Health Literacy and Family Factors in the Transition to Adult Care in Adolescents with Type I Diabetes

Health Literacy and Family Factors in the Transition to Adult Care in Adolescents with Type I Diabetes Ellen M. Manegold Successful management of type 1 diabetes (T1DM) in adolescence involves multiple daily tasks, developmental changes, and the expectation of transition to an adult provider. Health literacy is one variable to consider in the context of transition, as studies have demonstrated the correlation of parental health literacy with health behaviors and outcomes, yet not studied adolescent health literacy in T1DM. Family factors (e.g., management responsibility, diabetes-specific family conflict, parental support) also are important to behavior and health outcomes in adolescents with T1DM. Study aims were to: 1) examine the association of adolescent health literacy to transition readiness and health outcome in T1DM; and 2) explore the extent to which family factors serve as moderators in health literacy predicting transition readiness and health outcome. Sixty-five youth and their caregivers completed measures. Results indicated a significant positive correlation among health literacy and T1DM knowledge. Higher parental responsibility was significantly correlated with greater written health literacy, greater transition readiness, and fewer parental supportive behaviors. Higher written health literacy was associated with lower family conflict. The relations among health literacy and transition readiness and glycemic control were not significant. No family factors were found to be moderators for health literacy and transition readiness or glycemic control. Given the complex definition of health literacy and dearth of comprehensive validated measures in adolescents, our measures may not have adequately reflected global health literacy in the context of disease management. Future directions include studying additional aspects of health literacy and other variables potentially impacting health behaviors. HEALTH LITERACY AND FAMILY IN T1DM TRANSITION iii Acknowledgements My time at West Virginia University has afforded me the opportunity to work with numerous individuals whose work I admire. Training with my mentor, Christina Duncan, Ph.D., has been a tremendous gift, as she has guided me from day one in learning important professional and personal lessons. I am incredibly grateful for past and present members of the Pediatric Lab for Adherence and Transition who were instrumental in many ways throughout this process. I am indebted to the families at the WVU Medicine Pediatric Endocrinology Clinic for their participation and trust in our research team. Similarly, this project could not have been completed without the support of the medical team, including Brian Ely, MD, Evan Jones, MD, Leah Woodburn, MS, RD, LD, and Daphne Barlow, CDE. Thank you to my committee members, Elisa Krackow, Ph.D., Julie Hicks Patrick, Ph.D., and Pamela Murray, MD, MHP, for their time and expertise on this project. Personally, I am grateful to my parents, Ed and Mary Lou Manegold, for their unwavering support during these past five years. I appreciate the encouragement of my family members and friends, including Jon Stoltman and the StoltFamily, who were invested in this journey. A special thank you to those who called, wrote, and even traveled to visit the mountains and swamp. I share this achievement with all of you. HEALTH LITERACY AND FAMILY IN T1DM TRANSITION iv Table of