The Effect of Illness Identity and Social Relationships on Treatment Adherence in Adolescents with Type 1 Diabetes
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Background: In addition to the demands of the treatment regimen, adolescents with type 1 diabetes must balance the typical tasks of development, such as establishing autonomy, figuring out who they are in relation to the world, and fitting in with peers.;Methods: A mixed-methods approach was used to explore how adolescents viewed themselves with diabetes and how their established identity affected certain psychosocial attributes (social competence, perceived friend reactions, social support, and diabetes-specific self-esteem) and health-related outcomes (self-care, glycemic control, and quality of life). Individual interviews were conducted to explore life with diabetes and determine identity status, and coded using grounded theory methodology. Groups were created based on whether the adolescent had "incorporated" or "contained" their illness, and compared on validated measures for psychosocial attributes and health outcomes.;Results: Results indicated that adolescents (N=83), ages 13-21, who incorporated their illness into their identities had higher diabetes-specific self-esteem (p=.001), more perceived social competency ( p=.023), and more social support (p=.019). They also had better self-care (p=.002), better glycemic control (p=.008), and greater life satisfaction (p=.002). Regressions assessing predictors of incorporation determined that self-esteem (p=.002) and social competency (p=.028) were both significant independent predictors of incorporation. Furthermore, only diabetes-specific self-esteem (ps<.001) was a significant independent predictor of all three health outcomes: better glycemic control, self-care, life satisfaction. Even in the presence of identity status, only diabetes-specific self-esteem was a significant independent predictor of glycemic control (beta=-.40, p<.001), self-care (0=.5 p<.001), and life satisfaction (beta=.53, p<.001). Conclusions: These findings suggest that incorporation of the illness is associated with better physical and mental health and success in redefining the self and life with T1DM. Furthermore, diabetes-specific self-esteem is associated with better health outcomes, even despite identity status, and suggests that the extent of satisfaction and confidence in one's ability to perform diabetes self-care routines may be the "active ingredient" that explains the effect of identity on HbA 1 c. Diabetes care providers should be aware of identity and self-esteem as integral parts of chronic illness adjustment, and should assess for such issues during adolescence to combat potential issues with self-care and glycemic control.
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