ESPE Abstracts

Background: Psychological characteristics of patients with type 1 diabetes mellitus (DM1) factor significantly into the effectiveness of disease self-control training. An important part of I-concept of child with DM1, along with internal picture of disease, is internal picture of health (IPH). IPH is an individual’s special attitude towards his/her health, represented by recognizing its value and taking active and positive effort to improve it.

Objective and hypotheses: To determine the nature of changes in internal picture of health while teaching self-control of the disease to adolescents with DM1.

Method: in 157 children 4–18 years old (84 girls and 73 boys) with DM1 a research of IPH was conducted before and after the self-control training cycle (3 months), using psycho-semantical method (content-analysis of mini-essay: «My health»). Structural components (behaviour, self-assessment, values, emotions, will, interpersonal relations, etc.) and dynamic characteristics (desire to preserve and maintain health, disease presence denial, destructive behaviour, etc.) were defined.

Results: Among the hierarchy of structure and content components of IPH in adolescents with DM1, both before and after training, the top three are self-assessment, behavioral and cognitive-declarative components. After the exercise, faith and hope for cure component moved up to the 4^th place, previously held by control component. One half of teens displayed lack of defined locus of control, while the other half displayed dominating internal locus of health control, understanding that health depends on one’s own efforts. Therapeutic studies with adolescents with DM1 led to decreased percentage of patients with ambivalent position (from 63 to 11%) and increased percentage of children whod is closed IPH, concerning only the pole of health (from 31 to 78%), meaning reduced fixation on disease. These changes of IPH were accompanied by improved metabolic compensation, seen in indicators H_BA1C (from (9.80±0.02)% to (8.14±0.13)%, P<0.05).

Conclusion: While teaching self-control to adolescents with DM1 it is necessary to give attention to the formation of such IPH components as control, faith in cure, motivation and will. Formation of internal locus for one’s health control while teaching self-control to adolescents with DM1 determines the efficiency of treatment of disease.