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Previous issue date: 2016-02-26 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Type 1 Diabetes Mellitus (DM1) is a chronic health condition characterized by excess blood glucose and deficient production of insulin by the pancreas, requiring daily intake of
insulin for metabolic control. Metabolic control is affected by psychosocial variables, especially during adolescence, a phase in which individuals are at the risk of stress responses. The way adolescents deal with stress partially depends on their coping
repertoire. Adaptive coping strategies enable better glycemic control and adherence to
treatment, which is based on medication and self-care behavior, such as following a
specific diet, blood sugar monitoring and exercising. Considering the characteristics of this
development phase and DM1, this study analyzed the relationships among stressors,
coping and treatment adherence in adolescents with DM1 based on the Motivational
Theory of Coping. Ten adolescents participated in the study, five of each sex, aged
between 12 and 15 years old, with a medical diagnosis of DM1, attending
elementary/middle school (7) or high school (3). A sociodemographic questionnaire
including the Brazil Economic Classification Criteria, the Diabetes Self-Care Activities
Measure (DSCA), the Questionnaire on Stress in Patients with Diabetes (QSD-R),
the Adolescent/Child?s Self-Report Responses to Stress (RSQ-Pediatric Diabetes- DPed)
with linguistic validation authorized by the authors, together with the Coping Diabetes
Scale for Adolescents (COPE-DIA), especially developed for this study, were individually
applied. Data were collected in the Associa??o de Diabetes Juvenil [Juvenile Diabetes
Association] facility in Birigui, SP, Brazil and at the adolescents? homes. Data analysis was
quantitative using non-parametric statistics and qualitative with the description of two
cases. Behavior with greater adherence, verified through DSCA, were Blood glucose
monitoring and Medication taking (insulin and/or pills). According to the QSD-R, Stress
caused by hypoglycemia was considered the most significant stressor by most
adolescents, followed by Therapeutic Regime and Somatic Complaints. The most frequent
stressors, according to the two instruments that assessed diabetes stressors, were linked
to diabetes treatment and feelings of guilt for not complying with medical
recommendations. According to RSQ-D-Ped, the adolescents dealt with DM1 by using the
following coping strategies: Involuntary Engagement (Excitement and Rumination) and
Secondary Control Coping (Positive Thinking, Acceptance, Distraction and Cognitive
Restructuring). According to COPE-DIA, stressors were more frequently considered a
challenge than a threat to the individuals? basic needs for Relationship, Competence and
Autonomy, presenting the following coping strategies: Search for Information, Search for
Support, Problem-Solving, Isolation (related to the need of Relationship), Escape,
Delegation and Helplessness (related to the need of Competence). Anger was the most
frequently reported emotional response. Coping seems to affect the relationship between
the therapeutic regimen and exercise. This analysis of motivational variables involved in
the process of treatment adherence among adolescents with diabetes provided
prescriptive data for future interventions directed to this population. This study also
contributed to the field of research proposing a more developmentalist analysis of
variables relevant for treatment adherence in this age group. / O Diabetes Mellitus Tipo 1 (DM1) ? uma condi??o cr?nica de sa?de caracterizada pelo excesso de glicose no sangue e produ??o deficiente de insulina pelo p?ncreas, exigindo a ingest?o di?ria de insulina para o controle metab?lico. Este ? afetado por vari?veis psicossociais, especialmente durante a adolesc?ncia, que ? uma fase de risco para rea??es de estresse. A forma como o adolescente lida com o estresse depende, em parte, de seu repert?rio de enfrentamento. As estrat?gias de enfrentamento [EE] adaptativas permitem um melhor controle glic?mico e maior ades?o ao tratamento. Este ?ltimo est? baseado em medicamentos e comportamentos de autocuidado, como o seguimento de dieta alimentar, o monitoramento da glicemia e a realiza??o de atividades f?sicas. Considerando as caracter?sticas dessa fase de desenvolvimento e do DM1, esta pesquisa analisou as rela??es entre estressores, o enfrentamento da doen?a e a ades?o ao tratamento, em adolescente com DM1, a partir da Teoria Motivacional do Coping. Participaram 10 adolescentes, 5 de cada sexo, com idade entre 12 e 15 anos e diagn?stico m?dico de DM1; cursavam o Ensino Fundamental (7) e o Ensino M?dio (3). Foram aplicados, individualmente, um Question?rio Sociodemogr?fico, com o Crit?rio de Classifica??o Socioecon?mica Brasil, o Question?rio de Atividades de Autocuidado (QAD), o Question?rio de Estresse Face ? Diabetes-R (QSD-R), o Adolescente/Child?s Self-Report Responses to Stress (RSQ-Pediatric Diabetes- D-Ped), com valida??o lingu?stica autorizada, e a Escala de Coping do Diabetes para Adolescentes (COPE-DIA) especialmente elaborada. Os dados foram coletados na Associa??o de Diabetes Juvenil (ADJ), na cidade de Birigui/SP e nas resid?ncias dos adolescentes. A an?lise de dados foi quantitativa, atrav?s de an?lise estat?stica n?o param?trica, e qualitativa, com descri??o de dois casos. Os comportamentos do QAD com maior ades?o foram: Monitoramento da glicemia e Uso de Medica??o (insulina e/ou comprimidos). O Estresse Face ? Hipoglicemia foi considerado o estressor mais significativo pela maioria dos adolescentes, seguido do Regime Terap?utico e das Queixas Som?ticas, no QSD-R. Considerando os dois instrumentos que avaliaram os estressores do diabetes, foram mais frequentes aqueles ligados aos cuidados com o tratamento do diabetes e ao sentimento de culpa pelo n?o cumprimento das orienta??es m?dicas. Os adolescentes lidavam com o DM1 com EE de Engajamento Involunt?rio (Excita??o Emocional e Rumina??o) e Engajamento de Controle Secund?rio (Pensamento Positivo, Aceita??o, Distra??o e Reestrutura??o
Cognitiva), segundo o RSQ-D-Ped. Pelo COPE-DIA, avaliaram os estressores mais como um desafio do que amea?a ?s suas necessidades b?sicas de Relacionamento, Compet?ncia e Autonomia, apresentando EE de Busca de Informa??o, Busca de Suporte, Resolu??o de Problemas, Isolamento (relativos ? necessidade de Relacionamento), Fuga, Delega??o e Desamparo (relativos ? necessidade de Compet?ncia). A rea??o emocional de raiva foi a mais frequente. O coping parece afetar a rela??o entre o regime terap?utico e a atividade f?sica. Essa an?lise das vari?veis motivacionais envolvidas no processo de ades?o ao tratamento em adolescentes com diabetes forneceu dados prescritivos para futuras interven??es com essa popula??o. Contribui tamb?m para a ?rea de pesquisa, ao propor uma an?lise mais desenvolvimentista das vari?veis relevantes ? ades?o ao tratamento nessa faixa et?ria.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede.bibliotecadigital.puc-campinas.edu.br:tede/853 |
| Date | 26 February 2016 |
| Creators | Vict?rio, Vanessa Marques Gibran |
| Contributors | Enumo, S?nia Regina Fiorim, Machado, Wagner de Lara, Carneiro, Berenice Victor, Perosa, Gimol Benzaquen, Rodrigues, Olga Maria Piazentin Rolim |
| Publisher | Pontif?cia Universidade Cat?lica de Campinas, Programa de P?s-Gradua??o em Psicologia, PUC-Campinas, Brasil, CCV ? Centro de Ci?ncias da Vida |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_CAMPINAS, instname:Pontifícia Universidade Católica de Campinas, instacron:PUC_CAMP |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 2588426296948062698, 500, 500, 600, -8078962403216510360, 2075167498588264571 |
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