Effects of a behavioral intervention on treatment adherence and stress management in adolescents with IDDM

Abstract

Objective: To evaluate the effects of a behavioral program to increase treatment adherence and to improve stress management in adolescents with IDDM.

Research design and methods: A quasi-experimental pretest-posttest design with a nonequivalent control group was used. Eighteen subjects were assigned to the experimental group, which received the program, while nineteen subjects made up the control group, which received routine medical care. During the 12 intervention sessions with diabetic adolescents, different procedures were applied: instruction, blood glucose discrimination training, role-playing, relaxation exercises, self-instructions, problem-solving strategies, and homework, among others.

Results: The results show significant changes in the experimental group in variables related to diabetes information (patients and their parents), adherence, daily hassles, uneasiness and likelihood of response in social interactions, skills and frequency of glycemic analyses, blood glucose estimate errors, and negative family support (parents). The program had no effect on either dietary and physical exercise or glycemic control. The improvements, which were maintained at a follow-up carried out 13 months after finishing the program, were: patients' information about physiopathology (P = 0.000), diet (P = 0.000), physical exercise (P = 0.048), glucose testing (P = 0.030), and insulin (P = 0.000), barriers to adherence frequency (P = 0.000), severity of daily hassles (P = 0.006), and degree of uneasiness in social interaction (P = 0.000).

Conclusions: This research introduces the novelty of integrating several behavioral procedures within a wide-ranging package that affects aspects implied in diabetes control such as treatment adherence and stress management. The testing of similar programs on samples of subjects with glycemic control difficulties would be useful.