Contracting and monitoring relationships between adolescents with type I diabetes

描述(由申请人提供)： I型糖尿病是一种常见的儿童慢性病。许多儿科患者，特别是青少年，有糟糕的自我管理做法，导致他们的血糖水平控制不佳。越来越多的证据表明，这可能是与青春期相关的正常社会和发展需求与治疗需求之间冲突的结果。通常，在青少年试图获得更多自主性和自我认同感的时候，父母为了强制实施适应性养生行为，会试图对孩子的行为施加控制。虽然这种试图独立的尝试在发育上是合适的，但青少年可能会通过危害他们的糖尿病控制的行为来表达这些努力。我以前在这方面的工作表明，我们可以利用移动技术作为一种强大的工具来改善糖尿病治疗，方法是改变与糖尿病自我管理相关的亲子关系，并在青少年和医疗保健团队之间建立联系，以便无需父母干预即可轻松解决有关治疗调整的问题。这将通过使用行为契约来实现。从本质上讲，三方关系将通过小组协商进行谈判，并通过共同商定的三个实体合同来巩固：父母、青少年和提供者团队。孩子将通过手机血糖仪与一个医疗团队联系起来，该团队将帮助青少年进行自我管理。同时，家长将被要求不要对随后的自我管理决定进行“唠叨”，因为这一职能将由相关的医疗保健团队承担。家长们将意识到，移动系统创建的链接将能够比目前通过自我报告更准确地评估自我监控行为。这种类型的行为干预有可能缓解因糖尿病治疗行为引起的亲子冲突而导致的糟糕的自我管理决定。这项研究的独特之处在于，它将行为契约作为一种改变关系而不是个人行为的方式，并将技术作为一种监控行为的方式。这项建议的研究目标是：(1)开发一种行为契约，以解决亲子关系中可协商的冲突点；(2)评估行为契约在改变亲子关系方面的有效性，该契约由一种新型的手机血糖监测系统监测。对于目标1，我们将使用半结构化访谈来告知行为契约的发展，该契约将解决青少年与父母关系中与糖尿病相关的冲突的可谈判点。对于目标2，我们将进行一项试点研究，以确定这份合同与我们基于手机的血糖监测系统一起执行的情况。焦点小组以及调查问卷将被用来获得关于合同的有用性、青少年与父母关系中的冲突、患者感知的生活质量以及患者自我管理能力的信息。越来越需要有效和实际的心理社会干预措施，以协助管理儿童慢性疾病。虽然我们的研究重点是I型糖尿病，但针对这一特定人群的研究结果也可能适用于其他慢性儿童疾病。

DESCRIPTION (provided by applicant): Type I diabetes is a common chronic disease of childhood. Many pediatric patients, notably adolescents, have poor self-management practices that result in suboptimal control of their blood glucose levels. Increasingly evidence suggests that this is likely the result of conflicts between normal social and developmental needs associated with adolescence and the demands of therapy. Often parents, in an effort to enforce adaptive regimen behavior, try to exert control over their children's actions precisely when adolescents are attempting to achieve more autonomy and self-identity. While such attempts toward independence are developmentally appropriate, adolescents may express these efforts through behaviors that are jeopardizing to their diabetes control. My previous work in this area suggests that we can use mobile technology as a powerful tool to improve diabetes therapy by both modifying the parent-child relationship as it relates to diabetes self-management and by establishing a link between the adolescent and health care team such that questions about therapeutic adjustments can be easily addressed without the need for parental intervention. This will be accomplished through the use of a behavioral contract. In essence, a three-way relationship will be negotiated in group consultation and solidified by a mutually agreed upon three-entity contract: parent, adolescent and provider team. The child will be linked, via the cell phone glucometer, to a health care team who will assist the adolescent with their self-management. At the same time, parents will be requested to not engage in "nagging" about subsequent self-management decisions since this function will be assumed by the linked health care team. Parents will be made aware that the link created by the mobile system will be able to more accurately assess self-monitoring behavior than is currently possible through self report. This type of behavioral intervention has the potential to mitigate poor self-management decisions that results from parent-child conflict over diabetes therapy behaviors. This research is unique in its use of behavioral contracts as a way to alter a relationship instead of individual behaviors, and in its use of technology as a way to monitor behavior. The research aims of this proposal are: (1) to develop a behavioral contract that addresses the negotiable points of conflict within the parent-child relationship, (2) to assess the effectiveness of a behavioral contract in altering the parent-child relationship as monitored by a novel cell phone glucose monitoring system. For aim 1, we will use semi-structured interviews to inform the development of a behavioral contract that will address the negotiable points of diabetic related conflict in the adolescent-parent relationship. For aim 2, we will conduct a pilot study to determine how this contract performs in conjunction with our cell phone based glucose monitoring system. Focus groups, as well as survey questionnaires, will be used to elicit information about the usefulness of the contracts, conflict in the adolescent-parent relationship, the patient's perceived quality of life, and the patient's competence in self-management. There is an increasing need for effective and practical psychosocial interventions to assist in the management of chronic childhood diseases. While our research focuses on type I diabetes, the findings with this particular population could also be adapted for other chronic childhood diseases.