Understanding Self-Care Patterns in Adults With Type 1 Diabetes: Insights From a Mixed Methods Study

Abstract

Aim: The aim of this study was to explore self-care among adults with type 1 diabetes (T1D) to (1) characterise possible self-care profiles in adults with T1D; (2) explain self-care maintenance, monitoring and management within the self-care profiles; and (3) develop a typology of self-care in adults with T1D.

Design: Mixed-methods study with explanatory sequential design.

Methods: Participants (n = 200) completed a validated self-care survey. Cluster analysis of survey data was performed to identify self-care profiles. Then, semi-structured individual interviews were performed with a nested sample (n = 20) stratified by these profiles. Directed content analysis was applied to transcript data to describe self-care within profiles. Findings were integrated via joint display to develop a typology of self-care in adults with T1D.

Data sources: A total of 200 adults with T1D were recruited from a diabetes centre in a large, urban US city from 6/2022 to 11/2022 (quantitative phase) and a nested sample (n = 20) from 12/2022 to 4/2023 (qualitative phase).

Results: We identified three self-care profiles: Expert, Inconsistent and Novice. Expert self-care was characterised by a steadfast and holistic approach to maintaining health, the use of internal and external cues to monitor for health changes and informed management decision-making when health changes were detected. Inconsistent self-care was characterised by the capability to maintain health, often limited by low health prioritisation, a lack of perceived need for greater effort and compulsive management decision-making. Novice self-care was characterised by difficulty maintaining health and limited skill development in more advanced self-care processes, including monitoring for and managing health changes.

Conclusions: This study identified an Expert-Inconsistent-Novice typology of self-care in adults with T1D, aligning with previous research and suggesting a stable typology across conditions.

Implications for the profession and/or patient care: Characterising self-care among adults with T1D may facilitate aligning support with individual needs.

Impact: Progression towards Expert self-care may offer clinically meaningful improvements in glycaemic control and reduced risk for diabetes complications.

Reporting method: Good Reporting of A Mixed Methods Study (GRAMMS) Checklist.

Patient or public contribution: No patient or public contribution.

Keywords: cluster analysis; self‐care; type 1 diabetes mellitus.