Contracting and Monitoring Relationships for Adolescents with Type 1 Diabetes: A Pilot Study
Contracting and Monitoring Relationships for Adolescents with Type 1 Diabetes: A Pilot Study
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DOI：
10.1089/dia.2010.0181
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发表时间：
2011-05-01
影响因子：
5.4
通讯作者：
Marrero, David G.
中科院分区：
文献类型：
--
作者：
Carroll, Aaron E.;DiMeglio, Linda A.;Marrero, David G.
背景：青少年的发展处于一个过渡时期--从父母照顾的儿童到能够自我照顾、独立判断和自我指导解决问题的年轻人。我们希望开发一种青少年糖尿病管理的行为契约，解决亲子关系中关于自我监测的一些可协商的冲突点，然后在一项试点研究中评估其有效性，作为基于手机的新型血糖监测系统的一部分。方法：在本研究的第一阶段，我们使用半结构访谈技术来确定青少年与父母关系中与糖尿病相关的冲突的主要来源，确定可能促进或抑制控制的因素，并确定合理的目标和期望。这些数据随后被用来为行为契约的发展提供信息，该契约解决了父母和他们的青少年之间可协商的冲突来源。这项研究的第二阶段是一个为期3个月的试点研究，以衡量一个新的手机血糖监测系统将如何支持合同，并对血糖管理、家庭冲突和生活质量产生影响。结果：对10名青少年-照顾者进行了访谈。争论的主要主题是关于糖尿病管理的唠叨。作为行为合同的谈判点，出现了另外两个主题：血糖测试和与糖尿病临床团队的联系。10对青少年-家长参与了该系统和合同的试点测试。糖尿病自我管理状况有显著改善，从55.2提高到61.1(P<；0.01)。血红蛋白A1c也显著降低，从试验开始时的8.1%下降到3个月时的7.6%(P<；0.04)。结论：这项研究证实了先前的研究结果，即移动技术确实在改善青少年1型糖尿病的护理方面提供了巨大的潜力。此外，行为契约可能是减少唠叨并通过行为改变改善结果的重要辅助工具。
Background: Adolescents are developmentally in a period of transition-from children cared for by their parents to young adults capable of self-care, independent judgment, and self-directed problem solving. We wished to develop a behavioral contract for adolescent diabetes management that addresses some negotiable points of conflict within the parent-child relationship regarding self-monitoring and then assess its effectiveness in a pilot study as part of a novel cell phone-based glucose monitoring system.Methods: In the first phase of this study we used semistructured interview techniques to determine the major sources of diabetes-related conflict in the adolescent-parent relationship, to identify factors that could facilitate or inhibit control, and to determine reasonable goals and expectations. These data were then used to inform development of a behavioral contract that addressed the negotiable sources of conflict between parents and their adolescent. The second phase of this research was a 3-month pilot study to measure how a novel cell phone glucose monitoring system would support the contract and have an effect on glucose management, family conflict, and quality of life.Results: Interviews were conducted with 10 adolescent-caregiver pairs. The major theme of contention was nagging about diabetes management. Two additional themes emerged as points of negotiation for the behavioral contract: glucose testing and contact with the diabetes clinical team. Ten adolescent-parent pairs participated in the pilot test of the system and contract. There was a significant improvement in the Diabetes Self-Management Profile from 55.2 to 61.1 (P < 0.01). A significant reduction in hemoglobin A1c also occurred, from 8.1% at the start of the trial to 7.6% at 3 months (P < 0.04).Conclusions: This study confirms previous findings that mobile technologies do offer significant potential in improving the care of adolescents with type 1 diabetes. Moreover, behavioral contracts may be an important adjunct to reduce nagging and improve outcomes with behavioral changes.