Assessment of coping in adults with type 1 diabetes

The development of Type 1 diabetes has a profound impact on many aspects of everyday life, health and well-being. In this thesis the literature relevant to different aspects coping with Type 1 diabetes is reviewed. The research described in the thesis includes (i) a prospective assessment of how psychosocial factors affect diabetes-related outcomes in adults following the onset of Type 1 diabetes, (ii) qualitative analysis of interviews that were conducted to explore the patient's perspective of what it means to cope with diabetes, and (iii) the development, pilot testing, and subsequent partial validation of a diabetes-specific questionnaire. The Edinburgh Prospective Diabetes Study examines the relationships between psychosocial variables recorded at diagnosis and diabetes related outcomes recorded at four months (n = 69), 12 months (n = 65), 24 months (n = 56) and 36 months (n = 40) after diagnosis. The results showed that individuals who had a lower socio-economic status had consistently poorer glycaemic control at 24 months (p < 0.001) and at 36 months (p < 0.01) after diagnosis. Diabetes knowledge at four months after diagnosis was a significant predictor of glycaemic control at 12 months (r= 0.35, p < 0.01) and at 36 months after diagnosis (r = 0.35, p < 0.05). In adults, self-reported outcomes were significantly predicted by longstanding psychological (e.g. personality traits) and social factors (e.g. quality of life). There was some evidence to suggest that coping strategies have an intermediate position between psychosocial factors and diabetes-related outcomes. The results and their implications for future research are discussed in terms of existing theories of coping. To date there are few psychometrically sound instruments capable of assessing how well a person is coping with their diabetes. With this in mind, the present research was undertaken to develop a new diabetes self-report measure termed the Diabetes Impact, Adjustment and Lifestyle Scales (DIALS). The development, pilot testing and partial validation of the DIALS are described. Semi-structured interviews (n = 1 0) were conducted to explore the patients' descriptions of their adjustment to diabetes and the impact that diabetes has on aspects of their daily life. A grounded theory approach (Strauss, 1987) was adopted to analyse the data. Several domains were established, from which items were generated. Two studies, a small pilot study (n =57), and a large cross-sectional validation study (n = 246) were carried out to establish the underlying structure, internal consistency, partial validity, and stability of the DIALS. Principal components analysis of the DIALS identified five dimensions: Impact, Adherence, Information-seeking, Fear of complications and Diabetes-related distress. Overall, the results suggest that the DIALS is a valid, reliable and stable indicator of coping in adults with Type 1 diabetes. A hierarchal model of causal relationships between psychological constructs (i.e. personality traits and illness-related coping constructs) and the DIALS was formulated and tested formally using Structural Equation Modelling. There was considerable overlap in the constructs, with evidence for two latent variables relating to 'emotionoriented' and 'task-oriented coping'. In summary, coping variables may be important mediators in the link between antecedent variables such as longstanding character traits (e.g. personality) and self-reported outcomes of diabetes.