title: Contracting and monitoring relationships for adolescents with type 1 diabetes: a pilot study.
abstract: BACKGROUND
  Adolescents are developmentally in a period of transition-from children cared for by their parents to young adults capable of self-care, independent judgment, and self-directed problem solving. We wished to develop a behavioral contract for adolescent diabetes management that addresses some negotiable points of conflict within the parent-child relationship regarding self-monitoring and then assess its effectiveness in a pilot study as part of a novel cell phone-based glucose monitoring system.
  
  
  METHODS
  In the first phase of this study we used semistructured interview techniques to determine the major sources of diabetes-related conflict in the adolescent-parent relationship, to identify factors that could facilitate or inhibit control, and to determine reasonable goals and expectations. These data were then used to inform development of a behavioral contract that addressed the negotiable sources of conflict between parents and their adolescent. The second phase of this research was a 3-month pilot study to measure how a novel cell phone glucose monitoring system would support the contract and have an effect on glucose management, family conflict, and quality of life.
  
  
  RESULTS
  Interviews were conducted with 10 adolescent-caregiver pairs. The major theme of contention was nagging about diabetes management. Two additional themes emerged as points of negotiation for the behavioral contract: glucose testing and contact with the diabetes clinical team. Ten adolescent-parent pairs participated in the pilot test of the system and contract. There was a significant improvement in the Diabetes Self-Management Profile from 55.2 to 61.1 (P < 0.01). A significant reduction in hemoglobin A1c also occurred, from 8.1% at the start of the trial to 7.6% at 3 months (P < 0.04).
  
  
  CONCLUSIONS
  This study confirms previous findings that mobile technologies do offer significant potential in improving the care of adolescents with type 1 diabetes. Moreover, behavioral contracts may be an important adjunct to reduce nagging and improve outcomes with behavioral changes.
authors.affiliation: Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. aaecarro@iupui.edu
authors.forename: Aaron E
authors.initials: AE
authors.lastname: Carroll
authors.forename: Linda A
authors.initials: LA
authors.lastname: DiMeglio
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stein
authors.forename: David G
authors.initials: DG
authors.lastname: Marrero
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation* / Q000523:psychology; D017028:Caregivers / Q000523:psychology; D040421:Cell Phone; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000628:therapy; D054541:Family Conflict / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006040:Goals; D015438:Health Behavior; D006801:Humans; D007196:Indiana; D008297:Male; D017008:Negotiating / Q000523:psychology; D010287:Parent-Child Relations; D010349:Patient Compliance / Q000523:psychology; D010865:Pilot Projects; D011369:Professional-Patient Relations; D011788:Quality of Life
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human