A Multicomponent Motivational Intervention to Improve Adherence Among Adolescents With Poorly Controlled Type 1 Diabetes: A Pilot Study

Department of Psychiatry, Geisel School of Medicine at Dartmouth, University of Texas Health Science Center at San Antonio, University of Arkansas for Medical Sciences, and Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center.
Journal of Pediatric Psychology (Impact Factor: 2.91). 05/2013; 38(6). DOI: 10.1093/jpepsy/jst032
Source: PubMed


To adapt and pilot test a multicomponent motivational intervention that includes family-based contingency management (CM) for adolescents with poorly controlled type 1 diabetes.

A total of 17 adolescents, age 12-17 years (M = 14.8, SD = 1.5), with type 1 diabetes (duration M = 6.2 years, SD = 4.5) and mean HbA1c of 11.6% (SD = 2.5%) were enrolled. Adolescents and their parents received 14 weeks of motivational interviewing, clinic-based CM, and parent-directed CM that targeted increased blood glucose monitoring (BGM).

Adolescents significantly increased their BGM (p < .001) and showed significantly improved HbA1c levels (glycemic control) from pre-to posttreatment (p < .0001).

The magnitude of improvements in the frequency of BGM and glycemic control in adolescents with type 1 diabetes is encouraging and will be tested in a randomized controlled trial.

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    • "Research has shown that problem solving and emotion focused coping strategies, either alone or in combination, may be effective (Wysocki et al., 2006). Several programs have focused on motivational components such as motivational interviewing (Stanger, 2013). Similarly, for patients with type 2 diabetes, health coaching, a perspective that enables patients to identify their own expectations vis-à-vis their health, has been associated with increases in positive health outcomes (Wolever et al., 2010). "

    Journal of Psychotherapy Integration 01/2015; DOI:10.1037/int0000019
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    • "However, although parents rated the electronic monitor (MDILog-II) and supervision charts useful, they also rated them high on difficulty to use and had an average of 47% errors in making changes in the level of parental supervision earned based on child adherence. Stanger and colleagues (Stanger et al., 2013) used a three-component adherence intervention consisting of motivational interviewing (MI), family-based cognitive behavior therapy, and contingency management in a pre-post single group design to increase blood glucose monitoring (BGM) in teens with diabetes aged 12–17 years. The unique aspect of this study is that contingencies in the form of monetary rewards were modeled from the teen substance abuse literature and given by the interventionist to teens based on achieving individualized but gradually increasing BGM goals that led to a ultimate goal of 6 BGM a day, 5 days a week. "

    Journal of Pediatric Psychology 06/2013; 38(6). DOI:10.1093/jpepsy/jst040 · 2.91 Impact Factor
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    ABSTRACT: Helping parents change key behaviors may reduce the risk of child maltreatment. However, traditional provider-centered approaches to working with the parents of pediatric patients may increase resistance to behavioral change. Motivational interviewing (MI) is a patient-centered communication technique that helps address problems of provider-centered approaches. In this article, evidence for use of MI to address several risk factors for child maltreatment is reviewed, including parental substance abuse, partner violence, depression treatment, harsh punishment, and parental management of children's health. Fundamental components of MI that may be incorporated into clinical practice are presented.
    Pediatric Clinics of North America 10/2014; 61(5). DOI:10.1016/j.pcl.2014.06.014 · 2.12 Impact Factor
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