Publication Date

2019-08-01

Availability

Embargoed

Embargo Period

2021-07-31

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Psychology (Arts and Sciences)

Date of Defense

2019-06-21

First Committee Member

Annette M. La Greca

Second Committee Member

Alan M. Delamater

Third Committee Member

Rebecca J. Bulotsky-Shearer

Fourth Committee Member

Janine E. Sanchez

Fifth Committee Member

Patrice G. Saab

Abstract

More than 200,000 youth in the United States have type 1 diabetes (T1D; Centers for Disease Control and Prevention, 2017), with approximately 17,900 newly diagnosed cases between 2011 and 2012. Treatments are complex, including multiple daily insulin injections or insulin pump use, monitoring of blood glucose levels and carbohydrate intake, and exercise (Wysocki, Buckloh, & Pierce, 2017). Only 21% of adolescents in the United States meet American Diabetes Association recommended goals for glycemic control (Wood et al., 2013). Multiple factors influence adherence in adolescence and subsequent health outcomes, including normative developmental tasks, parental involvement, and transition readiness. Research suggests that the quality of the patient-provider relationship is associated with treatment adherence and health outcomes. However, only three empirical studies have examined patient-provider relationships in pediatric T1D. All three identified that better perceived patient-provider relationship was associated with better treatment adherence (Croom et al., 2011; Taylor et al., 2016). Thus, this study aimed to fill gaps in the existing body of research by examining: 1) self-reported treatment adherence as a mediator of the association between patient-perceived provider autonomy support and health outcomes, 2) group differences in this model (i.e., biological sex, degree of parental involvement, degree of transition readiness), and 3) the direction and magnitude of associations between provider autonomy support and self-management (i.e., self-reported adherence), across two years. Study aims were examined using data from a longitudinal, multi-site study of disease management in adolescents with T1D. Study data was collected via survey and laboratory results at baseline (n = 165), 12 months (n = 156), and 24 months (n = 144). At baseline, participants were 49.1% male, 79.4% Caucasian, with a mean age of 16.4 years (SD = 1.3). Mediation with multiple group comparisons and autoregressive cross-lagged panel models were analyzed with MPlus, to examine the study aims. Results identified a path from patient-provider relationship, to self-reported treatment adherence, and a path from self-reported treatment adherence to glycemic control. Associations between these variables varied by patient biological sex, degree of parental involvement, and degree of transition readiness. Specifically, the patient-provider relationship was associated with better treatment adherence for females, those with moderate parental involvement, and those with low transition readiness. No reciprocal longitudinal associations were identified between self-management and patient-provider relationship. Concurrent correlations were at baseline and 12 months. Results suggest the importance of the patient-provider relationship for predicting self-management, and the potential benefit of interventions to improve patient-centered care. Future research should examine the impact of interventions targeting patient-provider relationship on treatment adherence among adolescents, and examine provider characteristics as potential moderators of the association between patient-provider relationship, treatment adherence, and subsequent health outcomes.

Keywords

type 1 diabetes; adherence; adolescent; patient provider communication; diabetes; glycemic control; autonomy support

Available for download on Saturday, July 31, 2021

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