medications, which, in turn, was associated
with worse glycemic control. Interestingly,
perceiving family members perform more
diabetes-specific supportive behaviors was
not associated with medication adherence
or glycemic control, and family members’
supportive behaviors co-occurred with
nonsupportive behaviors.
According to qualitative findings, participants
think educating family members
(i.e., providing them with information)
about diabetes may not stop family members
from performing nonsupportive, sabotaging
behaviors. Participants reported
feeling sabotaged by family members who
are well informed about diabetes and its
demands, but are unmotivated to make
changes themselves or help the participant
to make changes. In addition, we found
that “miscarried help,” a concept introduced
in the pediatric diabetes literature
to explain interpersonal conflict that occurs
when a caregiver attempts to supervise an
adolescent’s self-care behaviors (24,25),
may also be relevant to adults with diabetes.
Miscarried helping behaviors are
characterized by an intent to perform supportive
behaviors that infringe upon an individual’s
self-efficacy (24) and lead to
relationship conflict about diabetes that
has been associated with rebellion and
poor health outcomes in adolescents with
the condition (24,25). This construct is distinct
from sabotaging behaviors, in which
family members know that the individual
should perform a healthy behavior, but
encourage the individual to perform an
unhealthy behavior. Moreover, overly solicitous
behaviors are associated with
lower self-reported diabetes self-efficacy
and less physical activity, even when people
with diabetes perceive these behaviors
as helpful (26). Thus, family members
who are too involved in diabetes management
can create conflict and undermine an
individual’s success at performing diabetes
self-care activities. In our study, participants
reported both receiving unappreciated
help from family members and
performing nagging or threatening behaviors
to encourage self-care behaviors
in their other family members who have
diabetes. This evidence, although preliminary,
presents an area for further research.
There are several limitations associated
with this study. Participants were recruited
from a single site and self-selected to
attend a focus group and/or complete the
survey, thereby limiting the generalizability
of our results. In addition, the parent study
was designed with different foci, so we
did not prevent family members with a