Edinburgh Napier University

  Background: Emerging adulthood (18 to 29 years) is a developmental period where the individuals undergo physical and emotional changes, become more independent, and engage in risky health behaviors. In particular, emerging adults (EAs) with type 1 diabetes (T1D) report worsening physical and psychological health. The high prevalence of psychological complications like symptoms of depression, reduced health related quality of life and diabetes-related distress, negatively impact adherence to treatment and glycemic control.
The factors affecting the health of EAs with T1D are not identical across cultures, and most studies on this topic are conducted in the West. The literature supports the effect of the social variables on diabetes-related health and complications, but provides limited evidence on the influence of these variables across cultures.
Aim: The aim was to develop a theoretically driven, culturally oriented, conceptual framework that can be used to study the psychosocial aspects of diabetes complications in EAs with T1D. This framework describes the relationship between empirically derived predictor variables, diabetes-related health, and psychological complications, while highlighting the influence of culture on these relationships.
Method: An extensive review of the theoretical and empirical literature about EAs with type 1 diabetes was conducted. Relevant theories were identified: Emerging Adulthood theory, Transition theory, and Self-Care in Chronic Illness theory, that help in understanding the dynamics and the effects of transitioning into emerging adulthood on diabetes-related health. The empirical evidence solicited focused on the socio-cultural influences on diabetes-related health and psychological complications.
Results: The overarching theme that houses the framework is ‘emerging adulthood’, characterized by the nature of transition that EAs go through, transition facilitators and barriers, and patterns of response. This theme reflects the unique cultural and developmental aspects that are stipulated to influence the management and wellbeing of EAs with T1D. Within this theme, sociodemographic and clinical predictors are studied in relation to physical outcomes such as glycemic control and acute diabetes complications, and psychological complications like diabetes distress, anxiety and depression. These relationships are conceived to be mediated by diabetes self-care and moderated by social support. The differences between individualistic and collectivist cultures are mainly reflected through the effect of family support on diabetes management. However, there is limited research on the ethnic and cultural effects on diabetes-related health and psychological complications within different cultures, especially during the developmental stages.
Discussion: EAs with T1D demonstrate poor health outcomes, necessitating the delivery of effective and culturally sensitive care. Despite the theoretical recognition of the socio-cultural effects on health outcomes and psychological complications, few studies examined this influence. Empirical evidence corroborates the effect of social support on diabetes health during emerging adulthood. However, this support varies with cultural and ethnic diversity.
The proposed comprehensive framework allows understanding of the variables that affect the health of EAs with T1D, grounded in the psycho-socio-cultural and developmental context of this vulnerable population. The framework lends itself to mixed methods research methodology that can provide quantitative data about variables and their associations, and rich qualitative data about the psychosocial experiences of EAs with T1D.