Assessing Family Sharing of Diabetes Responsibilities

Anderson, Barbara J.; Auslander, Wendy; Jung, Kenneth C.; Miller, J. Phillip; Santiago, Julio V.

doi:10.1093/jpepsy/15.4.477

Cited by 442 publications

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“…Another critical family variable receiving increased attention is the division of responsibility between parents and children for diabetes care, and there is consensus that premature independence in self-management leads to negative clinical outcomes (B. J. Anderson, Auslander, Jung, Miller, & Santiago, 1990; B. J. Anderson & Brackett, 2000;Wysocki, Hough, Ward, & Green, 1992).…”

Section: Social and Environmental Variablesmentioning

confidence: 99%

Diabetes and behavioral medicine: The second decade.

Gönder-Frederick¹,

Cox²,

Ritterband³

2002

Journal of Consulting and Clinical Psychology

166

144

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Diabetes management depends almost entirely on behavioral self-regulation. Behavioral scientists have continued a collaboration with other health systems researchers to develop a holistic approach to this disease. The authors summarized the literature in 4 major areas: self-management of diabetes, psychosocial adjustment and quality of life, neuropsychological impact, and psychobehavioral intervention development. Progress made in each of these areas over the past decade is highlighted, as are important issues that have not yet received sufficient scientific attention. Emerging areas likely to become central in behavioral research, such as diabetes prevention, are introduced. The future of behavioral medicine in diabetes is also discussed, including topics such as the changing role of psychologists in diabetes care, the urgent need for more and better intervention research, the growing importance of incorporating a health system-public health perspective, and obstacles to the integration of psychobehavioral approaches into routine health care delivery.A profound event in diabetes management during the past decade was the release of the 1993 report of the National Institutes of Health (NIH) funded Diabetes Control and Complications Trial (DCCT; DCCT Research Group, 1993), which radically altered both the goals and the philosophy of treatment of this disease. The DCCT was a controlled, prospective trial following more than 1,400 adults and adolescents with Type 1 diabetes (T1DM) over an average of 6.5 years. The results provided strong evidence that the use of intensive treatment regimens to maintain tighter glucose control can delay or prevent the development of at least some of the devastating long-term complications of diabetes, including retinopathy and nephropathy. Subsequent studies replicated these findings and demonstrated the benefits of maintaining tighter metabolic control for patients with Type 2 diabetes (T2DM; Ohkubo et al., 1995;Reichard, Nilsson, & Rosenqvist, 1993;Turner, Cull, & Holman, 1996).It is almost impossible to overestimate the impact of the DCCT on diabetes treatment and research. Seemingly overnight, large numbers of patients were expected to follow a demanding, intensive treatment regimen that previously had been recommended only for those who were most highly motivated and diligent in their diabetes self-management. Health care practitioners were also expected to know how to help patients achieve these lofty treatment goals. In addition to problems in implementing intensive treatment, questions arose concerning the effects of these regimens on quality of life (QOL) for patients. Intensive regimens also posed new dilemmas for health care practitioners and patients, not the least of which was the dramatic increase in risk for episodes of severe hypoglycemia when patients attempted to lower blood glucose (BG) levels. It quickly became clear that the greatest challenge to contemporary diabetes treatment was overcoming the many psychobehavioral and social-environmental barriers to optimal ...

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Section: Social and Environmental Variablesmentioning

confidence: 99%

Diabetes and behavioral medicine: The second decade.

Gönder-Frederick¹,

Cox²,

Ritterband³

2002

Journal of Consulting and Clinical Psychology

166

144

View full text Add to dashboard Cite

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“…A dolescents with type 1 diabetes have been found to have more problems with adherence to their self-care than younger children, even though they possess greater diabetes knowledge (1,2). With the onset of adolescence, youths tend to spend increasing time with their friends.…”

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confidence: 99%

Attributions of Adolescents With Type 1 Diabetes in Social Situations

et al. 2006

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OBJECTIVE -To examine the relationships among negative attributions of friend reactions (NAFRs) within a social context, anticipated adherence difficulties, diabetes stress, and metabolic control. RESULTS -Path analysis demonstrated an excellent fit of a model depicting an indirect relationship between NAFRs and metabolic control through the mechanisms of expected adherence difficulties and diabetes stress. RESEARCH DESIGN AND METHODSCONCLUSIONS -Adolescents who make NAFRs are likely to find adherence difficult in social situations and have increased feelings of stress, with the latter associated with poorer metabolic control. Intervention efforts to address negative attributions may impact adherence behavior and feelings of stress, especially if specific contexts of self-care behavior are taken into account. Diabetes Care 29:818 -822, 2006A dolescents with type 1 diabetes have been found to have more problems with adherence to their self-care than younger children, even though they possess greater diabetes knowledge (1,2). With the onset of adolescence, youths tend to spend increasing time with their friends. The adherence decisions made by adolescents with diabetes while with their friends reflect an interaction of situational circumstances and the nature and history of the relationships with particular peers. Furthermore, these factors likely affect the adolescents' expectations and attributions for the reactions they will receive from their friends if they follow their treatment regimens.Adolescents may be aware of potential health complications from poor adherence but still have difficulty maintaining their regimen because they are apprehensive about being singled out by others (3,4). While adolescents demonstrate better problem solving regarding diabetes self-management issues than do children, adolescents become increasingly influenced by what they anticipate would be negative reactions or disapproval from friends in social situations that would require adherence behaviors (2). Decisions not to engage in self-care are misguided because the empirical work available suggests that friends tend to provide emotional support and encourage following the treatment regimen (4).A social information-processing model of adjustment provides an explicit framework for viewing the role of cognitive processes in the problem behavior choices of youth (5). These cognitive processes include filtering only specific aspects of the situation, incorrectly appraising others' intentions, or assessing the situation as threatening in terms of potential consequences. This model may describe processes involved with adherence efforts around peers. The model suggests that adolescents with type 1 diabetes may perceive adherence behavior as difficult in social situations due to a fear of negative friend evaluations. Such attributions and anticipated adherence difficulties (AADs) (and likely poor adherence) are problematic not only because of the health impact but also because the adolescents are missing opportunities for friend support.Ot...

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“…This developmental task may be more complicated for adolescents with type 1 diabetes because, at this time in their lives, both metabolic control and treatment adherence often deteriorate [7][8][9][10][11][12][13][14], and less parental involvement in diabetes care has been associated with poorer diabetes outcomes [8,15]. In contrast, adolescents whose parents remain involved in self-care activities show better adherence and more effective glycemic control [7,16].…”

mentioning

confidence: 99%

Adolescent views of diabetes-related parent conflict and support: a focus group analysis

Weinger

OʼDonnell

Ritholz

2001

Journal of Adolescent Health

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Purpose-To increase understanding of adolescent-parent diabetes-related conflicts and supports in the management of type 1 diabetes by means of a focus group research approach.Methods-Twenty-four adolescents (10 boys and 14 girls, age 13-15 years; 97% white) participated in three same-sex focus groups at two diabetes summer camps. The focus group leader used a prepared set of open-ended questions to guide the 90-minute sessions. Sessions were taperecorded, transcribed, and analyzed by a set procedure for qualitative analysis to identify the adolescents' perspectives on parent-adolescent sources of diabetes-related conflict and support.Results-Adolescents reported the following sources of diabetes-related conflict: parental worry and intrusive behaviors; parental lack of understanding and blaming behaviors, and the parents focus on the future vs. the adolescent focus on the present. With regard to diabetes-related support, the teens identified parental understanding of the demands of diabetes and parental provision of reassurance about their child's illness and normative functioning.Conclusions-Adolescents' perceptions of parental worry, lack of understanding, and resulting intrusive and blaming behaviors are major areas of conflict that need to be addressed in the management of type 1 diabetes.

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Assessing Family Sharing of Diabetes Responsibilities

Cited by 442 publications

References 0 publications

Diabetes and behavioral medicine: The second decade.

Diabetes and behavioral medicine: The second decade.

Attributions of Adolescents With Type 1 Diabetes in Social Situations

Adolescent views of diabetes-related parent conflict and support: a focus group analysis

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