Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Melanie K. Bean, Ph.D.

Second Advisor

Rosalie Corona, Ph.D.


Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses. Glycemic control among patients with T1D often deteriorates during adolescence; yet little is known about the most effective way for providers to communicate with adolescents to prevent this decline. Given the importance of effective communication, examination of effective patient-provider communication strategies is needed. The current investigation used Motivational Interviewing (MI) as a framework to help characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined the relations between provider communication and T1D self-management and control.

Participants were five pediatric endocrine providers and 55 adolescents with T1D (49% female; 76% White; M age= 14.8 years, SD= 1.6). Mean T1D duration was 7.9 years (SD= 3.9) and mean baseline HbA1c was 8.58% (SD= 1.4). Adolescents and caregivers completed surveys related to diabetes self-management and psychosocial functioning at a routine endocrinology visit and again at one and three months post-baseline. Medical encounters were audio-recorded and coded. HbA1c was obtained via medical chart review at baseline, three, and six month appointments.

Hierarchical multiple regressions revealed that, after controlling for prior MI training (providers) and adolescent baseline HbA1c, age, and race, use of MI non-adherent behavior (e.g., confronting, persuading) was associated with 1) poorer three month HbA1c, F(5,45)= 11.19, p < .001; R2 = .554 and 2) worse adolescent diabetes adherence, F(5, 46)= 9.86, p < .001; R2= .517. MI non-adherent behavior emerged as a significant predictor in each model, t(45)= 2.13,p = .038, β = .242 and t(46) = -2.39, p= .021, β= -.300, respectively. A mediation analysis determined that patient self-efficacy for diabetes self-management mediated the relation between the use of these MI non-adherent behaviors and lower diabetes adherence.

In TalkT1me, providers’ overreliance on persuasion and confronting adolescents about the risks of non-adherence was paradoxically associated with poorer glycemic control and adherence. Certain communication techniques that are inconsistent with MI, like confronting or persuading, appear to have a negative impact on diabetes self-care and HbA1c. Results from this evaluation of naturally occurring communication can help guide targeted training efforts to enhance communication and improve diabetes self-care with these vulnerable patients.


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