Cognitive and behavioral determinants of compliance in diabetics.

The interaction between patient and medical team is especially stressful in cases of diabetes, because of the high potential for critical behaviors by the team and for avoidance or aggressive behaviors by the patient. This study examined some cognitive and behavioral correlates of compliance behaviors in 70 insulin-dependent diabetics. A special scale was developed to evaluate specific cognitions, behaviors, and anxiety during confrontations with the physician, dietitian, nurse, and secretary. Another special scale was developed to evaluate compliance with self-care behaviors in diabetes. Cognitive and behavioral coping skills specific to patient-medical team encounters were found to be significant correlates of various compliance variables in the following order: maintenance of positive self-esteem and efficacy during criticism, positive acceptance of criticism, avoidance of conflict by offering compromise solutions, and assertive request for follow-up with a specific doctor. Each was found to be a significant predictor of compliance behaviors. The findings indicate the importance of positive cognitive and assertive coping skills in specific stressful situations involving the patient and medical team.