Examining Multilevel Factors Affecting Participation in Physical Activity Among Adolescents With Type 1 Diabetes Using the Socio-Ecological Model

Examining Multilevel Factors Affecting Participation in Physical Activity Among Adolescents With Type 1 Diabetes Using the Socio-Ecological Model

The goal of this observational study is to examine the multilevel factors influencing physical activity participation in adolescents with Type 1 diabetes (T1D) within the framework of the Socio-Ecological Model (SEM). Physical activity is a multidimensional behavior shaped by individual, interpersonal, institutional, community, and policy-level influences, and it plays a critical role in diabetes management, metabolic health, and overall well-being in youth with T1D.

The main questions it aims to answer are:

Do factors at the individual, interpersonal, institutional, community, and policy levels of the Socio-Ecological Model significantly influence physical activity participation, social participation, and diabetes management in adolescents with Type 1 diabetes? Which modifiable barriers and facilitators at these multiple levels are associated with higher or lower levels of physical activity?

Participants diagnosed with Type 1 diabetes will complete questionnaires assessing their daily living activities, exercise habits, social participation, psychosocial characteristics, and perceived social and environmental support. Objective measurements related to circadian rhythm patterns and glycemic control will also be collected. The study will analyze how multilevel socio-ecological factors are associated with physical activity behavior, social engagement, and diabetes management outcomes.

The findings are expected to provide a comprehensive biopsychosocial understanding of physical activity behaviors in adolescents with Type 1 diabetes and to inform the development of supportive, school- and community-based intervention strategies aimed at improving quality of life, self-efficacy, psychological resilience, and sustainable participation in physical activity.

Inclusion Criteria:

• Diagnosed with Type 1 diabetes at least 1 year prior to enrollment,
• Aged between 9 and 18 years,
• Currently attending school in Istanbul,
• Willing to participate in the study (with voluntary consent),
• HbA1c value ≥ 8% within the past year,
• Reported glucose metabolism biomarkers,
• Sufficient cognitive ability to understand and complete the questionnaires,
• Under regular medical follow-up and using at least one glucose monitoring device.

Exclusion Criteria:

• Lack of parental consent,
• Presence of additional neurological, motor, or cognitive disorders,
• Inadequate mental status or diagnosis of moderate to severe intellectual disability,
• Presence of systemic comorbid diseases,
• Failure to report HbA1c data.