The Pediatric Self-Management Model provides an overview of how behavioral factors influence children’s chronic medical illnesses. This general framework is used to organize the present review of how self-management behaviors, contextual factors, and processes impact health outcomes for adolescent youth with type 1 diabetes. Adherence has been widely studied in the diabetes literature, and there are consistent findings demonstrating associations between aspects of self-management, adherence, and metabolic control, yet there are still equivocal approaches to adherence assessment methodology (e.g. global versus specific measures). Metabolic control is a hallmark health outcome for youth with type 1 diabetes, but additional outcomes need to be further explored. Future research should utilize the Pediatric Self-Management Model’s operational definitions to guide empirically-supported interventions for youth with type 1 diabetes.
Behavioral factors, type 1 diabetes, youth
The authors have no conflicts of interest to declare.
September 11, 2012
Jessica C Kichler, PhD, CDE, Cincinnati Children’s Hospital Medical Center, Behavioral Medicine and Clinical Psychology, 3333 Burnet Ave, MLC 3015, Cincinnati, OH 45229, US. E: firstname.lastname@example.org
Adherence to medical regimen is often identified as a hallmark modifiable factor that impacts health outcomes for those with chronic medical illnesses.
Adherence to medical regimen is often identified as a hallmark modifiable factor that impacts health outcomes for those with chronic medical illnesses. Rapoff suggests that adherence to medical regimens is estimated to be between 50–55 % for all chronically ill patients.1 He describes a number of patient and family (e.g., demographic, adjustment/coping, family involvement), disease- and regimen-related correlates to adherence; however, correlates do not imply causation and should be interpreted cautiously.1 Researchers have rated non-adherence rates to be between 20 to 93 %1–3 for youth with type 1 diabetes and have found that adherence is widely accepted as related to diabetes control.4
In a recent review article, Modi et al. make a distinction between two constructs: self-management (i.e., the interactions of health behaviors and related processes that patients and families engage in to care for chronic medical conditions) and adherence (i.e., the extent to which a person’s behavior coincides with medical or health advice).5 In their Pediatric Self-Management Model, self-management influences adherence, which then affects outcomes, including health outcomes. The authors also suggest that there may be certain self-management factors that impact outcomes without the mediating role of adherence in pediatric conditions.5
This present review article will focus on the first two of three stages in the Pediatric Self-Management Model, self-management and adherence, to discuss the behavioral factors that may influence health outcomes for youth with type 1 diabetes during adolescence (see Figure 1). Findings from individual, family, peer, and group therapy interventions that have targeted these behavioral factors in order to improve health outcomes will then be outlined.
Modi et al. describe the construct of self-management as having three components.5 The first component is self-management behaviors, which are the actual behaviors performed by the youth and/or family in order to care for a chronic medical illness. Secondly, there are contextual variables, which are four systems that impact how the self-management behaviors occur. These include individual, family, community, and healthcare domains. Finally, there are processes that link the self-management behaviors with the contextual systems. These processes include individuals’ cognitive, emotional, and social perceptions. Three components of self-management, self-management behaviors, contextual variables, and processes as they relate to youth with type 1 diabetes, will be reviewed below (see Table 1).
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