A social ecological perspective on diabetes care: Supporting adolescents and caregivers.

摘要

The diabetes illness management regimen is complex and demanding, requiring daily motivation and self-control. Adolescents with diabetes face unique risks for which social support may be one protective factor. The importance of social support from family and friends is well documented in the literature. Support for the caregiver and support from the health care provider, conversely, are understudied. These four sources of social support, considered together, span the adolescent's micro-, meso-, and exosystems constituting a social ecological model of social support for diabetes. The primary aim of this study was to test this model. The hypotheses were that each source of social support would independently and positively contribute to illness management when evaluated simultaneously, after controlling for adolescent and caregiver demographics and that illness management behavior would mediate the relationship between social support and diabetes health. A secondary data analysis of adolescents with chronically poorly managed diabetes was undertaken. Structural equation modeling was used to test the study hypotheses. A total of 146 adolescents and their primary caregivers participated in the study. Participants were primarily African American, low-income single-parent families. Results from the analysis did not support the model as hypothesized but did support an alternative model. In the alternative model, exosystem, but not mesosystem, support was positively associated with microsystem support. Microsystem support was directly related to adolescents' illness management behavior and indirectly related to adolescents' health status. Findings from this study introduce an innovative model of social support for adolescents with diabetes. Supporting the caregiver of adolescents with diabetes may have a beneficial impact on the social support environment in which adolescents perform their daily illness care. A more supportive daily care environment, in turn, may translate to better illness management and better illness health. Social support intervention may be an important strategy for medical social workers, as members of multidisciplinary medical treatment teams, treating adolescents with diabetes and their families.