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How Camps Can Help Adolescents Self-Manage Diabetes
Understanding how summer camps that utilize intentional programming are well situated to better meet the needs of campers is extremely valuable. The following study was presented at the 2006 Camp Research Symposium held at the American Camp Association National Conference and provides some practical applications for camp directors and camp professionals to consider for the future.
The Role of Theory-Based Programming in Camp: A Three-Year Evaluation of Diabetes Camps
With a strong tradition for more than 150 years, summer camps have been shown to be a supportive and beneficial environment for youth, especially for children and adolescents facing a variety of medical conditions (Winfree, Williams, & Powell 2002). With diabetes (type 1) being considered one of the most psychologically and behaviorally demanding chronic illnesses facing adolescents (Cox & Gonder-Fredrick 1992), the potential for camps to positively impact the lives of adolescents is great. The ultimate goal for an adolescent diagnosed with type 1 diabetes is effective self-management, resulting in his or her physiology emulating that of a nondiabetic body (Andrews 2000).
Self-determination theory (SDT) has been successfully applied to individuals with diabetes as a way to influence individual motivation for diabetes self-management (Williams, Freedman, & Deci 1996, 1998; Williams, McGregor, Zeldman, Freedman, & Deci 2004). Self-determination theory postulates that individuals whose behaviors originate from volition or choice as compared from control or pressure are more prone to long-term adherence to particular goal-oriented behaviors (Williams, Freedman, & Deci 1998). With SDT as a theoretical foundation, programming with intention has been successfully used in organized camps in effort to increase measurable outcomes. Applying a Benefits-Based Programming (BBP) approach (Hurtes, Allen, Stevens, & Lee 2000) to camp with the target outcome of increased self-determination for diabetes self-management provides adolescents the opportunity for better adherence to appropriate diabetes regimen.
Autonomy supportive environments are needed for individuals to take ownership of their behavior (Ryan & Deci 2000). Autonomy supportive environments require providing an environment involving choice, perspective taking, and rationale provision (Sheldon, Williams, & Joiner 2003). Choice allows for ownership, perspective taking offers a sense of empathy and understanding, and rationale provision may limit perceptions of control (Deci & Flaste 1995).
Although the research using summer camps appears to be promising (Hill, 2004; Sibthorp, Paisley & Hill 2003), there is limited understanding of how camps positively influence adolescents with diabetes and the specific mechanisms within camps that may foster outcomes for increased diabetes self-management. Therefore, the purpose of these studies was to examine the effects of intentionally programmed camps on motivation for diabetes management among adolescents with type 1 diabetes and explore the specific mechanisms within camp that may foster perceptions of autonomy support.
Results and Discussion
Using SDT as a foundation for intentional programming with a target outcome of increased self-management, research on organized summer camps and wilderness programs was conducted over a consecutive three-year period ending in 2004. Research also focused on the specific mechanisms within camp that could foster perceptions of autonomy support.
Utilizing a BBP design, the Recreation Opportunities for Adolescents with Diabetes (ROAD) program was created in 2002 to assess self-management of diabetes and autonomous behavior. The findings from the study were used to design a program in 2003 for teens participating in an existing summer diabetes camp. Finally, based on theoretical underpinnings of autonomy support (Deci & Ryan 2004), and the previous research on BBP applied to diabetes camps, the Activity Specific Autonomy Support Questionnaire was created to provide insight into perceptions of autonomy support by campers participating in a six-day, residential camp program during the summer of 2004.
Results from the BBP portion of the study that targeted competence, autonomy, and relatedness for diabetes management indicated that participants in a wilderness program increased their sense of relatedness and their autonomous regulation of diet. Participants in an adapted camp program reported an increase in self-efficacy for diabetes care over the comparison group (Sibthorp, et al. 2003). Moreover, the results of the research suggest that an autonomy supportive camp staff were an important component and predictor of competence, autonomy, and relatedness for diabetes management post camp (Hill & Sibthorp 2006).
In an attempt to isolate the specific camp experiences and participant characteristics in camp that yield increased perceptions of autonomy support for adolescents with diabetes, nature of competition (competitive and noncompetitive) and instructional approaches (leader-centered and camper-centered) were found to influence male and female campers perceptions of autonomy. Specifically, females indicated lower perceptions of autonomy support in competitive activities and events that used a leader-centered format for instruction, compared to their male peers.
Camps utilizing a benefit-based approach to programming in conjunction with an understanding of specific camp experiences and participant characteristics are better positioned to meet the needs of adolescents diagnosed with diabetes. The findings suggest that autonomy supportive techniques and approaches can be fostered through effective training. The findings also suggest that traditional competitive activities may thwart opportunities for autonomy support, and leader-centered instruction in camp may not be the most effective approach to working with adolescents with diabetes as related to autonomy support. Finally, perceptions of autonomy support vary by gender, suggesting that meeting the needs of campers should include awareness of gender differences in nature of competition and instruction type.