Situational Obstacles to Adherence for Adolescents with Diabetes

Abstract

Twenty adolescents with insulin-dependent diabetes mellitus were interviewed to obtain samples of problem situations that create obstacles to dietary adherence. The resulting 57 situations were analyzed using a reliable coding system to determine the presence or absence of 28 stimulus features. A hierarchical cluster analysis was used to identify 10 relatively homogeneous categories of obstacles to dietary adherence: being tempted to stop trying; negative emotional eating; facing forbidden foods; peer interpersonal conflict; competing priorities; eating at school; social events and holidays; food cravings; snacking when home, alone, or bored; and social pressure to eat. Diabetes educators should consider an individual's ability to cope with this array of obstacles to adherence when individualizing treatment. Dietary intervention then can be personalized to address specific situational obstacles.

Self-Management Behaviors, Racial Disparities, and Glycemic Control Among Adolescents With Type 2 Diabetes

“…These 2 subscales were derived from a previously validated scale of perceived barriers to diet and exercise in adults with T2DM 35 and from 2 other validated scales of perceived barriers in adolescents and adults with diabetes. 28,29 The internal reliability of the healthy eating barriers scale and exercise barriers scale in the current study was good (Cronbach's ␣ of .78, and .77, respectively).…”

“…Questions were selected and adapted from previously validated surveys of healthy and chronically ill adolescents, adolescents with T1DM, and adults with diabetes. [26][27][28][29][30][31][32][33][34] The majority of questions were close ended, but some open-ended questions were included to better ascertain adolescents' perceptions about barriers to selfcare behaviors. A series of open-ended questions asked adolescents what they thought was the hardest thing about checking blood sugars, performing exercise, following a diet, and other behaviors.…”

Development and initial validation of the barriers to diabetes adherence measure for adolescents

“…An area of self-care barriers not well-studied in this population, but very relevant, are those related to the awareness of time, rushing, and planning. Several studies have found that time management, feeling pressured, or an unwillingness to take the time for self-care create barriers to adherence [27–29]. …”

Lessons Learned from a Community Based Lifestyle Intervention for Youth at Risk for Type 2 Diabetes

“…Many overweight and children and adolescents experience stress due to poor body image, low self- esteem, feelings of shame and embarrassment and other feelings of social isolation [17,18] Sharing their experiences with other children who have faced similar circumstances can lead to understanding, empathy, and mutual support. Peer support among individuals with the same chronic health problem is a powerful intervention because it combines the benefits of receiving and giving social support [19–22].…”