title: Self-management in type 2 diabetes: the adolescent perspective.
abstract: The purpose of this study was to document barriers and facilitators of self-management as perceived by adolescents with type 2 diabetes.
  
  
  
  Focus groups were conducted with adolescents diagnosed with type 2 diabetes. Adolescents aged 13 to 19 years were recruited from an academic medical center diabetes clinic. Between 2003 and 2005, 6 focus groups were used to elicit responses from the adolescents related to self-management of their diabetes. Questions were asked by trained group facilitators. Transcripts were coded by 3 reviewers. Qualitative analyses were conducted using NVIVO software.
  
  
  
  A total of 24 adolescents participated in 6 focus groups. Coding resulted in 4 common domains affecting self-management: adolescent psychosocial development; the role of others with diabetes; environmental influences; and adolescents' problem-solving/coping skills. Adolescents identified both barriers to and facilitators of self-management within each domain. Barriers often related to social situations, embarrassment, seeking acceptance or perceived normalcy, and balancing competing interests. Adolescents viewed having another family member with diabetes as both a positive and a negative influence. Environmental influences, including school and family situations, had a large impact on self-management behaviors. Making sensible food choices was a common challenge. Descriptions of problem-solving or coping skills were limited, but cognitive techniques, such as reframing, were described.
  
  
  
  Adolescents with type 2 diabetes identified many barriers to self-management, particularly related to interpersonal interactions, the influence of others with diabetes, and environmental influences. Results suggest that improving self-management in adolescents may require multimodal interventions to address individual, family, and social processes.
authors.affiliation: The School of Nursing, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Mulvaney, Ms Baughman)|The Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Mulvaney, Ms VanderWoude)
authors.forename: Shelagh A
authors.initials: SA
authors.lastname: Mulvaney
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia (Dr Mudasiru)
authors.forename: Eniola
authors.initials: E
authors.lastname: Mudasiru
authors.affiliation: The Department of Psychology, Vanderbilt University, Nashville, Tennessee (Dr Schlundt)
authors.forename: David G
authors.initials: DG
authors.lastname: Schlundt
authors.affiliation: The School of Nursing, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Mulvaney, Ms Baughman)
authors.forename: Cara L
authors.initials: CL
authors.lastname: Baughman
authors.affiliation: Meharry Medical College, Nashville, Tennessee (Dr Fleming)
authors.forename: Mary
authors.initials: M
authors.lastname: Fleming
authors.affiliation: The Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Mulvaney, Ms VanderWoude)
authors.forename: Ann
authors.initials: A
authors.lastname: VanderWoude
authors.affiliation: The Department of Endocrinology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Russell, Dr Elasy)
authors.forename: William E
authors.initials: WE
authors.lastname: Russell
authors.affiliation: The Department of Endocrinology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Russell, Dr Elasy)
authors.forename: Tom A
authors.initials: TA
authors.lastname: Elasy
authors.affiliation: The Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rothman)
authors.forename: Russell
authors.initials: R
authors.lastname: Rothman
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000534:rehabilitation*; D004522:Educational Status; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010290:Parents; D011340:Problem Solving; D000297:Psychology, Adolescent; D012648:Self Care; D011795:Surveys and Questionnaires