title: Momentary assessment of social context and glucose monitoring adherence in adolescents with type 1 diabetes.
abstract: OBJECTIVE
  To investigate the associations between momentary social context and glucose monitoring adherence in adolescents with type 1diabetes (T1D).
  
  
  METHODS
  For 14 days, patients (14-18 years old, T1D duration >1 year) of a pediatric diabetes clinic carried handheld computers that prompted them to report their location, companionship, and attitudes toward companions at the times they usually checked their glucose, and again 30 minutes later to report whether they checked their glucose and, if not, why. Associations between social context factors and checking glucose (adherence) were analyzed using logistic generalized estimating equations and adjusted for age, sex, duration of T1D, and pump use.
  
  
  RESULTS
  Thirty-six participants (mean age 16.6 ± 1.5 years, mean duration of T1D 8.7 ± 4.4 years) completed 971 context and 1,210 adherence reports, resulting in 805 paired reports. Median signal response rate was 63%. The odds of checking glucose was higher when participants expressed very strong desire to blend in (adjusted odds ratio [AOR] = 2.30, 95% confidence interval 1.07-4.94, p = .03). Strong desire to impress others was associated with decreased likelihood of checking glucose (AOR = .52, 95% confidence interval .28-.97, p = .04.) Location, solitude, type of companion, and attitudes toward companions were not significantly associated with checking glucose.
  
  
  CONCLUSIONS
  Desire to blend in may support glucose monitoring adherence and desire to impress others may impede this behavior in adolescents with T1D. Other dimensions of social context were not linked to checking glucose in this study.
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA 02115, USA. Joshua.borus@childrens.harvard.edu
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Borus
authors.forename: Emily
authors.initials: E
authors.lastname: Blood
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Volkening
authors.forename: Lori
authors.initials: L
authors.lastname: Laffel
authors.forename: Lydia A
authors.initials: LA
authors.lastname: Shrier
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D015190:Blood Glucose Self-Monitoring; D034201:Computers, Handheld; D016001:Confidence Intervals; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012931:Social Environment; D012944:Social Support