Date of Award

May 2014

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Kathleen J. Sawin

Committee Members

Jessica Kichler, Joshua Mersky, Rachel Schiffman, Julia Snethen

Keywords

Adolescence, Depressive Symptoms, Diabetes Quality of Life, Self-Management, Theory Development, Type 1 Diabetes Mellitus

Abstract

Advances in treatment technology and the importance of obtaining normoglycemia in order to prevent or delay complications associated with Type 1 Diabetes Mellitus (T1DM) has shifted much of the emphasis of diabetes self-management (SM) onto the adolescent and his or her family. The primary responsibility for managing T1DM in childhood is with the parent whereas during adolescence, increasing levels of responsibility for SM are transferred to the adolescent. This study examined the relationships of key context and process variables on proximal (self-management behaviors [SMB]) and distal outcomes (metabolic control and diabetes-specific health-related quality of life [DQOL]) from the Individual and Family Self-management Theory (IFSMT) in a cohort of adolescents with T1DM. The aims in this correlational, cross-sectional study included testing components of the IFMST by examining relationships among select context, process, and outcome variables thought to contribute to effective SMB in adolescents with T1DM and determining whether SMB mediated the relationship of IFSMT process variables on metabolic control and DQOL. Families were recruited from an ambulatory diabetes clinic in a Midwestern children's hospital. Participants included 103 adolescent-parent dyads (adolescents aged 12-17 years with T1DM) from an outpatient diabetes clinic. The dyads each completed a self-report survey including instruments intended to measure study variables from the IFSMT. Using hierarchical multiple regression, context (depressive symptoms) and process (communication) variables explained 37% of the variance in SMB. Regimen complexity and depressive symptoms explained 11% of the variance in metabolic control. Only regimen complexity was significant at Step 1. Neither of the regression steps adding process variables or SMB were significant. For DQOL, context (depressive symptoms) variables explained 26% of the variance at Step 1, 36% of the variance when process (self-efficacy and communication) variables were added at Step 2 and 52% of the total variance was explained when SM behaviors were added at Step 3. In the final model, three variables were significant: depressive symptoms, self-efficacy, and SMB. The criteria for mediation of SMB by the process variables were not met. IFSMT served as a cogent model for understanding key concepts, processes, and outcomes essential to SM in adolescents and families dealing with the complex disease, T1DM.

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