ORIGINAL RESEARCH Adolescents developing life skills for managing type 1 diabetes: a qualitative, realistic evaluation of a guided self-determination-youth intervention Gitte R. Husted, Bente Appel Esbensen, Eva Hommel, Birger Thorsteinsson & Vibeke Zoffmann Accepted for publication 8 March 2014 Correspondence to G.R. Husted: e-mail: gitte.husted@regionh.dk Gitte R. Husted MScN RN PhD Student The Paediatric Department, Nordsjællands Hospital Hillerød, University of Copenhagen, Denmark Bente Appel Esbensen MScN DMSc RN Research Manager Associate Professor Research Unit of Nursing and Health Science, Copenhagen University Hospital, Glostrup, Denmark and Department of Public Health Faculty of Health and Medical Sciences, University of Copenhagen, Denmark Eva Hommel MD DMSc Consultant Steno Diabetes Center, Gentofte, Denmark Birger Thorsteinsson MD DMSc Professor Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital Hillerød, University of Copenhagen, Denmark and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark Vibeke Zoffmann MPH PhD RN Associate Professor Steno Diabetes Center, Gentofte, Denmarkand NKLMS, Oslo University Hospital, Norway HUSTED G.R., ESBENSEN B.A., HOMMEL E., THORSTEINSSON B. & ZOFFMANN V. (2014) Adolescents developing life skills for managing type 1 diabetes: a qualitative, realistic evaluation of a guided self-determination-youth intervention. Journal of Advanced Nursing 00(0), 000–000. doi: 10.1111/jan.12413 Abstract Aim. To explore and illustrate how the Guided Self-Determination-Youth method influences the development of life skills in adolescents with type 1 diabetes supported by their parents and healthcare providers. Background. Evidence-based methods that accomplish constructive cooperation between adolescents with poorly controlled type 1 diabetes, their parents and healthcare providers are needed. We adjusted an adult life skills intervention comprising reflection sheets and advanced communication for use by adolescent- parent-professional triads in outpatient visits. Design. A qualitative realistic evaluation design comprising eight context-mechanism- outcome configurations directed the analysis of the Guided Self-Determination- Youth’s influence on adolescent-parent-professional triads to evaluate what worked for whom, how and in what circumstances. Thirteen adolescents aged 13–18 years diagnosed with type 1 diabetes for ≥1 year and having poor glycaemic control participated together with 17 parents and eight healthcare providers. Data were collected from December 2009–March 2012 and consisted of digitally recorded outpatient Guide Self-Determination-Youth visits collected during the intervention period (11Á5–24Á5 months) and semi-structured interviews at 6-month follow-up. Findings. Emerging life skills in adolescents were identified as: (1) developing new relatedness with healthcare providers and parents; (2) becoming decision makers in their own lives with diabetes; and (3) growing personally. Reflection sheets combined with healthcare providers’ advanced communication were central to promoting mutual problem-solving. Conclusion. A life skills approach turned outpatient visits into person-specific visits with improved cooperation patterns in the triads. Combining reflection sheets and advanced communication skills supported adolescents in beginning a process of developing life skills. Keywords: adolescents, autonomy-supportive intervention, decision-making, nurs- ing, outpatient clinic, type 1 diabetes © 2014 John Wiley & Sons Ltd 1