by Ron Ramsing, Ph.D., and Eddie Hill, Ph.D.
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.
Background
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.
Practical Applications
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.
Research Highlights
- Benefits-based programming serves as a framework for camp
and better positions recreation professionals to meet the needs of
youth development:
- identify desired outcomes;
- program for those specific outcomes;
- assess the outcomes; and
- share findings with organizations that can benefit from results.
- Benefits-based programming resources and research:
- www.lin.ca/lin/resource/html/bbp.htm
- Allen, L., Stevens, B., Hurtes, K., & Harwell, R. (1998).
Benefits-based programming of recreation services training manual.
Ashburn, VA: National Recreation and Park Association.
- Allen, L., Cox, J., & Cooper, N. (2006). The impact of a
summer day camp on the resiliency of disadvantaged youths. Journal
of Physical Education, Recreation, and Dance, 77(1),12-23.
- Camps that provide activities based on an understanding of sex differences
are better suited to increase campers’ perceptions of autonomy
support.
- Experiences may be effectively engineered to meet the needs
of campers. Programming with intention, such as through the use
of the benefits-based programming model, can better meet the needs
of participants. For example, in a diabetes camp multiple education
sessions could be offered with the intent of providing choice. In this
example, choice is the intended outcome of the program and is essential
for diabetes self-management.
- Evidence exists that practitioners can create intentional
activities that provide for authentic experiences. Camp programs
that are perceived as being highly controlling potentially inhibit
genuine emotions and feelings. Real experiences may be enhanced by camper-centered
versus leader-centered approaches. For example, in wilderness settings
campers may be responsible for their own shelter and food preparation.
Intentional programs that focus on camper-centered activities result
in a sense of authenticity that has been shown to increase independence.
| References |
| Andrews, L. W. (2000). Blunting after-meal glucose
spikes. Diabetes Self-Management, 1, 33. |
| Cox, D. J., & Gonder-Frederick, L. (1992).
Major developments in behavioral diabetes research. Journal of Consulting
Clinical Psychology, 60, 628-638. |
| Deci, E. L., & Flaste, R. (1995). Why we
do what we do. New York: Penguin Books. |
| Deci, E. L., & Ryan, R. M. (2004). Self-determination
theory: An approach to human motivation and personality. Retrieved
March 2, 2004, from http://www.psych.rochester.edu/SDT/index.html. |
| Hill, E. & Sibthorp, J (2006). Autonomy
support at diabetes camp: A self-determination theory approach to
therapeutic recreation. Therapeutic Recreation Journal, 40, 21-24. |
| Hill, E. (2004). The effects of an intentional
recreation program on internalization of type 1 diabetes management
among adolescents. Doctoral dissertation, University of Utah, Salt
Lake City. |
| Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation
of intrinsic motivation, social development and well-being. American Psychologist,
55, 68-78. |
| Sibthorp, J., Paisley, K., & Hill, E. (2003). Intentional programming in
wilderness programs. Journal of Physical Education, Recreation, and Dance, 74(8),
21-24. |
| Williams, G. C., Freedman, Z. R., & Deci,
E. L. (1996). Promoting motivation for diabetes self-regulation of
HbA1c. Diabetes, 45, 13. |
| Williams, G. C., Freedman, Z. R., & Deci,
E. L. (1998). Supporting autonomy to motivate glucose control in
patients with diabetes. Diabetes Care, 21, 1644-1651. |
| Williams, G. C., McGregor, H. A., Zeldman, A.,
Freedman, Z. R., & Deci, E. L. (2004). Testing a self-determination
theory process model for promoting glycemic control through diabetes
self-management. Health Psychology, 23, 58-66. |
| Winfree, C., Williams, R., & Powell, G.
(2002). Children with cancer: Positive benefits of camp. Camping
Magazine, 75(6), 27-34. |
Originally published in the 2007 January/February
issue of Camping Magazine. |
