Parent-adolescent communication and adherence to diabetes treatment in adolescents with diabetes: The mediating role of decision-making competence.

摘要

Despite its potential importance, decision-making competence has received little if no attention with regards to pediatric populations. The development of decision-making competence is particularly relevant for children and adolescents with diabetes, who must manage a complex treatment regimen and make daily decisions about treatment-related issues. The aim of the present study was to examine adolescent decision-making competence in a sample of adolescents with diabetes and their parents. Specifically, the present study hypothesized that parent-adolescent communication would be associated with better adolescent decision-making competence and better adherence to treatment. In addition, it was hypothesized that greater decision-making competence would be associated with better adherence to the diabetes treatment regimen. The final hypothesis was that adolescent decision-making competence would mediate the relationship between parent-adolescent communication and adherence to treatment. That is, parent-adolescent communication would influence adherence indirectly via decision-making competence.;The sample consisted of 63 adolescents with Type I diabetes and their parents. An observational measure was used to assess communication behaviors during a parent-adolescent problem solving task. Self-report questionnaires were used to measure adolescent maladaptive decision-making (hypervigilance and buckpassing) and parent perceptions of adherence to the diabetes treatment regimen. Provider report of adherence and an objective assessment of adherence were also obtained.;Consistent with the hypotheses, more negative parent-adolescent communication was associated with higher levels of adolescent maladaptive decision-making and worse adherence to diabetes treatment. One type of adolescent maladaptive decision-making, hypervigilance, was associated with worse adherence to treatment according to parent report. Contrary to hypotheses, adolescent decision-making competence did not mediate the relationship between parent-adolescent communication and adherence to treatment.;These results identified adolescent decision-making competence as a potentially important correlate of both parent-adolescent communication and adherence to diabetes treatment and highlight several areas for future research. These include the development of diabetes-specific measures of decision-making competence, comparison of normative and diabetes-related decision-making, and use of prospective designs to determine the way in which adolescent decision-making competence develops over time. Additional research on decision-making competence in children and adolescents with chronic illness will inform the development of interventions to improve adherence to treatment, as well as other health-related outcomes.