Factors Affecting Self-Care Performance in Adolescents with Type I Diabetes According to the PEN-3 Cultural Model

BACKGROUND: Adolescence is the most difficult period to control and manage type 1 diabetes (T1D), and various perceptions, enablers, and nurturers influence self-care behaviors in these patients. OBJECTIVES: The purpose of this study was to identify factors affecting self-care performance in adolescents with T1D, according to the PEN-3 cultural model. METHODS: In this study, in-depth interviews were conducted initially with 26 participants, and one group discussion was held with 13 participants. Assessment domains of the PEN-3 model (key influence on health behaviors and impact of behavior on health) guided the analysis of qualitative study and focus group data. Finally, the data were classified to a 3 × 3 table, based on the PEN-3 model. RESULTS: The most common positive PEN included awareness of self-care behaviors, attitude towards the disease, impact of spirituality on self-care, easy access to needed medical services, and maternal support. The negative PEN included attitude of patients and parents towards reasons of becoming sick (why me), awareness about the disease and its causes, low self-efficacy, limited training, high cost of blood glucose test strips, lack of educational therapeutic curricula based on spirituality, ignoring the role of spirituality in treatment and self-care, and conflict between parents and patients. CONCLUSIONS: The results of this study can be used to guide the development of cultural group therapy interventions aimed at increasing adherence to self-care behaviors among Iranian adolescents with T1D.