FAMILY, AUTONOMY AND SELF-CARE IN ADOLESCENTS WITH IDDM

有效的干预方案必须以改善糖尿病控制的显著变量为基础。虽然文献支持家庭关系过程影响青春期糖尿病的控制，并表明自主发展是与自我保健相关的主要过程，但很少有人关注自主性作为一种主要能力，在青春期的发展过程中，它可以解除自我保健和糖尿病控制。本研究的长期目的是促进中重度糖尿病青少年的自主性发展，在青春期早期和中期提高自我保健和糖尿病控制。本研究的具体目的是：(1)描述IDDM青少年家庭关系过程、自主、自我照顾和糖尿病控制的发展进程；(2)评估青少年自主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，其中自主发展具有中心中介作用。采用横断面和纵向队列序列设计，274名11至15岁的青少年及其家人将被纳入研究，并进行为期2年的前瞻性随访，直到13至17岁。本研究将以家长-青少年子系统为研究重点，并在家访期间通过自述问卷和揭示差异家庭互动任务来获取数据。这项任务将包括由父母和青少年讨论青少年和糖尿病的具体家庭问题。青少年自主性（情感、认知和行为）、家庭关系过程（凝聚力、敌对冲突、父母分离焦虑、自主相关性和自主性抑制）、自我保健（普遍、疾病相关和糖尿病责任分工）和糖尿病控制的措施将被采用。糖尿病控制将通过糖化血红蛋白水平在两个间隔四个月。横截面数据将使用回归/相关程序进行分析。纵向数据将通过带随机系数的层次线性模型（HLM）进行分析。模型拟合将通过几种方法进行评估，包括拟合优度和单个受试者斜率的诊断图。

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.