SITUATIONAL OBSTACLES TO ADHERENCE FOR ADOLESCENTS WITH DIABETES

Twenty adolescents with insulin-dependent diabetes mellitus were inter viewed to obtain samples of problem situations that create obstacles t o dietary adherence. The resulting 57 situations were analyzed using a reliable coding system to determine the presence or absence of 28 sti mulus features. A hierarchical cluster analysis was used to identify 1 0 relatively homogeneous categories of obstacles to dietary adherence: being tempted to stop trying; negative emotional eating; facing forbi dden foods; peer interpersonal conflict; competing priorities; eating at school; social events and holidays; food cravings; snacking when ho me, alone, or bored; and social pressure to eat. Diabetes educators sh ould consider an individual's ability to cope with this array of obsta cles to adherence when individualizing treatment. Dietary intervention then can be personalized to address specific situational obstacles.