FAMILY, AUTONOMY AND SELF-CARE IN ADOLESCENTS WITH IDDM

有效的干预方案必须基于改善糖尿病控制的显著变量。虽然文献支持家庭关系过程影响青春期糖尿病的控制，并建议自主性发展是与自我照顾相关的主要过程，但很少有人关注自主性是随着青春期的发展而解除自我照顾和糖尿病控制的主要能力。本研究的长期目标是促进青少年IDDM患者的自主性发展，以加强青少年在青春期早期和中期的自我照顾和糖尿病控制。具体目标是(1)描述青少年IDDM患者的家庭关系过程、自主性、自理和糖尿病控制的发展进程；(2)评估青少年自主性发展和家庭关系过程对自我照顾和糖尿病控制的影响模型，其中自主性发展具有中心中介作用。研究将采用横断面和纵向队列序贯设计相结合的方法，对274名11-15岁的青少年及其家人进行为期2年的前瞻性跟踪调查，直到13-17岁。重点将放在亲子系统上，数据将在家访期间通过自我报告问卷和显示差异的家庭互动任务获得。这项任务将包括由家长(S)和青少年讨论青少年和糖尿病特定的家庭问题。将采用青少年自主(情绪、认知和行为)、家庭关系过程(凝聚力、敌对冲突、父母分离焦虑、自主相关和自主性抑制)、自我照顾(普遍的、与疾病相关的和糖尿病责任的分工)和糖尿病控制的测量方法。糖尿病的控制将通过每隔四个月两次糖化血红蛋白水平来控制。横截面数据将使用回归/相关程序进行分析。纵向数据将通过具有随机系数的分层线性模型(HLM)进行分析。模型拟合度将通过几种方法进行评估，包括拟合度和个别受试者斜坡的诊断图。

Effective intervention programs must be based on salient variables that improve diabetes control. Although literature supports that family relational processes influence diabetes control in adolescence and suggests that autonomy development is a major process associated with self-care, little attention has focused on autonomy as a primary capability that ungirds self- care and diabetes control as adolescence progresses. The long- term objective of this research is the facilitation of autonomy development in adolescents with IDDM to enhance self-care and diabetes control as adolescent's progress through early and middle adolescence. Specific aims are (1) to describe the developmental progression of family relational processes, autonomy, self-care and diabetes control in adolescents with IDDM and (2) to evaluate a model of influences of adolescent autonomy development and family relational processes on self-care and diabetes control, in which autonomy development has a central mediating role. A combined cross-sectional and longitudinal cohort-sequential design will be used and 274 adolescents between the ages of 11 and 15 years and their families will be enrolled and followed prospectively for 2 years until ages 13 through 17. The focus will be on the parent- adolescent subsystem and data will be obtained during a home visit through self-report questionnaires and a revealed difference family interaction task. The task will involve discussion of adolescent and diabetes specific family issues by parent(s) and adolescent. Measures of adolescent autonomy (emotional, cognitive and behavioral), family relational processes (cohesion, hostile conflict, parental separation anxiety, autonomous-relatedness, and inhibition of autonomy), self care (universal, illness-related and division of diabetes responsibility), and diabetes control will be employed. Diabetes control will be by glycosylated hemoglobin levels at two intervals four months apart. Cross sectional data will be analyzed using regression/correlational procedures. Longitudinal data will be analyzed by hierarchical linear models (HLM) with random coefficients. Model fit will be evaluated by several methods, including goodness of fit and diagnostic plots of individual subject slopes.