Development of the Diabetes Family Adherence Measure (D–FAM)

Diabetes Care, 1986

The Diabetes Family Behavior Checklist (DFBC) was administered to 54 adults and 18 adolescents (<19 yr of age) with insulin-dependent diabetes mellitus (IDDM). Subjects and family members completed parallel forms of the DFBC at initial and 6-mo follow-up home interviews. During each of these periods, adherence was assessed via self-report, 1 wk of self-monitoring, and 24-h dietary recalls. The results showed reliable differences between adolescents and adults. More negative interactions with family members were reported by adolescents and their family members, and adolescents were in poorer metabolic control. For adults but not adolescents, negative DFBC scores were prospectively predictive of poorer regimen adherence over the 6-mo interval for measures of glucose testing, insulin injection, and dietary adherence. In addition, higher negative DFBC scores for adults were marginally associated with higher HbA1 levels (P < 0.10). We conclude that the DFBC is a promising measure o...

Journal of Pediatric Psychology, 2005

Objectives To examine family factors as predictors of metabolic control in children with type 1 diabetes and determine whether adherence behaviors mediate this relationship. Method Participants were 109 children (ages 8-18) and a parent. Measures of diabetes-specific family functioning and an adherence interview were completed. Glycosylated hemoglobin (HbA1c) was the index of metabolic control. Results Family functioning and adherence were strongly associated with metabolic control. Combined with demographic information, these constructs accounted for 49% of the variance in metabolic control. Age moderated the relation between aspects of family functioning and HbA1c. Path analyses suggest that adherence mediates the relationship between family functioning and metabolic control. Conclusions Family functioning and adherence behaviors are strongly related to a child's health status. Assessment of diabetes-specific family functioning, in addition to adherence, is an important factor in understanding metabolic control.

International Journal of Behavioral Medicine, 2008

Background: Diabetes is a common disease in pediatric populations. Family functioning has been related to child adaptation to diabetes. Purpose: To determine the impact of family factors on diabetes, particularly the influence of family support and family environment on adherence to treatment, quality of life, and metabolic control in Portuguese adolescents with type 1 diabetes, taking in consideration age, sex, duration of disease, and social class. Method: This study used a cross-sectional design. A sample of 157 Portuguese diabetic patients filled disease-specific measures on adherence and quality of life and family functioning measures. Hypotheses were that family support and an organized family environment (high cohesion and low conflict) would be positively associated with better adherence, metabolic control, and quality of life. Results: This study’s results confirmed that adherence was predicted by family support for females and lower-class patients while metabolic control was predicted by family conflict for upper-class patients. Quality of life was predicted by lack of family conflict and family social support for both males and females as well as lower-class patients. Conclusion: The results highlight the importance of studying family variables in adolescents’ diabetes care within the wider cultural factors affecting the patient.

Children s Health Care

This study examined relations among diabetes-specific family factors, adherence to medical regimen, quality of life (QOL), and glycemic control in youth and adolescents with type 1 diabetes. During an endocrinologist visit, patient and parent–caregiver dyads (n = 70) completed family factors and QOL measures and participated in a structured interview to assess medical regimen compliance, and the patient's glycemic control was assessed by a medical professional. Combined measures accounted for 42% of the variance in glycemic control. QOL partially mediated adherence and glycemic control. Ethnic minority status was associated with poorer glycemic control.

Children's Health Care, 2005

This study evaluated the factor structure of the Diabetes Self-Management Profile (DSMP), a structured interview for diabetes regimen adherence for children with type 1 diabetes. Study aims included a detailed examination of parent-child agreement in ratings of adherence. The DSMP was administered to 121 children and their parents during routine visits to a tertiary care diabetes clinic. Confirmatory factor analysis of the rationally derived five subscales yielded poor fit indexes. Subsequent exploratory factor analysis supported a two-factor solution for both the parent and child DSMP adherence ratings with factors named Food and Insulin Schedule Adherence and Adherence to Blood Sugar Testing and Adjustments. The internal consistency of the factors was acceptable, and predictive validity was supported vis-à-vis positive correlations with metabolic control (HbA1c). This factor structure appears to provide a brief yet reliable and valid framework for assessing adherence and predicting metabolic control in children. In addition, parent-child agreement varied as a function of age. However, poor metabolic control did not relate to higher parent-child disagreement.

Journal of Youth and Adolescence, 1986

Two samples of insulin-dependent diabetic youths were studied in successive attempts to refine a brief patient self-report measure of general long-term adherence to a diabetic regimen. Validity and reliability were assessed for both samples by measuring a number of related variables: locus of control, stressful life events, knowledge of diabetes, parent report, and glycosylated hemoglobin. Initial evidence of validity was demonstrated in a variety of criterion areas. Both reliability and validity were replicated on the second sample. Adherence is discussed as a complex multidimensional variable, the measurement of which requires several different methods, including the selfreport measure described here. Warnings about social desirability as a confounding factor were discussed, as were suggestions for other adherence measures.

Diabetes Mellitus has assumed a worldwide pandemic. Projections have estimated that the population of sufferers would double within the next two decades. Managing diabetes can be quite complex, requiring lifelong and significant changes to the patient’s lifestyle. Patients must adhere to treatment regimens that include dietary restrictions, physical activity goals, and self-monitoring of glucose levels. Diabetic patients who have appropriate social and family support have been found to have better adherence to self-care behaviors. Good support from family provides patients with practical help and can buffer the stresses of living with a chronic illness like diabetes mellitus. However, the exact mechanism by which family support affects patient adherence is not yet completely understood. Further research is needed to address how the differences in types of support are linked to patient outcome. The purpose of this review is to summarize what is known of the impact of family and social support on medication adherence in patients with diabetes.

Journal of Developmental & Behavioral Pediatrics, 2018

Objective-Informed by the family stress and family investment models, this study investigated whether income is indirectly related to adherence and glycemic control through parenting constructs among youth with type 1 diabetes. Methods-Youth and their families (n=390) from four geographically-disperse pediatric endocrinology clinics in the United States were participants in a multi-site clinical trial from 2006-2009 examining the efficacy of a clinic-integrated behavioral intervention targeting family disease management for youth with type 1 diabetes. Baseline data were collected from youth age 9 to 14 years and their parents. Parents reported family income and completed a semi-structured interview assessing diabetes management adherence. Parents and children reported diabetesspecific parent-child conflict. Children completed measures of collaborative parent involvement and authoritative parenting. Hemoglobin A1c (HbA1c), a biomarker of glycemic control, was analyzed centrally at a reference laboratory. The relations of income, parenting variables, regimen, adherence, and HbA1c were examined using structural equation modeling. Results-Lower family income was associated with greater parent-child conflict and a less authoritative parenting style. Authoritative parenting was associated with more collaborative parent involvement and less parent-child conflict, both of which were associated with greater adherence, which was associated with more optimal glycemic control (p<.05 all associations). Indirect effects of family income on adherence and glycemic control through parenting constructs were significant (p<.001). Conclusions-Findings lend support for the family stress and family investment models, suggesting that lower family income may negatively impact parent-child constructs, with adverse effects on diabetes management.

Journal of Family Psychology, 2017

This study explored whether shared self-control across a family system, including adolescent, mother, and father self-control, as well as the interaction of mother and father self-control, was associated with ease of completing adherence tasks, and the completion of adherence behaviors related to the type 1 diabetes (T1D) regimen. 137 adolescents (M = 13.48 years), mothers, and fathers completed a self-report measure of self-control, while adolescents also self-reported on ease of completing adherence tasks and the frequency with which they completed adherence tasks. Higher adolescent, mother, father, and the interaction of mother and father self-control were each associated with greater adolescent perceptions of ease of completing adherence tasks. Also, greater adolescent perception of ease of adherence mediated the association of higher adolescent, father, and the interaction of mother and father self-control on more frequent adherence behaviors. The results are consistent with the idea that family members may share the load of self-control within the family system. The results point to the importance of assessing and intervening within the entire family system to support improved quality of life and better adherence to the medical regimen in adolescents with type 1 diabetes.

Revista da Escola de Enfermagem da USP, 2014

This cross-sectional study aimed to analyze the adherence to drug and non-drug treatments in 17 Family Health Strategy units. A total of 423 patients with type 2 diabetes mellitus were selected through stratified random sampling in Family Health Strategy units of a city in the state of Minas Gerais, Brazil, in 2010. The results showed that the prevalence rate of adherence to drug therapy was higher than 60% in the 17 units investigated; in relation to physical activity, adherence was higher than 60% in 58.8% units; and for the diet plan, there was no adherence in 52.9% units. Therefore, we concluded that adherence to drug therapy in most units was high and the practice of physical activity was heterogeneous, and in relation to diet adherence, it was low in all units. We recommend strengthening of institutional guidelines and educational strategies, in line with SUS guidelines, so that, professionals may face the challenges imposed by the lack of adherence.