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Self-management in Type 2 Diabetes

The Adolescent Perspective

From the School of Nursing, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Mulvaney, Ms Baughman), the Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Mulvaney, Ms VanderWoude), Emory University School of Medicine, Atlanta, Georgia (Dr Mudasiru), the Department of Psychology, Vanderbilt University, Nashville, Tennessee (Dr Schlundt), Meharry Medical College, Nashville, Tennessee (Dr Fleming), the Department of Endocrinology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Russell, Dr Elasy), and the Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rothman).

Correspondence to Shelagh A. Mulvaney, PhD, Vanderbilt University School of Nursing, 461 21st Avenue South, Godchaux Hall, Room 425, Nashville, TN 37240 (shelagh.mulvaney{at}vanderbilt.edu).

Purpose

The purpose of this study was to document barriers and facilitators of self-management as perceived by adolescents with type 2 diabetes.

Methods

Focus groups were conducted with adolescents diagnosed with type 2 diabetes. Adolescents aged 13 to 19 years were recruited from an academic medical center diabetes clinic. Between 2003 and 2005, 6 focus groups were used to elicit responses from the adolescents related to self-management of their diabetes. Questions were asked by trained group facilitators. Transcripts were coded by 3 reviewers. Qualitative analyses were conducted using NVIVO software.

Results

A total of 24 adolescents participated in 6 focus groups. Coding resulted in 4 common domains affecting self-management: adolescent psychosocial development; the role of others with diabetes; environmental influences; and adolescents' problem-solving/coping skills. Adolescents identified both barriers to and facilitators of self-management within each domain. Barriers often related to social situations, embarrassment, seeking acceptance or perceived normalcy, and balancing competing interests. Adolescents viewed having another family member with diabetes as both a positive and a negative influence. Environmental influences, including school and family situations, had a large impact on self-management behaviors. Making sensible food choices was a common challenge. Descriptions of problem-solving or coping skills were limited, but cognitive techniques, such as reframing, were described.

Conclusion

Adolescents with type 2 diabetes identified many barriers to self-management, particularly related to interpersonal interactions, the influence of others with diabetes, and environmental influences. Results suggest that improving self-management in adolescents may require multimodal interventions to address individual, family, and social processes.

The Diabetes Educator, Vol. 34, No. 4, 674-682 (2008)
DOI: 10.1177/0145721708320902


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