- Email: [email protected]
165. Self-Efficacy Mediates the Associations of Parental Coercion and Autonomy Support to Adherence in Adolescents With Type 1 Diabetes
Journal of Adolescent Health 56 (2015) S85eS129
SAHM e 2015 Annual Meeting: Research Poster Abstracts RESEARCH POSTER SESSION II: CHRONIC ILLNESS 164. ADOLESCENT, CAREGIVER, AND PROVIDER PREFERENCES FOR AN ASTHMA SELF-MANAGEMENT APP Delesha M. Carpenter, PhD, Lorie L. Geryk, PhD, Courtney Arrindell, BS, Deborah Tate, PhD, Dayna S. Alexander, PhD, Adam Sage, MS, Betsy L. Sleath, PhD. University of North Carolina at Chapel Hill. Purpose: The purpose of this abstract is present formative data from adolescents, their caregivers, and medical providers regarding their preferences for a mobile asthma self-management application (app). We will present data regarding desired app design, features, and content. Although the number of asthma self-management apps has increased in recent years; to our knowledge, no app has been developed specifically for adolescents. Methods: We recruited a convenience sample of adolescents with persistent asthma (n¼20), their caregivers (n¼20), and health care providers (n¼6) from two pediatric practices in an urban area of North Carolina. To be eligible, adolescents had to be 12-16 years of age, have moderate to severe persistent asthma, speak and read English, own a mobile device, and be present with an English-speaking adult caregiver. Each participant was given an iPod Touch and asked to critique two selfmanagement apps [AsthmaMD (adult-focused) and iAsthma in Control (child-focused)] during an in-person interview after a regularly-scheduled clinic visit and again, via phone interview, after one week of app use. Provider reactions to apps were collected during a 30-minute in-person interview. Using semistructured interviews and surveys, we asked participants to identify the app features they found most useful and describe additional features that could help adolescents better manage their asthma. Additionally, participants rated the usefulness of specific features of the apps on a scale ranging from 1 (not at all useful) to 5 (very useful). Ease of use for each app was also assessed by adolescents and caregivers on a scale of 1 (very easy) to 5 (very difficult). Eighty percent of participants completed the follow-up phone interviews. Each digitally recorded, transcribed interview was imported into MAXQDA, coded, and analyzed. Demographic and perceived usefulness data were analyzed using SPSS version 11.0. Results: Adolescents were primarily Black (47%) and male (60%). Fifty-seven percent of adolescents, 50% of caregivers, and 50% of providers preferred iAsthma in Control, and both adolescents and caregivers found iAsthma easier to use. Adolescents ranked the personalized charting function and asthma self-check features as most useful, caregivers ranked the symptom diary and the ability to send the doctor your report most useful, and providers ranked the appointment reminder feature most useful. The peak flow monitoring feature was ranked lowest among adolescents, caregivers, and providers.
Conclusions: Although participants agreed that symptom tracking features would be useful in an asthma self-management app, preferences for user interface and additional self-management features varied among adolescents, caregivers, and providers. Although our study sample was diverse, our results may not generalize to children and providers in other clinical settings. App developers should be aware of the varied preferences of adolescents and members of their social support network (i.e. providers and caregivers) when developing asthma self-management apps. Sources of Support: This study was supported by the American Lung Association. 165. SELF-EFFICACY MEDIATES THE ASSOCIATIONS OF PARENTAL COERCION AND AUTONOMY SUPPORT TO ADHERENCE IN ADOLESCENTS WITH TYPE 1 DIABETES Sara E. Landers, BS, Elizabeth Friedrich, BA, Victoria Miller, PhD. The Children’s Hospital of Philadelphia. Purpose: Parenting style has been identified as a predictor of a number of different outcomes, including positive and negative health behaviors. Parental coercion and autonomy support are especially relevant during adolescence, when youth begin to strive for more autonomy. Prior research has not yet identified the mechanisms through which parenting exerts its effects on healthrelated outcomes. Self-efficacy is one potential mediator: when parents encourage independent problem solving and decision making independence, the adolescent may learn that he/she has the abilities needed to carry out specific goals or tasks. In contrast, parental use of punitive disciplinary strategies and pressure to elicit a favorable response (i.e., coercion) may send the opposite message. The objective of this study was to test the hypothesis that self-efficacy would mediate the association of coercion and autonomy support to treatment adherence in a sample of adolescents with type 1 diabetes (T1D). Methods: Participants included 98 adolescents with T1D (ages 1016 years) and their parents, who were enrolled in a longitudinal study about youth decision making involvement in chronic illness management discussions. Parents and adolescents completed questionnaires assessing parenting style, diabetes-related selfefficacy, and treatment adherence. Following procedures outlined by Baron and Kenny (1986) and Holmbeck (1997), a series of hierarchical linear regressions were used to test the mediation hypothesis. All regressions utilized baseline data and controlled for adolescent age. Results: As expected, higher parental coercion was associated with lower self-efficacy (b ¼ -.28, p ¼ .006) and worse adherence (b ¼ -.42, p < .0001). Higher parental autonomy support was associated with higher self-efficacy (b ¼ .27, p ¼ .008) and better adherence (b ¼ .25, p ¼ .01). The associations of coercion and autonomy support to adherence were significantly reduced when selfefficacy was included in the models (Sobel’s test¼ -2.39, p < .02 and 2.38, p < .02, respectively). These findings suggest that, as expected,
1054-139X/Ó 2015 Society for Adolescent Health and Medicine. All rights reserved.
S86
Poster Abstracts / 56 (2015) S85eS129
self-efficacy mediated the associations of parenting style to treatment adherence. Conclusions: The use of coercive strategies by parents sends the message that adolescents are ineffective in meeting parental expectations and, in this study, was associated with worse adherence to diabetes treatment, via lower self-efficacy. In contrast, practices that support the adolescent’s autonomy appeared to bolster selfefficacy, which was associated with better adherence. Interventions to improve treatment adherence and promote positive health behaviors in a variety of contexts should attend to both contextual (parenting) and individual (self-efficacy) variables that are associated with health outcomes. Limitations of this analysis include the cross-sectional design, reliance on self-report measures, and inability to determine causality. For example, parents may employ specific parenting strategies in response to youths’ inadequate adherence. When follow-up visits are complete, longitudinal analyses will be conducted to examine reciprocal associations between parenting, self-efficacy, and adherence over time. Sources of Support: This research was supported by R01HD064638 (PI: Miller) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
knowledge. Both pragmatic and emotional support was provided by close friends who play a valuable role in recognising the importance of T1D management, whilst also accepting and normalising the condition. Considerable variations in experiences of support provided in relation to T1D in the school environment were reported by all participants, including the extent to which peers were encouraged or even permitted to support patients. Conclusions: This research highlights the need for greater awareness of T1D in schools amongst teachers and peers, but encouragingly suggests that simple educational sessions can be easily implemented and are well received. There is a lack of standardised high school policies in the UK in relation to the management of T1D. This important aspect of the care pathway should be addressed to ensure there are no barriers to optimal T1D self-management for adolescents in their school environment. Sources of Support: Diabetes UK
166.
EFFECT OF HOSPITALIZATION ON WEIGHT RESTORATION IN ADOLESCENTS WITH RESTRICTIVE EATING DISORDERS Cynthia J. Kapphahn, MD, MPH 1, Rebecca Hehn, MA 2, Elizabeth R. Woods, MD, MPH, FSAHM 2, Kathleen A. Mammel, MD, FSAHM 3, Sara F. Forman, MD 2, Martin Fisher, MD, FSAHM 4, Kelly A. Robinson, BA 2, Ellen S. Rome, MD, MPH 5, Albert C. Hergenroeder, MD, FSAHM 6.
ADOLESCENTS WITH DIABETES AND THE SCHOOL ENVIRONMENT e GETTING BY WITH A LITTLE HELP FROM THEIR FRIENDS? Joanna M. Brooks, PhD. University of Huddersfield.
RESEARCH POSTER SESSION II: EATING DISORDERS 167.
1
Stanford University School of Medicine; 2Boston Children’s Hospital; University of Michigan; 4Cohen Children’s Medical Center North Shore - Long Island Jewish Medical Center; 5Cleveland Clinic Lerner College of Medicine at Case; 6Baylor College of Medicine, Texas Children’s Hospital. 3
Purpose: As the social focus of young people shifts through adolescence from their family to their friends, peer influences can have an impact across a range of adolescent behaviours. Type 1 diabetes (T1D) is amongst the most common forms of chronic illness to affect young people and children in Europe and North America. Self-management of the condition is crucial, but managing their T1D is often very difficult for adolescents. It has been suggested that interventions to support young people with T1D could usefully include their friends and peers, but there has been very little research into how adolescent peers think about and respond to T1D. In this research, we explored T1D from the perspective of patients, friends, and peers. Methods: Qualitative methods to provide a real depth of understanding were employed. We recruited from participants from a diabetes service for children and young people based at a large teaching hospital in the North of England and conducted dyadic interviews with adolescent diabetes patients aged 13-15 years and a nominated close friend (n¼20). We then carried out three focus groups sessions with participants without any necessary prior knowledge of diabetes in a high school setting. Data were analysed using Template Analysis, a systematic and iterative technique for thematically coding qualitative data in hierarchical clusters. Our final template and data interpretations were also subject to independent scrutiny from young people the same age as our research participants who assessed the findings in terms of relevance and usefulness from their own perspective. Results: Limited awareness of T1D amongst their peer group generally and teaching staff was reported by all our interview participants. Although patient participants were confident they could rely on their close friends in relation to their T1D, friends themselves varied considerably in the extent of their T1D
Purpose: Data from low-weight patients with restrictive eating disorders (ED)s treated in outpatient adolescent medicine-based ED treatment programs were analyzed, to determine whether there was an association between hospitalization and weight restoration to >90% median Body Mass Index (mBMI) at one-year follow-up. Methods: Data at presentation and one-year follow-up of 700 lowweight ED patients aged 9-21 years presenting in 2010 were retrospectively collected from 14 adolescent-medicine based ED programs. Weight restoration was defined as >90%mBMI (%mBMI ¼ patient’s BMI/median BMI for age x 100) at one-year follow-up. Association between weight restoration and treatment at a higher level of care was analyzed for patients <85%mBMI and <80%mBMI at time of presentation. Results: For patients presenting at <85%mBMI, those who were hospitalized had 2.38 (95% CI: 1.16, 4.85) times the odds of weight restoration compared to patients who were not hospitalized; the odds of weight restoration increased to 4.53 (95%CI: 1.76,11.6) when controlling for baseline %mBMI, illness duration, and diagnosis. When restricting the analysis to patients <80%mBMI at presentation, those who were hospitalized had 3.19 (95% CI: 1.26, 8.04) times the odds of weight restoration compared to patients who were not hospitalized; odds of weight restoration increased to 5.68 (95% CI: 1.84, 17.6) when controlling for age and baseline %mBMI. Conclusions: In this national cohort, patients presenting to adolescent medicine-based ED programs at weights 90%mBMI at one-year follow-up.
SAHM e 2015 Annual Meeting: Research Poster Abstracts RESEARCH POSTER SESSION II: CHRONIC ILLNESS 164. ADOLESCENT, CAREGIVER, AND PROVIDER PREFERENCES FOR AN ASTHMA SELF-MANAGEMENT APP Delesha M. Carpenter, PhD, Lorie L. Geryk, PhD, Courtney Arrindell, BS, Deborah Tate, PhD, Dayna S. Alexander, PhD, Adam Sage, MS, Betsy L. Sleath, PhD. University of North Carolina at Chapel Hill. Purpose: The purpose of this abstract is present formative data from adolescents, their caregivers, and medical providers regarding their preferences for a mobile asthma self-management application (app). We will present data regarding desired app design, features, and content. Although the number of asthma self-management apps has increased in recent years; to our knowledge, no app has been developed specifically for adolescents. Methods: We recruited a convenience sample of adolescents with persistent asthma (n¼20), their caregivers (n¼20), and health care providers (n¼6) from two pediatric practices in an urban area of North Carolina. To be eligible, adolescents had to be 12-16 years of age, have moderate to severe persistent asthma, speak and read English, own a mobile device, and be present with an English-speaking adult caregiver. Each participant was given an iPod Touch and asked to critique two selfmanagement apps [AsthmaMD (adult-focused) and iAsthma in Control (child-focused)] during an in-person interview after a regularly-scheduled clinic visit and again, via phone interview, after one week of app use. Provider reactions to apps were collected during a 30-minute in-person interview. Using semistructured interviews and surveys, we asked participants to identify the app features they found most useful and describe additional features that could help adolescents better manage their asthma. Additionally, participants rated the usefulness of specific features of the apps on a scale ranging from 1 (not at all useful) to 5 (very useful). Ease of use for each app was also assessed by adolescents and caregivers on a scale of 1 (very easy) to 5 (very difficult). Eighty percent of participants completed the follow-up phone interviews. Each digitally recorded, transcribed interview was imported into MAXQDA, coded, and analyzed. Demographic and perceived usefulness data were analyzed using SPSS version 11.0. Results: Adolescents were primarily Black (47%) and male (60%). Fifty-seven percent of adolescents, 50% of caregivers, and 50% of providers preferred iAsthma in Control, and both adolescents and caregivers found iAsthma easier to use. Adolescents ranked the personalized charting function and asthma self-check features as most useful, caregivers ranked the symptom diary and the ability to send the doctor your report most useful, and providers ranked the appointment reminder feature most useful. The peak flow monitoring feature was ranked lowest among adolescents, caregivers, and providers.
Conclusions: Although participants agreed that symptom tracking features would be useful in an asthma self-management app, preferences for user interface and additional self-management features varied among adolescents, caregivers, and providers. Although our study sample was diverse, our results may not generalize to children and providers in other clinical settings. App developers should be aware of the varied preferences of adolescents and members of their social support network (i.e. providers and caregivers) when developing asthma self-management apps. Sources of Support: This study was supported by the American Lung Association. 165. SELF-EFFICACY MEDIATES THE ASSOCIATIONS OF PARENTAL COERCION AND AUTONOMY SUPPORT TO ADHERENCE IN ADOLESCENTS WITH TYPE 1 DIABETES Sara E. Landers, BS, Elizabeth Friedrich, BA, Victoria Miller, PhD. The Children’s Hospital of Philadelphia. Purpose: Parenting style has been identified as a predictor of a number of different outcomes, including positive and negative health behaviors. Parental coercion and autonomy support are especially relevant during adolescence, when youth begin to strive for more autonomy. Prior research has not yet identified the mechanisms through which parenting exerts its effects on healthrelated outcomes. Self-efficacy is one potential mediator: when parents encourage independent problem solving and decision making independence, the adolescent may learn that he/she has the abilities needed to carry out specific goals or tasks. In contrast, parental use of punitive disciplinary strategies and pressure to elicit a favorable response (i.e., coercion) may send the opposite message. The objective of this study was to test the hypothesis that self-efficacy would mediate the association of coercion and autonomy support to treatment adherence in a sample of adolescents with type 1 diabetes (T1D). Methods: Participants included 98 adolescents with T1D (ages 1016 years) and their parents, who were enrolled in a longitudinal study about youth decision making involvement in chronic illness management discussions. Parents and adolescents completed questionnaires assessing parenting style, diabetes-related selfefficacy, and treatment adherence. Following procedures outlined by Baron and Kenny (1986) and Holmbeck (1997), a series of hierarchical linear regressions were used to test the mediation hypothesis. All regressions utilized baseline data and controlled for adolescent age. Results: As expected, higher parental coercion was associated with lower self-efficacy (b ¼ -.28, p ¼ .006) and worse adherence (b ¼ -.42, p < .0001). Higher parental autonomy support was associated with higher self-efficacy (b ¼ .27, p ¼ .008) and better adherence (b ¼ .25, p ¼ .01). The associations of coercion and autonomy support to adherence were significantly reduced when selfefficacy was included in the models (Sobel’s test¼ -2.39, p < .02 and 2.38, p < .02, respectively). These findings suggest that, as expected,
1054-139X/Ó 2015 Society for Adolescent Health and Medicine. All rights reserved.
S86
Poster Abstracts / 56 (2015) S85eS129
self-efficacy mediated the associations of parenting style to treatment adherence. Conclusions: The use of coercive strategies by parents sends the message that adolescents are ineffective in meeting parental expectations and, in this study, was associated with worse adherence to diabetes treatment, via lower self-efficacy. In contrast, practices that support the adolescent’s autonomy appeared to bolster selfefficacy, which was associated with better adherence. Interventions to improve treatment adherence and promote positive health behaviors in a variety of contexts should attend to both contextual (parenting) and individual (self-efficacy) variables that are associated with health outcomes. Limitations of this analysis include the cross-sectional design, reliance on self-report measures, and inability to determine causality. For example, parents may employ specific parenting strategies in response to youths’ inadequate adherence. When follow-up visits are complete, longitudinal analyses will be conducted to examine reciprocal associations between parenting, self-efficacy, and adherence over time. Sources of Support: This research was supported by R01HD064638 (PI: Miller) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
knowledge. Both pragmatic and emotional support was provided by close friends who play a valuable role in recognising the importance of T1D management, whilst also accepting and normalising the condition. Considerable variations in experiences of support provided in relation to T1D in the school environment were reported by all participants, including the extent to which peers were encouraged or even permitted to support patients. Conclusions: This research highlights the need for greater awareness of T1D in schools amongst teachers and peers, but encouragingly suggests that simple educational sessions can be easily implemented and are well received. There is a lack of standardised high school policies in the UK in relation to the management of T1D. This important aspect of the care pathway should be addressed to ensure there are no barriers to optimal T1D self-management for adolescents in their school environment. Sources of Support: Diabetes UK
166.
EFFECT OF HOSPITALIZATION ON WEIGHT RESTORATION IN ADOLESCENTS WITH RESTRICTIVE EATING DISORDERS Cynthia J. Kapphahn, MD, MPH 1, Rebecca Hehn, MA 2, Elizabeth R. Woods, MD, MPH, FSAHM 2, Kathleen A. Mammel, MD, FSAHM 3, Sara F. Forman, MD 2, Martin Fisher, MD, FSAHM 4, Kelly A. Robinson, BA 2, Ellen S. Rome, MD, MPH 5, Albert C. Hergenroeder, MD, FSAHM 6.
ADOLESCENTS WITH DIABETES AND THE SCHOOL ENVIRONMENT e GETTING BY WITH A LITTLE HELP FROM THEIR FRIENDS? Joanna M. Brooks, PhD. University of Huddersfield.
RESEARCH POSTER SESSION II: EATING DISORDERS 167.
1
Stanford University School of Medicine; 2Boston Children’s Hospital; University of Michigan; 4Cohen Children’s Medical Center North Shore - Long Island Jewish Medical Center; 5Cleveland Clinic Lerner College of Medicine at Case; 6Baylor College of Medicine, Texas Children’s Hospital. 3
Purpose: As the social focus of young people shifts through adolescence from their family to their friends, peer influences can have an impact across a range of adolescent behaviours. Type 1 diabetes (T1D) is amongst the most common forms of chronic illness to affect young people and children in Europe and North America. Self-management of the condition is crucial, but managing their T1D is often very difficult for adolescents. It has been suggested that interventions to support young people with T1D could usefully include their friends and peers, but there has been very little research into how adolescent peers think about and respond to T1D. In this research, we explored T1D from the perspective of patients, friends, and peers. Methods: Qualitative methods to provide a real depth of understanding were employed. We recruited from participants from a diabetes service for children and young people based at a large teaching hospital in the North of England and conducted dyadic interviews with adolescent diabetes patients aged 13-15 years and a nominated close friend (n¼20). We then carried out three focus groups sessions with participants without any necessary prior knowledge of diabetes in a high school setting. Data were analysed using Template Analysis, a systematic and iterative technique for thematically coding qualitative data in hierarchical clusters. Our final template and data interpretations were also subject to independent scrutiny from young people the same age as our research participants who assessed the findings in terms of relevance and usefulness from their own perspective. Results: Limited awareness of T1D amongst their peer group generally and teaching staff was reported by all our interview participants. Although patient participants were confident they could rely on their close friends in relation to their T1D, friends themselves varied considerably in the extent of their T1D
Purpose: Data from low-weight patients with restrictive eating disorders (ED)s treated in outpatient adolescent medicine-based ED treatment programs were analyzed, to determine whether there was an association between hospitalization and weight restoration to >90% median Body Mass Index (mBMI) at one-year follow-up. Methods: Data at presentation and one-year follow-up of 700 lowweight ED patients aged 9-21 years presenting in 2010 were retrospectively collected from 14 adolescent-medicine based ED programs. Weight restoration was defined as >90%mBMI (%mBMI ¼ patient’s BMI/median BMI for age x 100) at one-year follow-up. Association between weight restoration and treatment at a higher level of care was analyzed for patients <85%mBMI and <80%mBMI at time of presentation. Results: For patients presenting at <85%mBMI, those who were hospitalized had 2.38 (95% CI: 1.16, 4.85) times the odds of weight restoration compared to patients who were not hospitalized; the odds of weight restoration increased to 4.53 (95%CI: 1.76,11.6) when controlling for baseline %mBMI, illness duration, and diagnosis. When restricting the analysis to patients <80%mBMI at presentation, those who were hospitalized had 3.19 (95% CI: 1.26, 8.04) times the odds of weight restoration compared to patients who were not hospitalized; odds of weight restoration increased to 5.68 (95% CI: 1.84, 17.6) when controlling for age and baseline %mBMI. Conclusions: In this national cohort, patients presenting to adolescent medicine-based ED programs at weights 90%mBMI at one-year follow-up.