Diabetes: Kids Respond Better To 'Can Do' Than To Threats

Physicians and other health care providers tend to warn patients about the consequences of not sticking with their prescribed treatments, but researchers now say they may be going about it the wrong way.

Nicole Palardy, MA, and colleagues at The University of Alabama,Tuscaloosa and Birmingham, surveyed 101 adolescents aged 11-17 who were diagnosed with insulin-dependent diabetes mellitus (IDDM).

They suggest that young people with IDDM might be more likely to respond to messages that build up their ability to stick with prescribed treatments than to those that emphasize the negative consequences of not following their treatment plans.

"Nonadherence to medical treatments is a prevalent problem that poses serious risks to the health status of chronically ill patients," they write in the January issue of the Journal of Developmental and Behavioral Pediatrics. "Practitioners attempt to address this problem by communicating to their patients the negative consequences oif nonadherence."

Acknowledging that patients' health attitudes significantly influence whether or not they stick with their treatment plans, the researchers set out to compare attitudes and match them to reported adherence levels. They measured the youths' frequency of adherence to their treatment plans during the previous seven days, then examined the adolescents' responses to five factors, two asking about "threat appraisals":

Vulnerability - What was the likelihood that they would get sick if they didn't follow the treatment. Would they have an insulin reaction, get gangrene, or renal failure?

Severity of risks - How sick did they think they would get if they didn't stick with the plan? Would they miss one day of school? Several days of school? Would they die?

And three asking about "coping appraisals":

Response efficacy - How effective did they consider the four major components of their treatments (insulin injections, blood glucose monitoring, diet, and exercise)?

Self-efficacy - How much did they believe they could carry out the treatment tasks?

Response costs - How important were the "personal costs" of treatment, such as pain, inconvenience, and embarrassment?

Most of the adolescents who thought that following the treatment plan includes some "personal costs" were less likely to adhere to the full treatment, the researchers found.

They suggested that "health messages that address the coping appraisal process, e.g., response costs, might be more effective for increasing adherence to treatments than messages that focus on the threat appraisal process, e.g., risks of non adherence. Challenging cognitions concerning response costs and altering adolescents' lifestyles to involve fewer response costs might also enhance adherence to...treatment."

The study was supported in part by a grant from The University of Alabama Research Grants Committee