The Program for the Study of Health Care Relationships funded 11 researchers in CT to study various aspects of health care relationships and adherence. The individuals listed below each received grants for one year (2001-02). They were awarded funds on the basis of a competitive review process and the scientific merit of their proposals. The wide range of disciplines they represent and their research interests demonstrated the diversity and complexity inherent in studying health care relationships.

• Development of an Instrument to Measure Patients' Trust of Health Care Providers
• Exploration of the Effect of Nausea, Self-Efficacy, and Health Care Relationships on Medication Adherence in HIV/AIDS Patients
• Advance Care Planning: A Team Approach
• Assisting Older Adults To Communicate Their Pain After Surgery
• The Effect of a Specialized RN Intervention Designed to Maximize Patient-Provider Relationships on Adherence to Anti-Depressant Medication
• Pilot Study of Rapid Electronic Adherence Reporting with Provider Feedback on Adherence to Antiretroviral Therapy (HCR 01-12)
• Development of a Measure of Family Management of Childhood Chronic Illness
• The Contribution of Health Care Professionals to Parent and Child Self-Management of Type 1 Diabetes
• Enhancing Treatment Access and Adherence among Women of Hispanic Origin: The Roles of Relationships and Cultural Responsiveness in Behavioral Health Care
• Elicitation of Patient with Adaptive Conjoint Analysis

The Contribution of Health Care Professionals to Parent and Child Self-Management of Type 1 Diabetes

Schilling, L.S., Grey, M., Knafl, K.A., and Knafl, G.K.

Despite providers' assumptions, little is known about the relationships of SM and utilization of HCPs to QOL and HbA1c. This exploratory study was designed to investigate these relationships. Twenty-two youth (age 8 to19 years; n=13 females, 9 males) were interviewed separately utilizing a semi-structured interview guide. Purposive sampling, by age and gender, from two existing studies on the effects of coping skills training was utilized. Interview transcripts were entered into a qualitative software program and codes were developed. Qualitative data were used to rate dyads on six components of SM and five components of utilization of HCPs. A total SM score was calculated from the six component scores, with higher scores indicating more focused, less conflicted, and more intensive SM. A total HCP score was calculated from the six component scores, with higher scores indicating more less problematic, more satisfying, and more frequent use of HCPs. Data on QOL (DQOL-Y, satisfaction, impact and worry) and metabolic control (HbA1c) were collected. Correlational analyses revealed that age (p=.03), satisfaction with current level of SM responsibility (p=.005), frequency of HCP contact (phone or email) between visits (p=.04), report of useful HCP visits (p=.008), and total HCP utilization score (p=.002) were associated with higher QOL satisfaction scores. Age (p=.02) was associated with higher QOL-impact scores, or lower QOL. Higher frequency of using blood glucose levels to alter regimen (p=.001) was associated with lower QOL-impact scores, or higher QOL. Age (p=.0002), duration of illness (p=.04), and report of useful HCP visits (p=.04) were associated with higher QOL-worry scores, or lower QOL. Report of more BG tests/day was associated with decreased QOL-worry scores, or higher QOL. Reported history of problems with HCPs (p=.0009) were associated with higher HbA1c levels. Total SM and HCP scores were not significantly related (r=.33, ns). Findings suggest that how youth and their parents self-manage diabetes and collaborate with HCPs affects both youths' quality of life and metabolic control, suggesting the importance of positive communications with these youth to promote good outcomes.

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