The Effect of an Intervention Based on the Roy Adaptation Model on Glycated Haemoglobin Levels in Adolescents with Diabetes: A Randomised Controlled Trial

Abstract

Aim

This study evaluated the effect of a Roy Adaptation Model (RAM)-based educational intervention on A1C levels and adaptive behaviors in adolescents with type 1 diabetes, and its contribution to physiological, psychosocial, and behavioral adaptation within a holistic nursing framework.

Methods

This randomized controlled trial included 60 adolescents aged 11 to 18 years followed in a pediatric endocrinology clinic. Participants were randomly assigned to an intervention group receiving structured RAM-based education, individualized tasks, and follow-up support (n = 30), or a control group receiving an educational brochure (n = 30). Data were collected at baseline and three months postintervention using a Sociodemographic Form, the Diabetes Knowledge Assessment Form, and clinical A1C records.

Results

Compared with the control group, the intervention group showed significant improvements in diabetes knowledge, adaptive behaviors, and A1C levels (p < .05). Interventions targeting RAM's adaptive modes contributed to glycemic control by strengthening psychosocial adaptation.

Conclusion

RAM-based nursing interventions promote physiological, psychosocial, and behavioral adaptation in adolescents with type 1 diabetes. Structured education enhances self-care, glycemic control, and coping. Integrating holistic nursing approaches into pediatric diabetes care is essential for improving outcomes.

Keywords

type 1 diabetes adolescents Roy Adaptation Model holistic nursing glycated hemoglobin randomized controlled trial

Get full access to this article

View all access options for this article.

References

Alimohammadi

Maleki

Abbasi

Shakerian

Hemati

Aghajani

, et al. (2018). The effect of adaptation training on controlling maladaptation behaviors in adolescents with asthma based on Roy Adaptation Model. Tanaffos, 17(2), 103. PMCID: PMC6320562. https://pmc.ncbi.nlm.nih.gov/articles/PMC6320562/

Alligood

M. R.

(2017). Nursing theorists and their work-E-book: Nursing theorists and their work-e-book. Elsevier Health Sciences.

Altundağ

(2018). The effect of education and social support on the adaptation of children with type 1 diabetes to the disease. Pamukkale Medical Journal, 1(2), 137–144. https://doi.org/10.5505/ptd.2017.90958

American Diabetes Association. (2018). Glycemic targets: Standards of medical care in diabetes—2018. Diabetes Care, 41(Suppl. 1), S55–S64. https://doi.org/10.2337/dc18-S006

Anderson

B. J.

Brackett

Finkelstein

Laffel

(2002). Parental involvement in diabetes management tasks: Relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus. The Journal of Pediatrics, 130(2), 257–265. https://doi.org/10.1016/S0022-3476(02)70333-1

Bakker

Apelqvist

Schaper

N. C.

, & International Working Group on the Diabetic Foot Editorial Board. (2012). Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes/Metabolism Research and Reviews, 28(Suppl 1), 225–231. https://doi.org/10.1002/dmrr.2253

Couper, J. J., Haller, M. J., Greenbaum, C. J., Ziegler, A.-G., Wherrett, D. K., Knip, M., & Craig, M. E. (2018). ISPAD clinical practice consensus guidelines 2018: Stages of type 1 diabetes in children and adolescents. Pediatric Diabetes, 19, 20–27. https://doi.org/10.1111/pedi.12734

Delamater

A. M.

de Wit

McDarby

Malik

J. A.

Acerini

C. L.

(2014). Psychological care of children and adolescents with type 1 diabetes. Pediatric Diabetes, 15(Suppl. 20), 232–244. https://doi.org/10.1111/pedi.12191

Doğan

Çam

(2020). The effect of adaptation theory-based therapeutic approach on adolescents’ anger management. Journal of Child and Adolescent Psychiatric Nursing, 33(2), 85–94. https://doi.org/10.1111/jcap.12268

10.

Edraki

Zarei

Soltanian

Moravej

(2020). The effect of peer education on self-care behaviors and the mean of glycosylated hemoglobin in adolescents with Type 1 diabetes: A randomized controlled clinical trial. International Journal of Community Based Nursing and Midwifery, 8(3), 209–218. https://doi.org/10.30476/ijcbnm.2020.82296.1051

11.

Elamin

S. M.

Arshad

N. F. M.

Redzuan

A. M.

Othman

Musa

N. H.

Hassan

, et al. (2024). Information needs on type 1 diabetes mellitus (T1DM) and its management in children and adolescents: A qualitative study. BMJ Open, 14(4), e079606. https://doi.org/10.1136/bmjopen-2023-079606

12.

Grey

Boland

E. A.

Davidson

Sullivan-Bolyai

Tamborlane

W. V.

(2000). Short-term effects of coping skills training as an adjunct to intensive therapy in adolescents. Diabetes Care, 23(12), 1873–1878. https://doi.org/10.2337/diacare.23.12.1873

13.

Gulcu

Arslan

Arslanoglu

(2020). Effectiveness of web-based exercise training in adolescents with type 1 diabetes. Duzce University Health Sciences Institute Journal, 10(3), 279–288. https://doi.org/10.33631/duzcesbed.589195

14.

Güneş

E. O.

Çetinkaya

Ş.

(2026). The use of the Roy Adaptation Model in clinical nursing care of an adolescent diagnosed with type 1 diabetes (case report). Frontiers in Clinical Diabetes and Healthcare, 7, 1721420. https://doi.org/10.3389/fcdhc.2026.1721420

15.

Guyton

A. C.

Hall

J. E.

(2013). Textbook of medical physiology (12th ed., p. 950). Nobel Medical Bookstores.

16.

Hanna

K. M.

Alazri

Eisenhauer

C. M.

(2025). A theory of transitions influencing diabetes self-management among emerging adults with type 1 diabetes. Advances in Nursing Science, 48(1), E32–E39. https://doi.org/10.1097/ANS.0000000000000524

17.

Harazneh

Malak

M. Z.

Ayed

(2024). Adolescents and type 1 diabetes: A grounded theory on adolescents' experiences of adaptation to type 1 diabetes. Journal of Pediatric Nursing, 76, e159–e166. https://doi.org/10.1016/j.pedn.2024.02.026

18.

Harris

(2021). Sister Callista Roy Adaptation Model. In Alligood

M. R.

(Ed.), Nursing theorists and their work e-book (23rd ed., p. 247). Elsevier. https://www.elsevier.com/books/nursing-theorists-and-their-work/alligood/978-0-323-75702-7

19.

Harvey

J. N.

(2015). Psychosocial interventions for the diabetic patient. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 8, 29–43. https://doi.org/10.2147/DMSO.S44352

20.

Helgeson

V. S.

Reynolds

K. A.

Siminerio

Escobar

Becker

(2014). Parent and adolescent distribution of responsibility for diabetes self-care: Links to health outcomes. Journal of Pediatric Psychology, 39(5), 497–508. https://doi.org/10.1093/jpepsy/jsu017

21.

Henríquez-Tejo

Cartes-Velásquez

(2018). Impacto psicosocial de la diabetes mellitus tipo 1 en niños, adolescentes y sus familias: Revisión de la literatura. Revista Chilena de Pediatría, 89(3), 391–398. https://doi.org/10.4067/S0370-41062018005000507

22.

Hilliard

M. E.

Y. P.

Rausch

Dolan

L. M.

Hood

K. K.

(2013). Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. Journal of Adolescent Health, 52(1), 28–34. https://doi.org/10.1016/j.jadohealth.2012.05.009

23.

Hood

K. K.

Beavers

D. P.

Yi-Frazier

Bell

Dabelea

McKeown

R. E.

, et al. (2014). Psychosocial burden and glycemic control during the first 6 years of diabetes: Results from the SEARCH for diabetes in youth study. Diabetes Care, 37(9), 2557–2564. https://doi.org/10.2337/dc13-2559

24.

Hood

K. K.

Huestis

Maher

Butler

Volkening

Laffel

L. M. B.

(2006). Depressive symptoms in children and adolescents with type 1 diabetes: Association with diabetes-specific characteristics. Diabetes Care, 29(6), 1389–1391. https://doi.org/10.2337/dc06-0087

25.

Iannotti

R. J.

Schneider

Nansel

T. R.

Haynie

D. L.

Plotnick

L. P.

Clark

L. M.

, et al. (2006). Self-efficacy, outcome expectations, and diabetes self-management in adolescents with type 1 diabetes. Journal of Developmental & Behavioral Pediatrics, 27(2), 98–105. https://doi.org/10.1097/00004703-200604000-00003

26.

International Diabetes Federation. (2017). IDF Diabetes Atlas (8th ed.). [International Diabetes Federation, 2017].. https://fmdiabetes.org/wp-content/uploads/2018/03/IDF-2017.pdf

27.

International Diabetes Federation. (2024). Type 1 diabetes. [International Diabetes Federation, 2024]. https://idf.org/about-diabetes/types-of-diabetes/type-1-diabetes/

28.

International Diabetes Federation (IDF), & International Society for Pediatric and Adolescent Diabetes (ISPAD). (2011). Global IDF/ISPAD guideline for diabetes in childhood and adolescence. [International Diabetes Federation, 2011]. https://idf.org/media/uploads/2023/05/attachments-50.pdf .

29.

Kacaroğlu Vicdan

Karabacak

B. G.

(2014). Among nursing models: Roy Adaptation Model. Acibadem University Journal of Health Sciences, 4, 255–259. https://izlik.org/JA44GT29HE

30.

Katsarou

Gudbjörnsdottir

Rawshani

, et al. (2017). Type 1 diabetes mellitus. Nature Reviews Disease Primers, 3(1), 1–17. https://doi.org/10.1038/nrdp.2017.16

31.

Malkawi

Bani Hani

Al Shikh

(2025). Depression and anxiety among adolescents with type 1 diabetes mellitus: Systematic review of literature. The Open Nursing Journal, 19, e18744346393599. https://doi.org/10.2174/0118744346393599250908085129

32.

Ministry of National Education, Turkey. (2017). Turkey nutrition guide. Ministry of National Education. https://okulsagligi.meb.gov.tr/meb_iys_dosyalar/2017_01/27102535_tyrkiye_beslenme_rehberi.pdf.

33.

Missambou Mandilou

S. V.

Atipo-Ibara Ollandzobo

L. C.

Kitemo Mpolo

F. L. G.

, et al. (2021). Psychosocial functioning and health-related quality of life in children, adolescents, and young adults with type 1 diabetes mellitus in Congo. Pediatric Diabetes, 22(4), 675–682. https://doi.org/10.1111/pedi.13187

34.

Nahcivan

N. Ö.

Tekin

(2012). Roy adaptation theory. In Velioğlu

(Ed.), Concepts and theories in nursing (pp. 364–389). Akademi Press and Publishing.

35.

National Childhood Diabetes Group. (2018). Childhood diabetes: Diagnosis and treatment guidelines. National Juvenile Diabetes Group. https://cocukendokrindiyabet.org/wp-content/uploads/cocukluk-cagi-diyabeti-tani-ve-tedavi-rehberi-2018.pdf.

36.

Phelan

Lange

Cengiz

Gallego

Majaliwa

Pelicand

, et al. (2018). ISPAD clinical practice consensus guidelines 2018: Diabetes education in children and adolescents. Pediatric Diabetes, 19(Suppl. 27), 75–83. https://doi.org/10.1111/pedi.12762

37.

Republic of Turkey, General Directorate of Public Health. (2018a). Childhood educator guide. Ministry of Health. https://ekutuphane.saglik.gov.tr/Ekutuphane/kitaplar/COCUKLUK_CAGI_DIYABETI_EGITIMCI_REHBERI.pdf

38.

Republic of Turkey, Ministry of Health, General Directorate of Public Health. (2018b). Physical activity guide for children and adolescents with chronic diseases. Ministry of Health. https://ekutuphane.saglik.gov.tr/Yayin/713

39.

Republic of Turkey, Ministry of Health, General Directorate of Public Health. (2018c). Guideline for diagnosis, treatment, and follow-up of type 1 diabetes in primary health care. Ministry of Health. https://ekutuphane.saglik.gov.tr/Yayin/711

40.

Roy

Whetsell

M. V.

Frederickson

(2009). The Roy Adaptation Model and research. Nursing Science Quarterly, 22(3), 209–211. https://doi.org/10.1177/0894318409338692

41.

Sadeghnezhad Forotaghe

Vanaki

Memarian

(2011). The effect of nursing care plan based on “Roy Adaptation Model” on psychological adaptation in patients with diabetes type II. Evid Based Care, 1(1), 5–20. https://unmf.umsu.ac.ir/article-1-1094-en.html .

42.

Santos

F. R. M.

Bernardo

Gabbay

M. A.

Dib

S. A.

Sigulem

Costa

, et al. (2013). The impact of knowledge about diabetes, resilience and depression on glycemic control: A cross-sectional study among adolescents and young adults with type 1 diabetes. Diabetology & Metabolic Syndrome, 5, 55. https://doi.org/10.1186/1758-5996-5-55

43.

Schilling

L. S.

Grey

Knafl

K. A.

(2009). The concept of self-management of type 1 diabetes in children and adolescents: An evolutionary concept analysis. Journal of Advanced Nursing, 65(9), 1755–1766. https://doi.org/10.1111/j.1365-2648.2009.05075.x

44.

Silverstein

Klingensmith

Copeland

Plotnick

Kaufman

Laffel

Clark

(2005). Care of children and adolescents with type 1 diabetes: A statement of the American Diabetes Association. Diabetes Care, 28(1), 186–212. https://doi.org/10.2337/diacare.28.1.186

45.

Spencer

Cooper

Milton

(2010). Qualitative studies of type 1 diabetes in adolescence: A systematic literature review. Pediatric Diabetes, 11(5), 364. https://doi/10.1111/j.1399-5448.2009.00603.x https://doi.org/10.1111/j.1399-5448.2009.00603.x

46.

Tatoğlu

Ayyildiz

T. K.

(2025). Effects of health education based on the Roy Adaptation Model on the healthy lifestyle behaviors and self-esteem of working adolescents: A randomized controlled trial. Public Health Nursing (Boston, Mass.), 42(3), 1288–1301. https://doi.org/10.1111/phn.13546

47.

Tuohy, E., Gallagher, P., Rawdon, C., Murphy, N., McDonnell, C., Swallow, V., & Lambert, V. (2025). Parent-adolescent communication, self-efficacy, and self-management of Type 1 diabetes in adolescents. Science Diabetes Self-Management and Care, 51(1), 73–84. https://doi.org/10.1177/26350106241304424

48.

Turkish Diabetes Foundation. (2018). Diabetes diagnosis and treatment guide. Turkish Diabetes Foundation. https://www.turkdiab.org/admin/PICS/files/Diyabet_Tani_ve_Tedavi_Rehberi_2018.pdf .

49.

Turkish Society of Endocrinology and Metabolism. (2016). Diabetes mellitus and management of its complications: Diagnosis, treatment, and follow-up guide. Turkish Society of Endocrinology and Metabolism. https://tekinakpolat.com/wp-content/uploads/2016/11/seker-hastaligi.pdf .

50.

Vaillancourt

Mok

Frei

Shahin

Ferland

Beauséjour

, et al. (2023). Qualitative study exploring the perspectives of emerging adults with type 1 diabetes after transfer to adult care from a pediatric diabetes center in Montreal, Canada. BMJ Open, 13(10), e076524. https://doi.org/10.1136/bmjopen-2023-076524

51.

Wiebe

D. J.

Berg

C. A.

Korbel

Palmer

D. L.

Beveridge

R. M.

Upchurch

, et al. (2005). Children’s appraisals of maternal involvement in coping with diabetes: Enhancing our understanding of adherence, metabolic control, and quality of life across adolescence. Journal of Pediatric Psychology, 30(2), 167–178. https://doi.org/10.1093/jpepsy/jsi004

52.

Yeh

C. H.

(2002). Health-related quality of life in pediatric patients with cancer: A structural equation approach with the Roy Adaptation Model. Cancer Nursing, 25(1), 74–80. https://doi.org/10.1097/00002820-200202000-00013

53.

Young-Hyman

de Groot

Hill-Briggs

Gonzalez

J. S.

Hood

Peyrot

(2016). Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(12), 2126–2140. https://doi.org/10.2337/dc16-2053

54.

Zhao

Huang

Zheng

(2021). Effectiveness of internet and phone-based interventions on diabetes management of children and adolescents with type 1 diabetes: A systematic review. Worldviews on Evidence-Based Nursing, 18(3), 217–225. https://doi.org/10.1111/wvn.12511