Deborah J. Wiebe

Adolescent Disclosure to Parents and Daily Management of Type 1 Diabetes

Objectiveu2003To examine how adolescents’ daily disclosure to parents about type 1 diabetes management may foster a process whereby parents gain knowledge and are viewed as helpful in ways that may aid diabetes management.u2003Methodsu2003A total of 236 late adolescents (M age = 17.76) completed a 14-day diary where they reported daily disclosure to, and solicitation from, their parents, how knowledgeable and helpful parents were, and their self-regulation failures and adherence; blood glucose was gathered from meters.u2003Resultsu2003Multilevel models revealed that adolescent disclosure occurred in the context of greater parent solicitation and face-to-face contact and was positively associated with adolescents’ perceptions of parental knowledge and helpfulness. Disclosure to mothers (but not to fathers) was associated with better diabetes management (fewer self-regulation failures, better adherence).u2003Conclusionsu2003Adolescent disclosure may be an important way that parents remain knowledgeable about diabetes management and provide assistance that serves to support diabetes management.

Adolescents’, mothers’, and fathers’ reports of adherence across adolescence and their relation to HbA1c and daily blood glucose

This study examined what is measured by adolescents’, mothers’, and fathers’ reports of adolescents’ adherence to the type 1 diabetes regimen and how such reports relate to HbA1c and daily blood glucose. Two-hundred fifty-two adolescents (M agexa0=xa012.49 at baseline), mothers, and 188 fathers completed an adapted Self-Care Inventory (LaGreca et al. in Child Health Care 19(3):132–139, 1990) every 6xa0months for 2.5xa0years, HbA1c was gathered from medical records, and daily number of blood glucose tests (BGT) and blood glucose mean (BGM) were obtained from glucose meters at one time point. A multitrait-multimethod approach decomposing adherence indicated that fathers’ reports reflected a stable perception across time, mothers’ reports a shared view within the family that varied with HbA1c across time, and adolescents’ reports a unique view. Fathers’ and mothers’ reports were related to HbA1c; adolescents’ reports were not, but were uniquely associated with BGT. Family members’ adherence reports capture different information across time, with implications for measuring adherence and for family processes.

Secrecy From Parents and Type 1 Diabetes Management in Late Adolescence

OBJECTIVESnThis study examined (a) associations of parent-adolescent relationship characteristics and adolescent problem behavior with late adolescents secrecy from parents about type 1 diabetes management, and (b) whether secrecy was associated with diabetes and psychological outcomes independently of these factors.nnnMETHODSnAdolescents (Nu2009=u2009247, Mageu2009=u200917.76 years) completed survey measures of diabetes-related secrecy from parents, disclosure, parental acceptance, parental knowledge, and conduct problems. Mothers and adolescents reported on adolescent adherence to diabetes regimens and adolescents reported their depressive symptoms. Glycemic control was obtained from HbA1c test kits.nnnRESULTSnAdolescent-reported disclosure to parents was uniquely negatively associated with secrecy from parents. Controlling for relationship variables, conduct problems, and sociodemographic and illness-related variables, secrecy from mothers was uniquely associated with poorer glycemic control and secrecy from both parents was associated with lower adherence.nnnCONCLUSIONSnSecrecy about type 1 diabetes management is uniquely associated with diabetes outcomes independent of other relationship characteristics and problem behaviors.

Translating self-persuasion into an adolescent HPV vaccine promotion intervention for parents attending safety-net clinics.

OBJECTIVEnSelf-persuasion is an effective behavior change strategy, but has not been translated for low-income, less educated, uninsured populations attending safety-net clinics or to promote human papillomavirus (HPV) vaccination. We developed a tablet-based application (in English and Spanish) to elicit parental self-persuasion for adolescent HPV vaccination and evaluated its feasibility in a safety-net population.nnnMETHODSnParents (N=45) of age-eligible adolescents used the self-persuasion application. Then, during cognitive interviews, staff gathered quantitative and qualitative feedback on the self-persuasion tasks including parental decision stage.nnnRESULTSnThe self-persuasion tasks were rated as easy to complete and helpful. We identified six question prompts rated as uniformly helpful, not difficult to answer, and generated non-redundant responses from participants. Among the 33 parents with unvaccinated adolescents, 27 (81.8%) reported deciding to get their adolescent vaccinated after completing the self-persuasion tasks.nnnCONCLUSIONSnThe self-persuasion application was feasible and resulted in a change in parents decision stage. Future studies can now test the efficacy of the tablet-based application on HPV vaccination.nnnPRACTICE IMPLICATIONSnThe self-persuasion application facilitates verbalization of reasons for HPV vaccination in low literacy, safety-net settings. This self-administered application has the potential to be more easily incorporated into clinical practice than other patient education approaches.

Variations in Daily Sleep Quality and Type 1 Diabetes Management in Late Adolescents

UNLABELLEDnOBJECTIVEu2003: To determine how between- and within-person variability in perceived sleep quality were associated with adolescent diabetes management.nnnMETHODSnA total of 236 older adolescents with type 1 diabetes reported daily for 2 weeks on sleep quality, self-regulatory failures, frequency of blood glucose (BG) checks, and BG values. Average, inconsistent, and daily deviations in sleep quality were examined.u2003 RESULTSu2003: Hierarchical linear models indicated that poorer average and worse daily perceived sleep quality (compared with ones average) was each associated with more self-regulatory failures. Sleep quality was not associated with frequency of BG checking. Poorer average sleep quality was related to greater risk of high BG. Furthermore, inconsistent and daily deviations in sleep quality interacted to predict higher BG, with more consistent sleepers benefitting more from a night of high-quality sleep.u2003 CONCLUSIONSu2003: Good, consistent sleep quality during late adolescence may benefit diabetes management by reducing self-regulatory failures and risk of high BG.

Academic achievement and metabolic control in adolescents with type 1 diabetes

ABSTRACT Management of type 1 diabetes in adolescence is a complex task requiring self-control within individual and interpersonal domains. This is similarly requisite for academic achievement. Grade point average (GPA) was examined as a barometer of diabetes management reflective of self-control in a challenging daily context. Adolescents with type 1 diabetes (n = 172) completed questionnaires on self-control, self-efficacy, parent/peer relationships, and adherence, while mothers reported GPA. Self-control, self-efficacy, and parent/peer relationships predicted GPA, adherence and HbA1c. GPA predicted HbA1c above and beyond adherence and self-control predictors. GPA may be a valuable indicator of individual and interpersonal self-control processes required for diabetes management.

Iowa Gambling Task Performance Prospectively Predicts Changes in Glycemic Control among Adolescents with Type 1 Diabetes

OBJECTIVESnGood glycemic control is an important goal of diabetes management. Late adolescents with type 1 diabetes (T1D) are at risk for poor glycemic control as they move into young adulthood. For a subset of these patients, this dysregulation is extreme, placing them at risk for life-threatening health complications and permanent cognitive declines. The present study examined whether deficiency in emotional decision making (as measured by the Iowa Gambling Task; IGT) among teens with T1D may represent a neurocognitive risk factor for subsequent glycemic dysregulation.nnnMETHODSnAs part of a larger longitudinal study, a total of 241 high-school seniors (147 females, 94 males) diagnosed with T1D underwent baseline assessment that included the IGT. Glycated hemoglobin (HbA1c), which reflects glycemic control over the course of the past 2 to 3 months, was also assessed at baseline. Of the 241,189 (127 females, 62 males, mean age=17.76, mean HbA1c=8.11) completed HbA1c measurement 1 year later.nnnRESULTSnBaseline IGT performance in the impaired range (per norms) was associated with greater dysregulation in glycemic control 1 year later, as evidenced by an average increase in HbA1c of 2%. Those with normal IGT scores (per norms) exhibited a more moderate increase in glycemic control, with an HbA1c increase of 0.7%. Several IGT scoring approaches were compared, showing that the total scores collapsed across all trials was most sensitive to change in glycemic control.nnnCONCLUSIONSnIGT assessment offers promise as a tool for identifying late adolescents at increased risk for glycemic dysregulation. (JINS, 2017, 23, 204-213).

Coordination of Self- and Parental-Regulation Surrounding Type I Diabetes Management in Late Adolescence

BackgroundType 1 diabetes management involves self- and social-regulation, with past research examining components through individual differences unable to capture daily processes.PurposeDynamical systems modeling was used to examine the coordinative structure of self- and social-regulation (operationalized as parental-regulation) related to daily diabetes management during late adolescence.MethodsTwo hundred and thirty-six late adolescents with type 1 diabetes (M agexa0=xa017.77xa0years, SDxa0=xa0.39) completed a 14-day diary reporting aspects of self- (e.g., adherence behaviors, cognitive self-regulation failures, and positive and negative affect) and parental-regulation (disclosure to parents, knowledge parents have, and help parents provide).ResultsSelf-regulation functioned as one coordinative structure that was separate from parental-regulation, where mothers and fathers were coordinated separately from each other. Mothers’ perceived helpfulness served as a driver of returning adolescents back to homeostasis.ConclusionsThe results illustrate a dynamic process whereby numerous facets of self- and social-regulation are coordinated in order to return diabetes management to a stable state.

Elucidating patient-perceived role in “decision-making” among African Americans receiving lung cancer care through a county safety-net system

PurposeWe explored patient-perceived role in “decision-making” related to active treatment and palliation among African Americans receiving lung cancer care through a county safety-net system.MethodsDrawing from a cohort of over 100 African Americans treated in a safety-net hospital, we invited a subsample of 13 patient-caregiver dyads to participate in a series of dyadic, ethnographic interviews conducted at the patients’ homes. Over 40xa0h of transcripts were analyzed in an iterative process resulting in reported themes.ResultsFindings from ethnographic interviews demonstrated that healthcare communication with physicians is difficult for patients. While caregivers and patients describe a deep engagement in lung cancer care, they expressed a concurrent lack of understanding of their prognosis and outcomes of treatment. Dyads did not discuss their lung cancer experience in terms of decision-making; rather, most articulated their role as following physician guidance. Distinct lack of understanding about disease course, severity, and prognosis may constrain patient perception of the need for informed decision-making over the course of care.ConclusionsDyadic interviews detailing safety-net patient experiences of lung cancer care raise important questions about how clinicians, as well as researchers, conceptualize processes of informed decision-making in vulnerable populations.Implications for Cancer SurvivorsSafety-net patients may not perceive their role as involving informed decision-making and further may lack understanding of disease course and individual prognosis. Safety-net patient dyads expressed high involvement in care and a desire for clarity; clinicians should be prepared to clearly communicate disease stage and prognosis.

Attention Problems as a Predictor of Type 1 Diabetes Adherence and Metabolic Control Across Adolescence

ObjectivenManagement of type 1 diabetes is a difficult self-regulatory process requiring continued attention to complex regimen tasks. The purpose of this study was to examine whether youths attention problems were associated with poorer adherence and HbA1c across time, and whether higher parental involvement reduced these associations.nnnMethodsnAdolescents with type 1 diabetes (Nu2009=u2009199, M ageu2009 =u200912.43u2009years, SDu2009=u20091.50) and their mothers rated youths attention problems and adherence at three time points. Adolescents rated parents diabetes-specific monitoring and behavioral involvement. HbA1c was collected from medical records.nnnResultsnAdolescents (but not mothers) greater reports of attention problems compared with their average related to lower adherence across time. Adolescents (but not mothers) reports of greater attention problems compared with their average related to lower adherence across time.nnnConclusionsnYouth attention problems may help us understand poor adherence, and interventions to promote parental involvement may buffer this risk.