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SA JOURNAL OF DIABETES & VASCULAR DISEASE
researchers should also know that two or more children may have
equal resource characteristics and context, but their developmental
trajectories will be quite different if one is motivated to succeed
and persist in tasks despite having diabetes.
Thechild’swell-beingislinkedtohisorherresourcecharacteristics,
whether physical, mental or emotional, and the environment in
which it exists. Therefore, assessment of the child’s psychological
well-being and environment are crucial in optimising diabetes care
and psychosocial well-being of the child with diabetes.
To understand the lives of young people with diabetes, clinicians
and researchers need to identify areas of strength and vulnerability
in the child’s ecology; understand the multi-directional interactions
between nature and nurture and also that there is differential
susceptibility to the influence of nature and nurture in children with
diabetes; conduct evaluation studies to demonstrate efficacy of
interventions targeting the ecology of a child with diabetes so that
clinicians do not re-invent the wheel, undertaking interventions
that do not work; and initiate and/or improve relationships
between different stakeholders important for diabetes care such
as the family, community, school, diabetes international bodies
and pharmaceutical companies in order to improve the well-
being of children. Then there is a need to sensitise and educate
communities on diabetes and how to help children with diabetes
so that positive outcomes for children are realised at the school
and community level.
Conclusion
Deriving from empirical evidence, this article has illustrated how
the bioecological model can be used to understand diabetes care
and the psychosocial well-being of children. It shows that the
proposition of ecological thinking is that diabetes, behaviour and
its determinants are interrelated. Future studies should investigate
how the bioecological model can be applied in everyday paediatric
diabetes. This also means that ecological interventions that
foster behavioural and contextual change through targeting
environmental factors that are most likely to influence diabetes
care and psychosocial well-being are possible. Unlike medical
interventions delivered by a healthcare provider at the individual
level, the proposed interventions are larger scale and emphasise
the complexity of behaviour and the environment (person ×
environment interaction) rather than a person’s behaviour only.
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