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VOLUME 14 NUMBER 1 • JULY 2017
11
SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
Applying the bioecological model to understand factors
contributing to psychosocial well-being and healthcare of
children and adolescents with diabetes mellitus
GIVEN HAPUNDA, AMINA ABUBAKAR, FONS VAN DE VIJVER
Correspondence to: Given Hapunda
Department of Psychology, University of Zambia, Lusaka, Zambia; Department
of Culture Studies, Tilburg University, Tilburg, the Netherlands
e-mail:
given.hapunda@unza.zmAmina Abubakar
Department of Culture Studies, Tilburg University, Tilburg, the Netherlands;
Neuroassessment, Centre for Geographic Medicine Research, Kilifi, Kenya;
Department of Public Health, Pwani University, Kenya
Fons van de Vijver
Department of Culture Studies, Tilburg University, Tilburg, the Netherlands;
Work Well Unit, North-West University, Potchefstroom, South Africa; School
of Psychology, University of Queensland, Brisbane, Australia
S Afr J Diabetes Vasc Dis
2017;
14
: 11–17
Abstract
We discuss the bioecological model of Urie Bronfrenbreener
and its application to diabetes care and the psychosocial
well-being of children with diabetes in sub-Saharan Africa.
Using empirical evidence, this article demonstrates that the
bioecological model provides an important framework for
understanding diabetes care needs and the interventional
strategies required to enhance the well-being of children
living with diabetes. It also discusses clinical and research
implications. The advantage of applying the bioecological
model in drawing up interventional strategies for those
living with diabetes is that it targets large-scale public health
interventions, unlike medical intervention, which focuses on
a single individual.
Keywords:
bioecological model, PPCT, children, adolescents,
diabetes care, psychosocial well-being
Introduction
Healthcare providers, psychologists, parents and significant others,
such as teachers, require comprehensive knowledge of social and
biological factors that contribute to the personal development
and healthcare of children and adolescents with diabetes mellitus.
Diabetes mellitus is a metabolic disorder of multiple aetiologies,
characterised by chronic hyperglycaemia with disturbances of
carbohydrate, fat and protein metabolism, resulting from defects
in insulin secretion, insulin action or both.
1,2
One framework, which could help improve knowledge
on environmental and biological factors that contribute to
the development, healthcare and psychosocial well-being of
children living with chronic illness such as diabetes mellitus is the
bioecological model of Urie Bronfenbrenner.
3
This model could help
researchers and healthcare practitioners understand a phenomenon
within a larger context, in this case a framework for understanding
the factors that produce and maintain health and health-related
issues in diabetes. The bioecological model allows the identification
of strategic points of interventions and to understand how social
problems are produced and sustained within and across the various
ecological systems.
Research evidence indicates that the most efficient preventative
and interventional strategies for childhood problems consider the
context in which a child lives, the interactions a child has with
other people, and the influence of institutions and policies in the
immediate and wider environment.
4
These ecologies are considered
to influence a developing child.
5
As a result, it is useful to understand
how the bioecological model can be used to understand the needs
of children with diabetes.
The aim of this article is to discuss the application of the
bioecological model to diabetes care and psychosocial well-being in
children and adolescents with diabetes in sub-Saharan Africa. We
review the ecological model based on the interrelationships in the
process–person–context time model concept of the bioecological
theory.
6
Then we discuss how the bioecological model can be
applied to understanding diabetes care and psychosocial issues
that affect children with diabetes within the sub-Saharan African
context. Finally, clinical and research implications are discussed.
The bioecological model
The bioecological theory of development posits that human
development is a transactional process, influenced by an individual’s
interactions with various aspects and spheres of the environment.
7
The bioecological theory has four major components: process,
person, context and time, also known as the process–person–
context–time (PPCT) model.
8
Process
The proximal or near processes involve all sorts of transactions
between the child and the immediate surroundings that are
responsible for the development of the child’s competence and
general well-being.
5
Proximal processes are near contexts to a
child, involving a reciprocal interaction between a child and the
environment. It is a bidirectional relationship between the child and
the environment.
To be effective (contribute to child’s competence and well-
being), the transaction between the child and the environment
must occur on a fairly regular basis over an extended period of time
in a reciprocal manner. The transactions must be enduring, and
participating in such interactive processes over time generates the
ability, motivation and knowledge necessary for development.
Therefore, proximal processes are an important engine of