Anderson B J, Auslander W F, Jung K C, Miller J P, Santiago J V
Mental Health Unit, Joslin Diabetes Center, Boston, Massachusetts 02215.
J Pediatr Psychol. 1990 Aug;15(4):477-92. doi: 10.1093/jpepsy/15.4.477.
This study examined sharing of diabetes responsibilities between mothers and their diabetic children and the relationship between patterns of mother-child sharing of responsibility for diabetes tasks and demographic variables, adherence, and metabolic functioning in children with insulin-dependent diabetes mellitus (IDDM). A factor analysis of the Diabetes Family Responsibility Questionnaire (DFRQ), a 17-item questionnaire developed for the present study, resulted in a meaningful three-factor solution. Factors included responsibilities related to regimen tasks, General Health Maintenance, and Social Presentation of Diabetes. Analysis indicated that the DFRQ had adequate internal consistency and concurrent validity. One hundred and twenty-one children with IDDM, 6-21 years of age, and their mothers completed the DFRQ. Glycosylated hemoglobin (HbA1c) was used to index the child's level of metabolic control. Results of multiple regression analyses indicated that the child's age, disease duration, and sex are significant predictors of mother and child patterns of sharing diabetes responsibilities. Disagreements between mothers and children in perceptions of who is assuming responsibility and adherence level were significant predictors of HbA1c. Results indicated that children assume increasing responsibility with increasing age. Clinicians should not assume that mothers and children communicate about the sharing of diabetes responsibilities in the family or about changes in expectations of who is responsible as children develop. To foster better control and adherence in diabetic children, members of the health care team can help to identify diabetes tasks for which no one in the family takes responsibility.
本研究考察了患有胰岛素依赖型糖尿病（IDDM）的母亲与子女之间糖尿病责任的分担情况，以及母子在糖尿病任务责任分担模式与人口统计学变量、依从性和儿童代谢功能之间的关系。对为本研究编制的17项糖尿病家庭责任问卷（DFRQ）进行因素分析，得出了一个有意义的三因素解决方案。这些因素包括与治疗方案任务、一般健康维护以及糖尿病社会表现相关的责任。分析表明，DFRQ具有足够的内部一致性和同时效度。121名6至21岁的IDDM儿童及其母亲完成了DFRQ。糖化血红蛋白（HbA1c）被用来衡量儿童的代谢控制水平。多元回归分析结果表明，儿童的年龄、病程和性别是母子糖尿病责任分担模式的重要预测因素。母子在谁承担责任的认知和依从水平上的分歧是HbA1c的重要预测因素。结果表明，随着年龄增长，儿童承担的责任越来越多。临床医生不应假定母亲和孩子会就家庭中糖尿病责任的分担或随着孩子成长谁负责的期望变化进行沟通。为了促进糖尿病儿童更好的控制和依从性，医疗团队成员可以帮助确定家庭中无人承担责任的糖尿病任务。
