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Fathers involved in children with type 1 diabetes: finding the balance between disease control and health promotion
University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.ORCID iD: 0000-0003-3792-6600
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background:

Type I diabetes is a chronic disease that places great demands on the child and family. Parental involvement has been found to be essential for disease outcome. However, fathers’ involvement has been less studied, even though high paternal involvement has been correlated with less disease impact on the family and higher quality of life among adolescents.

Aim: The overall aim of the study was to explore and analyze constructions of fathers’ involvement in their child’s everyday life with type 1 diabetes from an ecological and health promotion perspective. Four specific aims were applied: 1) explore and describe discourses in health care guidelines for children with type 1 diabetes in Nordic countries, focusing on parents' positioning (I), 2) analyze how Swedish pediatric diabetes teams perceived and discussed fathers’ involvement in the care of their child with type 1 diabetes, and to discuss how the teams’ attitudes toward the fathers’ involvement developed during a focus group process (II), 3) explore and discuss how fathers involved in caring for their child with type 1 diabetes experience support from their pediatric diabetes team in everyday life with their child (III), and 4) analyze how involved fathers to children with type 1 diabetes understand their involvement in their child’s daily life and to discuss their perceptions from a health promotion perspective (IV).

Material and methods: A qualitative and inductive approach was applied. Data were collected and analyzed during 2010-2012. The sample consisted of three pediatric guidelines originating from Norway, Denmark and Sweden (I), three Swedish pediatric diabetes teams (PDTs) (II), and 11 (III) and 16 (IV) fathers of children with type 1 diabetes who scored high involvement on the Parental Responsibility Questionnaire. Data were collected through repeated focus group discussions with the PDTs (II), online focus group discussions (III) and individual interviews (III, IV) with the fathers. Three analysis methods were applied: analysis of discourses (I), Constructivist Grounded Theory (II, III) and content analysis (IV).

Findings: The findings illuminated the complex interaction between the pediatric guidelines, the PDTs and the fathers. Fathers highly involved in their child’s daily life experienced different levels of tension between the general recommendations and their personal experiences of living with a child with type 1 diabetes (III). The fathers regarded their involvement in their child’s diabetes care as additional to their general parenting, and a fine balance was identified between a health promotion perspective and a controlling involvement. The common denominator between the highly involved fathers was their use of parental leave (IV). The PDTs initially perceived fathers’ involvement as gendered and balanced on the mother’s agement, but as focus was set on fathers’ engagement the PDTs increased their awareness of this and started to identify and encourage their engagement II). At the macro-level, parents’ voices were diminished in Nordic pediatric diabetes guidelines in favor of an expert discourse (I).

Conclusions: Fathers’ involvement concerning a child with type 1diabetes is constructed in a complex way, based on an interaction between the fathers’ perceptions of their additional involvement and the support provided by the PDTs; the PDTs’ perceptions of the fathers’ involvement; and how parents/fathers are constructed in pediatric diabetes guidelines. In order to promote the health and well-being of children with type 1 diabetes, fathers’ involvement needs to be taken into account in the pediatric guidelines as well as in clinical practice. 

Place, publisher, year, edition, pages
Gothenburg: Nordic School of Public Health , 2013. , 60 p.
Series
NHV rapporter, ISSN 0283-1961 ; 2013:1
Keyword [en]
children, fathers’ involvement, health promotion, pediatric diabetes team, type 1
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Public health science
Identifiers
URN: urn:nbn:se:hv:diva-5808ISBN: 978-91-86739-48-5 (print)OAI: oai:DiVA.org:hv-5808DiVA: diva2:679903
Public defence
Nordic School of Public Health, Box 12133, 402 42 Göteborg (Swedish)
Opponent
Supervisors
Available from: 2014-01-16 Created: 2013-12-17 Last updated: 2015-03-04Bibliographically approved
List of papers
1. Swedish pediatric diabetes teams' perception of fathers' involvement: A Grounded Theory study
Open this publication in new window or tab >>Swedish pediatric diabetes teams' perception of fathers' involvement: A Grounded Theory study
2013 (English)In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 15, no 2, 179-185 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to analyze how Swedish pediatric diabetes teams perceived and discussed fathers' involvement in the care of their child with type 1 diabetes. It also aimed to discuss how the teams' attitudes towards the fathers' involvement developed during the data collection process. The Constructivist Grounded Theory design was used and data were collected during three repeated focus group discussions with three Swedish pediatric diabetes teams. The core category of the teams' perception of fathers' involvement emerged as: If dad attends, we are happy – if mom doesn't, we become concerned. Initially the teams balanced their perception of fathers' involvement on the mother's role as the primary caregiver. In connection with the teams' directed attention on fathers, in the focus group discussions, the teams' awareness of the importance of fathers increased. As a consequence, the team members began to encourage fathers' engagement in their child's care. We conclude that by increasing the teams' awareness of fathers as a health resource, an active health promotion perspective could be implemented in pediatric diabetes care.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2013
Keyword
fathers' involvement, Grounded Theory, health promotion, pediatric diabetes teams, type 1 diabetes
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Public health science
Identifiers
urn:nbn:se:hv:diva-5731 (URN)10.1111/nhs.12011 (DOI)000319879100007 ()23167983 (PubMedID)2-s2.0-84878792528 (Scopus ID)
Available from: 2013-11-13 Created: 2013-11-13 Last updated: 2017-12-06Bibliographically approved
2. Fathers' encounter of support from paediatric diabetes teams: the tension between general recommendations and personal experience
Open this publication in new window or tab >>Fathers' encounter of support from paediatric diabetes teams: the tension between general recommendations and personal experience
Show others...
2013 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 21, no 3, 263-270 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this grounded theory study was to explore and discuss how fathers involved in caring for a child with type 1 diabetes experienced support from Swedish paediatric diabetes teams (PDTs) in everyday life with their child. Eleven fathers of children with type 1 diabetes, living in Sweden and scoring high on involvement on the Parental Responsibility Questionnaire, participated. Data were collected from January 2011 to August 2011, initially through online focus group discussions in which 6 of 19 invited fathers participated. Due to high attrition, the data collection continued in eight individual interviews. A semi-structured interview guide was used, and the fathers were asked to share experiences of their PDT's support in everyday life with their child. A simultaneous and constant comparison approach to data collection and analysis allowed the core category to emerge: the tension between general recommendations and personal experience. This core category illuminates how the fathers experienced tension between managing their unique everyday life with their child and balancing this to meet their PDT's expectations with regard to blood glucose levels. The core category was supported by two categories: the tension between the fathers'and their PDT's knowledge, whereby fathers reported discrepancies between their PDT's medical knowledge and their own unique knowledge of their child; and the tension between the fathers'and their PDT's goals, whereby the fathers identified differences between the familys' and their PDT's goals. As a dimension of the core category, fathers felt trust or distrust in their PDT. We conclude that to achieve high-quality support for children with diabetes and to enhance their health and well-being, involved fathers' knowledge of their unique family situation needs to be integrated into the diabetes treatment.

Place, publisher, year, edition, pages
United Kingdom: Wiley-Blackwell, 2013
Keyword
family health practice, health promotion, involved fathers, paediatric diabetes team, type 1 diabetes
National Category
Medical and Health Sciences
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Public health science
Identifiers
urn:nbn:se:hv:diva-4946 (URN)10.1111/hsc.12013 (DOI)000317076400005 ()2-s2.0-84875809888 (Scopus ID)
Available from: 2012-12-26 Created: 2012-12-26 Last updated: 2017-12-06Bibliographically approved
3. Parents' discursive resources: Analysis of discourses in Swedish, Danish and Norwegian health care guidelines for children with diabetes type 1
Open this publication in new window or tab >>Parents' discursive resources: Analysis of discourses in Swedish, Danish and Norwegian health care guidelines for children with diabetes type 1
2012 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 2, 363-371 p.Article in journal (Refereed) Published
Abstract [en]

The incidence of diabetes type 1 in children, the most common metabolic disorder in childhood, increases worldwide, with highest incidence in Scandinavia. Having diabetes means demands in everyday life, and the outcome of the child's treatment highly depends on parents' engagement and involvement. The aim of this study was to explore and describe discourses in health care guidelines for children with diabetes type 1, in Sweden, Norway and Denmark during 2007-2010, with a focus on how parents were positioned. As method a Foucauldian approach to discourse analysis was applied, and a six-stage model was used to perform the analysis. The findings shows a Medical, a Pedagogic and a Public Health discourse embedded in the hegemonic Expert discourse. The Expert discourse positioned parents as dependent on expert knowledge, as recipients of education, as valuable and responsible for their child's health through practicing medical skills. This positioning may place parents on a continuum from being deprived of their own initiatives to being invited to take an active part and could result in feelings of guilt and uncertainty, but also of security and significance. From this study we conclude that guidelines rooted in the Expert discourse may reduce opportunities for parents' voices to be heard and may overlook their knowledge. By broadening the selection of authors of the guidelines to include patients and all professionals in the team, new discourses could emerge and the parents' voice might be more prominent. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

Keyword
Diabetes type 1, Discourse analysis, Expert discourse, Guidelines, Parents' voice
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-3964 (URN)10.1111/j.1471-6712.2011.00942.x (DOI)000304000000020 ()2-s2.0-84861006995 (Scopus ID)02839318 (ISSN) (ISBN)
Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2017-12-08Bibliographically approved
4. Fathers' involvement in their child's diabetes care - seen from a health promotion perspective
Open this publication in new window or tab >>Fathers' involvement in their child's diabetes care - seen from a health promotion perspective
Show others...
(English)In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549XArticle in journal (Refereed) Accepted
Place, publisher, year, edition, pages
Thousand Oaks, Calif: Sage Publications
Keyword
Diabetes Care, parents, involvement
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science; NURSING AND PUBLIC HEALTH SCIENCE, Public health science
Identifiers
urn:nbn:se:hv:diva-5837 (URN)
Note

Ingår i avhandling

Available from: 2013-12-30 Created: 2013-12-30 Last updated: 2017-12-06Bibliographically approved

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