THE DEVELOPMENT OF THE HEALTH COMPETENCES OF CHILDREN WITH DIABETES MELLITUS IN DIVERSE ENVIRONMENTS

Abstract

Diabetes mellitus is a disease during which certain processes in the body which maintain a normal blood glucose concentration become imbalanced. With diabetes, the level of blood glucose increases, affecting the entire metabolism. Diabetes mellitus is becoming a leading disease in paediatric endocrinology, and causes health problems and complications that can shorten life expectancy. In Lithuania, cases of type 1 diabetes mellitus in children have been registered since 1983. More than 995 children and young people (up to 19 years of age) were registered in 2019. On average, more than 80 children are diagnosed with diabetes in the country per year. After  10–20 years, poorly controlled diabetes can cause damage not only to the endocrine system, but also to other bodily systems: it can cause the appearance of diabetic retinopathy, diabetic neuropathy, chronic kidney disease, cardiovascular diseases (stroke, ischemic heart disease, peripheral vascular diseases), infertility problems, and foot complications. Moreover, in order to keep glucose levels as optimal as possible, children with diabetes need daily insulin injections, as without them they are not able to survive. Diabetes mellitus becomes a challenge for the whole family, as the rhythm of family life changes and additional responsibilities to maintain the stability of the child’s health are assumed. In order to control the disease, children and their parents need information, skills and values that can be acquired in various educational environments. Research conducted in Lithuania and abroad is focused on the treatment of patients with diabetes, disease management, and the psychological problems experienced by parents who have learned about their child’s illness. Nonetheless, this topic has not been extensively studied from an educational perspective, and there is a lack of research that analyses the diversity of environments in which the health competences of children with diabetes mellitus can be developed. Researchers note that the involvement of children with diabetes in the process of health competence development as well as their acquisition of knowledge and skills depend on their educational environments. By providing educational functions, the shapers of educational environments convey knowledge regarding health competence, teach, offer advice and demonstrate the necessary skills, as well as form value attitudes that help children and their parents to achieve better control of the disease, which is the goal of secondary prevention. Thus, the diversity of environments for the development of health competences helps parents and their children to learn as much as possible about this chronic disease and acquire skills that enable them to properly manage its consequences. However, not all environments for the development of health competences encourage their development. Accordingly, this article aims to reveal the development of the health competences of children with diabetes mellitus in various environments.      The research object is the development of the health competences of children with diabetes mellitus in various environments. The aim of the article is to reveal the development of the health competences of children with diabetes mellitus in various environments. Tasks: 1. Highlight the importance of the educational environment for education. 2) Identify environments for the development of children’s health competences. 3) Reveal how and in which environments children with diabetes mellitus develop health competences. Research questions: 1. What environments exist for the development of the health competences of children with diabetes mellitus? 2. What health competence aspects do children with diabetes mellitus develop in various environments? 3. Which educational environments are the most acceptable for children and why? Research methods. Theoretical – the analysis, summarization and systematization of scientific literature methods were used; empirical – the semi-structured interview method was used for data collection; the content analysis method was applied for the analysis of research data. Research context and participants. Semi-structured interviews with children with diabetes mellitus were conducted in the period from 5 February 2019 to 1 September 2021. Children were chosen because their health states depended on their health competences (knowledge, skills and value attitudes). In total, 7 children (4 girls and 3 boys) aged from 12 to 16 with diabetes mellitus agreed to participate in the qualitative research. The children had been diagnosed from 1 to 7 years ago and were selected according to the following criteria: 1) children with diabetes mellitus; 2) children with diabetes mellitus aged from 7 to 18 years. The analysis of the experiences of children with diabetes mellitus who participated in the research allowed six environments for the development of children’s health competences to be distinguished: medical institutions; family environments; summer/health camps; self-directed learning environments; social media; and environments involving other people with similar issues. However, it is not only the diversity of environments for the development of health competence that is important, but also how different environments encourage children with diabetes mellitus to get involved and actively develop their health competences. The analysis of research data on the importance of environments for the development of health competences in children with diabetes mellitus allowed four factors to be distinguished. The research results show that it is important for children that their educational environment: is safe and cosy; provides them with the opportunity to reveal their personalities, be themselves and express their thoughts; enables them to develop through experiences; and is organised in a manner that motivates children and includes interesting activities and creative methods. Conclusions: 1. Children with diabetes mellitus find the diversity and availability of educational environments important, since diabetes is a chronic disease and needs to be extensively controlled to avoid possible complications in the future. It is easier for children with diabetes to get involved in the process of health competence development when interesting and relevant topics are discussed, when there is mutual encouragement and interaction between the participants of the educational process, and when the child can actively engage and learn. 2. Empirical research established that children with diabetes mellitus can acquire health competences in the following environments: medical institutions; family environments; summer/health camps; self-directed learning environments; social media; and environments involving other people with similar issues. In these environments, children receive knowledge regarding type 1 diabetes mellitus, develop skills that help them to control this chronic disease, and form value attitudes and understand that health is the most important thing. 3. The research identified that it is important for children with diabetes mellitus to create various educational environments where they can fully understand their disease.