青少年糖尿病患者的视频会议：家庭因素
Videoconferencing for Teens With Diabetes: Family Matters.
作者信息
Duke Danny C, Wagner David V, Ulrich Jenae, Freeman Kurt A, Harris Michael A
机构信息
Oregon Health & Science University, Portland, OR, USA Harold Schnitzer Diabetes Health Center, Portland, OR, USA
Oregon Health & Science University, Portland, OR, USA.
出版信息
J Diabetes Sci Technol. 2016 Jun 28;10(4):816-23. doi: 10.1177/1932296816642577. Print 2016 Jul.
BACKGROUND
Adolescence is a developmental period associated with increased difficulty managing diabetes. During adolescence family functioning, including miscarried helping, family conflict, and acceptance of illness, is an important predictor of adherence to treatment recommendations. Multiple barriers exist to receiving behavioral health interventions to address suboptimal adherence. We hypothesized that behavioral family systems therapy-diabetes (BFST-D) delivered via telehealth would yield changes in family functioning that were not significantly different than changes in clinic-based treatment. Furthermore, that BFST-D would significantly improve overall family functioning.
METHODS
Ninety adolescent participants and their parents were randomized to receive BFST-D via telehealth or traditional (Clinic) treatment conditions. Repeated measures ANOVAs were used to assess changes in mean scores across pre, post, and follow-up assessments. Mediation analyses were conducted using methods outlined by Sobel and were confirmed by bootstrapping.
RESULTS
Changes in miscarried helping, family conflict and adjustment to illness were not significantly different across groups. Overall, clinically significant improvements were identified in youth- and parent-reported miscarried helping, family conflict, and acceptance of illness. Reductions in family conflict mediated the relationship between changes in miscarried helping and acceptance of illness. In addition, improvements in family functioning were associated with changes in adherence and glycemic control.
CONCLUSIONS
Results provide strong support for BFST-D (and similar interventions) delivered via telehealth as yielding outcomes no different than clinic-based treatment. In addition, further support was provided for the effectiveness of BFST-D.
背景
青春期是一个糖尿病管理难度增加的发育阶段。在青春期，家庭功能，包括未成功的帮助、家庭冲突和对疾病的接受程度，是遵循治疗建议的重要预测因素。在接受行为健康干预以解决依从性欠佳方面存在多种障碍。我们假设通过远程医疗提供的行为家庭系统疗法 - 糖尿病（BFST-D）会使家庭功能发生变化，且与基于诊所的治疗所产生的变化无显著差异。此外，BFST-D 将显著改善整体家庭功能。
方法
90 名青少年参与者及其父母被随机分配接受通过远程医疗或传统（诊所）治疗条件下的 BFST-D。重复测量方差分析用于评估在治疗前、治疗后和随访评估期间平均得分的变化。中介分析采用索贝尔概述的方法进行，并通过自抽样法得到证实。
结果
未成功的帮助、家庭冲突和对疾病的适应方面的变化在各组之间无显著差异。总体而言，在青少年和父母报告的未成功的帮助、家庭冲突以及对疾病的接受程度方面发现了具有临床意义的改善。家庭冲突的减少介导了未成功的帮助变化与对疾病接受程度之间的关系。此外，家庭功能的改善与依从性和血糖控制的变化相关。
结论
结果为通过远程医疗提供的 BFST-D（以及类似干预措施）提供了有力支持，表明其产生的结果与基于诊所的治疗无异。此外，还为 BFST-D 的有效性提供了进一步支持。
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