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). "
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    ABSTRACT: A substantial percentage of youngsters with diabetes have treatment adherence problems that inevitably reduce treatment efficacy. Effective adherence to a diabetes treatment regimen requires adolescents' motivation to manage goal pursuit in the face of personal and situational obstacles. However, interventions are usually associated only with health promotion and not with the motivational structure typical of adolescents, their perceived purpose in life and their meaningful personal goals. Using principles for the motivation and self-regulation of goals adapted from the fields of social and personality psychology, we suggest a motivation-based conceptual framework to address the problem of treatment adherence. We argue that the failure to adhere to treatment is partially the result of the conflict between adolescents' health-related goals and their personal goals. We suggest that adolescents' motivation for treatment adherence can be increased and reinforced by forging an association between their personal life goals and their health-related goals. We present a 2-phase model for goal setting and goal striving that aims to improve patient evaluation and ability to cope with resource delusion in the face of numerous self-regulatory challenges associated with adherence to the medical treatment regimen for diabetes. (PsycINFO Database Record
    Full-text · Article · Jan 2015 · Journal of Psychotherapy Integration
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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. "

    Preview · Article · Jun 2013 · Journal of Pediatric Psychology
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    ABSTRACT: Suboptimal regimen adherence among youth with type 1 diabetes (T1D) is a common challenge for patients, families, and providers. Motivational interviewing (MI) is a brief communication style designed to elicit intrinsic motivation and strengthen commitment to behavior change goals. As pediatric MI research expands, a critical review of its evidence base and applicability to promote adherence behaviors for youth with T1D is needed. This review introduces the core tenets of MI and clinical applications in T1D, synthesizes the existing MI research in T1D, and discusses the next steps in MI research. Overall, mixed results for MI interventions in T1D reflect variations in research study design and clinical implementation. Targeting adherence rather than glycemic outcomes typically demonstrates greater results, highlighting the promise of MI to facilitate meaningful and enduring improvements in youths' T1D adherence behaviors.
    No preview · Article · Oct 2014 · Current Diabetes Reports
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