoses by proper identification of self-care deficits and to plan effective nursing care for the adolescents with T1 DM; (e) for nursing educators to guide nursing students related to the nursing care of adolescents with T1 DM and the applications of self-care deficit theory of Orem for nursing management of the chronic illness in the clinical practices; (f) to encourage nursing researchers to do further research studies in this area; (g) nursing profession to develop nursing discipline by improving scientific knowledge and scientific studies and (h) giving benefits for the whole society by addressing health issues in most significant aspects in the society.
1:4 Problem Statements
The cultural and social background in the Sri Lankan family system is unique. The children and adolescents are closely bound to their parents and other family members within the Sri Lankan family system. The national survey on “Emerging issues among adolescents in Sri Lanka” identified a strong influence between family and adolescents. School adolescents (10-14 years) are very close to their family (60%). A larger population was proud of their family. 32% of out of school adolescents (15-19 years) saw their family as caring and warm. 75% of adolescents thought they could depend on their families. (Thalagala et al 2004). It is generally seem that the adolescents with T1 DM are not very capable and independent with diabetes management self-care tasks in Sri Lanka. However, it has not been studied scientifically. Basic conditioning factors associated with self-care behavoiur (Orem, 2001) shows that the self-care behavior and sharing of self-care responsibilities are influenced by the socio-demographic and cultural factors in the Sri Lankan context. The Sri Lankan socio-cultural factors might influence in a different manner as it is unique. There are no scientific studies available in this area and no specific recommendations on the process of sharing diabetes care responsibilities for self-care of adolescents considering the Sri Lankan socio- cultural context were made. The self-care behavior and the pattern of sharing self- care responsibilities among the adolescents with T1 DM were not scientifically studied within the Sri Lankan socio-cultural context.
The cultural beliefs, customs, folk practices and habits influence the day today living activities of people. Adolescents who diagnosed T1 DM have to adhere with many self-care activities relevant to the management of the disease. Their activities of daily living cannot be excluded from the self-care activities of diabetes management. Dietary management, physical activities and exercise, multiple doses of insulin, continuous follow up care, complications, preventive measures are lifelong activities which should be accomplished by the adolescents with T1 DM. Self-care behaviour of patients is influenced by their perceptions, believes, values and external cultural environment. The family system in Sri Lanka, religions, beliefs and practices influence the views of health care, health practices, hospitalization and long term care in chronic diseases such as T1 DM.
A holistic health belief system incorporates the physical, spiritual, religious and dietary practices of a specific culture. Perceptions of health and illness, hospitalization, meaning of living with a chronic disease, dietary & daily living habits, alternative health care therapies and spiritual interventions are incorporated with self-care behavior of patients with diabetes. Perceptions on the causes of the illness, health seeking behavior , understanding the process of the disease and treatments, interaction with the health care system & health care professionals, behaviour relevant to the disease and health decision making are influenced by a particular living culture.
The holistic approach of nursing care emphasizes achieving the goals to meet specific need s of the patients. Provision of nursing care for the adolescent with T1 DM should focus on the self-care behaviour of the patients considering their specific culture. Further, adolescents are in a transition stage. The effect of cultural background towards the diabetes self-care might be specific due to the physical, cognitive, social and spiritual uniqueness of the adolescents. The nursing care should be sensitive to cultural dimensions which influence self-care behaviour of diabetes. However, little is known in the literature about the self-care behaviour among the adolescents with T1 DM within the Sri Lankan socio-culture context. Although this aspect is vital in the provision of nursing care, the scientific studies in this area are not found in the literature. The current study provides prompt scientific assessments and exploration of self-care behaviour among the adolescents with T1 DM with the sensitivity of Sri Lankan socio-cultural context.