Diabetes Mellitus in Maltese Youth
Examining Feelings, Knowledge and Perceptions
of Maltese Children and Adolescents
Judith Rocchiccioli, PhD., RN, Karen Jagiello, MSN, RNC, Emily Cleaves, Rachel Crockett,
Samantha Muntean, Andrea Virden
James Madison University in conjunction with the Malta Institute of Health
Introduction
Methods
Malta has the largest incidence of Diabetes
Mellitus in the world. Currently it is estimated
that over 10% of the Maltese population have
diabetes with the incidence steadily increasing,
particularly among children who are vulnerable
and obese. Children and adolescents with
juvenile diabetes live a different life than other
youth their age. Juvenile diabetes requires
children to be placed on strict diets and
exercise regimens, causing them to feel
differently physically, emotionally and socially.
This research examines the experience of
Maltese children with juvenile diabetes,
focusing on their outlook of the disease itself,
current knowledge of the disease and their
feelings about the treatment they receive.


Sample recruited by Mater Dei Hospital of
children who had been diagnosed with
Diabetes Mellitus for 6 months or longer

Sample comprised of 11 participants:
Children’s group 6 (4 female, 2 male)
Adolescent group 5 (3 female, 2 male)

The purpose of this study was to assess the
perceptions and knowledge of Diabetes
Mellitus (DM) in Maltese children who have
been diagnosed with diabetes mellitus for at
least 6 months. This research represents a
beginning effort to learn more about Maltese
children diagnosed with Juvenile Diabetes with
regard to their social needs, feelings and
perceptions of the disease. The research
question asked “what are the perceptions of
Maltese children aged 7 – 18 regarding their
disease, their ability to cope socially and their
learning needs related to DM” was asked to
two focus groups of Maltese children and
adolescents.
Feelings of Anger, Fear or Shame
• Children’s Group
Participants divided into two focus groups
(7-12 and 13-18 years of age)


Purpose
Qualitative study using the Grounded
theory (Glaser & Strauss, 1967; Strauss &
Corbin, 1998)
Themes
Interview directed by faculty with JMU
students recording verbal and non-verbal
responses of subjects. A recording of the
interview was made to compare those
results.
Transcripts and recordings analyzed for
common themes
Directed Questions:
1. What is the hardest thing about having
Diabetes?
2. Does having diabetes make you feel different?
If so, how?
3. Do you feel you are treated differently by the
following:
-your parents
-your friends
-your school
-others (please name)
4. Do you understand your diet and exercise? If
not, what do you need help with?
5. Do you ever feel angry or sad about having
this disease? When?
6. Does having diabetes make you feel scared or
frightened? When?
7. If you would be granted just one wish relating
to your disease, what would you wish for?
•
-“Sometimes when I play football with my friends and
when I feel a hypo we entirely stop the game because
of me. I feel a bit jealous”
- “I feel scared when I feel very low and you’re a lot
away from home to get some sweets and to get the
sugar up”
Adolescent Group
- “This past two weeks I’ve been getting angry, I feel
like I want to miss these injections because I don’t
have time to study”
-“I am quite a lot scared if I have diabetes. But I am
quite scared having diabetes and not being with my
family”
Perceptions of Being Treated Differently
• Children’s Group
-“Cause when I play when I feel dizzy at least I have my
friends helping me. They go call my mom and they
come down and bring my glucose”
-“They (parents) are a bit overprotective because every
hour, did you check it? Did you check it? It kind of bugs
me when every hour they say.”
• Adolescent Group
-“I think all of them, my teachers from school, because
if they see me laying down, they ask me if I’m not
feeling well. They let me leave class if I’m not supposed
to.”
-“My parents annoy me about my sugar being ok. So,
yes I feel like I am treated differently at times
Feelings of Embarrassment
• Children’s Group
•
-“ I’m not saying that they do this, but they can make
fun of me because I have diabetes”
-“I wait until everyone is out of the classroom and I go
to the back of the class”
-“I don’t tell my friends that I have diabetes because I
like to play with my neighbors and I don’t tell them
cause’ I’m shy and they do not know what it means”
Adolescent Group
-“It makes me quite different because before the break
at school I have to get injections, so I go out of the
class and do my injection. It is annoying because all of
my friends ask where I am going, and I say the toilet; I
don’t want everyone knowing where I am going”
Feelings
of Anger, Fear,
and Shame
Unclear
Expectations
of the
Future
Perceptions
of being treated
differently
Feelings
of
Embarrassment
Lack
of
Freedom
Perceptions
of
Juvenile Diabetes
Lack
of
Social Support
Six Common Themes Identified
Limitations
- Cultural differences between American
researchers and Maltese children.
- The subjects did not feel comfortable
discussing their illness to “strangers”
- The subjects felt obligated to strictly
answer the questions given and not
elaborate into further conversation.
-The female subjects were shy around the
male subjects.
- Limited to the country of Malta.
Conclusions
Children with diabetes need added support
from their friends, families, and health
professionals
Emotional factors should be taken into
consideration when treating both young
children and adolescents with diabetes.
More studies of this type are needed to build
theory on how to care for these children.
Many thanks to the staff at Mater Dei Hospital Diabetes Clinic for their assistance with this study.