Family support, treatment adherence, and responsibility among adolescents with Type I diabetes

Data suggest that family factors are important to treatment adherence for adolescents with diabetes, who are making the transition from greater parental involvement to increasing responsibility for their own diabetes care. One factor linked to better adherence is social support from family members (Shafer, McCaul, & Glasgow, 1986; Hanson, Henggeler, & Burgen, 1987a, 1987b). However, studies relating family support and adherence are limited by methodological problems, and have rarely considered developmental aspects of the relationship between family support and diabetes outcomes. The developmental literature emphasizes the need to consider subfunctions of family support to understand how support relates to specific health outcomes (Cauce, Felner, & Primavera, 1982), yet studies relating family support to adherence have not examined these subfunctions. This study examined the relationships among family support and its subfunctions and adherence and responsibility for diabetes care, with particular attention to developmental aspects of these relationships.Seventy-four adolescents with Type I diabetes completed assessments of general family support, diabetes-specific support, responsibility and adherence. The Diabetes Social Support Interview was used to assess the four conceptual support subfunctions: Tangible, Informational, Belonging, and Emotional support.Results indicated that family support was inversely related to age. Furthermore, as expected, older subjects reported greater responsibility for their own diabetes care and lower adherence levels. Higher levels of diabetes-specific family support were related to better adherence, even after controlling for age. Higher levels of diabetes-specific support were also related to greater parental involvement in diabetes care. Among the subfunctions, Belonging support was the most strongly related to adherence, whereas Tangible support was most strongly related to responsibility. Exploratory analyses suggested that Tangible support may be related to adherence for younger adolescents, whereas Emotional support may be related to adherence in older adolescents.Findings confirm that family support is important to diabetes care, and suggest that the transfer of responsibility may indeed contribute to perceptions of decreased support during adolescence. Results imply that it would be helpful if adolescents\u27 families altered the types of supportive behaviors directed toward their adolescents rather than relinquishing most involvement in diabetes management