Abstract
An important objective of diabetes care is to provide patients with self-regulation skills. For patients to assume responsibility for their own regimens, they need to have good problem-solving skills to cope with ongoing personal, social, and environmental barriers to adherence. Therefore, a Diabetes Problem Solving Interview for adults was developed and evaluated with 126 non-insulin-dependent outpatients. Interviewers elicited problem-solving strategies patients would use to cope with a variety of situations potentially interfering with dietary, exercise, and glucose testing adherence. Interviews were tape recorded and coded by trained raters to produce scores on both overall problem-solving skill ratings and frequency of use of different types of strategies. Results revealed only minor influences of patient characteristics on problem-solving measures. Prospective analyses revealed that problem-solving measures were significant and independent predictors of levels of dietary and exercise self-care at a 6-month follow-up.
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Anderson, L. A. (1990). Health-care communication and selected psychosocial correlates of adherence in diabetes managment.Diabetes Care 13: 66–76.
Ary, D. V., Toobert, D., Wilson, W., and Glasgow, R. E. (1986). A patient perspective on factors contributing to nonadherence to diabetes regimens.Diabetes Care 9: 168–172.
Chancy, E. F., O'Leary, M. R., and Marlatt, G. A. (1978). Skill training with alcoholics.J. Consult. Clin. Psychol. 46: 1092–1104.
Cox, D. J., Gonder-Frederick, L., Pohl, S., and Pennebaker, J. W. (1986). Diabetes. In Holroyd, K. A., and Creer, T. L., (eds.),Self-Management of Chronic Disease, Academic Press, New York.
D'Zurilla, T. (1986).Problem Solving Therapy, Springer, New York.
D'Zurilla, T., and Goldfried, M. (1971). Problem-solving and behavior modification.J. Abnorm. Psychol. 78: 104–126.
Follansbee, D. J., La Greca, A. M., and Citrin, W. S. (1983). Coping skills training for adolescents with diabetes. Paper presented at the Annual Meeting of the American Diabetes Association, San Antonio, Texas.Diabetes 32 (Suppl. 1): 147 (abstr.).
Foxx, R. M., Martella, R. C., and Marchand-Martella, N. E. (1989). The acquisition, maintenance, and generalization of problem-solving skills by closed head-injured adults.Behav. Ther. 20: 61–76.
Gilchrist, L. D., Schinke, S. P., Bobo, J. K., and Snow, W. H. (1986). Self-control skills for preventing smoking.Addict. Behav. 11: 169–174.
Glasgow, R. E. (1990). Compliance to diabetes regimens: Conceptualization, complexity, and determinants. In Cramer, J. A., and Spilker, B. (eds.),Patient Compliance in Medical Practice and Clinical Trials, Raven Press, New York.
Glasgow, R. E., Klesges, R. C., Mizes, J. S., and Pechacek, T. F. (1985a). Quitting smoking strategies used and variables associated with success in a stop-smoking contest.J. Consult. Clin. Psychol. 55: 905–912.
Glasgow, R. E., Wilson, W. W., and McCaul, K. D. (1985b). Regimen adherence: A problematic construct in diabetes research.Diabetes Care 8: 300–301.
Glasgow, R. E., McCaul, K. D., and Schafer, L. D. (1986). Barriers to regimen adherence among persons with insulin-dependent diabetes.J. Behav. Med. 9: 65–77.
Glasgow, R. E., McCaul, K. D., and Schafer, L. D. (1987). Self-care behaviors and glycemic control of Type I diabetes.J. Chron. Dis. 40: 399–412.
Glasgow, R. E., Toobert, D. J., Riddle, M., Donnelly, J., Mitchell, D. L., and Calder, D. (1989). Diabetes-specific social learning variables and self-care behaviors among persons with Type II Diabetes.Health Psychol. 8: 285–303.
Goldfried, M. R., and D'Zurilla, T. J. (1969). A behavioral-analytic model for assessing competence. In Spielberger, C. D. (ed.),Current Topics in Clinical and Community Psychology, Vol. 1, Academic Press, New York.
Heppner, P. P., Neal, G. W., and Larson, L. M. (1984). Problem solving training as prevention with college students.Personnel Guid. J. 62: 514–519.
Hollingshead, A. B. (1975). Four factor index of social status. Unpublished manuscript, Yale University, New Haven, Conn.
Irvine, A. A., Bobbitt, S. A., and Carter, W. R. (1990). Adherence to the diabetic regimen: The role of environmental barriers (submitted for publication).
Johnson, S. B., Pollak, T., Silverstein, J. H., Rosenbloom, A. L., Spillar, R., McCallum, M., and Harkavy, J. (1982). Cognitive and behavioral knowledge about insulin-dependent diabetes among children and parents.Pediatrics 69(6): 708–713.
Johnson, S. B., Silverstein, J., Rosenbloom, A., Carter, R., and Cunningham, W. (1986). Assessing daily management in childhood diabetes.Health Psychol. 5: 545–564.
Kovacs, M., and Feinberg, T. (1982). Coping with juvenile onset diabetes mellitus. In Baum, A., and Singer, J. (eds.),Handbook of Psychology and Health, Vol. 2, Erlbaum, Hillsdale, N.J.
McCaul, K. D., Glasgow, R. E., and Schafer, L. D. (1987). Diabetes regimen behaviors: Predicting adherence.Med. Care 25: 868–881.
Meichenbaum, D., and Turk, D. C. (1987). Teaching self-regulatory skills. In Meichenbaum, D., and Turk, D. C. (eds.),Facilitating Treatment Adherence: A Practitioner's Guidebook, Plenum Press, New York.
Nezu, A. M. (1986a). Cognitive appraisal of problem solving effectiveness: Relation to depression and depressive symptoms.J. Clin. Psychol. 42: 42–48.
Nezu, A. M. (1986b). Efficacy of social problem-solving therapy approach for unipolar depression.J. Consult. Clin. Psychol. 54: 196–202.
Nezu, A. M., Nezu, C. M. Saraydarian, L., Kalmar, K., and Ronan, G. F. (1986). Social problem solving as a moderating variable between negative life stress and depressive symptoms,Cognit. Ther. Res. 10(5): 489–498.
Orme, C. M., and Binik, Y. M. (1989). Consistency of adherence across regimen demands.Health Psychol. 8: 27–43.
Platt, J. J., and Spivack, G. (1975).Manual for the Means-End Problem-Solving Procedure (MEPS): A Measure of Interpersonal Cognitive Problem Solving Skill, Hahnemann Community Mental Health/Mental Retardation Center, Department of Mental Health Sciences, Hahnemann Medical College and Hospital, Philadelphia, Penn.
Turk, D. C., Holzman, A. D., and Kerns, R. D. (1986). Chronic pain. In Holroyd, K. A., and Creer, T. L. (eds.),Self-Management of Chronic Disease: Handbook of Clinical Interventions and Research, Academic Press, Orlando, Fla.
Wilson, W., Ary, D., Biglan, A., Glasgow, R. E., Toobert, D. J., and Campbell, D. (1986). Psychosocial predictors of self-care behaviors (compliance) and glycemic control in non-insulin-dependent diabetes mellitus.Diabetes Care 9: 614–622.
Wysocki, T., Green, L., and Huxtable, K. (1989). Blood glucose monitoring by diabetic adolescents: Compliance and metabolic control.Health Psychol. 8: 267–284.
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This research was supported by Grant DK 35524 from the National Institute of Diabetes, Digestive and Kidney Diseases.