Demonstrating competence: a qualitative study of diabetes management during adolescence

This study utilized a qualitative approach to examine the experience of managing diabetes from an adolescent perspective. The primary goal of this study was to suggest an alternative to the prevailing compliance/adherence paradigms found in the literature. Interview data collected from 11 adolescents, who have type 1 diabetes mellitus, were analyzed using grounded theory methodology. Data analysis revealed a core phenomenon, conceptualized as demonstrating competence, which defined the transitional process adolescents go through to assume increasing responsibility for their diabetes management. The model proposes that once adolescents acquire basic foundational knowledge about diabetes, they become increasingly more engaged in the process of managing their diabetes. Many intervening conditions, including internal, interpersonal, situational/environmental, and treatment factors, influence how adolescents manage their diabetes. These intervening conditions either facilitate the adolescent’s diabetes management or act to inhibit it. Consistently poor diabetes management results in a lack of demonstrated competence that is manifested in self-doubt in the adolescent and communicates to others that the adolescent is not ready to assume responsibility for diabetes management. The model predicts that the consequence for adolescents who demonstrate low competence is low autonomy with regard to performing diabetes tasks, making treatment decisions, and participating in age appropriate activities. In contrast, consistently good diabetes management allows the adolescent to demonstrate competence, which instills a sense of self-confidence within the individual and communicates to others that the adolescent is ready to mange diabetes independently. As a result, the model predicts that adolescents who demonstrate competence enjoy greater levels of autonomy. The study findings are discussed in terms of the theoretical and clinical implications of the model, as well as directions for future research.