This paper aims at examining the determining the factors that influence compliance in diabetes management in teenagers. It will start with, one, a brief description of why it is important to identify these factors. The factors that influence compliance and reason as to why they have to be addressed. Two, this paper is an evidence-based practice. It will focus on the umbilicus care practices. A table will be drawn to show the search terms used and how the literature search was done. There will be an explanation of the databases used, the inclusion and the exclusion criteria used and the scientific rationale behind it. Three, six key articles will be identified and an explanation of how the six were identified. Four, the literature of the articles will be discussed using the following format; mention the author and the title of the study. The methodology used. Discuss the findings obtained. Explain the implication of the study in the nursing practice and lastly discuss the future implication of the study. Five, conclude the paper with a summary of all that has been discussed above. Six, lastly, a discussion on the implication of this research to the medical and nursing profession. An explanation of the future implication of this research.
Diabetes is a chronic lifelong endocrine condition that affects both children and adults. The prevalence of diabetes is increasing with 2009 figures putting the levels at 35000 children under the age of 19 and close to 25000 under the age of 18 years with a prevalence of 209/100,100 in the 0-17 age group (Royal College of Pediatrics and Child Health, 2009). Of these figures, 96% have type 1 diabetes while 2% have type 2 diabetes. There is an increasing rate of 3% per year (Krone, Högler, & Barrett, 2009). The rising incidence is attributed to increased surveillance and rising risk factors including obesity (Haines, Wan, Lynn, Barrett, & Shield, 2007; Ehtisham, Barrett, & Shaw, 2010). The management of this condition is multifactorial and challenging to try to minimize the effects and complications. They include self-managed, regular insulin injections, diet, lifestyle modifications, and hyperglycemic drugs (Krone, Högler, & Barrett, 2009). Due to the burden of disease and high mortality, glycemic control should be a priority (García-Pérez et al, 2013). This is a big problem due to the consequences of poor glycemic control including, increased mortality and morbidity, increased health care costs and economic burdens, and increased complications such as ketoacidosis, hypoglycemia, diabetic retinopathy, nephropathy, cardiovascular disease, neuropathies, sexual dysfunctions and pregnancy complications (Polonsky & Henry, 2016)
The largest factor undermining glycemic control is compliance. It is defined as the extent a person’s behavior in following therapeutic interventions corresponds with the agreed upon guidelines from a healthcare professional. It is seemingly worse at adolescent as one transition from childhood to maturity. Decreased glycemic control to almost less than 50% of patients is attributed to compliance issues. The high social stressors at adolescence, coupled with unstable daily activities make diabetic control a challenge at this age. The UK figure put diabetic compliance in the general. The burden of disease among adolescents is thus high and the problem of compliance, its factors, and the required interventions need to be addressed (Delamater, 2006).
Sources to be used for the study had to be eligible and reliable. For this to be so a systematic approach was developed. It was used to determine the most suitable literature for the research in question. PICO: Population, Intervention, Counter Intervention, Outcome was used so as to identify the most useful articles.
|
Population |
Adolescents |
|
Intervention |
Identify the factors that affect the compliance with diabetic management in teenagers. |
|
Counter Intervention |
Parental influence, peer influence and depression on the compliance of diabetes management in teenagers. |
|
Outcome |
Identify the factors that affect the compliance with diabetes management so as to help nurses to develop knowledge on how to improve the adherence. |
Table 1. PICO
Patient compliance, adherence, factors, teenagers, type 1 diabetes, adolescence were the keywords used when doing the search. An intensive research was conducted using the keywords mentioned above. The databases used for the research included: Cochrane library, Medline, Clinical government trials, MIH library web of science. Critical Appraisal Skills Programme (CASP) was used so as to identify the most suitable articles to use. It was useful in analyzing and identifying the validity of the research questions. The process of analysis data led to the formulation of themes. These themes led to the development of recommendations that were made based on (Promoting Action on Research Implementation in Health Services) PARiHS framework.
|
Inclusion |
Exclusion |
|
Articles: ü 5-7 years old. ü On diabetes management compliance. ü On factors influencing diabetes compliance. ü Compliance with diabetes management in teenagers. |
Articles: ü older than 7 years. ü On factors affecting diabetes compliance in general population. |
Table 2: Inclusion and Exclusion criteria.
For further and in-depth research after obtaining the articles that answered the research question, these articles were hand searched on the internet. This was done so as to identify the eligibility and the relevance of the articles. The outcome consideration for the inclusion was used. The outcomes of research were as follows.
|
No |
Consideration criteria |
|
1 |
Diabetes management compliance in teenagers. |
|
2 |
Factors influencing diabetes management compliance in teenagers. |
|
3 |
Remove the barriers to diabetes management compliance in teenagers. |
|
4 |
Improve diabetes management compliance in teenagers. |
Table 3: The outcome consideration for the inclusion.
The following is a summary of how the inclusion and exclusion of articles were done using a PRIMA flow chart (Moher, The PRISMA Group, 2009). CASP, 2014; Public health services, 2011; Consort 2010 were used as the checklists for the reliability and validity of the articles that had been gathered. This was done so as to ensure that they answered the research question and also to critical appraise whether the literature obtained was strong or weak. The analysis of the articles finally led to the selection of six articles that will be used to answer the research question.
Table 4, PRISMA flow diagram (Moher, The PRISMA Group, 2009)
|
Author, year |
Research title |
Journal/article. |
|
Cox L., Hunt J., (2015). |
Factors that affect adolescents’ adherence to diabetes treatment |
Nursing children and young people |
|
Greening, L., Stoppelbein, L., Konishi, C., Jordan, S., (2015). |
Child routines and youths’ adherence to treatment for type 1 diabetes |
Journal of pediatric psychology |
|
Kichler, J., Moss, A., Kaugars, A., (2012). |
Behavioral Factors Influencing Health Outcome in Youth with type 1 Diabetes |
US Endocrinology |
|
McNamara, J et al. (2011). |
Contributing factors to poor adherence and glycemic control in pediatric type 1 diabetes: facilitating a move toward telehealth. |
Pediatric health |
|
Raymaekers K ., et al. (2017) |
The role of peers for Diabetes management in adolescent and emerging adults with type 1 diabetes. |
Diabetes Care |
|
Taddeo, D., Egedy, M., Frappier, J., (2016) |
Adherence to treatment in adolescents |
|
|
Warner, J.T. & O’Connell, H. (2009) |
Diabetes in children and young people in Wales: prevalence and outcome |
Diabetes Care |
Diabetes mellitus is a lifelong condition. Type 1 diabetes (T1D) is diagnosed in childhood (Diabetes UK 2014). In the United Kingdom, 33,600 people under 19 years old live with this condition. Patients with T1D their life expectancy is usually reduced by ten years on average. The adolescent is the period of psychological and physiological development that occurs between the age of 10 and 18 (WHO, 2013). It is considered to be a challenge for those with T1D. this is the stage at which the glycemic control deteriorates. This deterioration is usually as a result of non-compliance with the prescribed treatment (Helgeson et al. 2012). Compliance is defined as the extent to which a patient follows the medical advice so as to achieve the therapeutic goals (National Pediatric Diabetes Project Board and Royal College of Pediatrics and child health, 2012). The audit shows that only 16% of adolescent males and 15% of the adolescent females complies with the treatment of T1D.
It is important to control glycemic levels so that to prevent the short-term complications. These complications include diabetic ketoacidosis hypoglycemia, and hyperglycemia (Shaw and Cummings 2012). The long-term complications of not controlling the glycemic levels lead to renal diseases, cardiovascular diseases, neuropathies and retinopathies (Shaw and Cummings 2012).
It is evident that compliant to diabetes management is important so as to avoid immediate or lifelong complications. It is also clear that it is a challenge for most adolescents to comply with the diabetes management. The non-compliance is influenced by peers, parents/family, and depression. The literature review below will expound more on how the three influences adolescent compliance to diabetes management.
Cox and Hunt (2014) conducted a study on the factors that affect the adherence of adolescents to the diabetes treatment. It was as a result of increased health complications in late life which was traced back to uncontrolled glycemic levels in childhood. The aim of the study was to: one, identify the factors that influence adolescent’s compliance with diabetes management. Two, use this information to help improve nurse’s knowledge of the causes of non-compliance to the diabetes management so as to come up with interventions on how to improve treatment. The methodology used was a systematic review which involved a meta-analysis of literature reviews that were obtained from standard databases. The study sample was 256 teenagers.
Findings showed that: one, a good relationship between a parent and a teenager there is increased /improved compliance in comparison with those who have poor-quality relationships with their parents. It was also suggested that the adolescents adhere to theT1D treatment when they perceive their parents as encouraging rather than discouraging of independence. Two, parenting styles were found to influence TID management compliance. Compliance was found to be high to those adolescents who perceived their parents as authoritative in comparison to those who perceived their parents as authoritarian, neglectful or permissive.
In conclusion, it is clear that parenting has a huge role T1D management compliance. It can influence an adolescent negatively or positively. The research is important to nurses. One role of a nurse is being a counselor and patient’s advocates. With the knowledge on how parenting influences T1D management compliance the nurse will be able to advise the patients’ parents according. This will help in improving the compliance.
In addition, a study by (Taddeo, Egedy and Frappier 2008) on adherence to treatment in adolescents supported that parents and family support influences compliance to treatment. The study was done as a result of the increased premature deaths of adolescents which were blamed on decreased levels of compliance to treatment. The aim of the study was to identify the causes of non-compliance so as to remove the barriers and improve management. Same as (Cox and Hunt 2014) the study used systematic review which involved a meta-analysis of literature reviews using the standard database.
The findings were as follows: the parenting style was found to be having an influence on compliance with T1D management. As the adolescents grow the desire to have their own independence increases. They want to make their own choices. Having a disease makes them feel powerless. When the parenting style used is that of being overprotective it delays them from taking control of their lives and making important decisions like treatment which frustrates them. this lowers their adherence. As it was mentioned by (Cox and Hunt 2015) authoritarian parenting lowers adherence. In short, it parenting influences the adherence. To improve compliance parenting style that is most preferred is authoritarian
Raymaekers et al. (2007) conducted a study on the role of peers in the management of diabetes in adolescents. The study was as a result of the wide acknowledgment of the increasing importance of the peers in the life of adolescents and the emerging adults. The aim of the study was to find out the influence peers have on adolescents with T1D. a longitudinal study was done in which it used 467 adolescents with T1D as the sample size.
The findings stipulated that the peer support negatively predicts the diabetes-related distress. It also stated that with a positive peer orientation there are positive treatment outcomes. It also stated that poor treatment adherence is an indication of poor peer orientation. In conclusion, it is clear that for good compliance with T1D management the peer support should be made firm. This is important to the nurse as they will advocate this.
In addition to (Raymaekers et al. 2007) study, (Cox and Hunt 2014) conducted a study on the factors that affect the adherence of adolescents to the diabetes treatment. They emphasized on the influence of peers to the compliance to TID management. An adolescent is constantly faced with thoughts, agreements, and conflicts on the need of getting accepted by his/her peers and also from friendships. The study showed that adolescents who have negative thoughts about the peers’ reactions they are less likely to adhere to the TID management. It also found out that when there are conflicts among peers especially females, the compliance lowers. This study concludes that peers play a major role in T1D management.
McNamara et al. (2011) conducted a study on the factors that contribute to the poor adherence and the glycemic controls in pediatrics with T1D. The study was as a result of increased premature deaths of youths. The study aimed at determining the causes of poor adherence to TID management. The study utilized the systematic and meta-analysis of a literature review of articles obtained from the standard database.
The findings were as follows: depression causes poor adherence and control of glycemic levels. These can be attributed to peer victimization in their relationships. This can be through verbal or physical assault. Those adolescents who were victimized more got lonelier, depressed and socially anxious. It was found out there was a correlation between victimization and self-care management in T1D. the more the victimization the poor the adherence. This information is important as it gives the nurses information on the importance of ensuring that an adolescent with T1D does not get depressed so as to improve compliance with medication.
In addition to the influence of depression on T1D management (Kichler, Moss and Kaugars 2012) conducted a study on the behavioral factors that influence the health outcomes in the youths that have type one diabetes. The aim of the study was to identify the influence of one’s behavior on the T1D management. the study methodology used was a systematic and meta-analysis of literature reviews.
The results were as follows: as I mentioned earlier the physiological functioning both the internal and the external influences the adherence to medication. It was found that when one gets depressed this disrupts the adherence through reduced concentration. It also impacts on the judgment ability, decreases motivation and also causes memory impairment. In adolescents with T1D, it causes maladaptive eating behaviors and attitudes. It also brings about the insulin omission possibility so as to control weight. In summary, depression negatively affects the adherence to T1D management.
Lastly, (Greening 2015) conducted a study on the child routines and the youths’ compliance to the treatment for the T1D. the aim of the study was to explore how behavioral problems influences treatment compliance. The study was a cross-sectional study that concluded that behavioral problems, for example, depression causes a poor T1D management.
Conclusion
The study concludes that compliance to T1D management is very important as non-compliance has grave consequences. Adolescents face a challenge when it comes to T1D management as it is influenced by peers, parents, and depression. So as to reduce premature deaths of youths. The three barriers to compliance should be dealt with.
As mentioned above over 30000 adolescents have T1D. The researchers have clearly shown that most adolescents have poor adherence to T1D management and control of glycemic levels. This brings on complications, either immediately or later on in life. It is there important for the nurses to ensure that the adolescents adhere to their T1D management though overcoming the obstacles to TID management. This can be achieved through, one, the nurse should advise the parents on the best parenting style. Two, the nurse should ensure that the adolescent gets peer support. Three, the nurse should ensure that the adolescent does not get depressed. When this is achieved the compliance will be improved.
References
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Cox L., Hunt J., (2014). Factors that affect adolescents’ adherence to diabetes treatment. Nursing children and young people. 27 (1), 16-28.
Delamater, A. M. (2006). Improving Patient Adherence. Clinical Diabetes, 24(2), 71-77.
Diabetes UK (2014) Diabetes Facts and Stats. Available from: tinyurl.com/kymuvr7 (Last accessed: December 12, 2014.
Ehtisham, S., Barrett, T. G., & Shaw, N. J. (2010). Type 2 diabetes mellitus in UK children – an emerging problem. Diabetic Medicine, 17(12), 867-871.
García-Pérez, L.-E., Álvarez, M., Dilla, T., Gil-Guillén, V., & Orozco-Beltrán, D. (2013). Adherence to Therapies in Patients with Type 2 Diabetes. Diabetes Therapy, 4(2), 175-194.
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Guyatt, G.H., Oxman, A.D., Vist, G.E., et al. (2010). GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 336(7650), p924–926
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Helgeson VS et al (2009) Peer relationships and diabetes: retrospective and ecological momentary assessment approaches. Health Psychology. 28, 3, 273-282
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