Attributions of Adolescents With Type 1 Diabetes in Social Situations

Abstract

OBJECTIVE -To examine the relationships among negative attributions of friend reactions (NAFRs) within a social context, anticipated adherence difficulties, diabetes stress, and metabolic control. RESULTS -Path analysis demonstrated an excellent fit of a model depicting an indirect relationship between NAFRs and metabolic control through the mechanisms of expected adherence difficulties and diabetes stress. RESEARCH DESIGN AND METHODSCONCLUSIONS -Adolescents who make NAFRs are likely to find adherence difficult in social situations and have increased feelings of stress, with the latter associated with poorer metabolic control. Intervention efforts to address negative attributions may impact adherence behavior and feelings of stress, especially if specific contexts of self-care behavior are taken into account. Diabetes Care 29:818 -822, 2006A dolescents with type 1 diabetes have been found to have more problems with adherence to their self-care than younger children, even though they possess greater diabetes knowledge (1,2). With the onset of adolescence, youths tend to spend increasing time with their friends. The adherence decisions made by adolescents with diabetes while with their friends reflect an interaction of situational circumstances and the nature and history of the relationships with particular peers. Furthermore, these factors likely affect the adolescents' expectations and attributions for the reactions they will receive from their friends if they follow their treatment regimens.Adolescents may be aware of potential health complications from poor adherence but still have difficulty maintaining their regimen because they are apprehensive about being singled out by others (3,4). While adolescents demonstrate better problem solving regarding diabetes self-management issues than do children, adolescents become increasingly influenced by what they anticipate would be negative reactions or disapproval from friends in social situations that would require adherence behaviors (2). Decisions not to engage in self-care are misguided because the empirical work available suggests that friends tend to provide emotional support and encourage following the treatment regimen (4).A social information-processing model of adjustment provides an explicit framework for viewing the role of cognitive processes in the problem behavior choices of youth (5). These cognitive processes include filtering only specific aspects of the situation, incorrectly appraising others' intentions, or assessing the situation as threatening in terms of potential consequences. This model may describe processes involved with adherence efforts around peers. The model suggests that adolescents with type 1 diabetes may perceive adherence behavior as difficult in social situations due to a fear of negative friend evaluations. Such attributions and anticipated adherence difficulties (AADs) (and likely poor adherence) are problematic not only because of the health impact but also because the adolescents are missing opportunities for friend support.Ot...

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