Self-management in type 2 diabetes: the adolescent perspective.
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.
Mulvaney
Shelagh A
SA
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)
Mudasiru
Eniola
E
Emory University School of Medicine, Atlanta, Georgia (Dr Mudasiru)
Schlundt
David G
DG
The Department of Psychology, Vanderbilt University, Nashville, Tennessee (Dr Schlundt)
Baughman
Cara L
CL
The School of Nursing, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Mulvaney, Ms Baughman)
Fleming
Mary
M
Meharry Medical College, Nashville, Tennessee (Dr Fleming)
VanderWoude
Ann
A
The Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Mulvaney, Ms VanderWoude)
Russell
William E
WE
The Department of Endocrinology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Russell, Dr Elasy)
Elasy
Tom A
TA
The Department of Endocrinology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Russell, Dr Elasy)
Rothman
Russell
R
The Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rothman)
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