Preliminary Results: Improving Adherence in Social Situations

1. Preliminary Results: Improving Adherence in Social Situations for Adolescents with Type I Diabetes Katherine Simon, M.S. 1, Katie M. Fleischman, M.S. 1, Anthony A. Hains, Ph.D. 1, W. Hobart Davies, Ph.D. 1,2,3, Jessica Kichler, Ph.D. 2,3, & Ramin Alemzadeh, M.D. 3 University of Wisconsin-Milwaukee1, Medical College of Wisconsin2, & Children’s Hospital of Wisconsin3 Measures Introduction Figure 1: Individual Changes in DSQ Management of Type I insulin dependent diabetes involves adherence to complex daily behaviors, such as monitoring blood glucose levels, injecting insulin, and calculating carbohydrates. Some adolescents may feel unable to maintain these regimens within social contexts due to peer pressure and apprehension about being singled out (Susman-Stillman et al., 1997; Wysocki et al., 2003). These adherence difficulties are associated with diabetes-related stress, which is related to metabolic control. Previous research suggests that negative attributions have a role in adherence difficulties; therefore, the development of cognitive behavioral interventions geared towards challenging and restructuring negative thinking patterns may be key in addressing these concerns. • Demographic Information, including age, gender, ethnicity, and length of diagnosis, were collected during the initial intervention session by the adolescent. • Self-Care around Friends (SCF) is a 5-item questionnaire developed specifically for this study. It assesses adherence efforts in social situations and related distress that may occur due to these behaviors. The lower the score, the better adherence. The youth completed the SCF pre-intervention, post-intervention, and at a 4 week follow-up. • Diabetes Stress Questionnaire (DSQ; Boardway, Delamater, Tomakowsky, & Gutai, 1993) is a self-report measure that assesses daily stressors related to diabetes for adolescents. Two subscales, the Peer Stress and Adverse Interpersonal Effects subscales, were used in the current study (17 items ). The lower the score, the less stress related to adherence. The youth completed the DSQ pre-intervention, post-intervention, and at a 4 week follow-up. Hypothesis Figure 2: Individual Changes in SCF • The current study aimed to examine the feasibility of a problem solving intervention in increasing adherence in social situations for adolescents with Type 1 Diabetes. • Hypothesis: Participants in the intervention will report less stress and more compliance associated with diabetes self-care around peers. Results • HbA1c levels were not significantly correlated with any of the measures. • Repeated measure ANCOVAS were conducted to determine differences in pre-, post-, and follow-up intervention SCF and DSQ • Individual pre-, post-, and follow-up SCF and DSQ scores were graphed • See Table 1 for descriptive statistics and ANCOVAS and Graphs 1-3 for individual and group scores. Methods • This study is from patients presenting to a diabetes/endocrinology clinic at a large Midwestern children’s hospital. • Participants were recruited through phone calls and during clinic appointments. • The intervention consisted of a one-hour session with a trained graduate student, followed by three weekly phone calls, which focused on cognitive restructuring and problem solving training. Table 1: Descriptive Statistics and ANCOVAS Figure 3: Group Means for SCF and DSQ Participant Demographics Conclusions • These preliminary results indicated that there were no significant differences between pre-intervention and follow-up on the SCF and DSQ. • Interestingly, all participants indicated that they had informed their friends about their diagnosis and 50% stated that other kids in school were aware of their diagnosis, indicating that these youth may have been unique and future interventions should target those whose classmates are not aware of their diagnosis. • Trends in individual scores indicate that problem solving may be helpful for adherence in social situations; therefore, more research is needed. SCF = Self-Care around Friends; DSQ = Diabetes Stress Questionnaire; ns = Not Significant *p < . 10. **p < .05. ***p < .01.