Integrating the Family into the Camp Experience: Exploring the Impact of Residential Diabetes Family Camp
Hill, Eddie, Ramsing, Ron, Hill, Laura C., VAHPERD Journal
Background and Significance
Diabetes is considered to be one of the most psychologically and behavioral demanding chronic illnesses facing adolescents (Cox & Gonder-Frederick, 1992). With no cure for diabetes on the forefront, self-management has become the cornerstone of type 1 diabetes treatment (Mensing, et al., 2000; Ruggiero, et al., 1997). The ultimate goal for an adolescent diagnosed with type 1 diabetes is effective self-management or interdependent management. Yet, with nonadherence to appropriate regimens approaching 90% (Coates & Boore, 1998), effective diabetes management necessitates a team effort or support network. In the most global sense of the word, support for diabetes management with adolescents makes it a family disease (Anderson, Miller, Auslander, & Santiago, 1981) where the responsibility of day-to-day control involves many different people or significant stakeholders (e.g. family, health care team, recreation professionals, educators). This family approach (Solowiejczyk, 2004) to diabetes management is emerging as a critical model as the number of adolescents diagnosed with diabetes increases.
The implications of poor metabolic control are severe. Adolescents who lack diligent and continuous self-management skills, support, or motivation for diabetes control risk developing significant complications (American Diabetes Association, 2002; Brown, 1999) that may impact overall quality of life (Hoey, et al., 2001). Control of blood-glucose to near-normal levels has been shown to slow the onset and progression of complications such as eye, kidney, and nerve disease (American Diabetes Association, 2002; Brown, 1999; National Diabetes Information Clearinghouse, 2001; National Institute of Health, 2003). Moreover, research has shown that family structure may increase adherence to diabetes management due to the need for near-constant management of type 1 diabetes (Lerner & Lerner, 2001). Similarly, research has shown that better metabolic control is seen when youth evaluated their mothers as collaborating with, as opposed to controlling, their child when dealing with the problems associated with diabetes management (Wiebe et al., 2005). While adolescents assume more responsibility for the self-management of their diabetes as they grow older, parents continue to make contributions which may lead to family conflict (Schilling, Knafl, & Grey, 2006). Yet, Anderson (2004) found that family conflict can have a debilitating effect on metabolic control and therefore is a cause for concern for positive youth development. Furthermore, strained family dynamics that yield less effective diabetes management can also lead to immediate problems at school and other social setting (e.g. recreation programs).
In addition to family dynamics influencing diabetes management, adolescent behavioral problems such as aggression and antisocial conduct have been highly correlated with poor metabolic control during adolescence and young adulthood (Bryden, et al., 2001). These behavioral challenges sometimes require special services in school and possible psychotherapeutic services outside of school. In addition, adolescents with diabetes are diagnosed with more psychiatric disorders than their non-diabetic peers (Blanz, Rensch-Riemann, Fritz-Sigmund, & Schmidt, 1993; Mayou, Peveler, Davies, Mann, & Fairburn,1991). Recent evidence also indicates an increase in emotional problems such as anxiety and depression with poor glycemic control (Bryden, et al., 2001; Diabetes Forecast, 2008). Thus, the psychological and social ramifications of poor diabetes management are just as important to address as the physiological.
Practitioners have successfully applied self-determination theory as a way to significantly influence individual motivation for diabetes self-management, resulting in increased metabolic control (Williams, Freedman, & Deci, 1996, 1998; Williams, McGregor, Zeldman, Freedman, & Deci, 2004). …