Clinical and sociodemographic factors associated with the quality of life of children and adolescents with type 1 diabetes.

OBJECTIVE: To analyze clinical and sociodemographic factors associated with the health-related quality of life of children and adolescents with type 1 Diabetes Mellitus. METHOD: A quantitative, cross-sectional and analytical study, developed in a municipality in northeastern Brazil, between March and September 2021, with 81 children/adolescents with type 1 Diabetes Mellitus and their guardians/caregivers. A questionnaire containing sociodemographic and clinical variables and two quality of life instruments were used. Descriptive and inferential analysis was carried out. RESULTS: Adolescents whose parents had a family income greater than a minimum wage had a lower prevalence of impaired quality of life when compared to those with a lower income. Adolescents with time since diagnosis of less than four years had a satisfactory quality of life, and children aged 8 to 12 years who self-administered insulin had a lower prevalence of high quality of life compared to those who did not. CONCLUSION: Adolescents with a family income of less than a minimum wage, diagnosis time of more than four years and children aged 8-12 who self-administer insulin need greater professional support to have a better quality of life.

Clinical and sociodemographic factors associated with the quality of life of children and adolescents with type 1 diabetes / Factores clínicos y sociodemográficos asociados a la calidad de vida de niños y adolescentes con diabetes tipo 1 / Fatores clínicos e sociodemográficos associados à qualidade de vida do público infantojuvenil com diabetes tipo 1

ABSTRACT Objective: To analyze clinical and sociodemographic factors associated with the health-related quality of life of children and adolescents with type 1 Diabetes Mellitus. Method: A quantitative, cross-sectional and analytical study, developed in a municipality in northeastern Brazil, between March and September 2021, with 81 children/adolescents with type 1 Diabetes Mellitus and their guardians/caregivers. A questionnaire containing sociodemographic and clinical variables and two quality of life instruments were used. Descriptive and inferential analysis was carried out. Results: Adolescents whose parents had a family income greater than a minimum wage had a lower prevalence of impaired quality of life when compared to those with a lower income. Adolescents with time since diagnosis of less than four years had a satisfactory quality of life, and children aged 8 to 12 years who self-administered insulin had a lower prevalence of high quality of life compared to those who did not. Conclusion: Adolescents with a family income of less than a minimum wage, diagnosis time of more than four years and children aged 8-12 who self-administer insulin need greater professional support to have a better quality of life.

RESUMEN Objetivo: Analizar los factores clínicos y sociodemográficos asociados a la calidad de vida relacionada con la salud de niños y adolescentes con Diabetes Mellitus tipo 1. Método: Estudio cuantitativo, transversal y analítico, desarrollado en un municipio del Nordeste brasileño, entre marzo y septiembre de 2021, con 81 niños/adolescentes con Diabetes Mellitus tipo 1 y sus tutores/cuidadores. Se utilizó un cuestionario que contenía variables sociodemográficas y clínicas y dos instrumentos de calidad de vida. Se realizó análisis descriptivo e inferencial. Resultados: los adolescentes cuyos padres tenían un ingreso familiar superior a un salario mínimo tuvieron una menor prevalencia de deterioro de la calidad de vida en comparación con aquellos con menores ingresos. Los adolescentes con un tiempo de diagnóstico menor a cuatro años tuvieron una calidad de vida satisfactoria, y los niños de 8 a 12 años que se autoadministraron insulina tuvieron una menor prevalencia de alta calidad de vida en comparación con los que no lo hicieron. Conclusión: Los adolescentes con ingreso familiar menor a un salario mínimo, tiempo de diagnóstico mayor a cuatro años y niños de 8 a 12 años que se autoadministran insulina necesitan mayor apoyo profesional para tener una mejor calidad de vida.

RESUMO Objetivo: Analisar os fatores clínicos e sociodemográficos associados à qualidade de vida relacionada à saúde de crianças e adolescentes com Diabetes Mellitus tipo 1. Método: Estudo quantitativo, transversal e analítico, desenvolvido em um município do Nordeste brasileiro, entre março e setembro de 2021, com 81 crianças/adolescentes com Diabetes Mellitus tipo 1 e seus responsáveis/cuidadores. Utilizaram-se um questionário contendo as variáveis sociodemográficas e clínicas e dois instrumentos de qualidade de vida. Realizou-se análise descritiva e inferencial. Resultados: Adolescentes cujos pais tinham renda familiar superior a um salário mínimo apresentaram prevalência menor de qualidade de vida prejudicada, quando comparados àqueles com renda inferior. Adolescentes com tempo de diagnóstico menor que quatro anos apresentaram qualidade de vida satisfatória, e crianças de 8 a 12 anos que faziam autoaplicação de insulina apresentaram prevalência menor de qualidade de vida alta em relação às que não realizavam. Conclusão: Adolescentes com renda familiar inferior a um salário mínimo, tempo de diagnóstico superior a quatro anos e crianças de 8-12 anos que realizam autoaplicação de insulina necessitam de maior suporte profissional para ter melhor qualidade de vida.

Modelo teórico-metodológico de elaboração e validação de tecnologia educacional para a área da enfermagem / Modelo teórico-metodológico con el objetivo de crear y validar tecnología educativa para el área de enfermería / Theoretical-methodological model to develop and validate educational technology for the nursing area

Objetivo: apresentar um modelo teórico-metodológico para nortear a elaboração e validação de tecnologia educacional do tipo cartilhas educativas para a área da Enfermagem. Método: trata-se de um estudo teórico-reflexivo, baseado na Taxonomia de Bloom. Resultados: o estudo apresentou um modelo teórico-metodológico que descreve a elaboração do roteiro e conteúdo do material educativo seguindo as recomendações da Taxonomia de Bloom, na dimensão do processo cognitivo. Ainda, apresentou os passos para elaboração e validação de cartilhas educativas: diagnóstico situacional, revisão de literatura e documental, seleção e sumarização de conteúdo, elaboração do roteiro, criação e diagramação de imagens, validação com especialistas e com o público-alvo. Considerações finais: a proposição do modelo teórico-metodológico solidifica o conhecimento da literatura e auxilia enfermeiros e pesquisadores na elaboração de cartilhas educativas com maior rigor científico e passíveis de efetividade.

Objetivo: presentar un modelo teórico-metodológico para orientar la creación y validación de tecnología educativa del tipo folletos didácticos para el área de Enfermería. Método: estudio teórico-reflexivo basado en la Taxonomía de Bloom. Resultados: el estudio presentó un modelo teórico-metodológico que describe la elaboración del guión y contenido del material educativo siguiendo las recomendaciones de la Taxonomía de Bloom, en la dimensión del Proceso cognitivo. También presentó los pasos para crear y validar folletos educativos: Diagnóstico situacional, Revisión de documental y de la literatura, Selección e sumario del contenido, Elaboración del guión, Creación y diagramación de imágenes, y Validación con especialistas y con la población objetivo. Consideraciones finales: la propuesta del modelo teórico-metodológico consolida el conocimiento existente en la literatura y auxilia enfermeros e investigadores en la creación de folletos educativos con mayor rigor científico y buenas perspectivas de efectividad.

Objective: to present a theoretical-methodological framework guiding the development and validation of educational technology, specifically didactic booklets for the Nursing area. Method: this is a theoretical-reflexive study grounded on Bloom's Taxonomy. Results: the study presented a theoretical-methodological model outlining the educational material script and content development in accordance with Bloom's Taxonomy recommendations, in the Cognitive Process dimension. Additionally, it outlined the steps for creating and validating educational booklets: situational analysis, literature and documentary review, content selection and summarization, script development, creation and layout of the illustrations, validation with experts, and validation with the target audience. Final considerations: the theoretical-methodological model proposal consolidates the knowledge existing in the literature and assists nurses and researchers in creating educational booklets with greater scientific rigor, increasing their effectiveness potential.

A Video Game for Brazilian T1D Children about Knowledge of Disease and Self-care: A Methodological Study.

BACKGROUND: Video games are interactive technologies able to support children in health promotion, behavior changes, and chronic disease self-management. The use of health behavior change determinants in video game design can increase its effectiveness. This study describes the process of designing a video game for Brazilian children with T1D clarifying the use of health behavior change determinants that may influence self-management behaviors. METHODS: This was a methodological study based on health behavior change theories and the user-centered design approach. The results of a qualitative study conducted with children aged 7 to 12 years identified learning needs about knowledge on diabetes and self-care tasks which contribute to inappropriate behaviors. A Behavioral Diagnosis presented health behavior change determinants, capable of influencing children's learning needs and behaviors, that were considered to design The Heroes of Diabetes-the power of knowledge. RESULTS: The results presented the process of designing 4 mini games with its description and theory foundation to reach children's lack of understanding about T1D, insulin's role, SMBG requirements, food groups and physical activity's role in glycemic control. Knowledge, goal settings, extrinsic and intrinsic motivation determinants were related with video games design features. CONCLUSIONS: The findings support the use of health behavior change determinants into video game design as a guide to achieve children learning needs and that might influence self-management behaviors.

Validation of an educational game about first aid for schoolchildren.

OBJECTIVES: to validate the content and appearance of an educational game about first aid for schoolchildren with experts in education and health. METHODS: this is a methodological, quantitative and descriptive research, carried out using the Delphi technique, using an online collection instrument, covering 55 items of the game. Content and appearance assessment was performed by 26 judges. The data were analyzed using Content Validity index. RESULTS: the final prototype is presented in a board format, composed of four buildable pawns and 117 cards between questions, alerts and challenges. Overall Content Validity index of 0.95 and greater than 0.8 was obtained for all items in two Delphi rounds. CONCLUSIONS: the educational game validated by experts is a pedagogical tool for teaching first aid to schoolchildren as an option to traditional educational practices.

Validation of an educational game about first aid for schoolchildren / Validación de un juego educativo sobre primeros auxilios para escolares / Validação de jogo educativo sobre primeiros socorros para crianças escolares

ABSTRACT Objectives: to validate the content and appearance of an educational game about first aid for schoolchildren with experts in education and health. Methods: this is a methodological, quantitative and descriptive research, carried out using the Delphi technique, using an online collection instrument, covering 55 items of the game. Content and appearance assessment was performed by 26 judges. The data were analyzed using Content Validity index. Results: the final prototype is presented in a board format, composed of four buildable pawns and 117 cards between questions, alerts and challenges. Overall Content Validity index of 0.95 and greater than 0.8 was obtained for all items in two Delphi rounds. Conclusions: the educational game validated by experts is a pedagogical tool for teaching first aid to schoolchildren as an option to traditional educational practices.

RESUMEN Objetivos: validar el contenido y apariencia del juego educativo de primeros auxilios para niños en edad escolar con expertos en el campo de la educación y la salud. Métodos: investigación metodológica, cuantitativa y descriptiva, realizada mediante la técnica Delphi utilizando un instrumento de recolección en línea, cubriendo 55 ítems del juego. La evaluación de contenido y apariencia fue realizada por 26 jueces. Los datos se analizaron mediante el índice de validación de contenido. Resultados: el prototipo final del juego se presenta en formato de tablero, compuesto por cuatro peones ensamblables y 117 cartas que incluyen preguntas, alertas y desafíos. Se obtuvo un índice de validación de contenido general de 0,95 y superior a 0,8 para todos los ítems, en dos rondas Delphi. Conclusiones: el juego educativo validado por los expertos es una herramienta pedagógica para la enseñanza de primeros auxilios a escolares como opción a las prácticas educativas tradicionales.

RESUMO Objetivos: validar o conteúdo e a aparência do jogo educativo sobre primeiros socorros para crianças em idade escolar com experts da área da educação e saúde. Métodos: pesquisa metodológica, quantitativa descritiva, realizada por meio da técnica Delphi a partir de instrumento de coleta online, contemplando 55 itens do jogo. A avaliação do conteúdo e aparência foi realizada por 26 juízes. Os dados foram analisados a partir do Índice de Validação de Conteúdo. Resultados: o protótipo final do jogo apresenta-se em formato de tabuleiro, composto por quatro peões montáveis e 117 cartas entre perguntas, alertas e desafios. Obteve-se Índice de Validação de Conteúdo geral de 0,95 e superior a 0,8 em todos os itens, em duas rodadas Delphi. Conclusões: o jogo educativo validado pelos experts é uma ferramenta pedagógica para o ensino de primeiros socorros com crianças escolares como opção às práticas educativas tradicionais.

Strategies to educate young people with type 1 diabetes mellitus on insulin therapy: systematic review / Estrategias para educar a los jóvenes con diabetes melitus tipo 1 sobre la insulinoterapia: una revisión sistemática / Estratégias para educar jovens com diabetes mellitus tipo 1 sobre insulinoterapia: revisão sistemática

ABSTRACT Objective: to identify evidence available in the literature on educational strategies used in the teaching of insulin therapy to children and adolescents with Type 1 diabetes mellitus. Method: systematic review undertaken in five databases, using the descriptors Insulin/therapeutic use, Patient education as topic, Diabetes mellitus type 1, Child, Infant, Adolescent and keywords, without any time limit. Primary studies on insulin therapy teaching were included, while research on insulin pumps was excluded. Results: 243 studies were identified, 13 of which were included. The results present educational strategies focused on children, adolescents and young people of up to 24 years of age, applied individually or in groups; by telephone contact or text messages by mobile phone; dramatization and educational camps; by a single professional or a multidisciplinary team. The strategies described in the analyzed studies addressed the adjustment of insulin dosages in everyday situations and education for insulin management, associated with the nutritional strategy of carbohydrate counting, diabetes education with a specific module on insulin therapy and intensive insulin use. The studies analyzed the effect of the educational intervention on several clinical and behavioral outcomes, such as glycated hemoglobin and self-efficacy. Conclusion: this review could not identify a single educational strategy able to improve metabolic and psychosocial outcomes. In most cases, nurses are the professionals responsible for the development of educational strategies focused on insulin therapy in children and adolescents with diabetes, regardless of the context in which they will be deployed. This confirms their role as educators.

RESUMEN Objetivo: identificar la evidencia disponible en la literatura sobre las estrategias educativas utilizadas para enseñar la terapia con insulina a niños y adolescentes con diabetes mellitus tipo 1. Método: revisión sistemática, realizada en cinco bases de datos, con los descriptores Insulina / uso terapéutico, Educación del paciente como tema, Diabetes mellitus tipo 1, Niño, Lactante, Adolescente y palabras clave, sin delimitación de períodos. Se incluyeron estudios primarios sobre la enseñanza de la terapia con insulina y se excluyó la investigación sobre la bomba de insulina. Resultados: se identificaron 243 estudios, de los cuales se incluyeron 13. Los resultados presentan estrategias educativas dirigidas a niños, adolescentes y jóvenes hasta los 24 años, aplicadas individualmente o en grupos; por contacto telefónico o mensajes de texto por teléfono celular; juegos de rol y campamentos educativos; por un solo equipo profesional o multidisciplinar. Las estrategias descritas en los estudios analizados abordaron el ajuste de la insulina en situaciones cotidianas y la educación para el manejo de la insulina, asociadas a la estrategia nutricional de conteo de carbohidratos, educación en diabetes con módulo específico sobre terapia insulínica y uso intensivo de insulina. Los estudios analizaron el efecto de la intervención educativa sobre varios resultados clínicos y conductuales, como la hemoglobina glucosilada y la autoeficacia. Conclusión: no fue posible determinar una única estrategia sobre la terapia con insulina capaz de mejorar el control metabólico y psicosocial. El desarrollo de estrategias educativas orientadas a la terapia con insulina para niños y adolescentes con diabetes, independientemente del contexto en el que se implementen, tiene, en su mayor parte, al enfermero como profesional responsable, lo que reafirma su rol educativo.

RESUMO Objetivo: identificar evidências disponíveis na literatura sobre estratégias educativas utilizadas no ensino da insulinoterapia às crianças e adolescentes com diabetes mellitus tipo 1. Método: revisão sistemática, realizada em cinco bases de dados, com os descritores Insulin/therapeutic use, Patient education as topic, Diabetes mellitus type 1, Child, Infant, Adolescent e palavras-chave, sem delimitação de período. Incluídos estudos primários acerca do ensino da insulinoterapia e excluídas pesquisas sobre bomba de insulina. Resultados: identificados 243 estudos, dos quais foram incluídos 13. Os resultados apresentam estratégias educativas direcionadas às crianças, adolescentes e jovens de até 24 anos de idade, aplicadas de forma individual ou em grupos; por contato telefônico ou mensagens de texto por celular; dramatização e acampamentos educativos; por um único profissional ou equipe multidisciplinar. As estratégias descritas nos estudos analisados abordaram ajuste da insulina em situações cotidianas e educação para manejo da insulina, associados com a estratégia nutricional de contagem de carboidratos, educação em diabetes com módulo específico sobre insulinoterapia e uso da insulina de forma intensiva. Os estudos analisaram o efeito da intervenção educativa sobre diversos desfechos clínicos e comportamentais, como a hemoglobina glicada e autoeficácia. Conclusão: não foi possível determinar uma única estratégia sobre a insulinoterapia capaz de melhorar o controle metabólico e psicossocial. O desenvolvimento de estratégias educativas voltadas à insulinoterapia de crianças e adolescentes com diabetes, independentemente do contexto em que serão implementadas, tem, em sua maioria, o enfermeiro como profissional responsável, o que reafirma seu papel educador.

A Fun Way to Learn About Diabetes: Using Therapeutic Play in a Brazilian Camp.

PURPOSE: Understanding disease mechanisms inside the body is crucial to engage youth with type 1 diabetes (T1D) in self-care behaviors. This study describes how Instructional Therapeutic Play (ITP) group sessions held by nurses in a Brazilian camp can enhance youth's understanding about T1D. DESIGN AND METHODS: Youth with T1D participated in video recorded ITP group sessions guided by the Sensitive Creative Method. First, participants were asked to create an artistic production based upon the query "What happens in the body of a young person who has diabetes?". They described their drawings and shared information, providing opportunities to discuss T1D pathophysiology. Second, campers were told a story about a child who had T1D onset using a rag doll and illustrative figures. Participants were asked to create a second artistic production based upon the same initial query. Finally, campers had another presentation of the drawings, discussion, and sharing through the question "How did the story told help you understand your diabetes?" Transcriptions of ITP sessions were submitted to thematic analysis. RESULTS: Twenty participants (9-17yo) were assigned to age/gender matched groups. Four themes were built: Designing insulin production; Experiencing the glycemic vigilance in diabetes management; The ITP session as a safe space to share challenges with nurses and peers; and Unraveling the myths of diabetes with the ITP session. CONCLUSION: Therapeutic play sessions enhanced youth's knowledge and unraveled myths of T1D pathophysiology. PRACTICE IMPLICATIONS: ITP sessions can be developed by nurses in order to deliver age-appropriate diabetes education to pediatric patients.

Conceptual framework for designing video games for children with type 1 diabetes.

OBJECTIVE: to present a theoretically based conceptual framework for designing video games for children with type 1 diabetes mellitus. METHODS: this was a methodological study that developed a conceptual framework with nine steps in view of health behavior change theories and the user-centered design approach as theoretical and methodological frameworks, respectively. Twenty-one children, aged 7 to 12 years, participated by expressing their needs and preferences related to diabetes and video games. Data were analysed following content analysis guidelines. Then, a choice of appropriate health behavioral change theories and their determinants that should be capable of influencing children's behaviors and preferences. RESULTS: the conceptual framework proposes a video game that consists of six phases, each addressing one stage of behavioral change and specific determinants, aligned with the needs and preferences identified by the participating children. This study shows the applicability of this framework in view of each proposed phase presenting examples and the children's ideas. CONCLUSION: the results of this study contribute to advance the discussion on how behavioral theories and their determinants should be related to the design of creative and funny video games considering the profile of the target population as well as its needs and preferences.

Children in outpatient follow-up: perspectives of care identified in interviews with puppet. / Crianças em seguimento ambulatorial: perspectivas do atendimento evidenciadas por entrevista com fantoche.

OBJECTIVE: To analyze the perspective of children on their health condition and experiences related to outpatient hospital care and the use of the puppets as a playful strategy to collect data. METHOD: A qualitative study with 16 children diagnosed with chronic diseases recruited in a pediatric outpatient clinic in countryside of Sao Paulo. Data were collected in October 2016 using a semi-structured interview and a puppet to facilitate communication. The interview transcripts were subjected to inductive thematic analysis. RESULTS: We constructed four themes: "Children in ambulatory follow-up: what do they know?"; "Emotions manifested in outpatient follow-up"; "The outpatient clinic of my dreams" and; "The use of puppets and the playful universe of interviews". FINAL CONSIDERATIONS: We identified the reasons and main feelings experienced during outpatient care, as well as the children's preferences regarding the physical and structural aspects of the outpatient clinic.

Conceptual framework for designing video games for children with type 1 diabetes / Estrutura conceitual para o desenvolvimento de videogames para crianças com diabetes mellitus tipo 1 / Estructura conceptual para el desarrollo de videojuegos para niños con diabetes tipo 1

ABSTRACT Objective: to present a theoretically based conceptual framework for designing video games for children with type 1 diabetes mellitus. Methods: this was a methodological study that developed a conceptual framework with nine steps in view of health behavior change theories and the user-centered design approach as theoretical and methodological frameworks, respectively. Twenty-one children, aged 7 to 12 years, participated by expressing their needs and preferences related to diabetes and video games. Data were analysed following content analysis guidelines. Then, a choice of appropriate health behavioral change theories and their determinants that should be capable of influencing children's behaviors and preferences. Results: the conceptual framework proposes a video game that consists of six phases, each addressing one stage of behavioral change and specific determinants, aligned with the needs and preferences identified by the participating children. This study shows the applicability of this framework in view of each proposed phase presenting examples and the children's ideas. Conclusion: the results of this study contribute to advance the discussion on how behavioral theories and their determinants should be related to the design of creative and funny video games considering the profile of the target population as well as its needs and preferences.

RESUMO Objetivo: apresentar uma estrutura teórica conceitual para o desenvolvimento de videogames para crianças com diabetes mellitus tipo 1. Métodos: este estudo metodológico desenvolveu uma estrutura conceitual com nove etapas, baseada em teorias de mudança de comportamentos em saúde e na abordagem do desenho centrado no usuário como referencial teórico e metodológico, respectivamente. Vinte e uma crianças entre 7 a 12 anos participaram do estudo, expressando suas necessidades e preferências relacionadas ao diabetes e videogames. Os dados foram analisados de acordo com as diretrizes de análise de conteúdo. Em seguida, foram selecionadas teorias de mudança de comportamentos em saúde e seus determinantes, que pudessem ser capazes de influenciar os comportamentos e preferências das crianças. Resultados: a estrutura conceitual propõe um videogame composto por seis fases, cada uma tratando de um estágio de mudança de comportamento e com determinantes específicos, alinhados às necessidades e preferências identificadas. O estudo mostra a aplicabilidade da estrutura desenvolvida, considerando cada fase proposta, apresentando exemplos e ideias das crianças. Conclusão: os resultados da pesquisa contribuem para o avanço nas discussões de como as teorias comportamentais e seus determinantes devem estar relacionados ao desenho de videogames criativos e divertidos, considerando o perfil da população alvo, assim como suas necessidades e preferências.

RESUMEN Objetivo: presentar una estructura teórica conceptual para el desarrollo de videojuegos para niños con diabetes mellitus tipo 1. Métodos: este estudio metodológico desarrolló una estructura conceptual con nueve etapas, basada en teorías de cambio de comportamientos en salud y en el enfoque del diseño centrado en el usuario como referencial teórico y metodológico, respectivamente. Veintiún niños entre 7 y 12 años participaron del estudio, expresando sus necesidades y preferencias relacionadas a la diabetes y a los videojuegos. Los datos fueron analizados de acuerdo con las directrices del análisis de contenido. Enseguida, fueron seleccionadas las teorías de cambio de comportamientos en salud y sus determinantes, que pudieran ser capaces de influenciar los comportamientos y preferencias de los niños. Resultados: la estructura conceptual propone un videojuego compuesto por seis fases, cada una tratando de una etapa de cambio de comportamiento y con determinantes especificos, alineados a las necesidades y preferencias identificadas. El estudio muestra la aplicabilidad de la estructura desarrollada, considerando cada fase propuesta, presentando ejemplos e ideas de los niños. Conclusión: los resultados de la investigación contribuyen para el avance en las discusiones de como las teorías comportamentales y sus determinantes deben estar relacionados al diseño de videojuegos creativos y divertidos, considerando el perfil de la población objetivo, así como sus necesidades y preferencias.

Crianças em seguimento ambulatorial: perspectivas do atendimento evidenciadas por entrevista com fantoche / Niños en seguimiento ambulatorio: perspectivas de la atención evidenciadas por entrevista con títere / Children in outpatient follow-up: perspectives of care identified in interviews with puppet

Resumo OBJETIVO Analisar a perspectiva da criança sobre a própria condição de saúde, suas experiências relacionadas ao atendimento ambulatorial hospitalar e ao uso de fantoches como estratégia lúdica para a coleta de dados. MÉTODO Estudo qualitativo, incluiu 16 crianças diagnosticadas com doenças crônicas, recrutadas em um ambulatório pediátrico do interior paulista. Os dados foram coletados em outubro de 2016 mediante entrevista semiestruturada e utilizou-se o fantoche como recurso facilitador na comunicação. As entrevistas foram analisadas por meio da análise temática indutiva. RESULTADOS Foram construídos quatro temas: "criança em seguimento ambulatorial: o que elas sabem?"; "emoções que perpassam o seguimento ambulatorial"; "o ambulatório dos meus sonhos"; e "a utilização dos fantoches e o universo lúdico da entrevista". CONSIDERAÇÕES FINAIS Foi possível identificar o motivo e os principais sentimentos vivenciados durante o atendimento ambulatorial, assim como as preferências das crianças acerca dos aspectos físicos e estruturais do ambulatório.

Resumen OBJETIVO Analizar la perspectiva del niño acerca de su condición de salud y experiencias relacionadas al a atención ambulatoria hospitalar y el uso de los títeres como estrategia lúdica para recoger datos. MÉTODO Estudio cualitativo, incluyó a 16 niños diagnosticados con enfermedades crónicas reclutadas en un ambulatorio pediátrico del interior paulista. Los datos fueron recolectados en octubre de 2016 mediante entrevista semiestructurada y se utilizó el fantoche como recurso facilitador en la comunicación. Las entrevistas fueron analizadas por medio del análisis temático inductiva. RESULTADOS Se construyeron cuatro temas: "niño en seguimiento ambulatorio: ¿qué saben?"; "Emociones que atraviesan el seguimiento ambulatorio"; "el ambulatorio de mis sueños" y; "la utilización de los títeres y el universo lúdico de la entrevista". CONSIDERACIONES FINALES Fue posible identificar el motivo y los principales sentimientos del seguimiento ambulatorio, así como las preferencias, de los niños, relacionados con los aspectos físicos y estructurales del ambulatorio.

Abstract OBJECTIVE To analyze the perspective of children on their health condition and experiences related to outpatient hospital care and the use of the puppets as a playful strategy to collect data. METHOD A qualitative study with 16 children diagnosed with chronic diseases recruited in a pediatric outpatient clinic in countryside of Sao Paulo. Data were collected in October 2016 using a semi-structured interview and a puppet to facilitate communication. The interview transcripts were subjected to inductive thematic analysis. RESULTS We constructed four themes: "Children in ambulatory follow-up: what do they know?"; "Emotions manifested in outpatient follow-up"; "The outpatient clinic of my dreams" and; "The use of puppets and the playful universe of interviews". FINAL CONSIDERATIONS We identified the reasons and main feelings experienced during outpatient care, as well as the children's preferences regarding the physical and structural aspects of the outpatient clinic.

The Value of Children's Voices for a Video Game Development in the Context of Type 1 Diabetes: Focus Group Study.

BACKGROUND: Children with type 1 diabetes mellitus (T1DM) face daily challenges performing self-care tasks, controlling symptoms, and dealing with psychosocial issues. The use of video games to improve health is a successful support for persons with chronic diseases, promoting adequate self-management through simulations of real life. Involving future users in the development of games is essential to generating innovative, creative, and effective programs. OBJECTIVE: Our goal is to identify what children with T1DM need to know about their disease and their self-care tasks as well as their preferences in video games. METHODS: Children with T1DM provided input about their learning needs, self-care tasks, and preferences in video games. Three categories were identified through qualitative content analysis: dealing with emotions and knowledge, practical skills and awareness, and game preferences. RESULTS: Children expressed concerns about the difficulties of self-care, lack of knowledge about diabetes, and lack of awareness about the consequences of behaviors related to self-care, which contribute to inappropriate behaviors and significantly impact self-management of their disease. They expressed enthusiasm for a video game for children with diabetes that considered their needs and preferences. CONCLUSIONS: Findings support the potential benefits when children's input is considered in game design. Consideration of customer needs and preferences is a powerful resource in the development of video games with enhanced learning experience.

Puppets as a strategy for communication with Brazilian children with cancer.

Children are considered competent social actors. Although they are able to express their opinions, they may have some difficulties in answering direct verbal questions, requiring researchers and health professionals to enter their world by using auxiliary resources for communication. This study presents the experience of using finger puppets as a playful strategy for improving interaction and communication with hospitalized children with cancer, aged seven to 12. It describes the strategy of making and using puppets as an auxiliary tool to communicate with children with cancer and presents the results and limitations of using puppets in clinical practice. The use of the puppets, creatively and in accordance with the children's motor, cognitive, and emotional development, showed benefits, such as allowing the children to freely express themselves; respecting their autonomy; and minimizing the hierarchical adult-child relationship. The use of puppets is an appropriate strategy to communicate with hospitalized children. This tool can also enrich clinical practice, as it encourages children with cancer to report their experience of being ill and also helps the health team during evaluation and intervention.

What Is It Like to Be a Child with Type 1 Diabetes Mellitus?

Diabetes mellitus is a complex disease that requires significant changes in lifestyle upon diagnosis, which may be difficult for children because of differences in growth and developmental levels. The purpose of this study was to increase our understanding of "what it is like" to be a child with type 1 diabetes mellitus and explore factors that interfere with disease management. Qualitative interviews using puppets constructed by children 7 to 12 years of age were conducted during clinic visits. The interviewer engaged in conversations to examine thoughts, feelings, and daily experiences with the management of diabetes. Results indicated that the children (N = 19) expressed emotions and psychosocial factors that may interfere with their ability to manage diabetes. These included conflicting desires, insecurity, fear, pain, inadequate knowledge, worry about long-term effects, prejudice, rejection, and shame. Findings suggest that during patient teaching at the time of diagnoses and follow-up clinic visits, clinicians address not only the physical aspects of the disease (blood sugar monitoring, insulin administration, diet and exercise management) but also examine emotional and psychosocial needs, and discuss strategies that will promote positive coping as children live with the complexities of growing up with diabetes.

Coping strategies used by hospitalized children with cancer undergoing chemotherapy.

PURPOSE: To analyze coping strategies used by children with cancer undergoing chemotherapy during hospitalization. DESIGN AND METHODS: This was an exploratory study to analyze qualitative data using an inductive thematic analysis. Semistructured interviews using puppets were conducted with 10 children with cancer, between 7 and 12 years old, who were hospitalized and undergoing chemotherapy. FINDINGS: The coping strategies to deal with chemotherapy were: understanding the need for chemotherapy; finding relief for the chemotherapy's side effects and pain; seeking pleasure in nourishment; engaging in entertaining activities and having fun; keeping the hope of cure alive; and finding support in religion. CONCLUSIONS: Children with cancer undergoing chemotherapy need to cope with hospitalizations, pain, medication side effects, idle time, and uncertainty regarding the success of treatment. These challenges motivated children to develop their own coping strategies, which were effective while undergoing chemotherapy. CLINICAL RELEVANCE: By gaining knowledge and further understanding about valid coping strategies during chemotherapy treatment, health professionals can mobilize personal and material resources from the children, health teams, and institutions aiming to potentiate the use of these strategies to make treatments the least traumatic.

Estratégias lúdicas de coleta de dados com crianças com câncer: revisão integrativa / Estrategias lúdicas de recolección de datos con niños con cáncer: revisión integradora / Playful strategies for data collection with child cancer patients: an integrative review

As crianças são as melhores fontes de informação sobre suas experiências e opiniões; e as pesquisas qualitativas têm privilegiado desenvolver e aplicar técnicas que deem vozes a elas e facilitem a sua aproximação com o pesquisador. Objetivou-se identificar, mediante revisão integrativa da literatura, recursos lúdicos utilizados na coleta de dados de pesquisas qualitativas com crianças com câncer e suas formas de aplicação. Realizaram-se buscas sistematizadas em bases de dados eletrônicas e biblioteca virtual, que, somadas a uma amostra não sistematizada, abrangendo o período de 2000 a 2010, totalizaram 15 estudos. Identificaram-se os recursos de desenho, brinquedo terapêutico, fantoche, fotografia e dinâmicas de criatividade e sensibilidade que, associados ou não à entrevista, mostraram-se facilitadores da coleta de dados, direta ou indiretamente, ampliando a interação com as crianças e permitindo maior expressão de seus sentimentos. São apresentadas vantagens e limitações da utilização desses recursos, contribuindo-se para o planejamento de pesquisas com crianças.

Los niños son las mejores fuentes de información sobre sus experiencias y opiniones e investigaciones cualitativas han privilegiado el desarrollo y la aplicación de técnicas que les den voces y faciliten su aproximación con el investigador. La finalidad fue identificar, mediante revisión integradora de la literatura, recursos lúdicos utilizados para recolectar datos con niños con cáncer y sus formas de aplicación. Fueron efectuadas búsquedas sistematizadas en bases de datos electrónicas y biblioteca virtual que, sumadas a una muestra no sistematizada, del 2000 al 2010, totalizaron 15 estudios. Fueron identificados los recursos de diseño, juguete terapéutico, fantoche, fotografía y dinámicas de creatividad y sensibilidad que, asociados o no a la entrevista, se mostraron facilitadores de la recolección de datos, directa o indirectamente, ampliando la interacción con los niños y permitiendo mayor expresión de sus sentimientos. Se presentan ventajas y limitaciones de estos recursos, contribuyendo a la planificación de investigaciones con niños.

Children are the best sources of information on their experiences and opinions, and qualitative studies have favored the development and application of techniques that facilitate their self-expression and approaching the researcher. Through an integrative literature review, the objective of this research was to identify playful resources used in qualitative research data collection with child cancer patients, and their forms of application. Systemized searches of electronic databases and a virtual library were undertaken, which, combined with a non-systemized sample, totaled 15 studies spanning the period from 2000 and 2010. Drawing, toys, puppets, photography and creativity and sensitivity dynamics were identified which, in association with interviews or not, were shown to directly or indirectly facilitate data collection, thereby broadening the interaction with the children, and permitting further expression of their feelings. The advantages and limitations of using these resources are presented, thus contributing to planning research with children.

Children with Type 1 Diabetes Mellitus and their friends: the influence of this interaction in the management of the disease.

Friends' support is a key element in the management of Type 1 Diabetes Mellitus. This study describes the influence of friends on the lives of children with Diabetes Mellitus and its implications for managing the disease. Empirical data were collected through semi-structured interviews, supported with the use of puppets, with 19 children aged between seven and 12 years old. The qualitative analysis of the testimonies allowed understanding the phenomenon from two perspectives: the attitude of friends towards the child, positively or negatively affecting the disease's management, and the attitude of the child toward friends. The knowledge of those involved and the interaction between the children with DM1 and their friends impacts the management of the disease. Understanding the implications of these interactions contributes to the delivery of qualified nursing care to this population.

Children with Type 1 Diabetes Mellitus and their friends: the influence of this interaction in the management of the disease / A criança com Diabetes Mellitus Tipo 1 e seus amigos: a influência dessa interação no manejo da doença / El niño con Diabetes Mellitus Tipo 1 y sus amigos: la influencia de esta interacción en el manejo de la enfermedad

Friends' support is a key element in the management of Type 1 Diabetes Mellitus. This study describes the influence of friends on the lives of children with Diabetes Mellitus and its implications for managing the disease. Empirical data were collected through semi-structured interviews, supported with the use of puppets, with 19 children aged between seven and 12 years old. The qualitative analysis of the testimonies allowed understanding the phenomenon from two perspectives: the attitude of friends towards the child, positively or negatively affecting the disease's management, and the attitude of the child toward friends. The knowledge of those involved and the interaction between the children with DM1 and their friends impacts the management of the disease. Understanding the implications of these interactions contributes to the delivery of qualified nursing care to this population.

O apoio dos amigos constitui-se em um dos elementos essenciais no manejo do Diabetes Mellitus Tipo 1. Este estudo objetivou descrever a influência dos amigos na vida da criança com Diabetes Mellitus e suas repercussões no manejo da doença. Os dados empíricos foram coletados por meio de entrevista semiestruturada, aliada à utilização de fantoches, com 19 crianças entre sete e 12 anos. A análise qualitativa dos depoimentos permitiu a apreensão do fenômeno por meio de duas perspectivas: a atitude dos amigos perante a criança, interferindo de forma positiva ou negativa no manejo da doença e a atitude da criança perante seus amigos. O conhecimento dos envolvidos e a interação entre a criança e seus amigos interferem no manejo da doença. Compreender as repercussões dessas interações contribui para o oferecimento de cuidado de enfermagem de qualidade a esse grupo.

El apoyo de los amigos constituye uno de los elementos esenciales en el manejo de la Diabetes Mellitus Tipo 1. Este estudio objetivó describir la influencia de los amigos en la vida del niño con Diabetes Mellitus y sus repercusiones en el manejo de la enfermedad. Los datos empíricos fueron recolectados por medio de entrevista semiestructurada, aliada a la utilización de muñecos, con 19 niños entre siete y 12 años de edad. El análisis cualitativo de las declaraciones permitió la comprensión del fenómeno por medio de dos perspectivas: la actitud de los amigos delante del niño (interfiriendo de forma positiva o negativa en el manejo de la enfermedad) y la actitud del niño delante de sus amigos. El conocimiento de los envueltos y la interacción entre el niño y sus amigos interfieren en el manejo de la enfermedad. Comprender las repercusiones de esas interacciones contribuye para el ofrecimiento de un cuidado de enfermería de calidad a ese grupo.

[Type 1 diabetes mellitus: evidence from the literature for appropriate management in children's perspective]. / Diabetes mellitus tipo 1: evidências da literatura para seu manejo adequado, na perspectiva de crianças.

The objective of this study was to identify the evidence available in the literature that address, for children's perspective, factors that are relevant for an appropriate management of type 1 diabetes mellitus. An integrative review was performed on the PubMed, CINAHL, LILACS, CUIDEN and PsycINFO databases, covering the period from 1998 to 2008 and using the following keywords: type 1 diabetes mellitus, child, prevention and control, triggering factors, emergencies, self care, learning and health education. Nineteen of the surveyed articles were selected, and their analysis revealed the following categories: living with diabetes; self care and glucose profile; the actions of family, friends and health professionals; and school. The evidence show that children appreciate the support they receive from their relatives, which have a direct relationship with being prepared for self care. Other members apart from their network are also valued. Areas that deserve attention are the school, the personal experience of each child, and health education.