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[IP] Help for non-compliant kids

>From the www.docguide.com web site:

Diabetic Kids Respond Better to 'Can Do' Than to Threats

WASHINGTON, MA -- February 12, 1998 -- Physicians and other health care
providers tend to warn patients about the consequences of not sticking
with their prescribed treatments, but researchers now say they may be
going about it the wrong way. 

Nicole Palardy, MA, and colleagues at The University of Alabama,
Tuscaloosa and Birmingham, surveyed 101 adolescents aged 11 to 17 who
were diagnosed with insulin-dependent diabetes mellitus (IDDM). They
suggest that young people with IDDM might be more likely to respond to
messages that build up their ability to stick with prescribed treatments
than to those that emphasise the negative consequences of not following
their treatment plans. 

"Non-adherence to medical treatments is a prevalent problem that poses
serious risks to the health status of chronically ill patients," they
write in the January issue of the Journal of Developmental and Behavioral
Pediatrics. "Practitioners attempt to address this problem by
communicating to their patients the negative consequences of

Acknowledging that patients' health attitudes significantly influence
whether or not they stick with their treatment plans, the researchers set
out to compare attitudes and match them to reported adherence levels.
They measured the youths' frequency of adherence to their treatment plans
during the previous seven days, then examined the adolescents' responses
to five factors, two asking about threat appraisals: 

Vulnerability -- What was the likelihood that they would get sick if they
didn't follow the treatment. Would they have an insulin reaction, get
gangrene, or renal failure;

Severity of risks -- How sick did they think they would get if they
didn't stick with the plan? Would they miss one day of school? Several
days of school? Would they die;

And three asking about coping appraisals: 

Response efficacy -- How effective did they consider the four major
components of their treatments (insulin injections, blood glucose
monitoring, diet and exercise);

Self-efficacy -- How much did they believe they could carry out the
treatment tasks;

Response costs -- How important were the personal costs of treatment,
such as pain, inconvenience and embarrassment?

Most of the adolescents who thought that following the treatment plan
includes some personal costs were less likely to adhere to the full
treatment, the researchers found. 

They suggested that health messages that address the coping appraisal
process, such as response costs, might be more effective for increasing
adherence to treatments than messages that focus on the threat appraisal
process. Challenging cognitions concerning response costs and altering
adolescents' lifestyles to involve fewer response costs might also
enhance adherence to treatment. 

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