Role of Parental Monitoring in Understanding the Benefits of Parental Acceptance on Adolescent Adherence and Metabolic Control of Type 1 Diabetes

Abstract

OBJECTIVE—This study examined 1) whether the benefits of mothers’ and fathers’ accepting relationships with their adolescents regarding diabetes control were due to parental monitoring and 2) how parents together may provide sufficient acceptance and monitoring for diabetes management. RESEARCH DESIGN AND METHODS—Adolescents aged 10–14 years with type 1 diabetes (n = 185) and their mothers (n = 185) and fathers (n = 145) completed assessments of parental acceptance and monitoring of diabetes tasks. Adolescents completed a modified version of the Self-Care Inventory (1) to measure adherence. A1C scores were used as a marker of glycemic control. RESULTS—Mediational analyses revealed that the benefits of adolescents’ reports of fathers’ acceptance on A1C and mothers’ and fathers’ acceptance on better adherence were partially mediated by monitoring. Both mothers’ and fathers’ monitoring and fathers’ acceptance had independent effects in predicting adherence. However, only fathers’ monitoring had an independent effect on A1C. The effect of fathers’ monitoring on A1C occurred as fathers were monitoring at a lower level than mothers. Mothers’ and fathers’ reports of their own acceptance and monitoring were not associated with A1C or adherence. CONCLUSIONS—Results reveal the importance of fathers’ acceptance and monitoring in diabetes management, a role that should be encouraged, despite the little attention it has received.

Parental Involvement and Adolescents' Diabetes Management: The Mediating Role of Self-Efficacy and Externalizing and Internalizing Behaviors

“…Nevertheless, paternal influences have particular significance during the transition from childhood to adolescence (Gavin & Wysocki, 2006;Schulman & Seiffge-Krenke, 1997) and adolescents are at highest risk when mothers and fathers are both involved at low levels (Wysocki et al, 2009). In our own work examining mothers' and fathers' involvement simultaneously, fathers' monitoring was uniquely related to diabetes outcomes, particularly when fathers displayed low levels of monitoring (Berg et al, 2008).…”

“…Both adherence and metabolic control are enhanced when parents are involved with their adolescent through a high quality relationship (Miller-Johnson et al, 1994), actively monitoring their adolescents' behavior (Berg et al, 2008;Ellis et al, 2007) and behavioral management in diabetes tasks (Wysocki et al, 1996). Although parental involvement is beneficial for diabetes management, we know very little about the process whereby it is linked with diabetes outcomes and whether this process is similar for mothers' versus fathers' involvement.…”

“…High-quality relationships characterized by acceptance from parents facilitate better adherence and metabolic control (Miller-Johnson et al, 1994;Skinner, John, & Hampson, 2000). Parental monitoring, consisting of regular contact with adolescents regarding their daily activities and knowledge about those activities (Dishion & McMahon, 1998), has been linked to better adherence and metabolic control (Berg et al, 2008;Ellis et al, 2007). Behavioral involvement (e.g., daily assistance regarding diabetes activities) has also been associated with better diabetes management (Anderson et al, 1997;Wysocki et al, 1996).…”

Diabetes mellitus tipo1: factores psicosociales y adaptación del paciente pediátrico y su familia. Revisión

“…La presencia de relaciones hostiles o rechazo y la percepción de escaso apoyo emocional constituyen factores de riesgo ante una adecuada evolución de la enfermedad. 25,30 Estos pacientes presentan mayor clínica depresiva cuando perciben un menor apoyo específico por parte de su familia. 22 Así, la presencia de intensos, duraderos y/o frecuentes conflictos parentales o intrafamiliares, desestructuración familiar, estilos parentales con una disciplina inconsistente o carente de claridad, exceso de rigidez o falta de flexibilidad familiar para adecuarse a las necesidades cambiantes propias de la infancia/ adolescencia o de las diferentes situaciones de enfermedad que se puedan crear (pautas nutricionales y de ejercicio, visitas ambulatorias, estancias hospitalarias, etc.)…”

Type 1 diabetes mellitus: psychosocial factors and adjustment of the pediatric patient and his/her family. Review

“…The presence of rejection or aggressive relationships and the sense of little emotional support are risk factors that hinder the adequate course of the disease. 25,30 These patients have a higher chance of experiencing depression when they perceive a low level of specific family support. 22 As a result, the most important risk factors for this population include intense, long-lasting and/or frequent conflicts between parents or among family members, family breakdown, incoherent or unclear parenting styles, excessive strictness or lack of family flexibility to adjust to the changing needs typical of childhood/adolescence or to the different situations related to the disease (nutrition and exercise recommendations, outpatient visits, hospital stays, etc.…”