الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 214 |  |  |
| | | from | 214 | | |
Abstract
Diabetes mellitus (DM) is one of the most common, important and costly chronic disease on a large scale with many physiological complications, such as increased rates of morbidity, heart disease, blindness and amputations; there are two common types of diabetes, Type 1 Diabetes (T1D) and Type 2 Diabetes (T2D) (Wilson et al., 2017).
In general, T1D is one of the most common chronic diseases in childhood and is being diagnosed at an increasing rate in adults. The onset of T1D, also called insulin-dependent diabetes, occurs commonly, but not consistently, during childhood or adolescence and manifests itself as a result of a vulnerability gene that makes an individual vulnerable to autoimmune-mediated demolition of the pancreatic beta cells, also called islet cells (Barrett, 2020).
School‐age children with T1D present unique challenges with regard to diabetes management. Daily high variability in eating and activity patterns, need for smaller insulin doses and frequent adjustments, developmental increases in independence, newly emerging language, self-awareness and self-control skills are all factors that complicate diabetes management. In response to these challenges, continuous subcutaneous insulin infusion (CSII) has become an increasingly common treatment in this age‐group (Merchant, 2016).
Summary
107
Psychosocial adjustment or adaptation refers to the ability of people to adapt to the environment, which means that the individual has sufficient mechanisms to feel contented, integrated, respond appropriately to the requirements of the environment, and achieve his goals. In childhood, psychosocial adjustment often refers to adaptation and work in some of the key areas that characterize this stage: the family and school settings (Burwinkle & Jones, 2017).
In this regard, maladjustment can manifest itself in various ways such as behavior problems, low self-esteem, emotional upheavals, poor peer relationships, and children with chronic diseases are more likely to show signs of maladjustment than healthy children. It would not be surprising if this also applied to their siblings, but although there is some evidence of the risks of maladjustment in siblings of chronically ill children, other studies have shown no increased risk (Ahern & Doane, 2018).
According to (Beck et al., 2019) T1D is one of the most common chronic childhood conditions, and adherence to treatment has important long-term implications. However, day-to-day care of chronic illness has great emotional and practical demands on family members and may affect the adaptation (ability to mentally, socially, and physically adapt to stress) of any family member (Beck et al., 2019). Therefore, through this study, the researcher seeks to assess the psychosocial
Summary
108
adjustment of school age children with type 1 of diabetes mellitus.
The psychosocial impact of living with diabetes can be a challenge for any child and any family but is particularly burdensome to those with maladaptive coping skills. So, the providers, families, and patients should all be aware of the developmental and psychosocial challenges in this age group and focus on patient-centered approaches to promote self-empowerment, decrease burdens and make diabetes more live-able (Phelan et al., 2018). Nurses need to integrate scientific knowledge with assessments of family composition, stress response, child developmental level, and family resources. Synthesis of complex data is critical for proper teaching and support of the family (Bajpai et al., 2019).
Significance of the study:
The onset of T1D, also called insulin-dependent diabetes, occurs commonly, during childhood or adolescence and manifests itself as a result of a vulnerability gene that makes an individual vulnerable to autoimmune-mediated demolition of the pancreatic beta cells, also called islet cells (Barrett, 2020).
Type 1 diabetes is one of the most common childhood diseases, affecting nearly 150 million children with diabetes worldwide and this number could double by 2025. In Egypt, 8 out of 100,000 children under the age of 14 have type 1 diabetes
Summary
109
(WHO, 2018). The development of type 1 diabetes entails a life-long judgment of a difficult treatment regimen that includes several daily insulin injections, blood glucose monitoring, a prescribed meal plan, and regular exercise (Northam et al., 2020). Managing children and youth with diabetes presents additional challenges in the form of emotional and psychological difficulties. Stress, by itself, may lead to an imbalance in the regulation of diabetes through psychological and physiological processes or associated changes in self-management behaviors. Diabetes is a risk factor for pre-school age mental disorders such as depression, anxiety, anorexia and isolation. It is important that the psychosocial problems and adjustment of children and adolescents with T1DM to be studied in order to improve the diabetic children’s management and results (McGrady and Hood, 2020). So, this study aimed at assessment of the psychosocial adjustment of school age children with type 1 of diabetes mellitus.
Aim of the study:
This study aimed to assess psychosocial adjustment of school age children with type I of diabetes mellitus.
Research question:
1. What are the psychological problems of school age children with type 1 of diabetes mellitus?
Summary
110
2. What are social problems of school age children with type 1 of diabetes mellitus?
3. What are psychosocial adjustment patterns of school age children with type 1 of diabetes mellitus?
A- Research design:
A descriptive study design to assess psychosocial adjustment of school age children with type I of diabetes mellitus in pediatric hospital affiliated to Ain Shams University (Out-patient Diabetic Clinic).
B- Setting:
The study was conducted at the Out-patient Diabetic Clinic affiliated to Ain Shams University, Egypt.
C- Subjects:
The actual sample size (150) that was selected according to flow rate of outpatient clinic follow up visits and medical record outpatient diabetic clinic in 2017 around 1400 children & 2018 around 1480 children respectively.
Sample criteria:
The sample was selected in the study according to certain criteria: children suffering from type 1 diabetes mellitus who will attend Out-patient Diabetic Clinic for a checkup and follow up according to the following criteria:
Summary
111
from both sexes.
At the age group(6 < 12 years)
Duration of the disease is not less than one year.
Data collection tools:
Three tools of data collection were used:
(1) Interviewing questionnaire.
(2) A semi-structured questionnaire (Salam, 2006 & Greca, 1988 and Jalwiec et al., 1991).
(3) Psychosocial Adjustment Pattern scale.
I- Interviewing questionnaire
It was designed by the researcher in the Arabic language after reviewing the related literature and consisted of 38 questions. It was divided into four parts:
Part (1): It was designed to assess children’s socio-demographic data as (medical history, cause, number of hospitalization, duration of disease). It included questions from 1-5.
Part (2): It was designed to assess children’s knowledge about disease as(age, sex, grade years, number of siblings, rank
Summary
112
of child in family, regularity in school attendance). It included questions from 6-12.
Part (3): It was designed to assess children’s knowledge regarding preventive measures for type 1 diabetes mellitus as (treatment precaution, insulin and diabetic food). It includes questions from 14-26.
Part (4): It was designed to assess children’s knowledge regarding exercise as (types of sports, complications of diabetes associated with exercise). It includes questions from 27-38.
Scoring system: each question was evaluated as 1 scores for correct answer and 0 scores for incorrect answer. The total knowledge was classified into:
- Satisfactory: 60% or more.
- Unsatisfactory: less than 60%.
II- A semi-structured questionnaire:
It was adopted from (Salam, 2006 & Greca,1988 and Jalwiec et al., 1991), and modified by the researcher to assess psychological and social problems related to diabetes among school age children