The division and transfer of care responsibilities in paediatric type 1 diabetes: A qualitative study on parental perspectives.
Jori Aalders, Esther Hartman, Frans Pouwer and 6 others
PMID 33591623WHAT IT FOUND
Parents of children with diabetes described transferring care as ongoing and uneven, not a one-time handover.
Age alone did not fit all families; recent lows, technology, child confidence and parent fears shaped who remembered, decided and performed tasks.
Key findings
01Transfer was experienced as a dynamic process with ups and downs, and parents repeatedly took back responsibilities they had previously given to the child.
02Parents often remembered and decided about diabetes tasks, while children mainly performed tasks; older children took more responsibility for deciding, informing others and giving insulin.
03Factors beyond age shaped transfer, including severe or unstable glucose values, hypoglycaemia awareness, sensor use, memory or developmental difficulties, child motivation, parental fear of letting go, and whether parents were nearby.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Small sample of 18 parents from mainly highly educated, working, intact Dutch families, so findings may not apply to other backgrounds. Only one parent per family was invited, and most participants were mothers, so the other parent's view and family negotiation were not fully captured. Children were not interviewed, so their perspective was inferred from parents. Participants were only parents of children aged 9 to 14 years, so younger and older adolescents were not represented. Dropout after consent was substantial, and responders were not compared with nonresponders, so selection bias is likely. The study reports themes and factors, not measured effects, and cannot show that any factor or behaviour improves diabetes outcomes. Some factors, such as autism, were present in only one family, and factors were described separately although they interacted. The sample was Dutch and recruitment occurred in hospitals and specialised centres, limiting transferability to other settings.
Declared interests
The authors declared no conflict of interest. The study was funded by the Dutch Research Council (NWO).
The easy way to misread this
Do not treat the listed factors as proven causes of better diabetes control or as evidence that a specific transfer strategy works. The study describes parents' views in a small, selective sample and did not test interventions or measure clinical outcomes.