Knowledge And Skills

It would seem natural to assume that knowledge of diabetes and its management, and competence in the accompanying injection, glucose monitoring and problem-solving skills are important determinants of patients' self-management behaviour and control of their diabetes. A series of meta-analyses and reviews consistently demonstrate that knowledge is predictive of better self-care and control13-16, but the strength of the association is relatively modest, with standardized ¿6 coefficients ranging from 0.14 to 0.41. However, it should be noted that the association between knowledge skills and adherence is notably higher for adolescents than for adults, (r = 0.41 and r = 0.15 respectively16). Why this should be the case is unclear, with several conflicting explanations possible, which warrant further investigation.

Regardless of this finding, despite the abundance of education at diagnoses, it should be remembered that the emotional upheaval experienced at this time may also serve to prevent retention of knowledge. Furthermore, for those diagnosed in childhood, the vast majority of education is targeted at the parents, with a formal programme of education for adolescents being the rare exception rather than the rule. We also cannot assume that parental knowledge, skills and experience will automatically be transferred to the growing child, or that parents always have the depth of knowledge and understanding necessary for them to educate their child.

That education and skills training may well succeed in making the individual more skilled and knowledgeable is not disputed, but this does not in itself guarantee changes in the individual's behaviour and control of his/her diabetes, an issue that is frequently not considered. For example some researchers have assumed that poor self-care may be the result of adolescents lacking the skills necessary to deal with the social consequences of managing their diabetes appropriately. This resulted in interventions geared at improving adolescents' social/stress management skills17-20. However, in only one of these studies19 did the intervention have a significant impact on diabetes control. Although the lack of significant results in these studies may be attributable to a number of methodological factors, it may well be that a lack of social skills is not the issue.

Thomas and colleagues21 assessed the problem-solving skills in social situations of adolescents with diabetes. Despite the fact that the young people could generate a range of solutions to the dilemmas posed, they deliberately chose less regimen-adherent and more peer-acceptable actions. This suggests that the adolescents did not lack the social/stress management skills necessary to manage their diabetes appropriately, they consciously chose not to use them. This is further supported by data indicating that young people with the greatest social skills actually had the poorest control of their diabetes19. This suggests that although diabetes knowledge and skills are necessary for good diabetes management, there are no guarantees that this knowledge and skill will be utilized by the adolescent. However, it should never be assumed that adolescents have the requisite skills and knowledge for successful diabetes management. As a result, ensuring adolescents have adequate knowledge and problem-solving skills should be a fundamental first step in any programme of adolescent diabetes care or intervention for adolescents23'24.

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