Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.
Pediatr Diabetes. 2019 Mar;20(2):217-225. doi: 10.1111/pedi.12810. Epub 2019 Jan 8.
Adolescents with type 1 diabetes (T1D) frequently experience deterioration in glycemic control. Providers have unique opportunities to address diabetes self-management, yet little is known about the most effective way to communicate with adolescents. This investigation used a motivational interviewing (MI) framework to characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined relations between adolescent patient-provider communication and (a) T1D self-management and (b) glycemic control (hemoglobin A1c [HbA1c]).
Medical encounters between pediatric endocrine providers and 55 adolescents with T1D (49% female; M age = 14.8 years; M baseline HbA1c = 8.6%) were audio recorded and coded using standardized rating instruments. Patients and parents completed measures assessing T1D care behaviors and self-efficacy. Assessments were completed at routine endocrinology visits (baseline) and 1 and 3-month post-baseline; HbA1c was obtained from medical records at baseline and 3-month.
Hierarchical multiple regressions showed that greater provider use of MI non-adherent behaviors (eg, confronting, persuading) was associated with (a) poorer 3-month HbA1c, P < 0.001; (b) worse 1-month adolescent diabetes adherence P < 0.001, and (c) lower diabetes self-efficacy at 1-month (P < 0.001) follow-up. Lower patient self-efficacy for diabetes self-management mediated the relation between provider use of MI non-adherent language and lower diabetes adherence (P = 0.020).
Providers' use of persuasion and confrontation regarding risks of non-adherence was associated with poorer glycemic control and adherence. Communication training for providers that targets reductions in MI-inconsistent language may have the potential to improve diabetes self-care in this vulnerable population.
青少年 1 型糖尿病（T1D）患者血糖控制经常恶化。医疗服务提供者有独特的机会来解决糖尿病自我管理问题，但对于与青少年交流的最有效方式知之甚少。本研究使用动机性访谈（MI）框架来描述医疗就诊中青少年患者与医疗服务提供者之间自然发生的交流，并探讨了青少年患者与医疗服务提供者之间的交流与（a）T1D 自我管理和（b）血糖控制（糖化血红蛋白 [HbA1c]）之间的关系。
记录儿科内分泌专家与 55 名 T1D 青少年（49%为女性；平均年龄为 14.8 岁；平均基线 HbA1c 为 8.6%）之间的医疗就诊，并使用标准化评分工具对其进行编码。患者和家长完成了评估 T1D 护理行为和自我效能的量表。评估在常规内分泌就诊时（基线）以及基线后 1 个月和 3 个月进行；HbA1c 则从基线和 3 个月的医疗记录中获取。
分层多元回归显示，提供者使用 MI 不依从行为（例如，对抗、说服）越多，（a）3 个月时的 HbA1c 越高，P<0.001；（b）1 个月时的青少年糖尿病依从性越差，P<0.001；以及（c）1 个月时的糖尿病自我效能越低，P<0.001）。糖尿病自我管理的患者自我效能越低，与提供者使用 MI 不一致语言与较低的糖尿病依从性之间的关系越强（P=0.020）。
提供者在谈论不依从风险时使用说服和对抗的方式与较差的血糖控制和依从性相关。针对减少 MI 不一致语言的提供者沟通培训可能有潜力改善这一弱势群体的糖尿病自我护理。
