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Court RJ, Swallow V, El-Yousfi S, Gray-Burrows K, Sotir F, Wheeler G, Kellar I, Lee JM, Mitchell R, Mlynarczyk W, Ramavath A, Dimitri P, Phillips B, Prodgers L, Pownall M, Kowalczyk M, Branchflower J, Powell L, Bhanbhro S, Weighall A, Martin-Kerry J. Children and young people's preferences and needs when using health technology to self-manage a long-term condition: a scoping review. Arch Dis Child 2024:archdischild-2023-326044. [PMID: 39142825 DOI: 10.1136/archdischild-2023-326044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/27/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND The use of patient-facing health technologies to manage long-term conditions (LTCs) is increasing; however, children and young people (CYP) may have preferences about health technologies which they interact or engage with, that influence their decision to use these technologies. AIMS To identify CYP's reported preferences about health technologies to self-manage LTCs. METHODS We undertook a scoping review, searching MEDLINE, PsycINFO and CINAHL in July 2021. Searches were limited to papers published between January 2015 and July 2021. We included any health technologies used to manage physical and mental LTCs. Qualitative content analysis of study data was undertaken to categorise data into themes and quantitative data were described and visually represented. We engaged CYP with LTCs to support the review design, interpretation of findings and development of recommendations. RESULTS 161 journal articles were included, describing preferences of CYP. Most included studies were undertaken in high-income countries. CYP's main preferences and needs were: design and functionality; privacy and sharing; customisation and personalisation of the technology; and interaction options within the technology. CONCLUSIONS This review highlights important preferences and needs that CYP may have before using technologies to self-manage their LTC. These should be considered when developing technology for this population. Future research should involve CYP throughout the development of the technologies, from identifying their unmet needs through to final design, development, evaluation and implementation of the intervention.
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Affiliation(s)
- Rosemary Jane Court
- Nursing and Midwifery, Sheffield Hallam University College of Health Wellbeing and Life Sciences, Sheffield, UK
| | - Veronica Swallow
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Sarab El-Yousfi
- School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - Kara Gray-Burrows
- School of Dentistry, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Fiona Sotir
- School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - Gemma Wheeler
- NIHR MedTech & In Vitro Diagnostics Co-operative Sheffield Children's Hospital, NIHR Sheffield CRF, Sheffield, UK
| | - Ian Kellar
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Jia Mang Lee
- Hull York Medical School, University of York, York, UK
| | - Robyn Mitchell
- Patient and Public Involvement (PPI) Group Member, University of York, York, UK
| | - Wiktoria Mlynarczyk
- Patient and Public Involvement (PPI) Group Member, University of York, York, UK
| | - Arnav Ramavath
- Patient and Public Involvement (PPI) Group Member, University of York, York, UK
| | - Paul Dimitri
- NIHR Children and Young People MedTech Cooperative, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Bob Phillips
- Leeds Children's Hospital, Leeds, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lucy Prodgers
- School of Psychology, University of Leeds, Leeds, UK
| | | | | | - Jacob Branchflower
- NIHR MedTech & In Vitro Diagnostics Co-operative Sheffield Children's Hospital, NIHR Sheffield CRF, Sheffield, UK
| | - Lauren Powell
- School of Education, The University of Sheffield, Sheffield, UK
| | - Sadiq Bhanbhro
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Anna Weighall
- School of Education, The University of Sheffield, Sheffield, UK
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Wu Y, Long TX, Huang J, Zhang Q, Forbes A, Li MZ. Delivering a Smartphone Serious Game-Based Intervention to Promote Resilience for Adolescents With Type 1 Diabetes: A Feasibility Study. J Pediatr Health Care 2024:S0891-5245(24)00139-1. [PMID: 38935014 DOI: 10.1016/j.pedhc.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION The aim of this study is to test the feasibility of a smartphone serious game-based intervention to promote resilience for adolescents with type 1 diabetes mellitus (T1DM). METHOD A two-arm feasibility study was employed. Adolescents with T1DM were recruited. Adolescents in intervention group completed the serious game (named "WeCan") in one month. We evaluated feasibility and acceptability using criteria such as the recruitment response rate, the follow-up response rate, and satisfaction. RESULTS Sixty-one adolescents with T1DM were included in this study. The study had a recruitment response rate of 62.89% (61/97) and an intervention completion rate of 64.52% (20/31). Eighty-two percent of the adolescents were satisfied with WeCan, which they perceived to have the advantages of being a lively format, attractive, and privacy, easy to operate, and improved attitude towards diabetes. CONCLUSIONS These findings suggest that WeCan demonstrated good feasibility among the target population. However, the efficacy of health-related outcomes needs to be clarified in future studies.
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Babbott KM, Serlachius A. Developing digital mental health tools for youth with diabetes: an agenda for future research. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1227332. [PMID: 37497385 PMCID: PMC10367007 DOI: 10.3389/fcdhc.2023.1227332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023]
Abstract
Youth living with diabetes face a concurrent challenge: managing a chronic health condition and managing the psychosocial and developmental changes that are characteristic of adolescence and young adulthood. Despite these unique challenges, psychological support is often difficult for youth with diabetes to access due to a lack of trained mental health professionals and other resource constraints. Digital wellbeing tools offer the potential to improve access to psychological support for this population. However, very few digital wellbeing tools exist for youth with diabetes. Of those that do exist, very few are evidence-based therapies, undermining their contribution to the field. Given the increasing global prevalence of diabetes in young people, the support necessitated by the challenges experienced by this population is not always accessible in a face-to-face setting and cannot be effectively scaled to meet demand. To support the health and wellbeing of youth with diabetes, there is a clear need to develop digital interventions that are widely accessible to users, but, more saliently, grounded in empirical evidence that supports their efficacy. Thus, the purpose of this paper is to offer an agenda for future research, including insights into which psychological techniques and behavioral change theories may be a good conceptual fit for digital mental health interventions, and how these tools may be best developed and utilized by the individuals that need them. Scalable, evidence-based wellbeing tools for this population are urgently required to improve psychological outcomes, and potentially, improve the equity of service access.
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Racey M, Whitmore C, Alliston P, Cafazzo JA, Crawford A, Castle D, Dragonetti R, Fitzpatrick-Lewis D, Jovkovic M, Melamed OC, Naeem F, Senior P, Strudwick G, Ramdass S, Vien V, Selby P, Sherifali D. Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review. JMIR Diabetes 2023; 8:e44652. [PMID: 37159256 DOI: 10.2196/44652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/23/2023] [Accepted: 04/01/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND For individuals living with diabetes and its psychosocial comorbidities (eg, depression, anxiety, and distress), there remains limited access to interprofessional, integrated care that includes mental health support, education, and follow-up. Health technology, broadly defined as the application of organized knowledge or skill as software, devices, and systems to solve health problems and improve quality of life, is emerging as a means of addressing these gaps. There is thus a need to understand how such technologies are being used to support, educate, and help individuals living with co-occurring diabetes and mental health distress or disorder. OBJECTIVE The purpose of this scoping review was to (1) describe the literature on technology-enabled integrated interventions for diabetes and mental health; (2) apply frameworks from the Mental Health Commission of Canada and World Health Organization to elucidate the components, type, processes, and users of technology-enabled integrated interventions for diabetes and mental health; and (3) map the level of integration of interventions for diabetes and mental health. METHODS We searched 6 databases from inception to February 2022 for English-language, peer-reviewed studies of any design or type that used technology to actively support both diabetes and any mental health distress or disorder in succession or concurrently among people with diabetes (type 1 diabetes, type 2 diabetes, and gestational diabetes). Reviewers screened citations and extracted data including study characteristics and details about the technology and integration used. RESULTS We included 24 studies described in 38 publications. These studies were conducted in a range of settings and sites of care including both web-based and in-person settings. Studies were mostly website-based (n=13) and used technology for wellness and prevention (n=16) and intervention and treatment (n=15). The primary users of these technologies were clients and health care providers. All the included intervention studies (n=20) used technology for clinical integration, but only 7 studies also used the technology for professional integration. CONCLUSIONS The findings of this scoping review suggest that there is a growing body of literature on integrated care for diabetes and mental health enabled by technology. However, gaps still exist with how to best equip health care professionals with the knowledge and skills to offer integrated care. Future research is needed to continue to explore the purpose, level, and breadth of technology-enabled integration to facilitate an approach to overcome or address care fragmentation for diabetes and mental health and to understand how health technology can further drive the scale-up of innovative integrated interventions.
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Affiliation(s)
- Megan Racey
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Carly Whitmore
- School of Nursing, McMaster University, Hamilton, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Paige Alliston
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
| | - Joseph A Cafazzo
- Healthcare Human Factors, University Health Network, Toronto, ON, Canada
- eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David Castle
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - Milos Jovkovic
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
| | - Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Farooq Naeem
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Peter Senior
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Seeta Ramdass
- Diabetes Action Canada, Toronto, ON, Canada
- McGill University, Montreal, QC, Canada
| | - Victor Vien
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Diana Sherifali
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
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Boggiss AL, Consedine NS, Hopkins S, Silvester C, Jefferies C, Hofman P, Serlachius AS. A Self-Compassion Chatbot to Improve the Wellbeing of Adolescents with Type 1 Diabetes During the COVID-19 Pandemic: What do Adolescents and their Healthcare Professionals Want? JMIR Diabetes 2023; 8:e40641. [PMID: 36939680 PMCID: PMC10166132 DOI: 10.2196/40641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/08/2022] [Accepted: 01/30/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Prior to the coronavirus (COVID-19) pandemic, adolescents with type 1 diabetes (T1D) already experienced far greater rates of psychological distress than their peers. With the pandemic further challenging mental health and increasing the barriers to maintaining optimal diabetes self-management, it is vital this population has access to remotely deliverable, evidence-based interventions to improve psychological and diabetes outcomes. Chatbots, defined as digital conversational agents, offer these unique advantages, as well as the ability to engage in empathetic and personalized conversations 24/7. Building on previous work developing a self-compassion program for adolescents with T1D, a self-compassion chatbot was developed for adolescents with T1D to address these concerns. However, the acceptability and potential clinical usability of a chatbot to deliver self-compassion coping tools to adolescents with T1D remained unknown. OBJECTIVE This qualitative study was designed to evaluate the acceptability and potential clinical utility of a novel self-compassion chatbot (called 'COMPASS') among adolescents aged 12 to 16 years with T1D and their diabetes healthcare professionals. METHODS Potential adolescent participants were recruited from previous participant lists, and online and in-clinic study flyers, whereas healthcare professionals were recruited from clinic emails and diabetes research special interest groups. Qualitative Zoom interviews exploring views on a newly developed self-compassion chatbot were conducted with 19 adolescents (in 4 focus groups), and 11 diabetes healthcare professionals (in 2 focus groups and 6 individual interviews), from March to April 2022. Transcripts were analyzed using directed content analysis to examine the features and content of greatest importance to both groups. RESULTS Adolescents were broadly representation of the youth population living with T1D in Aotearoa (58% female, 68% Aotearoa New Zealand European, 11% Māori). Healthcare professionals represented a range of disciplines including Diabetes Nurse Specialists (n = 3), Health Psychologists (n = 3), Dieticians (n = 3), and Endocrinologists (n = 2). Findings offer early insight into what adolescents with T1D and their healthcare professionals see as shared advantages of COMPASS and desired future additions, such as personalization (mentioned by all 19 adolescents), self-management support (mentioned by 13 of 19 adolescents), clinical utility (mentioned by all 11 healthcare professionals), and breadth and flexibility of tools (mentioned by 10 of 11 healthcare professionals). CONCLUSIONS Early data suggest that a self-compassion chatbot for adolescents with T1D is acceptable, relevant to common difficulties, and offers clinical utility during the COVID-19 pandemic. However, shared desired features amongst both groups, including problem-solving and integration with diabetes technology to support self-management, creating a safe peer-to-peer sense of community, and broadening the representation of different cultures, lived experience stories, and diabetes challenges, could further improve the potential of the chatbot. Based on these findings, the COMPASS chatbot is currently being improved to be tested in a future feasibility study. CLINICALTRIAL
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Affiliation(s)
- Anna Lynette Boggiss
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
| | - Nathan Sacha Consedine
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
| | - Sarah Hopkins
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
| | | | - Craig Jefferies
- Starship Children's Health, Auckland City Hospital, Auckland, NZ
| | - Paul Hofman
- Liggins Institute, University of Auckland, Auckland, NZ
| | - Anna Sofia Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
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Garner K, Boggiss A, Jefferies C, Serlachius A. Digital health interventions for improving mental health outcomes and wellbeing for youth with type 1 diabetes: A systematic review. Pediatr Diabetes 2022; 23:258-269. [PMID: 34913548 DOI: 10.1111/pedi.13304] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 01/20/2023] Open
Abstract
Digital health interventions are a promising alternative to face-to-face psychosocial interventions that may improve psychological outcomes in youth with diabetes. Several reviews have explored the efficacy of digital health interventions for adults and youth with some chronic health conditions; however, their efficacy among youth with type 1 diabetes is not known. This systematic review aims to assess digital health interventions targeting both psychological and physical health outcomes in youth with type 1 diabetes as well as to evaluate study quality and efficacy, and provide directions for future research in this area. Relevant studies were identified through searches conducted in MEDLINE, Embase, APA PsycInfo, Scopus, Cochrane Central, and CINAHL Plus up until February 2021. Studies were included if they were randomized; reported at least one psychological outcome that was assessed at ≥2 time points; included a digital health intervention; and were conducted in youth aged 5 to 25 years with type 1 diabetes. The revised Cochrane risk-of-bias (RoB 2) tool was used to assess risk of bias. Of the 5159 articles found, 15 met the inclusion criteria and were included in the review. Self-efficacy improved in 2 of the 3 studies which assessed self-efficacy; however, no consistent improvements were found for other psychological, behavioral, or physical outcomes. All studies showed some risk of bias concerns. More research is needed to make firm conclusions on the efficacy of digital health interventions for youth with diabetes. More specifically, interventions based on psychological theories are needed and studies of higher quality methodologies.
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Affiliation(s)
- Katie Garner
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Anna Boggiss
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Craig Jefferies
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
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