Structural model of patient-centered communication and diabetes management in early emerging adults at the transfer to adult care

  • Ashley C. BakerEmail author
  • Deborah J. Wiebe
  • Caitlin S. Kelly
  • Ascher Munion
  • Jonathan E. Butner
  • Michael T. Swinyard
  • Mary Murray
  • Cynthia A. Berg


Early emerging adulthood (ages 18–25) is a time of risk for type 1 diabetes (T1D) when relationships with parents and providers are changing. We examined whether individuals’ high-quality relationships with mothers are associated with greater perceptions of patient-centered communication (PCC) with their doctor and whether PCC is associated with better adherence and glycemic control through diabetes-related self-efficacy. Additionally, we tested whether associations of PCC with self-efficacy and diabetes outcomes are stronger among those who had transferred to adult care. One-year post-high school, 217 individuals with T1D (60% women, 53% in adult care) reported perceptions of maternal relationship quality, PCC, self-efficacy, and adherence. Glycemic control was measured via HbA1c assay kits. Structural equation modeling indicated good model fit and revealed indirect paths linking higher maternal relationship quality to better adherence through higher PCC, and higher PCC to better HbA1c through adherence. Transfer status moderated the link between PCC and self-efficacy, suggesting PCC may be especially important when emerging adults transfer to adult care.


Patient-centered communication Type 1 diabetes Transition to adult care Early emerging adulthood Self-efficacy Diabetes management 



We thank Jessica Marino for help with manuscript preparation and Perrin White for helpful comments on the manuscript.


Deborah J. Wiebe and Cynthia A. Berg received grant support from the National Institute of Diabetes and Digestive and Kidney Diseases (Grant Number R01DK092939)

Compliance with ethical standards

Conflict of interest

Ashley C. Baker, Deborah J. Wiebe, Caitlin S. Kelly, Ascher Munion, Jonathan E. Butner, Michael T. Swinyard, Mary Murray and Cynthia A. Berg declare they have no conflict of interest.

Human and animal rights and Informed consent

All reported studies with human subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines). Informed consent was obtained from all individual participants included in these studies.


  1. Aikens, J. E., Bingham, R., & Piette, J. D. (2005). Patient-provider communication and self-care behavior among type 2 diabetes patients. The Diabetes Educator, 31, 681–690. CrossRefGoogle Scholar
  2. American Diabetes Association. (2017). Standards of medical care in diabetes. Diabetes Care, 40, S105–S113. CrossRefGoogle Scholar
  3. Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469–480. CrossRefGoogle Scholar
  4. Arnett, J. J. (2004). Emerging adulthood: The winding road from the late teens through the twenties. New York: Oxford University Press.Google Scholar
  5. Berg, C. A., Butner, J. E., Wiebe, D. J., Lansing, A. H., Osborn, P., King, P. S., et al. (2017). Developmental model of parent-child coordination for self-regulation across childhood and into emerging adulthood: Type 1 diabetes management as an example. Developmental Review, 46, 1–26. CrossRefGoogle Scholar
  6. Berg, C. A., Queen, T., Butner, J. E., Turner, S. L., Lansing, A. H., Main, A., et al. (2016). Adolescent disclosure to parents and daily management of type 1 diabetes. Journal of Pediatric Psychology. Google Scholar
  7. Bowen, M. E., Henske, J. A., & Potter, A. (2010). Health care transition in adolescents and young adults with diabetes. Clinical Diabetes, 28, 99–106. CrossRefGoogle Scholar
  8. Browne, M., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Newbury Park, CA: Sage.Google Scholar
  9. Bryden, K. S., Dunger, D. B., Mayou, R. A., Peveler, R. C., & Neil, H. A. W. (2003). Poor prognosis of young adults with type 1 diabetes. Diabetes Care, 26, 1052–1057. CrossRefGoogle Scholar
  10. Bullock, J. G., Green, D. P., & Ha, S. E. (2010). Yes, but what’s the mechanism? (Don’t expect an easy answer). Journal of Personality and Social Psychology, 98, 550–558. CrossRefGoogle Scholar
  11. Ciechanowski, P., Russo, J., Katon, W., Von Korff, M., Ludman, E., Lin, E., et al. (2004). Influence of patient attachment style on self-care and outcomes in diabetes. Psychosomatic Medicine, 66, 720–728. CrossRefGoogle Scholar
  12. Clements, M. A., Lind, M., Raman, S., Patton, S. R., Lipska, K. J., Fridlington, A. G., et al. (2014). Age at diagnosis predicts deterioration in glycaemic control among children and adolescents with type 1 diabetes. BMJ Open Diabetes Research and Care, 2, e000039. CrossRefGoogle Scholar
  13. Cox, E. D., Smith, M. A., & Brown, R. L. (2007). Evaluating deliberation in pediatric primary care. Pediatrics, 120, e68–e77. CrossRefGoogle Scholar
  14. Croom, A., Wiebe, D. J., Berg, C. A., Lindsay, R., Donaldson, D., Foster, C., et al. (2010). Adolescent and parent perceptions of patient-centered communication while managing type 1 diabetes. Journal of Pediatric Psychology, 36, 206–215. CrossRefGoogle Scholar
  15. Dabelea, D., Mayer-Davis, E. J., Saydah, S., Imperatore, G., Linder, B., Divers, J., et al. (2014). Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA, 311, 1778–1786. CrossRefGoogle Scholar
  16. Epstein, S. (1983). Scoring and interpretation of the mother-father-peer scale. Unpublished manuscript. Department of Psychology, University of Massachusetts Amherst, Massachusetts, USA.Google Scholar
  17. Erickson, S. J., Gerstle, M., & Feldstein, S. W. (2005). Brief interventions and motivational interviewing with children, adolescents and their parents in pediatric health care settings. Archives of Pediatric Adolescence Medicine, 159 SRC, 1173–1180. CrossRefGoogle Scholar
  18. Goethals, E. R., Oris, L., Soenens, B., Berg, C. A., Prikken, S., Van Broeck, N., et al. (2017). Parenting and treatment adherence in type 1 diabetes throughout adolescence and emerging adulthood. Journal of Pediatric Psychology. Google Scholar
  19. Hanna, K. M., Weaver, M. T., Stump, T. E., Dimeglio, L. A., Miller, A. R., Crowder, S., et al. (2013). Initial findings: Primary diabetes care responsibility among emerging adults with type 1 diabetes post high school and move out of parental home. Child: Care, Health and Development, 39, 61–68. Google Scholar
  20. Hare, A. L., Marston, E. G., & Allen, J. P. (2011). Maternal acceptance and adolescents’ emotional communication: A longitudinal study. Journal of Youth and Adolescence, 40, 744–751.CrossRefGoogle Scholar
  21. Helgeson, V. S., Vaughn, A. K., Seltman, H., Orchard, T., Becker, D., & Libman, I. (2018a). Relation of parent knowledge to glycemic control among emerging adults with type 1 diabetes: A mediational model. Journal of Behavioral Medicine, 41, 186–194. CrossRefGoogle Scholar
  22. Helgeson, V. S., Vaughn, A. K., Seltman, H., Orchard, T., Libman, I., & Becker, D. (2018b). Trajectories of glycemic control over adolescence and emerging adulthood: An 11-year longitudinal study of youth with type 1 diabetes. Journal of Pediatric Psychology, 43, 8–18. CrossRefGoogle Scholar
  23. Hu, L., & Bentler, P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424–453. CrossRefGoogle Scholar
  24. Iannotti, R. J., Schneider, S., Nansel, T. R., Haynie, D. L., Plotnick, L. P., Clark, L. M., et al. (2006). Self-efficacy, outcome expectations, and diabetes self-management in adolescents with type 1 diabetes. Journal of Developmental and Behavioral Pediatrics, 27, 98–105. CrossRefGoogle Scholar
  25. Institute of Medicine (U.S.). (2001). Crossing the quality chasm: A new health system for the 21st century. Washington DC: National Academy Press.Google Scholar
  26. Kelly, C. S., Berg, C. A., Ramsey, M. A., Baker, A. C., Murray, M., Swinyard, M., et al. (2018). The role of social relationships in health care transition readiness in emerging adults with type 1 diabetes. Children’s Health Care, 47, 308–325. CrossRefGoogle Scholar
  27. King, P. S., Berg, C. A., Butner, J. E., Butler, J. M., & Wiebe, D. J. (2014). Longitudinal trajectories of parental involvement in type 1 diabetes and adolescents’ adherence. Health Psychology, 33, 424–432. CrossRefGoogle Scholar
  28. Lyons, S. K., Becker, D. J., & Helgeson, V. S. (2014). Transfer from pediatric to adult health care: effects on diabetes outcomes. Pediatric Diabetes, 15, 10–17. CrossRefGoogle Scholar
  29. Michie, S., Miles, J., & Weinman, J. (2003). Patient-centredness in chronic illness: What is it and does it matter? Patient Education and Counseling, 51, 197–206. CrossRefGoogle Scholar
  30. Miller, K. M., Foster, N. C., Beck, R. W., Bergenstal, R. M., DuBose, S. N., DiMeglio, L. A., et al. (2015). Current state of type 1 diabetes treatment in the U.S.: Updated data from the T1D exchange clinic registry. Diabetes Care, 38, 971–978. CrossRefGoogle Scholar
  31. Monaghan, M., Helgeson, V. S., & Wiebe, D. J. (2015). Type 1 diabetes in young adulthood. Current Diabetes Reviews, 11, 239–250. CrossRefGoogle Scholar
  32. Monaghan, M., Hilliard, M., Sweenie, R., & Riekert, K. (2013). Transition readiness in adolescents and emerging adults with diabetes: The role of patient-provider communication. Current Diabetes Reports, 13, 1–15. CrossRefGoogle Scholar
  33. Muthén, L., & Muthén, B. (2012). Mplus user’s guide (7th ed.). Los Angeles: Muthén & Muthén.Google Scholar
  34. Ng, J. Y. Y., Ntoumanis, N., Thogersen-Ntoumani, C., Deci, E. L., Ryan, R. M., Duda, J. L., et al. (2012). Self-determination theory applied to health contexts: A meta-analysis. Perspectives on Psychological Science, 7, 325–340. CrossRefGoogle Scholar
  35. Palmer, D. L., Osborn, P., King, P. S., Berg, C. A., Butler, J., Butner, J., et al. (2010). The structure of parental involvement and relations to disease management for youth with type 1 diabetes. Journal of Pediatric Psychology, 36, 596–605.CrossRefGoogle Scholar
  36. Peters, A. L., & Laffel, L. (2011). Diabetes care for emerging adults: Recommendations for transition from pediatric to adult diabetes care systems. Diabetes Care, 34, 2477–2485. CrossRefGoogle Scholar
  37. Ryan, R., & Deci, E. (2000). Self-determination theory and the facilitation of intrinsic motivation. American Psychologist, 55, 68–78. CrossRefGoogle Scholar
  38. Schwandt, A., Hermann, J. M., Rosenbauer, J., Boettcher, C., Dunstheimer, D., Grulich-Henn, J., et al. (2017). Longitudinal trajectories of metaboliccontrol from childhood to young adulthood in type 1 diabetes from a large German/austrian registry: A group-based modeling approach. Diabetes Care, 40, 309–316. CrossRefGoogle Scholar
  39. Sheehan, A. M., While, A. E., & Coyne, I. (2015). The experiences and impact of transition from child to adult healthcare services for young people with Type 1 diabetes: A systematic review. Diabetic Medicine, 32, 440–458. CrossRefGoogle Scholar
  40. US Medical Licensing Examination (USMLE). (2012). 2012 Step 2 CS content description and information for examinees testing for USMLE. Phi.Google Scholar
  41. Van Dam, H., Van Der Horst, F., Van Den Borne, B., Ryckman, R., & Crebolder, H. (2003). Provider-patient interaction in diabetes care: Effects on patient self-care and outcomes—A systematic review. Patient Education and Counseling, 51, 17–28. CrossRefGoogle Scholar
  42. Van Staa, A., Van Der Stege, H. A., Jedeloo, S., Moll, H. A., & Hilberink, S. R. (2011). Readiness to transfer to adult care of adolescents with chronic conditions: exploration of associated factors. Journal of Adolescent Health, 48, 295–302. CrossRefGoogle Scholar
  43. Weissberg-Benchell, J., & Shapiro, J. B. (2017). A review of interventions aimed at facilitating successful transition planning and transfer to adult care among youth with chronic illness. Pediatric Annals, 46, e182–e187. CrossRefGoogle Scholar
  44. Weissberg-Benchell, J., Wolpert, H., & Anderson, B. J. (2007). Transitioning from pediatric to adult care: A new approach to the post-adolescent young person with type 1 diabetes. Diabetes Care, 30, 2441–2446. CrossRefGoogle Scholar
  45. Wiebe, D. J., Baker, A. C., & Marino, J. A. (in press). Medical systems and patient provider relationships. In A. M. Delamater & D. G. Marrero (Eds.), Behavioral diabetes: Ecological perspectives. New York, NY: Springer.Google Scholar
  46. Wiebe, D. J., Chow, C. M., Palmer, D. L., Butner, J. E., Butler, J. M., Osborn, P., et al. (2014). Developmental processes associated with longitudinal declines in parental responsibility and adherence to type 1 diabetes management across adolescence. Journal of Pediatric Psychology, 39, 532–541. CrossRefGoogle Scholar
  47. Wiebe, D. J., Helgeson, V., & Berg, C. A. (2016). The social context of managing diabetes across the life span. American Psychologist, 71, 526–538. CrossRefGoogle Scholar
  48. Williams, G., McGregor, H., Zeldman, A., Freedman, Z., & Deci, E. (2004). Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychology, 23, 58–66. CrossRefGoogle Scholar
  49. Williams, G. C., Freedman, Z. R., & Deci, E. L. (1998). Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care, 21, 1644–1651. CrossRefGoogle Scholar
  50. Williams, G. C., McGregor, H., Zeldman, A., Freedman, Z. R., Deci, E. L., & Elder, D. (2005). Promoting glycemic control through diabetes self-management: Evaluating a patient activation intervention. Patient Education and Counseling, 56, 28–34. CrossRefGoogle Scholar
  51. Williams, G. C., Patrick, H., Niemiec, C. P., Williams, L. K., Divine, G., Lafata, J. E., et al. (2009). Reducing the health risks of diabetes: how self-determination theory may help improve medication adherence and quality of life. The Diabetes Educator, 35, 484–492.CrossRefGoogle Scholar
  52. Williams, G. C., & Zeldman, A. (2002). Patient-centered diabetes self-management education. Current Diabetes Reports, 2, 145–152.CrossRefGoogle Scholar
  53. Wong, J. C., Dolan, L. M., Yang, T. T., & Hood, K. K. (2014). Insulin pump use and glycemic control in adolescents with type 1 diabetes: Predictors of change in method of insulin delivery across two years. Pediatric Diabetes, 16, 592–599. CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Psychological Sciences and Health Sciences Research InstituteUniversity of California, MercedMercedUSA
  2. 2.Department of PsychologyUniversity of UtahSalt Lake CityUSA
  3. 3.Mountain Vista MedicineUniversity of Utah School of MedicineSalt Lake CityUSA
  4. 4.Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA

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