Parent–child interactions in the development of self-care among adolescents with chronic illness in Japan: A grounded theory approach

PURPOSE: We aimed to clarify how parent-child interactions influence the development of self-care among adolescents with chronic illnesses in Japan. METHODS: Eleven adolescent-guardian pairs were recruited from two hospitals in Japan. Adolescents, aged 16-24 years, were diagnosed with nephrotic syndrome or type 1 diabetes and were accompanied by one guardian. All participants were receiving treatment or outpatient follow-up care. Semi-structured interviews were conducted, and data were analyzed using grounded theory procedures described by Strauss and Corbin. RESULTS: Three major interactional processes and one sub-process- (1) Parent-Led Self-Care, (2) Challenges and Experimentation toward Autonomy, and (3) Realization of Self-Care Transition- and one sub-process, (2a) Disengaged Interaction under Attribution, were identified, underscoring the emotional functions within the parent-child subsystem. The findings revealed conflicts typical of adolescence-particularly within Interactional Process 2 and Sub-Interactional Process 2a-linked to poor disease control often seen during this developmental stage, as well as trial-and-error strategies of the parents to address these issues. CONCLUSIONS: The results indicate that interventions for adolescents with chronic illnesses should consider the parent-child subsystem as a unit and strengthen emotional support for both parties. Such strategies may be beneficial across varied cultural and clinical contexts. IMPLICATIONS TO PRACTICE: Nurses can attend not only to adolescent patients but also to adolescent-guardian interactions, and guide guardians in adjusting their involvement according to adolescents' self-care development. Furthermore, nurses may support adolescents' emotional needs in collaboration with guardians, particularly during periods when emotional support is challenging.