Type I diabetes is a common chronic disease of childhood. Many pediatric patients, notably adolescents, have poor self-management practices that result in suboptimal control of their blood glucose levels. Increasingly evidence suggests that this is likely the result of conflicts between normal social and developmental needs associated with adolescence and the demands of therapy. Often parents, in an effort to enforce adaptive regimen behavior, try to exert control over their children's actions precisely when adolescents are attempting to achieve more autonomy and self-identity. While such attempts toward independence are developmentally appropriate, adolescents may express these efforts through behaviors that are jeopardizing to their diabetes control. My previous work in this area suggests that we can use mobile technology as a powerful tool to improve diabetes therapy by both modifying the parent-child relationship as it relates to diabetes self-management and by establishing a link between the adolescent and health care team such that questions about therapeutic adjustments can be easily addressed without the need for parental intervention. This will be accomplished through the use of a behavioral contract. In essence, a three-way relationship will be negotiated in group consultation and solidified by a mutually agreed upon three-entity contract: parent, adolescent and provider team. The child will be linked, via the cell phone glucometer, to a health care team who will assist the adolescent with their self-management. At the same time, parents will be requested to not engage in """"""""nagging"""""""" about subsequent self-management decisions since this function will be assumed by the linked health care team. Parents will be made aware that the link created by the mobile system will be able to more accurately assess self-monitoring behavior than is currently possible through self report. This type of behavioral intervention has the potential to mitigate poor self-management decisions that results from parent-child conflict over diabetes therapy behaviors. This research is unique in its use of behavioral contracts as a way to alter a relationship instead of individual behaviors, and in its use of technology as a way to monitor behavior.
The research aims of this proposal are: (1) to develop a behavioral contract that addresses the negotiable points of conflict within the parent-child relationship, (2) to assess the effectiveness of a behavioral contract in altering the parent-child relationship as monitored by a novel cell phone glucose monitoring system.
For aim 1, we will use semi-structured interviews to inform the development of a behavioral contract that will address the negotiable points of diabetic related conflict in the adolescent-parent relationship.
For aim 2, we will conduct a pilot study to determine how this contract performs in conjunction with our cell phone based glucose monitoring system. Focus groups, as well as survey questionnaires, will be used to elicit information about the usefulness of the contracts, conflict in the adolescent-parent relationship, the patient's perceived quality of life, and the patient's competence in self-management. There is an increasing need for effective and practical psychosocial interventions to assist in the management of chronic childhood diseases. While our research focuses on type I diabetes, the findings with this particular population could also be adapted for other chronic childhood diseases.
| Carroll, Aaron E; DiMeglio, Linda A; Stein, Stephanie et al. (2011) Contracting and monitoring relationships for adolescents with type 1 diabetes: a pilot study. Diabetes Technol Ther 13:543-9 |
