“My friends make it feel like I'm the same”: A qualitative study of psychosocial and peer factors in adolescent self-management of chronic conditions

Background

Adolescents with chronic conditions are at risk for poor health outcomes related to unsuccessful self-management. Additionally, the existing literature suggests that youth with chronic conditions are also at risk for experiencing difficulties in their social and peer relationships. However, the influence of peers and other psychosocial factors on self-management remains poorly understood.

Objective

To describe the interaction between psychosocial and peer relationship factors and self-management behaviors among adolescents with chronic conditions to identify targets for intervention.

Design/Methods

We recruited adolescents (12–17 years) with $\ge 1$ chronic condition from a single children's hospital. We conducted semi-structured interviews which were transcribed and independently coded by 2 researchers. An iterative codebook guided content analysis and coders meet weekly to resolve discrepancies.

Results

24 adolescents with a range of chronic conditions participated (54 % female, 21 % Black, 13 % Asian, 67 % White, 17 % Hispanic/Latin; mean age 14 years). The overarching theme: Self-management in the Context of Psychosocial Health was characterized by six subthemes: 1) multidimensional support needs, 2) feeling socially excluded, targeted and misunderstood, 3) fitting in versus standing out, 4) to share or not to share, 5) taking care of myself, and 6) “they know what you're going through”.

Conclusions

Across chronic conditions, peer interactions were complex; negative peer interactions contributed to poor psychosocial health outcomes (i.e., isolation) while positive interactions served as protective factors for self-management. Ownership and acceptance of their diagnosis both influenced and was influenced by an adolescent's relationships with their peers. Peer support was identified as a potential target to improve self-management.