Compriance Interventions for Children With Diabetes and Other Chronic Diseases
Alan M. Delamater University of Miami School of Medicine
The purpose of this chapter is to review studies of interventions to improve compliance to medical regimens in children with chronic diseases. Although studies of factors affecting regimen compliance in this population have increased in recent years, few controlled studies of the effects of compliance interventions have been reported in the literature. Relatively more studies of children with diabetes have been conducted than of other patient groups. This review therefore focuses on diabetes, not only because there is a larger literature, but also because diabetes can be considered a model chronic disease to investigate. The diabetic regimen requires compliance to a variety of health behaviors, including insulin administration, glucose testing, diet, exercise, and timing of all these regimen components, which impact on child and family life and have significant developmental effects. After reviewing the literature concerning factors affecting compliance and studies of compliance interventions for diabetic youths, intervention studies in other chronic diseases, including cystic fibrosis, renal disease, hemophilia, and myelomeningocele, are considered. Future research issues are then discussed, followed by summary and conclusions.
Regimen compliance has been assumed to be a key determinant of metabolic control of patients with diabetes. Some empirical studies have shown that compliance is predictive of metabolic control (e.g., Brownlee-Duffeck et al., 1987;