Beliefs individuals hold about themselves and their abilities can be categorized into three broad domains; value, capacity and control beliefs. Self-value beliefs, such as self-esteem and self-concept, reflect the way individuals describe or perceive themselves. These beliefs are typically measured using value judgements, self-descriptions or self-discrepancy models. However, these are primarily considered in the literature as indicators of adjustment or emotional well-being, and as such are seen to influence self-care and metabolic control in the same way as these more generic indices.

Self-capacity beliefs refer to individuals' beliefs in their ability to perform a task, and are similar to the concept of confidence. The construct widely used here is self-efficacy, which has been consistently related to adolescents' health behaviour42'62-64, with further studies reporting an association between self-efficacy and measures of metabolic control57'65'66. A further study67 found that adolescents who perceived themselves to have the energy and will power needed to manage their diabetes were in better control. Furthermore, Grey and colleagues68 found that higher self-efficacy was associated with better quality of life, less depression and higher self-esteem.

These studies are all cross-sectional and do not resolve the issue about the direction of causality. Theoretically, with skilled support and education utilizing the principles underlying Bandura's work on enhancing self-efficacy69, and Vygotsky's work on supporting cognitive development70, health care professionals and parents should be able to enhance adolescents' sense of competence and confidence in managing their diabetes.

However, one major barrier to achieving this, especially in adolescents, with the unpredictable effects of growth hormones to be considered, is the apparent lack of immediate response of their blood glucose tests to their self-management efforts. If self-efficacy is to be enhanced, it is essential that health care professionals focus on young people's behaviour, not their blood glucose records or metabolic control. This involves a huge change in habit, as it requires that the consultation is focused on an adolescent's actual behaviour, which means that the adolescent has to be comfortable with being honest and feel that he/she is respected and valued unconditionally71. Added to this change of focus to behaviour rather than physiology, it is equally imperative that health care professionals change their emphasis from the negative, and what has not been done, to the positive, and seek out success in young people, even if 'success' only means that they actually told you they did not do any glucose tests.

Control beliefs refer to individuals' perceptions of the control they have over their life and environment, and can be seen to reflect their beliefs in self-determination, karma or fate. The most commonly used construct in this area is locus of control, which was initially thought of as a continuum, with an internal locus at one end (self-determining) and an external locus at the other end (luck, fate, no control). Using a general measure of locus of control, several studies reported that it was not associated with metabolic control18'65'72'73'76-79. However, more recent developments in this area now consider locus of control along three distinct dimensions, with the external dimension split into the roles of 'powerful others' and 'chance factors', and also highlight the need to measure control perceptions specific to the domain under investigation. In the light of these theoretical developments, researchers have used health and diabetes-specific locus of control questionnaires, but unfortunately, these studies have similarly failed to generate consistent results7'18'81'82'84, although two studies have suggested that greater perceptions of control are related to psychological adjustment86'87.

The failure to find a consistent relationship between perceived control and health outcomes is surprising, considering the results using this construct in adults88'89. However, it should be remembered that adolescence is a developmental period in which young people are being given increasing amounts of responsibility and independence. Their own behavioural responses, therefore, are at times limited by adults, and this may be reflected in their control beliefs. More pragmatically, though, the research in this area has almost exclusively relied on blood glucose control as its dependent variable, where behavioural measures are more relevant. Furthermore, this research has examined only linear associations, when it may be that more realistic beliefs are adaptive for promoting diabetes self-care and control. Believing that everything is under our control, or that everything is due to chance are self-evidently maladaptive beliefs.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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