Triggered by life events and/or changes in individuals or their environments, transitions involve a linear process, moving from one stage of life to the next and may be classified as developmental, situational, health-illness, and/or organizational (McGoldrick, Preto, & Carter , 2016). For parents, one such developmental and situational transition occurs as they move from the parenting an adolescent stage to the launching an emerging adult stage (McGoldrick et al., 2016). Moving from one stage to another requires individuals and families to renegotiate their relationships with each other as they respond to individual and systemic changes, including various entries and exits from the family system (McGoldrick, et al., 2016). Families who are not able to adapt to both the individual and systemic changes affecting family members will become stuck or entrenched, subverting their healthy development along the lifespan (McGoldrick, et al., 2016).
This transition may be more challenging for parents of emerging adults with a chronic condition like type 1 diabetes mellitus (T1DM). Diabetes management, a process that may be increasingly complicated for both the teen and parent, can be challenging for families as they prepare for and eventually transition to college. This transition may lead to increased worry and distress for parents as going away to college often puts emerging adults at increased risk for poor glycemic control, loss to follow up care, acute complications, psychosocial issues, and sexual and reproductive health issues (ADA, 2018). This increased level of concern may cause parents to have difficulty letting go and become stagnant in their own transition.
There have been a number of studies focusing on the factors that influence readiness to transition with T1DM for young adults, but few focusing on parental readiness for transition. Nursing research has indicated that these factors may include parental worry, reluctance to “let go”, fear of the unknown including hypoglycemia, overall health status of the emerging adult, and concerns about the young adult’s self-efficacy (Ness, Saylor, & Selekman, 2018; Schultz & Smaldone, 2017). This heightened level of concern may complicate a parent’s ability to successfully prepare to themselves to transition from parent of an adolescent to launching an emerging adult.
Approach to Inquiry
The research question arose from the need to better understand existing research and identify gaps in the literature to inform recommendations for future research about factors that promote readiness to transition in parents of emerging adults with T1DM who will be going away to college. To map existing literature, a scoping review was conducted and guided by the five key stages of Arksey and O’Malley’s framework: 1. Identifying the research question, 2. Identifying relevant studies, 3. Study selection, 4. Charting the data and 5. Collating, summarizing, and reporting the results. An optional sixth stage, consultation with stakeholder, was omitted as it was not relevant to this review.
Relevant studies were identified using Web of Science, CINAHL, PsychINFO, SCOPUS, PubMed, and MedLine. Inclusion and exclusion criteria were developed to include only English language studies that described and or evaluated factors specific to the parent experience during transition. The initial search was restricted to studies completed within the past 5 years and used keywords such as ‘transition’, ‘mothers’, ‘readiness’, ‘emerging adult’ and ‘type 1 diabetes’ but this search resulted in a small number of applicable studies. Search terms were broadened to include ‘parent’, ‘letting go’, ‘emerging adult’, ‘young adult’, and ‘college’. Date limitations were removed as literature from other domains is not as sensitive to current practice.
Results
There were 28 studies that met the inclusion criteria. The majority of the studies were conducted in the United States (n=20), with a few studies from The Netherlands (n=2), Portugal (n=2), United Kingdom (n=2), Canada (n=1), and Turkey (n=1). Three themes affecting parental readiness to transition emerging adults with T1DM to college were identified: family and interpersonal dynamics, development of the parent as an individual, and parental distress. Seventeen studies focused on family and interpersonal dynamics, including parenting style. Seven studies focused on the development of the parent as an individual, while another eleven studies focused on distress. Results will be presented by theme followed by a discussion of identified factors that affect parental readiness for the transition of college-bound emerging adults with T1DM.
Discussion
Parents preparing to transition college-bound emerging adults with T1DM may struggle with letting go as their emerging adults begin to form and experience their own separate identities. Parents who gradually allow their emerging adult more autonomy while continuing to feel that they are able to parent meaningfully through the transition will experience less anxiety related to letting go and be more likely to successfully transition themselves. In order to move through the transition process, parents must be able to view their child as an individual within the context of their new environment, in this case the college setting (Mendonça & Fontaine, 2014). This level of parental maturity, or the ability to engage in a intimate, reciprocal relationship with one’s child is an important part of the individuation process that will support parents of college-bound emerging adults with a chronic condition such as T1DM.
The relationship between parent and young adult has been shown to be a powerful mediator for transition, facilitating better metabolic control and compliance; however parental over-involvement may be counterintuitive to youth assuming full responsibility for their diabetes management (Monaghan et al., 2015). Parents who still feel a great responsibility for their emerging adult’s diabetes management may continue to experience caregiver burden and increased levels of stress during the transition which may lead to ineffective coping and unsuccessful progress towards the next stage of parenting. T1DM can complicate efforts to promote and achieve autonomy, inadvertently stagnating the transition. Delaying the transition process for parents may lead to unresolved psychosocial crises including failure to identify themselves as an individual separate from their emerging adult which may, in turn, hinder their emerging adult’s transition to self-management.
Conclusion
Current research findings are not clear on parental readiness to transition and how that may facilitate emerging adults’ transition to college. While research has demonstrated that emerging adults with T1DM who have parents who are involved in diabetes management are likely to have better outcomes related to their diabetes, there is limited research that focuses on mitigating factors that promote readiness for parents as they work to move from parenting an adolescent to launching their emerging adult with T1DM to transition to college. When working with parents of college-bound emerging adults with T1DM, clinicians may want to consider parenting style and the degree to which parents view their emerging adults as individuals and if that perception is based on a realistic appraisal of their child’s ability to self-manage. Additional research is recommended to determining which factors lead to a greater sense of parental readiness to let go in transition to college with T1DM in order provide important information that will lead to interventions that will promote increased quality of life for parents leading to more effective transition.