Adolescentsʼ Health Attitudes and Adherence to Treatment for Insulin-Dependent Diabetes Mellitus

Abstract

Adolescents' health attitudes and adherence to treatment for insulin-dependent diabetes mellitus (IDDM) were evaluated using the protection motivation theory (PMT). We expected cognitive appraisals of adherence (self-efficacy for treatment management, response efficacy of treatment, response costs of adherence) to be more influential for adherence than appraisals of nonadherence (rewards of nonadherence, perceptions of the risks of nonadherence, perceived severity of the risks). Adolescents (N = 101) with IDDM completed self-report measures of treatment adherence and of the PMT variables. Hierarchical regression analyses revealed that cognitions concerning adherence explained a statistically significant proportion of the variance in treatment adherence (sr2 = .17). Response costs of adherence produced the strongest correlations with overall adherence and with three of the four individual components of IDDM treatment (insulin injections, blood glucose monitoring, diet). The findings suggest that persuasive health communications might focus on appraisals of adherence rather than on risks of nonadherence.

Applying the Transactional Stress and Coping Model to Sickle Cell Disorder and Insulin-Dependent Diabetes Mellitus: Identifying Psychosocial Variables Related to Adjustment and Intervention

“…Higher perceptions of the seriousness of IDDM and weaker beliefs in the personal susceptibility to IDDM complications also are associated with better metabolic control (Brownlee-Duffeck et al, 1987). Higher perceptions of the severity of IDDM also have been related to better treatment adherence in one study (Palardy et al, 1998), while another study found it to be related to worse dietary self-care (Skinner et al, 2000). One explanation for these conflicting results is that these studies relied on possibly faulty self-report measures of adherence that ask the adolescent to recall their self-care behaviors over a certain period of time.…”

Personal Models of Diabetes in Relation to Self-Care, Well-Being, and Glycemic Control

“…The Summary of Diabetes Self-Care Schedule (29) is a validated 12-item selfreport instrument that assesses four areas of diabetes self-management (diet, exercise, blood glucose monitoring, and injecting) over the previous 7 days, and it has been used previously with adolescents (18,20). The scales were scored by combining the scores for items contributing to the diet, exercise, and insulin injection scales.…”

“…Differentiating between long-and short-term beliefs may also be important in understanding the conflicting results for threat expectancies in previous work on adolescents with diabetes (18,20,25). Whether predicting anxiety, depression, or dietary self-management in adolescents, it was the short-term effects of the illness and its treatment (perceived impact of diabetes and effectiveness of treatment to control diabetes) that were important (19).…”

“…In a sample of over 2,000 participants, beliefs about treatment effectiveness proved to be a better predictor of selfmanagement than perceived barriers to adherence (16). Cross-sectional studies of adolescents have also supported an association between treatment effectiveness beliefs and self-care behavior (17,18). Moreover, treatment effectiveness beliefs in diabetes care can be split into two dimensions: the effectiveness of the regimen to control diabetes on a day-to-day basis and to prevent the long-term complications of diabetes.…”

Identification and Structural Characterization of Avian Beta-Defensin 2 Peptides from Pheasant and Quail

“…As a theoretical guide, PMT has been used in etiological studies to investigate various risk and protective behaviors, including tobacco use [2,9], alcohol consumption [10,11], physical activity [12][13][14], self-care [15], safe and protective behaviors at the worksite [3,16], parental protective behavior [17], safe computing practices [18,19], and environmental hazard reduction [20]. As a conceptual framework, PMT has been utilized in intervention research in the West to develop and evaluate programs for purposeful behavior change, including interventions to promote adherence to medical treatment regimens [21,22], to prevent substance use [10,11], and to discourage HIV risk behaviors and encourage HIV protective behaviors [23][24][25][26].…”