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Conflict between parents and children usually increases during the adolescent years, and diabetes often exacerbates it. The regimen followed to manage the disease is very demanding and can hamper teens' social activities when followed correctly.
Parents, worried about their children's health, often will criticize and nag in the hope of keeping them compliant. As parents become more desperate, the conflict often escalates into screaming matches.
To help remedy this situation, a team at the Joslin Diabetes Center in Boston designed an educational component to build teamwork between parent and adolescent and avoid conflict in diabetes management. "Our goal was to try to teach parents a more productive way to provide the support that teenagers need to follow this demanding regimen, but get them out of the role of policeman and critic," says Barbara J. Anderson, PhD, senior psychologist at Joslin and associate professor in psychiatry at Harvard Medical School.
Much of the education focused on behavior change, teaching parents and adolescents new ways of discussing the monitoring of the disease. For example, rather than using critical language like "bad blood sugars" or "bad numbers," they were taught to refer to blood glucose levels as being "in range" or "out of range."
The office-based educational intervention was tested in a one-year study. During the study, 85 patients with Type I diabetes were randomly assigned to one of three study groups: teamwork, attention control, and standard care.
Patients assigned to the teamwork group had a 20- to 30-minute education session with their parents participating either before or after their routine office visit. They had a total of four sessions at three- to four-month intervals. Research assistants who had received diabetes training taught the educational sessions. The research assistants used written teaching modules designed for the study and followed a scripted protocol to insure consistency. (These written modules should be available from the Joslin Diabetes Center by December 2000.)
At the first session, the parent and teen negotiated a responsibility-sharing plan that outlined who would be responsible for such tasks as drawing up insulin, determining the dose, giving the injection, and monitoring blood glucose. They also discussed how parental criticism often promotes negative behavior such as causing kids to stop checking their blood glucose levels.
At each meeting, the educator, parents, and teen would evaluate the family's diabetes management for the last three months, examine how they were working as a team, and look for ways to improve.
Families assigned to the attention control group would attend educational sessions at office visits but received traditional diabetes education. There was no discussion of conflict resolution issues, and the families did not negotiate a plan for teamwork. The third group received routine care but no educational interventions.
To determine the effect of the educational intervention, parents completed the Diabetes Family Conflict Scale at the start of the study and at its conclusion. The scale measures the degree of family conflict in 17 diabetes management tasks such as blood glucose monitoring. Parents also complete a checklist that assesses their perception of the frequency of supportive and unsupportive responses they have in regard to their child's diabetes management.
The study found that parental involvement in diabetes tasks declined in the families who were not involved in the educational intervention that fostered teamwork. Although fostering parental involvement in their teens' diabetes management increased the potential for conflict, the families in the teamwork group did not experience increased conflict. Some reported a decrease in conflict.
"Most of the patients who go to a good tertiary care center know what to do to manage their diabetes. It's just doing it; that is where the breakdown occurs. Education needs to be on the family management, and that was what was unique about our educational approach," explains Anderson.
For more information on this office-based intervention to maintain parent and adolescent teamwork in diabetes management, contact:
• Barbara J. Anderson, PhD, Senior Psychologist Joslin Diabetes Center, One Joslin Place, Boston, MA 02215. Telephone: (617) 732-2594. Fax: (617) 732-2451.