Adolescent and caregiver perspectives on provider–patient interactions in Type 2 diabetes.

Abstract

This study aimed to describe the experience of adolescents with Type 2 diabetes and their caregivers during medical encounters, in an effort to improve clinical care and outcomes in this population. Twenty-eight families were recruited from a Midwestern diabetes clinic. Adolescents (13-18 years old) identified as Black (50%), Caucasian (43%), and Hispanic (7%), with variable levels of glycemic control (glycosylated hemoglobin A1c ϭ 5.1-12.9%). Participants completed demographic and diseaserelated (adherence) questionnaires. Six adolescent and six caregiver focus groups were conducted and transcribed, coded, and systematically analyzed using principles of thematic analysis. Participants reported moderate to high rates of nonadherence. Qualitative themes indicated multiple factors influencing perceptions of the quality of provider-patient interactions. Participants' experiences of these interactions was affected by provider characteristics (e.g., gender, age), provider approach and communication style, systemic issues (e.g., long wait times), and caregivers assuming primary roles in medical encounters (e.g., more caregiver participation and caregiver disclosure of nonadherence). Focus group discussions provided rich information about the experiences of adolescents with Type 2 diabetes and implicate barriers in provider-patient interactions, including challenges in triadic interactions and communication around nonadherence, suggesting these areas should be considered in efforts to improve provider-patient interactions within this population.

Promoting High-Quality Health Communication Between Young Adults With Diabetes and Health Care Providers

“…Trust in the HCP is important and often facilitated by HCP assurances of confidentiality, honesty, good listening skills, and empathy (23). YAs with chronic illnesses also prefer direct communication with their HCPs rather than having HCPs communicate with their parents (24,25). These preferred characteristics mirror the elements of PCC characterized by trust, support, and patient engagement (26).…”

“…Similarly, compared with non-Hispanic White youths with type 1 diabetes, caregivers of Hispanic youths with type 1 diabetes reported more problems with communication, getting diabetes information, and receiving care that takes into account the child and family circumstances (54). Additionally, one qualitative study of adolescents (13-18 years of age) with type 2 diabetes from racially/ethnically diverse backgrounds found that youths reported discomfort with health communication (e.g., feeling shy or having difficulties forming questions), as well as a preference among Black families for a Black doctor because of perceptions of receiving more effective care (25), which has been echoed in the adult literature (55).…”

Introduction to special issue: Improving clinical practices in pediatric psychology through qualitative research.

“…The authors outline ways in which pediatric psychologists can help provide support and improve delivery of care for these families. Amirniroumand et al (2017) and Simms, Baumann, and Monaghan (2017) each studied patient-provider interactions among adolescents and young adults with diabetes. Amirniroumand and colleagues gathered the perspectives of a racially diverse sample of adolescents (ages 13 to 18) with Type 2 diabetes and their caregivers regarding interactions with providers in an effort to understand processes within these interactions that may promote or undermine clinical outcomes.…”