Abstract
Introduction: The purpose of this study was to describe the ways that parents and 11- to 15-year-old teens communicate and the recurrent themes and patterns of behavior that were revealed during brief interactions about issues related to diabetes management.
Method: A secondary qualitative analysis of data, based on a template for analysis developed from the literature, was completed on audiotaped interactions of 28 adolescents and their parents.
Results: Themes identified were frustration, fear, normalizing, trusting, and discounting. Trusting the adolescent to manage diabetes was difficult for the parents and was associated with frustration, fear, and discounting communication.
Discussion: Results support the need for clinicians to work with families to facilitate trust and positive parent-adolescent communication about diabetes management.
Introduction
An estimated 2.8 per 1000 adolescents aged 10 to 19 years have type 1 diabetes in the United States. Among some population groups such as non- Hispanic Whites, the incidence is as high as 3.18 per 1000. Among adolescents with diabetes, type 1 diabetes was the most prevalent type in all racial and ethnic groups except for American Indian adolescents (Search for Diabetes in Youth Study Group, 2006). The risk of developing diabetes is higher than that of developing any other severe chronic illness of childhood (National Institute of Diabetes and Digestive and Kidney Diseases, 2005.). There are no known preventative measures for type 1 diabetes.
The adolescent with type 1 diabetes is at risk for the complications of diabetes, which can be exacerbated by his or her "drive for independence and peer acceptance" (Silverstein et al., 2005, p. 190). The Diabetes Control and Complications Trial showed that long-term complications were decreased by intensive insulin therapy for type 1 diabetes (Santiago, 1993). This regimen requires proper nutrition and exercise, frequently monitoring blood glucose, and two or more insulin injections per day. Adolescents may be less vigilant with self-management, fail to recognize and treat hypoglycemia, and may resent close parental supervision (Silverstein et al.).
Adolescence is a transition time for families. As the adolescent attempts to establish a sense of individual identity and autonomy, it is common for conflicts to occur, and these conflicts often center on mundane recurring events (Montemayor & Hanson, 1985). Riesch and colleagues (2000) found that conflicts between parents and young adolescents (aged 11 to 14 years) from families in which adolescents did not have chronic illness were not emotionally intense. Although usual parent-adolescent conflicts are similar for families of adolescents with type 1 diabetes (Viikinsalo, Crawford, Kimbrel, Long, & Dashiff, 2005), communication about disease management can bring additional and unique sources of friction or conflicts that can influence such an adolescent's metabolic control (Anderson et al., 2002). The ability of parents to maintain team-oriented partnerships when communicating with their teen about diabetes is important to preventing the acceleration of conflict about disease management and promoting metabolic control. Only a few studies of interaction between teens and their parents about diabetes management have been conducted (Anderson et al., 1997, Laffel et al., 2003, Martin et al, 1998, Miller and Drotar, 2003). In these studies, communications have been examined with existing coding systems that were not diabetes specific and that did not capture the unique content of communications related to diabetes management. Therefore, the purpose of the current investigation was to describe the ways that parents and teens communicate and the recurrent themes and patterns of behavior that were revealed by the participants during brief interactions about diabetes management.