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Journal of Pediatric Psychology, Vol. 28, No. 1, 2003, pp. 67-79
© 2003 Society of Pediatric Psychology

A Follow-Up Study of Adherence and Glycemic Control Among Hong Kong Youths With Diabetes

Sunita M. Stewart, PhD1, Peter W. H. Lee, PhD2, David Waller, MD1, Carroll W. Hughes, PhD1, Louis C. K. Low, MB, CHB2, Betsy D. Kennard, PsyD1, Anna Cheng, FHKAM3 and Kwai-Fun Huen, FHKAM4

1 University of Texas Southwestern Medical Center at Dallas, 2 The University of Hong Kong, 3 Princess Margaret Hospital, 4 Tseung Kwan O Hospital

All correspondence should be sent to Sunita Mahtani Stewart, Psychiatry, UT Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75390-8589. E-mail: Sunita.Stewart{at}UTSouthwestern.edu.

Objective To extend longitudinally an earlier study of the pathway from symptoms of emotional distress (ED) through self-efficacy (SE) and adherence to glycemic control (GC) in youths with diabetes, and to examine the contribution of different specific adherence behaviors to changes in GC. Methods Fifty-six Hong Kong youths with diabetes received a follow-up evaluation 12-24 months after initial participation. ED, SE, self-reported adherence to medical regimen (SRA), and GC were assessed at both evaluations. Results The pathway from ED to SE to SRA to GC was replicated. Participants' SRA to regular checks on blood glucose levels, and taking steps to maintain levels in the recommended range, explained significant variance in changes in GC. Conclusions The model offers strategies to enhance health care in youths with diabetes. Findings support the importance of adherence to the medical regimen but emphasize the complexity of the relationship between adherence behaviors and GC. Self-regulatory behaviors, rather than compliance with fixed instructions, appear to have the most impact on GC.

Key words: type 1 diabetes; glycemic control; Hong Kong; adherence; compliance; adolescents; self-efficacy.


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