Chronic burden or silent companion? Experiences of children with type 1 diabetes: A metaphor and sentiment analysis

Abstract

Aim: This study aimed to explore how children with type 1 diabetes (T1D) conceptualize their condition through sentiment and metaphor analysis, addressing gaps in understanding their emotional and linguistic frameworks. Design: A mixed approach was employed, integrating computational sentiment analysis and qualitative metaphor analysis. Method: The study used a mixed-methods design. Metaphors were collected from 79 Turkish children aged 7-17 with T1D through a semi-structured interview including prompts such as Diabetes is like... because... and If diabetes were a color, it would be... because.... Metaphor responses were coded and grouped into seven categories: unpredictability, companionship, threat, control and management, physical and emotional impact, duality, and dependency on treatment. Computational sentiment analysis was performed on a randompurposeful subsample of 35 children's narratives using Python and NVivo. Results: Children generated 55 distinct metaphors describing their experiences of T1D. Most metaphors reflected negative or burdensome aspects of diabetes, with 57 % of children expressing predominantly negative emotions in their narratives. Positive emotions, linked to resilience and hope, were observed in 14 % of responses, while 29 % were neutral. The emotional tone and metaphor categories provided insight into both the psychological burden and adaptive coping mechanisms in pediatric T1D. Conclusion: Children's metaphors and emotional expressions highlight the complexity of living with T1D. Nursing and psychosocial interventions should consider both the cognitive and emotional dimensions revealed in children's own words to improve support and care. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.