Defining Resilience in Adolescents with Type 1 Diabetes
There is no standard way to define resilience in adolescent patients with type 1 diabetes, though many studies see resilience as an ability or process.
For adolescents with type 1 diabetes (T1D), resilience can mean achieving target glycemic outcomes despite challenges, though the current definition has not been standardized, according to a review published in the Journal of Pediatric Nursing.1
Defining Resilience in Adolescents with Type 1 Diabetes / rkris - stock.adobe.com
Although there has been significant advancement in diabetes technology, many adolescents with T1D do not achieve metabolic control targets. In this review, the researchers sought to analyze the existing data on resilience in adolescents with T1D in order to clarify the definition.
The researchers defined diabetes resilience as “achieving one or more positive outcomes despite exposure to significant risk or adversity.” While there have been studies analyzing diabetes resilience since 2000, the concept remains ill defined, particularly in an adolescent population.
The researchers performed a systematic search in CINAHL, PubMed/Medline, and PsycInfo databases. They included studies on resilience in adolescents with T1D aged 13 to 18 years that were published in peer-reviewed scientific journals. Out of 24 included studies, 21 were quantitative, 1 was qualitative, and 2 were mixed-methods.
READ MORE: Diabetes, Prediabetes Linked to Older Brain Age
Out of 24 studies, 14 gave a definition of resilience, with an additional 4 giving a definition of diabetes resilience specifically. Two studies defined resilience as comprised of 4 qualities: “a sense of hopefulness, an optimistic explanatory style, effective coping strategies, and positive problem-solving skills due to the complex construct of resilience.” In 9 studies, resilience was defined as an ability or capacity, such as the ability to achieve positive physical and mental health outcomes despite significant stressors. Another 4 studies defined it as a process that involves adapting to significant stressors or event. Resilience in this capacity is context-specific and dynamic, so an individual may be resilient in one scenario but not in another. One study defined resilience as a protective resource: the ability to use necessary resources for health.
In the 4 studies that defined diabetes resilience, they cited achievement of positive psychosocial and health outcomes, engagement in diabetes self-management, and achievement of glycemic targets despite challenges.
The studies used 6 different resilience instruments, including The Diabetes Strengths and Resilience Measure for adolescents (DSTAR-Teen; n=8), the Resiliency Scales for Children
and Adolescents (RSCA; n=4), the Connor-Davidson Resilience Scale (CD-RISC-10; n=2), the Resilience Scale (RS; n=2), the Adolescent Resilience Scale (ARS; n=1), and the Resilience Scale for Adolescents (READ; n=1). All instruments are self-assessments performed by patients.
In terms of Cronbach’s alpha, the researchers calculated the reliability of the scales. DSTAR-teen ranged from 0.78 to 0.90, ARS was 0.90, CD-RISC-10 was 0.83, RSCA was 0.97, READ was 0.95, and RS was 0.87. These reliability scores indicate a high internal consistency.
“This review highlighted the need for an explicit definition of the concept, because studies used different definitions of resilience or lacked a definition,” the researchers wrote. By giving a clear definition to diabetes resilience, future studies will be able to more effectively compare outcomes.
Despite the lack of a standardized definition, the researchers noted that the DSTAR-teen shows promise as a measure of resilience in adolescents with T1D and should be used in future studies.
READ MORE: Diabetes Resource Center
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