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

Abstract

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.

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References

  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. https://doi.org/10.1177/0145721705280829

    Article  PubMed  Google Scholar 

  2. American Diabetes Association. (2017). Standards of medical care in diabetes. Diabetes Care, 40, S105–S113. https://doi.org/10.2337/dc14-S014

    Article  Google Scholar 

  3. Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469–480. https://doi.org/10.1037//0003-066X.55.5.469

    Article  CAS  Google 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. https://doi.org/10.1016/j.dr.2017.09.001

    Article  Google 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. https://doi.org/10.1093/jpepsy/jsw056

    Article  PubMed  PubMed Central  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. https://doi.org/10.2337/diaclin.28.3.99

    Article  Google 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. https://doi.org/10.2337/diacare.26.4.1052

    Article  PubMed  Google 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. https://doi.org/10.1037/a0018933

    Article  PubMed  Google 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. https://doi.org/10.1097/01.psy.0000138125.59122.23

    Article  PubMed  Google 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. https://doi.org/10.1136/bmjdrc-2014-000039

    Article  PubMed  Google Scholar 

  13. Cox, E. D., Smith, M. A., & Brown, R. L. (2007). Evaluating deliberation in pediatric primary care. Pediatrics, 120, e68–e77. https://doi.org/10.1542/peds.2006-2602

    Article  PubMed  Google 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. https://doi.org/10.1093/jpepsy/jsq072

    Article  PubMed  PubMed Central  Google 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. https://doi.org/10.1001/jama.2014.3201

    Article  CAS  PubMed  PubMed Central  Google 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.

  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. https://doi.org/10.1001/archpedi.159.12.1173

    Article  Google 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. https://doi.org/10.1093/jpepsy/jsx053

    Article  PubMed  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. https://doi.org/10.1111/j.1365-2214.2011.01320.x

    CAS  Article  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.

    Article  PubMed  Google 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. https://doi.org/10.1007/s10865-017-9886-3

    Article  PubMed  Google 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. https://doi.org/10.1093/jpepsy/jsx083

    Article  PubMed Central  Google Scholar 

  23. Hu, L., & Bentler, P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424–453. https://doi.org/10.1037//1082-989x.3.4.424

    Article  Google 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. https://doi.org/10.1097/00004703-200604000-00003

    Article  PubMed  Google 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. https://doi.org/10.1080/02739615.2017.1354294

    Article  PubMed  PubMed Central  Google 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. https://doi.org/10.1037/a0032804

    Article  PubMed  Google 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. https://doi.org/10.1111/pedi.12106

    Article  PubMed  Google 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. https://doi.org/10.1016/S0738-3991(02)00194-5

    Article  PubMed  Google 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. https://doi.org/10.2337/dc15-0078

    Article  PubMed  Google Scholar 

  31. Monaghan, M., Helgeson, V. S., & Wiebe, D. J. (2015). Type 1 diabetes in young adulthood. Current Diabetes Reviews, 11, 239–250. https://doi.org/10.2174/1573399811666150421114957

    Article  PubMed  PubMed Central  Google 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. https://doi.org/10.3174/ajnr.A1650.Side

    Article  Google 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. https://doi.org/10.1177/1745691612447309

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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. https://doi.org/10.2337/dc11-1723

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ryan, R., & Deci, E. (2000). Self-determination theory and the facilitation of intrinsic motivation. American Psychologist, 55, 68–78. https://doi.org/10.1037/0003-066X.55.1.68

    Article  CAS  PubMed  Google 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. https://doi.org/10.2337/dc16-1625

    Article  PubMed  Google 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. https://doi.org/10.1111/dme.12639

    Article  CAS  PubMed  Google Scholar 

  40. US Medical Licensing Examination (USMLE). (2012). 2012 Step 2 CS content description and information for examinees testing for USMLE. Phi.

  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. https://doi.org/10.1016/S0738-3991(02)00122-2

    Article  PubMed  Google 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. https://doi.org/10.1016/j.jadohealth.2010.07.009

    Article  PubMed  Google 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. https://doi.org/10.3928/19382359-20170421-01

    Article  PubMed  Google 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. https://doi.org/10.2337/dc07-1249

    Article  PubMed  Google 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.

  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. https://doi.org/10.1093/jpepsy/jsu006

    Article  PubMed  PubMed Central  Google 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. https://doi.org/10.1037/a0040355

    Article  PubMed  Google 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. https://doi.org/10.1037/0278-6133.23.1.58

    Article  PubMed  Google 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. https://doi.org/10.2337/diacare.21.10.1644

    Article  CAS  PubMed  Google 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. https://doi.org/10.1016/j.pec.2003.11.008

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Williams, G. C., & Zeldman, A. (2002). Patient-centered diabetes self-management education. Current Diabetes Reports, 2, 145–152.

    Article  PubMed  Google 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. https://doi.org/10.1111/pedi.12221

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

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

Funding

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

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Correspondence to Ashley C. Baker.

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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.

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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.

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Baker, A.C., Wiebe, D.J., Kelly, C.S. et al. Structural model of patient-centered communication and diabetes management in early emerging adults at the transfer to adult care. J Behav Med 42, 831–841 (2019). https://doi.org/10.1007/s10865-019-00012-9

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Keywords

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