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“They Think It’s Helpful, but It’s Not”: a Qualitative Analysis of the Experience of Social Support Provided by Peers in Adolescents with Type 1 Diabetes

International Journal of Behavioral Medicine volume 27, pages 444–454 (2020)Cite this article

Abstract

Background

Adherence in type 1 diabetes has previously been found to be improved with effective social support. However, research has so far been unable to elucidate the effect of social support from peers in adolescents with type 1 diabetes, with studies concluding they may be both positively and negatively related to self-care and glycaemic control. The present study explores the experience of social support from peers in adolescents with type 1 diabetes using a qualitative methodology to address this lack of consensus in the literature, using the research question: “what is the meaning and experience of social support from peers in adolescents with type 1 diabetes?”

Methods

Semi-structured interviews using the Diabetes Social Support Interview schedule were employed. Twelve participants aged 15–18 were recruited from paediatric outpatient services. Transcripts were analysed using thematic analysis.

Results

Two overarching themes were noted within transcripts; A Sense of Normality and “They Think It’s Helpful, But It’s Not”. Overall, participants reported a desire for global support from peers and explored how and why diabetes-specific support behaviours were more likely to be interpreted as harassing.

Conclusions

These findings suggest that diabetes-specific support may not always be advantageous in aiding adolescents to reach and maintain optimal self-care. In addition, participants emphasise the acceptability of advice provided by peers with type 1 diabetes, making peer support and mentoring programmes an excellent candidate for future research.

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References

  1. Diabetes UK. Facts and stats. 2017.

  2. Diabetes UK. Controlling type 1 diabetes - regular testing, Portions & Adjusting Insulin. 2018.

  3. Juvenile Diabetes Research Foundation. About type 1 diabetes. 2018.

  4. Brady PJ, Song HJ, Butler J. Using an expert panel to develop social support program sequencing for young adults with type 1 diabetes. Health Promot Pract. 2017;18:789–97. https://doi.org/10.1177/1524839917720934.

    Article  PubMed  Google Scholar 

  5. Rodriguez M, Cohen S. Social support. In: Friedman H, editor. Encyclopedia of mental health. New York: Academic Press; 1998. p. 535–44.

    Google Scholar 

  6. House JS. Work stress and social support. Reading: Addison-Wesley; 1981.

    Google Scholar 

  7. Gallant MP. Social networks, social support and health-related behavior. In: Martin LR, DiMatteo MR, editors. The Oxford handbook of health communication, behavior change, and treatment adherence. Oxford: Oxford University Press; 2014. p. 305–23.

    Google Scholar 

  8. Uchino BN. Understanding the links between social support and physical health. Perspect Psychol Sci. 2009;4:236–55.

    Article  Google Scholar 

  9. Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52:145–61.

    Article  Google Scholar 

  10. Cohen S, McKay G. Social support, stress, and the buffering hypothesis: a theoretical analysis. In: Baum A, Taylor SE, Singer JE, editors. Handbook of psychology and health. Hillsdale: Erlbaum; 1984. p. 253–67.

    Google Scholar 

  11. Cutrona CE, Russell DW. Type of support and specific stress: towards a theory of optimal matching. In: Sarason BR, Sarason IG, Pierce GR, editors. Social support: an interactional view. New York: Wiley; 1990. p. 319–66.

    Google Scholar 

  12. Hayward MD, Gorman BK. The long arm of childhood: the influence of early-life social conditions on men’s mortality. Demography. 2004;41:87–107.

    Article  Google Scholar 

  13. Frech A. Healthy behavior trajectories between adolescence and young adulthood. Adv Life Course Res. 2012;17:59–68. https://doi.org/10.1016/j.alcr.2012.01.003.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Haas SA. Trajectories of functional health: the “long arm” of childhood health and socioeconomic factors. Soc Sci Med. 2008;66:849–61.

    Article  Google Scholar 

  15. Umberson D, Crosnoe R, Reczek C. Social relationships and health behavior across life course. Annu Rev Sociol. 2011;36:139–57. https://doi.org/10.1146/annurev-soc-070308-120011.Social.

    Article  Google Scholar 

  16. Crone EA, Dahl RE. Understanding adolescence as a period of social-affective engagement and goal flexibility. Nat Rev Neurosci. 2012;13:636–50.

    CAS  Article  Google Scholar 

  17. Peper JS, Dahl RE. Surging hormones—brain-behavior interactions during puberty. Curr Dir Psychol Sci. 2013;22:134–9.

    Article  Google Scholar 

  18. Larson RW, Richards MH. Daily companionship in late childhood and early adolescence: changing developmental contexts. Child Dev. 1991;62:284–300.

    CAS  Article  Google Scholar 

  19. Larson RW, Richards MH, Moneta G, Holmbeck GN, Duckett E. Changes in adolescents’ daily interactions with their families from ages 10-18: disengagement and transformation. Dev Psychol. 1996;32:744–54.

    Article  Google Scholar 

  20. Cattelino E, Glowacz F, Born M, Testa S, Bina M, Calandri E. Adolescent risk behaviours and protective factors against peer influence. J Adolesc. 2014;37:1353–62. https://doi.org/10.1016/j.adolescence.2014.09.013.

    Article  PubMed  Google Scholar 

  21. Choukas-Bradley S, Giletta M, Widman L, Cohen G, Prinstein MJ. Experimentally-measured susceptibility to peer influence and adolescent sexual behavior trajectories: a preliminary study. Dev Psychol. 2015;50:2221–7.

    Article  Google Scholar 

  22. Mercken L, Steglich C, Sinclair P, Holliday J, Moore LAR. A longitudinal social network analysis of peer influence, peer selection, and smoking behavior among adolescents in British schools. Health Psychol. 2012;31:450–9. https://doi.org/10.1037/a0026876.

    Article  PubMed  Google Scholar 

  23. Pezzulo AA, Tang XX, Hoegger MJ, MHA A, Ramachandran S, Moninger TO, et al. Peer influence predicts speeding prevalence among teenage drivers. J Saf Res. 2013;487:109–13. https://doi.org/10.1038/nature11130.Reduced.

    Article  Google Scholar 

  24. Visser L, de Winter AF, Veenstra R, Verhulst FC, Reijneveld S a. Alcohol use and abuse in young adulthood: do self-control and parents’ perceptions of friends during adolescence modify peer influence? The TRAILS study. Addict Behav. 2013;38:2841–6. https://doi.org/10.1016/j.addbeh.2013.08.013.

    Article  PubMed  Google Scholar 

  25. Viner R, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, et al. Adolescence and the social determinants of health. Lancet. 2012;379:1641–52. https://doi.org/10.1016/S0140-6736(12)60149-4.

    Article  PubMed  Google Scholar 

  26. Suris J, Michaud PA, Akre C, Sawyer SM. Health risk behaviors in adolescents with chronic conditions. Pediatrics. 2008;122:1113–8.

    Article  Google Scholar 

  27. Palladino DK, Helgeson VS. Friends or foes? A review of peer influence on self-care and glycemic control in adolescents with type 1 diabetes. J Pediatr Psychol. 2012;37:591–603.

    Article  Google Scholar 

  28. Brownson CA, Heisler M. The role of peer support in diabetes care and self-management. Patient. 2009;2:5–17.

    Article  Google Scholar 

  29. Ashraff S, Siddiqui A, Carline TE. The psychosocial impact of diabetes in adolescents: a review. Oman Med J. 2013;28:159–62.

    Article  Google Scholar 

  30. Berndt TJ. Developmental changes in conformity to peers and parents. Dev Psychol. 1979;15:608–16.

    Article  Google Scholar 

  31. Blakemore SJ, Mills KL. Is adolescence a sensitive period for sociocultural processing? Annu Rev Psychol. 2014;65:187–207. https://doi.org/10.1146/annurev-psych-010213-115202.

    Article  PubMed  Google Scholar 

  32. Wysocki T, Greco P. Social support and diabetes management in childhood and adolescence: influence of parents and friends. Curr Diab Rep. 2006;6:117–22.

    Article  Google Scholar 

  33. Potì S, Emiliani F, Palareti L. Subjective experience of illness among adolescents and young adults with diabetes. J Patient Exp. 2018;5:140–6. https://doi.org/10.1177/2374373517738234.

    Article  PubMed  Google Scholar 

  34. Dovey-Pearce G, Doherty Y, May C. The influence of diabetes upon adolescent and young adult development: a qualitative study. Br J Health Psychol. 2007;12:75–91. https://doi.org/10.1348/135910706X98317.

    Article  PubMed  Google Scholar 

  35. Hinder S, Greenhalgh T. “This does my head in”. Ethnographic study of self-management by people with diabetes. BMC Health Serv Res. 2012;12:83. https://doi.org/10.1186/1472-6963-12-83.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lehmkuhl HD, Merlo LJ, Devine K, Gaines J, Storch EA, Silverstein JH, et al. Perceptions of type 1 diabetes among affected youth and their peers. J Clin Psychol Med Settings. 2009;16:209–15. https://doi.org/10.1007/s10880-009-9164-9.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Helgeson VS, Reynolds KA, Escobar O, Siminerio L, Becker D. The role of friendship in the lives of male and female adolescents: does diabetes make a difference? J Adolesc Health. 2007;40:36–43. https://doi.org/10.1016/j.jadohealth.2006.07.007.

    Article  PubMed  Google Scholar 

  38. Raymaekers K, Oris L, Prikken S, Moons P, Goossens E, Weets I, et al. The role of peers for diabetes management in adolescents and emerging adults with type 1 diabetes: a longitudinal study. Diabetes Care. 2017;40:1678–84. https://doi.org/10.2337/dc17-0643.

    Article  PubMed  Google Scholar 

  39. Helgeson VS, Siminerio L, Escobar O, Becker D. Predictors of metabolic control among adolescents with diabetes: a 4-year longitudinal study. J Pediatr Psychol. 2009;34:254–70.

    Article  Google Scholar 

  40. Hains AA, Berlin KS, Davies WH, Smothers MK, Sato AF, Alemzadeh R. Attributions of adolescents with type 1 diabetes related to performing diabetes care around friends and peers: the moderating role of friend support. J Pediatr Psychol. 2007;32:561–70.

    Article  Google Scholar 

  41. Naar-King S, Podolski C-L, Ellis DA, Frey MA, Templin T. Social ecological model of illness management in high-risk youths with type 1 diabetes. J Consult Clin Psychol. 2006;74:785–9. https://doi.org/10.1037/0022-006X.74.4.785.

    Article  PubMed  Google Scholar 

  42. Pendley JS, Kasmen LJLJ, Miller DLDL, Donze J, Swenson C, Reeves G, et al. Peer and family support in children and adolescents with type 1 diabetes. J Pediatr Psychol. 2002;27:429–38.

    Article  Google Scholar 

  43. Greco P, Shroff Pendley J, McDonnell K, Reeves G. A peer group intervention for adolescents with type 1 diabetes and their best friends. Soc Pediatr Psychol. 2001;26:485–90.

    CAS  Article  Google Scholar 

  44. Kyngäs H. Compliance of adolescents with diabetes. J Pediatr Nurs. 2000;15:260–7. https://doi.org/10.1053/jpdn.2000.6169.

    Article  PubMed  Google Scholar 

  45. Pihlaskari AK, Wiebe DJ, Troxel NR, Stewart SM, Berg CA. Perceived peer support and diabetes management from adolescence into early emerging adulthood. Health Psychol. 2018;37:1055–8. https://doi.org/10.1037/hea0000662.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Bearman KJ, La Greca AM. Assessing friend support of adolescents’ diabetes care: the diabetes social support questionnaire-friends version. J Pediatr Psychol. 2002;27:417–28.

    Article  Google Scholar 

  47. Thomas AM, Peterson L, Goldstein D. Problem solving and diabetes regimen adherence by children and adolescents with IDDM in social pressure situations: a reflection of normal development. J Pediatr Psychol. 1997;22:541–61.

    CAS  Article  Google Scholar 

  48. Smith JA. Semi-structured interviewing and qualitative analysis. In: Smith JA, Harre R, Van Langenhove L, editors. Rethinking methods in psychology. London: Sage; 1995. p. 9–27.

    Google Scholar 

  49. Creswell JW, Plano Clark VL. Choosing a mixed methods design. In: Designing and conducting mixed methods research. 2nd ed. Thousand Oaks: Sage; 2011. p. 53–107.

    Google Scholar 

  50. Ando H, Cousins R, Young C. Achieving saturation in thematic analysis: development and refinement of a codebook. Compr Psychol. 2014; 3:03–CP.

  51. La Greca AM, Auslander WF, Greco P, Spetter D, Fisher E, Santiago J. I get by with a little help from my family and friends: adolescents’ support for diabetes care. J Pediatr Psychol. 1995;20:449–76.

    Article  Google Scholar 

  52. Malik JA, Koot HM. Assessing diabetes support in adolescents: factor structure of the Modified Diabetes Social Support Questionnaire (M-DSSQ-family). Pediatr Diabetesiabetes. 2011;12:258–65. https://doi.org/10.1111/j.1399-5448.2010.00691.x.

    Article  Google Scholar 

  53. Kitzinger J. Qualitative research: introducing focus groups. Bmj. 1995;311:299–302. https://doi.org/10.1136/bmj.311.7000.299.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  54. Braun V, Clarke V. Using thematic analysis in psychology. 2006. https://doi.org/10.1191/1478088706qp063oa.

  55. Bolger N, Zuckerman A, Kessler RC. Invisible support and adjustment to stress. J Pers Soc Psychol. 2000;79:953–61. https://doi.org/10.1037//0022-3514.79.6.953.

    CAS  Article  PubMed  Google Scholar 

  56. Howland M, Simpson JA. Getting in under the radar: a dyadic view of invisible support. Psychol Sci. 2010;21:1878–85. https://doi.org/10.1177/0956797610388817.

    Article  PubMed  Google Scholar 

  57. Charmaz K. Loss of self: a fundamental form of suffering in the chronically ill. Sociol Health Illn. 1983;5:168.

    CAS  Article  Google Scholar 

  58. Charmaz K. The body, identity, and self: adapting to impairment. Sociol Q VO. 1995;36:657.

    Article  Google Scholar 

  59. Glasgow RE, Toobert DJ, Gillette CD. Psychosocial barriers to diabetes self-management and quality of life. Diabetes Spectr. 2001;14:33–41.

    Article  Google Scholar 

  60. Borus JS, Laffel L. Adherence challenges in the management of type 2 diabetes in adolescents: prevention and intervention. Curr Opin Pediatr. 2010;22:405–11.

    Article  Google Scholar 

  61. Gillibrand R, Stevenson J. The role of partner relationships in the young person’s adherence to the diabetes self-care regime. Int J Behav Med. 2007;14:151–5. https://doi.org/10.1007/BF03000186.

    Article  PubMed  Google Scholar 

  62. Peyrot M, Rubin R, Lauritzen T, Snoek F, Matthews D, Skovlund S. Psychosocial problems and barriers to improved diabetes management: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study. Diabetes Care. 2005;28:2673–9. https://doi.org/10.1111/j.1464-5491.2005.01644.x.

    Article  PubMed  Google Scholar 

  63. Croom A, Wiebe DJ, Berg CA, Lindsay R, Donaldson D, Foster C, et al. Adolescent and parent perceptions of patient-centered communication while managing type 1 diabetes. J Pediatr Psychol. 2011;36:206–15. https://doi.org/10.1093/jpepsy/jsq072.

    Article  PubMed  Google Scholar 

  64. Hernandez-Tejada MA, Campbell JA, Walker RJ, Smalls BL, Davis KS, Egede LE. Diabetes empowerment, medication adherence and self-care behaviors in adults with type 2 diabetes. Diabetes Technol Ther. 2012;14:120423110411000. https://doi.org/10.1089/dia.2011.0287.

    Article  Google Scholar 

  65. National Institute for Health and Care Excellence. NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 2015.

  66. Buchbinder MH, Detzer MJ, Welsch RL, Christiano AS, Patashnick JL, Rich M. Assessing adolescents with insulin-dependent diabetes mellitus: a multiple perspective pilot study using visual illness narratives and interviews. J Adolesc Heal Off Publ Soc Adolesc Med. 2005;36:71.e9–13.

    Google Scholar 

  67. Doe E. An analysis of the relationships between peer support and diabetes outcomes in adolescents with type 1 diabetes. J Health Psychol. 2018;23:1356–66. https://doi.org/10.1177/1359105316656228.

    Article  PubMed  Google Scholar 

  68. Anderson BJ, Wolf FM, Burkhart MT, Cornell RG, Bacon GE. Effects of peer-group intervention on metabolic control of adolescents with IDDM. Randomized outpatient study. Diabetes Care. 1989;12:179–83.

    CAS  Article  Google Scholar 

  69. Grey M. Interventions for children with diabetes and their families. Annu Rev Nurs Res. 2000;18:149–70.

    CAS  Article  Google Scholar 

  70. Lu Y, Pyatak EA, Peters AL, Wood JR, Kipke M, Cohen M, et al. Patient perspectives on peer mentoring: type 1 diabetes management in adolescents and young adults. Diabetes Educ. 2014;41:59–68. https://doi.org/10.1177/0145721714559133.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  71. Grey M, Boland EA, Davidson M, Li J, Tamborlane WV. Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. J Pediatr. 2000;137:107–13. https://doi.org/10.1067/mpd.2000.106568.

    CAS  Article  PubMed  Google Scholar 

  72. Swann WB, Jetten J, Gómez Á, Whitehouse H, Bastian B. When group membership gets personal: a theory of identity fusion. Psychol Rev. 2012;119:441–56. https://doi.org/10.1037/a0028589.

    Article  PubMed  Google Scholar 

  73. Sani F, Herrera M, Wakefield JRH, Boroch O, Gulyas C. Comparing social contact and group identification as predictors of mental health. Br J Soc Psychol. 2012;51:781–90. https://doi.org/10.1111/j.2044-8309.2012.02101.x.

    Article  PubMed  Google Scholar 

  74. Schur HV, Gamsu DS, Barley VM. The young person’s perspective on living and coping with diabetes. J Health Psychol. 1999;4:223–36. https://doi.org/10.1177/135910539900400215.

    CAS  Article  PubMed  Google Scholar 

  75. Meijer SA, Sinnema G, Bijstra JO, Mellenbergh GJ, Wolters WH. Peer interaction in adolescents with a chronic illness. Pers Individ Dif. 2000;29:799–813. https://doi.org/10.1016/S0191-8869(99)00233-0.

    Article  Google Scholar 

  76. Helgeson VS, Mascatelli K, Seltman H, Korytkowski M, Hausmann LR. Implications of supportive and unsupportive behavior for couples with newly diagnosed diabetes. Health Psychol. 2016;35:1047.

    Article  Google Scholar 

  77. Lancaster BM, Pfeffer B, McElligott M, Ferguson AT, Miller M, Wallace D, et al. Assessing treatment barriers in young adults with type 1 diabetes. Diabetes Res Clin Pract. 2010;90:243–9.

    Article  Google Scholar 

  78. Allen D, Channon S, Lowes L, Atwell C, Lane C. Behind the scenes: the changing roles of parents in the transition from child to adult diabetes service. Diabet Med. 2011;28:994–1000. https://doi.org/10.1111/j.1464-5491.2011.03310.x.

    CAS  Article  PubMed  Google Scholar 

  79. Ritholz MD, Wolpert H, Beste M, Atakov-Castillo A, Luff D, Garvey KC. Patient-provider relationships across the transition from pediatric to adult diabetes care: a qualitative study. Diabetes Educ. 2013;40:40–7. https://doi.org/10.1177/0145721713513177.

    Article  PubMed  Google Scholar 

  80. Dickinson JK, O’Reilly MM. The lived experience of adolescent females with type 1 diabetes. Diabetes Educ. 2004;30:99–107.

    Article  Google Scholar 

  81. Peters LWH, Nawijn L, van Kesteren NMC. How adolescents with diabetes experience social support from friends: two qualitative studies. Scientifica (Cairo). 2014;2014:415849. https://doi.org/10.1155/2014/415849.

    Article  Google Scholar 

  82. Karlsson A, Arman M, Wikblad K. Teenagers with type 1 diabetes — a phenomenological study of the transition towards autonomy in self-management. Int J Nurs Stud. 2008;45:562–70. https://doi.org/10.1016/j.ijnurstu.2006.08.022.

    Article  PubMed  Google Scholar 

  83. Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC, et al. Adolescence: a foundation for future health. Lancet. 2012;379:1630–40. https://doi.org/10.1016/S0140-6736(12)60072-5.

    Article  PubMed  Google Scholar 

  84. Bukatko D. Child and adolescent development: a chronological approach. San Francisco: Houghton Mifflin; 2007.

    Google Scholar 

  85. Chao A, Whittemore R, Minges KE, Murphy KM, Grey M. Self-management in early adolescence and differences by age at diagnosis and duration of type 1 diabetes. Diabetes Educ. 2014;40:167–77. https://doi.org/10.1177/0145721713520567.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Austin S, Senecal C, Guay F, Nouwen A, Senécal C, Guay F, et al. Effects of gender, age, diabetes duration on dietary self-care in adolescents with type 1 diabetes: a self-determination theory perspective. J Health Psychol. 2011;16:917–28. https://doi.org/10.1177/1359105310396392.

    Article  PubMed  Google Scholar 

  87. Matziou V, Tsoumakas K, Vlahioti E, Chrysicopoulou L, Galanis P, Petsios K, et al. Factors influencing the quality of life of young patients with diabetes. J Diabetes. 2011;3:82–90. https://doi.org/10.1111/j.1753-0407.2010.00106.x.

    Article  PubMed  Google Scholar 

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Acknowledgements

My deepest thanks go to Dr. Stuart Allen, Dr. Mary Dobson, and Prof Jörg Huber for their support and advice throughout this research.

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    Emily Mattacola

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The University of Northampton, UK, sponsored the research as an open scholarship, and had no contribution to the study conception, design, acquisition, analysis or interpretation of the data.

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Mattacola, E. “They Think It’s Helpful, but It’s Not”: a Qualitative Analysis of the Experience of Social Support Provided by Peers in Adolescents with Type 1 Diabetes. Int.J. Behav. Med. 27, 444–454 (2020). https://doi.org/10.1007/s12529-020-09878-5

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Keywords

  • Adolescent
  • Diabetes
  • Social support
  • Peer
  • Qualitative