1. +
Motivation in
Health Behavior
of the Non-
Compliant
Adolescent with
Type I Diabetes
KIM FORBES
UNIVERSITY OF CENTRAL FLORIDA

2. + Background of the Problem
Adolescence is a time of transition into adulthood that presents its own
unique set of challenges. For the adolescent that must deal with a chronic
disease like type I diabetes, this period of emotional instability can be
especially difficult.
50% of adolescents with a chronic disease do not comply with
care recommendation (Kyngas, 2000).
It is important to understand the relationship between daily
emotion and stress and how it relates to health and health
behaviors (Larsen & Kasimatis, 1991).
The risk for poor treatment management and medical
intervention increases in those adolescents with depressive
symptoms and family conflict. This “at risk” subgroup averaged a
HbA1c of 11.2% and only 2.9 blood glucose checks per day (Hilliard,
Yelena, Rausch, Dolan & Hood, 2013).
 Depression has a direct negative impact on diabetes self-
treatment and perceived quality of life. Furthermore, parental and
health care staff support and encouragement is critically important
in regard to treatment compliance (Grey, Davidson, Boland& Tamborlane, 2001).

3. + ProblemState
ment
Adolescents with type I
diabetes experiencing
increased emotional stressors
such as depression and lack
of family or healthcare
provider support are more
likely to be non-compliant to
prescribed healthcare
regimes increasing the need
for medical intervention.

4. +
Significance of the Problem
According to data collected in 2010 by the Centers for Disease
Control and Prevention (2012) an estimated 215,000 children ages
19 and under have diagnosed diabetes.
 Diabetes contributes to premature mortality and many of these
deaths are preventable with the proper self-care management.
 Complications such as nephropathy, neuropathy or retinopathy
developed much earlier in those with poor blood glucose control.
The long-term health complications that arise from non-
compliance of the diabetic treatment regime and consequential
lack of metabolic control increase the need for medical
intervention and/or hospitalization.
 Patients with a HbA1c greater than 8.5% are likely to have a
diabetes-related hospitalization. In contrast, those with better
metabolic control were found to have decreased hospitalizations
and lower overall direct medical costs.
 The overall medical costs for patients with poor diabetes
management averages $356 more than for patients with good
control.
(Ying et al., 2011)

5. +
Specific Aims
To identify and analyze specific barriers to successful self-
management of the adolescent with type I diabetes and to create nursing
interventions that can be used to promote better overall metabolic results
by applying Cox’s theory of motivation in health and Interactive Model of
Client Health Behavior (IMCHB).
 Improved blood glucose control and overall long-term health for the
adolescent patient with type 1 diabetes.
 Decreasing the need for preventable medical intervention by
establishing a supportive and trusted client-provider relationship that
encourages individuality, autonomy and knowledge of proper self-care.
 Ensuring long-term compliance to the diabetic medical regime via the
constant and enduring emotional support of family.

6. +
Theoretical Framework/Model
Cox’s (1982) Interactive Model of Client Health Behavior (IMCHB)
was developed to explain the relationship between the patient’s personal and environmental
variables that may affect health care behaviors and the client-provider relationship that
influences these outcomes.
The Model has three components:
Singularity – the client’s background variables, expression of motivation,
estimation of the health care concern and the emotional response to that concern.
Elements of client-professional relationship - provision of health care
information to the client, affective support that considers the client’s singularity
and assesses for health care barriers, decisional control, and professional-
technical competencies.
Elements of health outcomes – utilization of health care services, clinical health
status indicators, severity of health problems, adherence to the recommended-
care regimen and satisfaction with care.
(Cox. 1982)

7. +Application of (IMCHB) to the Care Plan of
an Adolescent with Type 1 Diabetes
Cox (1982) states that for nursing consideration there are three specific
areas of this model that are operational, measurable and open to use for
intervention: (1) provision of health information (2) affective support and (3)
decisional control. The ultimate goal of these three guides of intervention is
the motivation of good self-care and better health care outcomes.
Nursing Interventions
 Education of both client and family centering on the disease
process and expectations of healthy outcomes through adherence
to medical regime can give the adolescent a sense of
empowerment and self-awareness that may aid in motivating
better self-care.
Identify risk factors of non-compliant behaviors that can affect
metabolic control through a comprehensive history and
assessment and by using tools such as the Family APGAR.

8. + IMCHB
nursing interventions cont.
Once risk factors are identified, the nurse should encourage
family involvement through family focused support groups or
therapy guided family interaction. It is necessary that follow-up
assessments be made in the area of family support and emotional
wellbeing to ensure longevity of good health behaviors.
It is necessary that follow-up assessments be made in the area
of family support and emotional wellbeing to ensure longevity of
good health behaviors.
In an adolescent patient, the power to participate in making
health care decisions is imperative to the success of motivating
proper self-care and therefore good metabolic control outcomes.
Decisional control gives the adolescent feelings of empowerment
that encourage self-efficacy and therefore increase self-esteem.

9. +
Summary
The care of the adolescent with type I diabetes is
proven to be a difficult task for healthcare providers.
The high risk of both short and long-term complications
in adolescents with decreased compliance and poor
metabolic control not only increases healthcare costs by
preventable medical interventions and hospitalizations; it
lowers the patient’s overall quality of life as well.
With so many outside factors that influence the
adolescent’s sense of wellbeing and emotion state during
a vulnerable developmental stage, there must be proper
consideration given to this in concordance with treatment
of the disease process itself.
Addressing the emotional needs of adolescent patients
creates an environment of caring that affects self-esteem
and increase feelings of empowerment that lead to better
compliance, better quality of life and fewer
hospitalizations.

10. + References
Cox, C. L. (1982). An interaction model of client health behavior: Theoretical
prescription for nursing. Advances in Nursing Science, 5, 41-56.
Grey, M., Davidson, M., Boland, E. A., & Tamborlane, W. V. (2001). Clinical and
psychosocial factors associated with achievement of treatment goals in
adolescents with diabetes mellitus. Journal of Adolescent Health, 28(5),
377-385.
Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood, K. K. (2013).
Predictors of deteriorations in diabetes management and control in
adolescents with type 1 diabetes. Journal of Adolescent Health, 52(1), 28-34.
Kyngäs, H. (2000). Compliance of adolescents with chronic disease. Journal of
Clinical Nursing, 9(4), 549-556.
Larsen, R. J., & Kasimatis, M. (1991). Day-to-day physical symptoms individual
differences in the occurrence duration and emotional concomitants of minor
daily illnesses. Journal of Personality, 59(3), 387-424.
Ying, A. K., Lairson, D. R., Giardino, A. P., Bondy, M. L., Zaheer, I., Haymond, M.
W., & Heptulla, R. A. (2011). Predictors of direct costs of diabetes care in
pediatric patients with type 1 diabetes. Pediatric Diabetes, 12(3), 177-182.