Thesis (D.Psych.)--Victoria University (Melbourne, Vic.), 2008. / Submitted in partial fulfillment of the Doctoral Program in Clinical Psychology. Includes bibliographical references.

This qualitative study was designed to gain an insight into the ways in which adolescents and young adults managed ?self? in their day - to - day diabetes management. It also examined the effect that illness self representations had on that management. A grounded theory approach using a symbolic interactionist framework was adopted based on 27 in- depth semi structured interviews with adolescents and young adults with diabetes. Respondents described the effects of diabetes management on the physical, emotional, social and related selves. They also described their various illness self representations. It often took an inordinate amount of work for the respondents to manage their diabetes. This ?management? work could be related to problems with their physiological control, emotional stressors, the need to be socially interactive, differing priorities or relational issues. Certainly even the most resilient respondents experienced periods of vulnerability and needed to nurture the ?self? The study generates new knowledge which builds upon the existing body of knowledge relating to the management of self in adolescents and young adults in the context of T1DM. The study established that whilst some health professionals are sensitive and cognizant of the needs of adolescents and young adults with diabetes, there is room for improvement in the way in which health professionals understand the complexities involved in diabetes management for adolescents and young adults / Doctor of Philosophy (PhD)

Thesis (Ph. D.)--Rutgers University, 2009. / "Graduate Program in Nursing." Includes bibliographical references (p. 81-87).

Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses. Glycemic control among patients with T1D often deteriorates during adolescence; yet little is known about the most effective way for providers to communicate with adolescents to prevent this decline. Given the importance of effective communication, examination of effective patient-provider communication strategies is needed. The current investigation used Motivational Interviewing (MI) as a framework to help characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined the relations between provider communication and T1D self-management and control. Participants were five pediatric endocrine providers and 55 adolescents with T1D (49% female; 76% White; M age= 14.8 years, SD= 1.6). Mean T1D duration was 7.9 years (SD= 3.9) and mean baseline HbA1c was 8.58% (SD= 1.4). Adolescents and caregivers completed surveys related to diabetes self-management and psychosocial functioning at a routine endocrinology visit and again at one and three months post-baseline. Medical encounters were audio-recorded and coded. HbA1c was obtained via medical chart review at baseline, three, and six month appointments. Hierarchical multiple regressions revealed that, after controlling for prior MI training (providers) and adolescent baseline HbA1c, age, and race, use of MI non-adherent behavior (e.g., confronting, persuading) was associated with 1) poorer three month HbA1c, F(5,45)= 11.19, p < .001; R2 = .554 and 2) worse adolescent diabetes adherence, F(5, 46)= 9.86, p < .001; R2= .517. MI non-adherent behavior emerged as a significant predictor in each model, t(45)= 2.13,p = .038, β = .242 and t(46) = -2.39, p= .021, β= -.300, respectively. A mediation analysis determined that patient self-efficacy for diabetes self-management mediated the relation between the use of these MI non-adherent behaviors and lower diabetes adherence. In TalkT1me, providers’ overreliance on persuasion and confronting adolescents about the risks of non-adherence was paradoxically associated with poorer glycemic control and adherence. Certain communication techniques that are inconsistent with MI, like confronting or persuading, appear to have a negative impact on diabetes self-care and HbA1c. Results from this evaluation of naturally occurring communication can help guide targeted training efforts to enhance communication and improve diabetes self-care with these vulnerable patients.

Introduction: Key studies have found an association between attachment style and poor diabetes outcomes in the adult diabetic populations. Specifically insecure attachment has been found to predict elevated glycated haemoglobin levels (HbA1c). Further studies have indicated that substance use and mental health difficulties also influence HbA1c. These factors have been looked at individually making it difficult to directly assess the overall effect of attachment on HbA1c and the potential mediating effects of substance use and mental health. The adolescent population has not been considered in studies examining these relationships. This study compares attachment security, level of substance use, interpersonal problems, anxiety and depression in relation to their role in blood glucose control in an adolescent population with Type 1 diabetes. Method: A quantitative, cross sectional, questionnaire design was employed to examine the role of the aforementioned factors in relation to HbA1c level. The target population included all patients aged 14 years to 18 years, inclusive, who attended for review at Diabetes Clinics across Lothian. Participants had a diagnosis of Type 1 Diabetes for at least one year and no additional diagnoses of mental health disorder or other chronic condition. At the clinic patients were approached and asked to complete a set of self report questionnaires. Measures of attachment were adapted versions of the Relationship Questionnaire (RQ) and the Relationship Scales Questionnaire (RSQ). Interpersonal problems were assessed using the short version of the Inventory of Interpersonal Problems (IIP-32). The Hospital Anxiety and Depression Scale (HADS) assessed levels of anxiety and depression. The Adolescent Substance Abuse Subtle Screening Inventory- A2 (SASSI-A2) was used to measure substance use. Blood glucose levels (HbA1c%) were obtained from clinic staff. A total of 88 participants returned completed questionnaires (response rate 79.3%). Results: When all correlations between predictors and HbA1c were examined, a negative correlation was found between attachment and HbA1c level. A positive correlation was found between anxiety and HbA1c level. Multiple regression analyses examined the relationship between attachment security and HbA1c before analysing additional predictors in the same model. No significant relationships emerged however the multiple regression model was not a significant fit for the data. Path Analysis considered all relationships between variables simultaneously while also providing information on how the model fits the data. Attachment security directly related to HbA1c levels when the contributions of gender, interpersonal problems and substance use were considered. Anxiety and depression did not predict HbA1c nor did they contribute to any other relationships with HbA1c. Interpersonal problems had a direct relationship with HbA1c when the contribution of substance use and attachment were considered. Conclusion: Attachment predicts HbA1c. The nature of this relationship is further understood when the contribution of additional psychological variables are considered. Methodological issues, clinical implications and directions for future research are discussed.