1
|
Coyne I, Sleath B, Surdey J, Pembroke S, Hilliard C, Chechalk K, Rafferty S, Rogerson S, Hughes M M, Murphy M, Cody D, Roche E. Intervention to promote adolescents' communication and engagement in diabetes clinic encounters: A pilot randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2024; 126:108322. [PMID: 38772095 DOI: 10.1016/j.pec.2024.108322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 04/26/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
AIM To conduct a pilot randomized trial of an intervention to improve adolescent question-asking and provider education during paediatric diabetes visits. METHODS Adolescents aged 11 to 17 with type 1 diabetes and their parents were enrolled from two urban tertiary paediatric clinics. Adolescents were randomised to the intervention group or control group. Adolescent consultations were audio-recorded, their HbA1c level was recorded, and they completed surveys after three clinic appointments. The intervention group completed a question prompt list and watched a video on a tablet with their parents before meeting their doctor and completed a short evaluation after each visit. RESULTS Six consultant endocrinologists and ninety-nine adolescents and their parents participated. The intervention increased adolescents' question asking and provider education in diabetes encounters. Total patient question-asking across the 3 consultations and a higher baseline HbA1c at time one was significantly associated with HbA1c at time three. CONCLUSIONS Question prompt lists and an educational video are useful tools to increase adolescents' question-asking and communication between adolescents and their providers. PRACTICE IMPLICATIONS Interventions that encourage adolescents' question-asking in healthcare encounters may lead to more meaningful providers-adolescents' communication and tailored education. Interventions to improve professionals' listening, communication and educational skills are also required.
Collapse
Affiliation(s)
- I Coyne
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland.
| | - B Sleath
- University of North Carolina at Chapel Hill, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - J Surdey
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - S Pembroke
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - C Hilliard
- Children's Health Ireland, Dublin 8, Ireland
| | - K Chechalk
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - S Rafferty
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - S Rogerson
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - M Hughes M
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - M Murphy
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - D Cody
- Children's Health Ireland, Department of Diabetes and Endocrinology, Crumlin, Dublin 12, Ireland
| | - E Roche
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland; Children's Health Ireland, Department of Endocrinology and Diabetes, Tallaght, Dublin 24, Ireland
| |
Collapse
|
2
|
Saikia M, Lassi ZS, McCall AL. Editorial: Developing strategies to improve diabetes management in college-going young adults. Front Endocrinol (Lausanne) 2024; 15:1402133. [PMID: 38660515 PMCID: PMC11039824 DOI: 10.3389/fendo.2024.1402133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Mridusmita Saikia
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
| | - Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Anthony L. McCall
- University of Virginia School of Medicine, Charlottesville, VA, United States
| |
Collapse
|
3
|
King C, Ridge K, Smyth J, Flinn AM, Leahy TR, Conlon N. Experience of pediatric to adult transition in immunology services: patient experience questionnaire and micro-costing analysis. Front Immunol 2024; 15:1270451. [PMID: 38510252 PMCID: PMC10952820 DOI: 10.3389/fimmu.2024.1270451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
The effective transition from pediatric to adult care for individuals with chronic medical conditions should address the medical, psychosocial and educational needs of the cohort. The views and experiences of service users and their families are an integral component of service development. This study sought to evaluate the current provision of transition services from pediatric immunology services to adult immunology services for patients with a diagnosis of an inborn error of immunity at St. James's Hospital, Dublin. We gathered patient perspectives on the experience of the transition process using a structured survey. In addition, we adopted a micro-costing technique to estimate the cost of implementing the current standard of care for these patients. Results of a micro-costing analysis suggest that the most significant component of cost in assessing these patients is on laboratory investigation, an area where there is likely significant duplication between pediatric and adult care. Perspectives from patients suggested that the transition period went well for the majority of the cohort and that they felt ready to move to adult services, but the transition was not without complications in areas such as self-advocacy and medication management. The transition process may benefit from enhanced communication and collaboration between pediatric and adult services.
Collapse
Affiliation(s)
- Catherine King
- Diagnostic and Clinical Immunology, St. James’s Hospital, Dublin, Ireland
| | - Katie Ridge
- Diagnostic and Clinical Immunology, St. James’s Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - James Smyth
- Finance Department, St. James’s Hospital, Dublin, Ireland
| | - Aisling M. Flinn
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Pediatric Immunology, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Timothy Ronan Leahy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Pediatric Immunology, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Niall Conlon
- Diagnostic and Clinical Immunology, St. James’s Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
4
|
Montilva-Monsalve J, Dimantas B, Perski O, Gutman LM. Barriers and Enablers to the Adoption of a Healthier Diet Using an App: Qualitative Interview Study With Patients With Type 2 Diabetes Mellitus. JMIR Diabetes 2023; 8:e49097. [PMID: 38113087 PMCID: PMC10762608 DOI: 10.2196/49097] [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: 05/17/2023] [Revised: 09/28/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Adopting a healthy diet is one of the cornerstones of type 2 diabetes (T2D) management. Apps are increasingly used in diabetes self-management, but most studies to date have focused on assessing their impact in terms of weight loss or glycemic control, with limited evidence on the behavioral factors that influence app use to change dietary habits. OBJECTIVE The main objectives of this study were to assess the enablers and barriers to adopting a healthier diet using the Gro Health app in 2 patient groups with T2D (patients with recently diagnosed and long-standing T2D) and to identify behavior change techniques (BCTs) to enhance enablers and overcome barriers. METHODS Two semistructured qualitative interview studies were conducted; the first study took place between June and July 2021, with a sample of 8 patients with recently diagnosed (<12 mo) T2D, whereas the second study was conducted between May and June 2022 and included 15 patients with long-standing (>18 mo) T2D. In both studies, topic guides were informed by the Capability, Opportunity, Motivation, and Behavior model and the Theoretical Domains Framework. Transcripts were analyzed using a combined deductive framework and inductive thematic analysis approach. The Behavior Change Wheel framework was applied to identify appropriate BCTs that could be used in future iterations of apps for patients with diabetes. Themes were compared between the patient groups. RESULTS This study identified similarities and differences between patient groups in terms of enablers and barriers to adopting a healthier diet using the app. The main enablers for recently diagnosed patients included the acquired knowledge about T2D diets and skills to implement these, whereas the main barriers were the difficulty in deciding which app features to use and limited cooking skills. By contrast, for patients with long-standing T2D, the main enablers included knowledge validation provided by the app, along with app elements to help self-regulate food intake; the main barriers were the limited interest paid to the content provided or limited skills engaging with apps in general. Both groups reported more enablers than barriers to performing the target behavior when using the app. Consequently, BCTs were selected to address key barriers in both groups, such as simplifying the information hierarchy in the app interface, including tutorials demonstrating how to use the app features, and redesigning the landing page of the app to guide users toward these tutorials. CONCLUSIONS Patients with recently diagnosed and long-standing T2D encountered similar enablers but slightly different barriers when using an app to adopting a healthier diet. Consequently, the development of app-based approaches to adopt a healthier diet should account for these similarities and differences within patient segments to reduce barriers to performing the target behavior.
Collapse
Affiliation(s)
- Jonas Montilva-Monsalve
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Bruna Dimantas
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Olga Perski
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Leslie Morrison Gutman
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| |
Collapse
|
5
|
Vaillancourt M, Mok E, Frei J, Dasgupta K, Rahme E, Bell L, Da Costa D, Nakhla M. Qualitative study exploring the perspectives of emerging adults with type 1 diabetes after transfer to adult care from a paediatric diabetes centre in Montreal, Canada. BMJ Open 2023; 13:e076524. [PMID: 37879699 PMCID: PMC10603410 DOI: 10.1136/bmjopen-2023-076524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Among youth living with type 1 diabetes (T1D), the increasing demands to diabetes self-care and medical follow-up during the transition from paediatric to adult care has been associated with greater morbidity and mortality. Inadequate healthcare support for youth during the transition care period could exacerbate psychosocial risks and difficulties that are common during emerging adulthood. The current investigation sought to explore the post-transfer perceptions of emerging adults living with T1D relating to their transition to adult care. RESEARCH DESIGN AND METHODS Thirty-three emerging adults living with T1D were recruited during paediatric care and contacted for a semistructured interview post-transfer to adult care (16.2±4.2 months post-transfer) in Montreal, Canada. We analysed data using thematic analysis. RESULTS We identified four key themes: (1) varied perceptions of the transition process from being quick and abrupt with minimal advice or information from paediatric healthcare providers (HCP) to more positive including a greater motivation for self-management and the transition being concurrent with the developmental period; (2) facilitators to the transition process included informational and tangible social support from HCPs and family or friends, a positive relationship with adult HCP and a greater ease in communicating with the adult care clinic or adult HCP; (3) barriers to adequate transition included lack of advice or information from paediatric HCPs, loss of support from HCPs and friends or family, the separation of healthcare services and greater difficulty in making appointments with adult clinic or HCP and (4) participants recommendations for improving the transition included increasing the length and frequency of appointments in adult care, having access to educational information, and better transition preparation from paediatric HCPs. CONCLUSIONS The experiences and perceptions of emerging adults are invaluable to guide the ongoing development and improvement of transition programmes for childhood-onset chronic illnesses.
Collapse
Affiliation(s)
| | - Elise Mok
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Jennifer Frei
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Kaberi Dasgupta
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Elham Rahme
- Department of Medicine, McGill University, Montreal, Québec, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Lorraine Bell
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Deborah Da Costa
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Meranda Nakhla
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| |
Collapse
|
6
|
West M, Sidhaye A, Thivierge M, Wolf RM. Development and implementation of a workshop for young adults with diabetes entering college and the workforce. Front Endocrinol (Lausanne) 2023; 14:1288215. [PMID: 37886638 PMCID: PMC10598457 DOI: 10.3389/fendo.2023.1288215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
The process of transitioning from pediatric to adult diabetes care for adolescents and young adults is challenging. This transition period may include many life changes, and can be fraught with worsening glycemic control leading to increased risk for diabetes-related hospitalizations and complications. Research has demonstrated that increased support during this period can help maintain engagement in diabetes care. Transition guidelines highlight the importance of preparation and readiness for transition. In this article, we discuss the development, implementation and content of a workshop for patients and parents/caregivers preparing for the transition to college, the workforce and adult diabetes care.
Collapse
Affiliation(s)
- Margaret West
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aniket Sidhaye
- Department of Medicine, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Meredith Thivierge
- Center for Diabetes and Endocrinology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Risa M. Wolf
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
7
|
Caccavale LJ, LaRose JG, Mazzeo SE, Bean MK. Development and Implementation of a Pilot Transition Preparation Intervention for Young Adults With Type 1 Diabetes in an Integrated Healthcare Setting. J Pediatr Psychol 2023; 48:228-240. [PMID: 36367835 PMCID: PMC10027053 DOI: 10.1093/jpepsy/jsac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility, acceptability, and preliminary efficacy of a multisystem transition preparation intervention, SHIFT, for young adults (YAs) with type 1 diabetes (T1D). METHODS A single-arm, clinic-based pilot was conducted with 25 YAs with T1D (M age = 18.9 ± 1.0 years; 80% female), their parents (n = 25), and their providers (n = 10). Young adults and parents participated in a 6-month intervention designed to enhance transition readiness and independent diabetes management. Providers viewed a video module highlighting their role preparing YAs for transition and received individualized reports of YA's goals and transition readiness. Intervention feasibility (i.e., recruitment, retention, and engagement) and acceptability (e.g., program satisfaction) were assessed. Assessments of transition readiness, diabetes engagement, hemoglobin A1c (HbA1c), and related psychosocial variables were conducted at baseline, post-intervention (6 m), and follow-up (9 m). Paired t-tests examined 0-6 m and 0-9 m changes in study constructs. RESULTS SHIFT was feasible, evidenced by recruitment (100% of sample recruited in 4 m), retention (100% at 6 m), and YA session attendance (100%). Program satisfaction was high for YAs, parents, and providers (9.12 ± 1.40, 8.79 ± 1.56, 8.20 ± 1.30, respectively, [out of 10]). Significant improvements (with effect sizes ranging from small to medium) were observed in parent and YA-reported transition readiness at 6 and 9 m (ps<.05) and diabetes engagement at 9 m (ps<.05). Although based on limited data due to COVID-19-related disruptions, a potential reduction in HbA1c was also observed. CONCLUSION Findings support the feasibility, acceptability, and preliminary efficacy of SHIFT (although limited by the single arm design and homogeneous sample), and suggest a larger randomized controlled trial is warranted.
Collapse
Affiliation(s)
- Laura Jean Caccavale
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Melanie K Bean
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
8
|
Limbert C, Tinti D, Malik F, Kosteria I, Messer L, Jalaludin MY, Benitez-Aguirre P, Biester S, Corathers S, von Sengbusch S, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1243-1269. [PMID: 36537530 DOI: 10.1111/pedi.13417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Catarina Limbert
- Unit of Paediatric Endocrinology and Diabetes, Hospital Dona Estefânia, Lisbon, Portugal.,Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Davide Tinti
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Faisal Malik
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Ioanna Kosteria
- Department of Endocrinology, Growth & Development, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Laurel Messer
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Biester
- Diabetes-Center for Children and Adolescents, Children's Hospital "Auf der Bult", Hannover, Germany
| | - Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Simone von Sengbusch
- Division of Pediatric Endocrinology and Diabetology, Campus Lübeck, University Medical Centre Schleswig-Holstein, Lübeck, Germany
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
9
|
Pembroke S, Cody D, Roche EF, Sleath B, Hilliard C, Brenner M, Coyne I. Encouraging adolescents' participation during paediatric diabetes clinic visits: Design and development of a question prompt list intervention. Diabetes Res Clin Pract 2022; 190:109985. [PMID: 35809690 DOI: 10.1016/j.diabres.2022.109985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
AIMS To investigate adolescents' communication with healthcare providers (HCPs) and co- design a question prompt list as one part of an intervention to increase patient participation and communication at diabetes clinic visits. METHODS Using an adolescent-led co-design approach we conducted interviews and focus groups with adolescents, parents, and healthcare providers (HCPs) and held workshops with both a Youth Advisory Group (YAG) and a Parent Advisory Group (PAG). RESULTS Adolescents and parents identified challenges categorised into four themes: negative experience communicating with HCPs, lacking patient education leading to disinterest, low self-confidence out of fear of being wrong and forgetting to ask question(s). Adolescents identified that a Question Prompt List (QPL) could help them to ask questions, be more confident and participate more. The design process was an iterative development that engaged all stakeholders. Parents and HCPs assumed adolescents had greater knowledge about diabetes than they had in reality. CONCLUSIONS Divergence in perceptions between adults and adolescents regarding patient knowledge of diabetes care demonstrates the importance of encouraging adolescents to ask the questions that matter to them. The QPL could be a useful means of supporting adolescents to actively participate in clinic encounters with healthcare providers.
Collapse
Affiliation(s)
- Sinead Pembroke
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland.
| | - Declan Cody
- Children's Health Ireland Crumlin, Cooley Road, Dublin 12, Ireland
| | - Edna F Roche
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland and Children's Health Ireland, Tallaght, Tallaght, Dublin 24, Ireland
| | - Betsy Sleath
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carol Hilliard
- Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
| | - Maria Brenner
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Imelda Coyne
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland.
| |
Collapse
|
10
|
Betz CL, Mannino JE, Disabato JA, Marner V. Health care transition planning: A potpourri of perspectives from nurses. J SPEC PEDIATR NURS 2022; 27:e12373. [PMID: 35388648 DOI: 10.1111/jspn.12373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Nurses have important roles as members of the healthcare transition (HCT) planning interdisciplinary team. Nursing's scope of practice and framework of care brings a distinctive and complementary approach to this expanding field in pediatric care. It is therefore relevant to better understand the extent to which pediatric nurses are involved with the provision of HCT services and model development. DESIGN AND METHODS This was a qualitative analysis of a national survey of pediatric nurses. A thematic iterative process was used to code data. Three coders separately analyzed responses and then met to compare and discuss until a final list of codes was achieved. The codes were further analyzed until themes and subthemes emerged. Throughout the process, disagreements were discussed and resolved until consensus was achieved. RESULTS A sample of 1814 pediatric nurses and nurse practitioners from two US professional organizations participated in this national survey to gather data on their involvement in HCT planning. This survey contained 17 items, one of which was an open-ended question stating: Is there anything else you would like to share about your role with the population of transitioning youth and young adults with chronic illness and/or disability? The analysis of responses provided by 154 nurses is presented. Initial coding resulted in 11 categories of data. Four major themes, including four subthemes, emerged from the analysis of responses: Support for the need for transition (subtheme: Nursing involvement); Guidance needed for professional practice (subtheme: Types of guidelines and training); Lack of service linkages to adult providers; and Difficulty letting go (two subthemes: Pediatric providers; Parents). PRACTICE IMPLICATIONS These findings indicated strong support for the need of HCT services and the importance of nursing involvement. However, challenges to HCT implementation were identified that include systemic, psychosocial, and educational barriers. As this field of practice and research continues to grow, it is important that pediatric nurses recognize the opportunities to have a clinical voice to develop nurse-led HCT services and programs.
Collapse
Affiliation(s)
- Cecily L Betz
- Department of Pediatrics, USC Keck School of Medicine, Los Angeles, California, USA
| | - Jennifer E Mannino
- Barbara H. Hagan School of Nursing and Health Sciences, Molloy College, New York, USA
| | | | | |
Collapse
|
11
|
Burch AE. Factors responsible for healthcare avoidance among rural adults in the Eastern Region of North Carolina. J Community Health 2022; 47:737-744. [PMID: 35675005 PMCID: PMC9174619 DOI: 10.1007/s10900-022-01106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 10/25/2022]
|
12
|
Ng AH, Pedersen ML, Rasmussen B, Rothmann MJ. Needs of young adults with type 1 diabetes during life transitions - An Australian-Danish experience. PATIENT EDUCATION AND COUNSELING 2022; 105:1338-1341. [PMID: 34544625 DOI: 10.1016/j.pec.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the similarities and differences in the needs of young adults with T1D during life transitions. METHODS Data obtained for this paper was based on three qualitative studies carried out in Denmark and Australia. In total, 33 Individual interviews and two focus groups (n = 46) were conducted. Data was analysed using thematic analysis. RESULTS The most pertinent themes related to the importance of support from peers with diabetes and healthcare professionals to help young adults adjust to independent living. The main difference experienced by Australian and Danish young adults related to the willingness and barriers in clinical attendance during this transitional period. CONCLUSIONS Clinical care for young adults with diabetes can be better adapted to support this population as they transition through significant milestones by engagement on the young adults' terms and encouraging young adults to seek out peer support. It is vital that clinical care is tailored to support them in order to ensure the best transition into adulthood with diabetes. PRACTICE IMPLICATIONS Clinicians need to adopt a person-centred approach when engaging with young adults with diabetes. Considerations need to be made around external factors related to life events in young adulthood that may influence diabetes care.
Collapse
Affiliation(s)
- Ashley H Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | | | - Bodil Rasmussen
- Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, Furlong Road, St Albans 3021 Victoria, Australia; Institute for Transformative Healthcare, Deakin University, Australia; Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Mette J Rothmann
- Steno Diabetes Center Odense, Odense University Hospital, Denmark; Department of Endocrinology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia
| |
Collapse
|
13
|
Cristello Sarteau A, Peerzada A, Goyal A, Praveen PA, Tandon N. Development and design of the first structured clinic-based program in lower resource settings to transition emerging adults with type 1 diabetes from pediatric to adult care. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000665. [PMID: 36962558 PMCID: PMC10021365 DOI: 10.1371/journal.pgph.0000665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Type 1 diabetes (T1D) is increasing in young people worldwide and more children in resource limited settings are living into adulthood. There is a need for rigorous testing and reporting of evidence-based and stakeholder-informed strategies that transition individuals with T1D from pediatric to adult care. We present the development of and design of the first structured transition program in Delhi, India, to inform similar efforts in India and resource limited settings. METHODS The intervention development team included clinicians and researchers with expertise in T1D and the implementation context. To select intervention outcomes, establish intervention targets, and design session modules, we drew upon formative research conducted at prospective intervention implementation sites, consensus guidelines, and previous care transition and behavior change research conducted in developed settings. We used the Template for Intervention Description and Replication and GUIDance for the rEporting of intervention Development checklists to report the intervention and development process. RESULTS The 15-month program ("PATHWAY") includes five quarterly ~30 minute sessions delivered predominantly by diabetes educators at pediatric and adult clinics, which coincide with routine care visits. Primary program components include educational and behavioral sessions that address psychosocial drivers of clinic attendance and self-management, diabetes educators as transition coordinators and counselors, and a one-year "overlap period" of alternating visits between pediatric and adult providers. CONCLUSIONS We followed a systematic and transparent process to develop PATHWAY, which facilitated rich description of intervention context, guiding principles, targets, and components. Dependence on previously published program examples to design PATHWAY may have introduced challenges for program feasibility and effectiveness, underscoring the importance of input gathering from prospective intervention actors at multiple points in the development process. This detailed report in combination with future evaluations of PATHWAY support efforts to increase rigorous development and testing of strategies to improve outcomes among emerging adults with T1D.
Collapse
Affiliation(s)
- Angelica Cristello Sarteau
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ariba Peerzada
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Delhi, India
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Delhi, India
| | - Pradeep A Praveen
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Delhi, India
| |
Collapse
|
14
|
Wolf RA, Haw JS, Martyn KK, Kimble LP. Diabetes Care Provider Perceptions Regarding Emerging Adults' Diabetes Self-Management Influences and Patient-Provider Visit Interactions Within a Safety-Net Hospital. Clin Diabetes 2022; 41:90-101. [PMID: 36714255 PMCID: PMC9845076 DOI: 10.2337/cd21-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The increasing number of emerging adults with diabetes (EAWD) being cared for in adult health care settings requires a better understanding of the needs of EAWD and their interactions with adult health care providers (HCPs). This article describes findings from interviews with endocrinologists and diabetes nurses from a safety-net health care system to investigate HCPs' perspectives regarding influences on EAWD self-management and HCP interactions with EAWD. HCPs frequently perceived lower EAWD engagement in diabetes management, which was complicated by barriers such as the emotional burden of diabetes, busy lives and multiple responsibilities, and limited access to resources; however, HCPs valued the role of information and communication at visits in tailoring care for EAWD. Measures to tailor care should address the psychosocial burden related to the life stage goals and priorities of EAWD, identification of resources for EAWD and HCPs, and further elucidation of effective self-management guidance and communication strategies to support EAWD in safety-net settings.
Collapse
Affiliation(s)
- Rachel A. Wolf
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
- Corresponding author: Rachel Wolf,
| | - J. Sonya Haw
- School of Medicine, Emory University, Atlanta, GA
| | - Kristy K. Martyn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Laura P. Kimble
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| |
Collapse
|
15
|
Morrissey EC, Casey B, Hynes L, Dinneen SF, Byrne M. Supporting self-management and clinic attendance in young adults with type 1 diabetes: development of the D1 Now intervention. Pilot Feasibility Stud 2021; 7:186. [PMID: 34641975 PMCID: PMC8513171 DOI: 10.1186/s40814-021-00922-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/29/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Self-management of type 1 diabetes (T1D) is complex and can be particularly challenging for young adults. This is reflected in the high blood glucose values and rates of clinic non-attendance in this group. There is a gap for a theory-based intervention informed by key stakeholder opinions to support and improve self-management in young adults with T1D. PURPOSE The aim of the work was to systematically co-develop an evidence-based and stakeholder-led intervention to support self-management and clinic engagement in young adults living with T1D in Ireland. Co-development was led by the Young Adult Panel. METHODS The Behaviour Change Wheel was used to guide the development. Five evidence sources were used to inform the process. An iterative co-design process was used with the Young Adult Panel. Initial intervention components were refined and feasibility tested using qualitative methods. RESULTS Environmental restructuring, education and training were selected as appropriate intervention functions. The co-design process, along with qualitative refinement and feasibility work, led to the final intervention content which consisted of 17 behaviour change techniques. The final D1 Now intervention consists of three components: a support worker, an agenda setting tool and an interactive messaging service. CONCLUSIONS The D1 Now intervention is now at pilot evaluation stage. Its transparent and systematic development will facilitate evaluation and future replications.
Collapse
Affiliation(s)
- Eimear C Morrissey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland.
- School of Medicine, National University of Ireland, Galway, Ireland.
| | - Bláthín Casey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lisa Hynes
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Sean F Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| |
Collapse
|
16
|
Pembroke S, Roche EF, Sleath B, Brenner M, Hilliard C, Cody D, Coyne I. Developing a video intervention to improve youth question-asking and provider education during paediatric diabetes clinic encounters: The Promoting Adolescents Communication and Engagement study. PATIENT EDUCATION AND COUNSELING 2021; 104:2170-2176. [PMID: 33640232 DOI: 10.1016/j.pec.2021.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/27/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Research on long-term health conditions indicates that adolescents are not actively involved during their medical visits. Active involvement is essential because this can help adolescents learn how to self-manage their treatment plan. OBJECTIVE To co-design a video intervention to improve youth question-asking and provider education during paediatric diabetes visits. PATIENT INVOLVEMENT A participatory-led approach was used to co-design the video, through a combination of interviews/ focus groups and the establishment of a Youth Advisory Group. METHODS First, focus groups and one-to-one interviews were held with adolescents, parents and healthcare providers. Second, two workshops were held with the Youth Advisory Group, Parent Advisory Group and stakeholders on script design. Finally, an iterative development of the video took place between the research team, videographer, both advisory groups and the steering committee. There were three rounds of feedback before the video was finalised. RESULTS Adolescents' content preferences included: 1) message of empowerment; 2) managing your diabetes so you can get on with the fun stuff in life; 3) Promoting independence; 4) Reasons for not speaking at clinic visits and reassurance; 5) Becoming comfortable to speak and ask questions at clinic visits; 6) Practical advice on how to ask questions. Formatting preferences included that the video should be short, divided into segments, with adolescents with diabetes acting in it, and speaking directly to the camera. DISCUSSION Identifying and reflecting adolescents' needs and preferences for engagement with healthcare providers was critical in the development process. Adolescents' participation in the co-design process was pivotal to the acceptability of the intervention for adolescents with diabetes. PRACTICAL VALUE The intervention may increase adolescents' participation in communication and interactions with healthcare providers, which may help them to be more active in the self-management of their condition.
Collapse
Affiliation(s)
- Sinead Pembroke
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland.
| | - Edna F Roche
- Department of Endocrinology and Diabetes, Children's Health Ireland, Tallaght, Dublin 24, Ireland; School of Medicine, Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Betsy Sleath
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland
| | - Carol Hilliard
- Department of Diabetes and Endocrinology, Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland; School of Medicine, Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Declan Cody
- Department of Diabetes and Endocrinology, Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland
| |
Collapse
|
17
|
Hernar I, Graue M, Richards DA, Strandberg RB, Nilsen RM, Rekdal M, Løvaas KF, Madsen TV, Tell GS, Haugstvedt A. Use of patient-reported outcome measures (PROMs) in clinical diabetes consultations: the DiaPROM randomised controlled pilot trial. BMJ Open 2021; 11:e042353. [PMID: 33853796 PMCID: PMC8054082 DOI: 10.1136/bmjopen-2020-042353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/17/2020] [Accepted: 03/31/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To pilot test the proposed DiaPROM trial components and address uncertainties associated with conducting a full-scale randomised controlled trial (RCT) to evaluate whether such a trial is feasible. DESIGN Two-arm pilot RCT. PARTICIPANTS Adults aged ≥18-39 years, with minimum 1 year type 1 diabetes duration, attending outpatient follow-up. Exclusion criteria were pregnancy, severe cognitive, somatic or psychiatric conditions and impaired vision. RANDOMISATION AND INTERVENTION All participants completed electronic Patient-Reported Outcome Measures (PROMs) prior to the annual diabetes consultation. Using computer-generated block-randomisation without blinding, we assigned participants in a 1:1 ratio stratified by sex to receive standard care or an intervention. Physicians reviewed diabetes distress scores (Problem Areas In Diabetes scale) and referred individuals with scores ≥30 or single item(s) ≥3 to minimum two diabetes nurse consultations where reported problems were reviewed and discussed. OUTCOMES Recruitment and retention rates; participants perceptions about intervention components. Variance and estimated between-group differences in follow-up scores (Diabetes Distress Scale (DDS), WHO 5-Well-being Index, Perceived Competence for Diabetes Scale and glycaemic control) and DDS correlation with baseline scores, to assist sample size calculations. RESULTS We randomised 80 participants to the control or intervention arm (one participant was later excluded). 23/39 intervention arm participants qualified for additional consultations and 17 attended. 67/79 attended the 12-month follow-up (15.2% attrition); 5/17 referred to additional consultations were lost to follow-up (29.4% attrition). Participants reported PROMs as relevant (84.6%) and acceptable (97.4%) but rated the usefulness of consultations as moderate to low. Baseline mean±SD DDS score was 2.1±0.69; DDS SD was 0.71 (95% CI: 0.60 to 0.86) at follow-up; correlation between baseline and follow-up DDS scores was 0.8 (95% CI: 0.7 to 0.9). CONCLUSIONS The pilot trial revealed need for intervention modifications ahead of a full-scale trial to evaluate use of PROMs in diabetes consultations. Specifically, participant acceptability and intervention implementation need further investigation.
Collapse
Affiliation(s)
- Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - David A Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ragnhild B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Roy Miodini Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | | | - Karianne Fjeld Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone V Madsen
- Norwegian Diabetes Register for Adults, Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
18
|
Skedgell KK, Cao VT, Gallagher KA, Anderson BJ, Hilliard ME. Defining features of diabetes resilience in emerging adults with type 1 diabetes. Pediatr Diabetes 2021; 22:345-353. [PMID: 33034097 DOI: 10.1111/pedi.13136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/12/2020] [Accepted: 10/04/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Emerging adulthood presents unique challenges for type 1 diabetes (T1D) management. Barriers to achieving optimal diabetes outcomes have been studied but less is known about how emerging adults overcome these challenges. Characterizing emerging adults' protective factors may help guide T1D care during this developmental period. We anticipated identifying social, cognitive, and behavioral protective factors and were open to additional themes. METHODS We analyzed transcripts from semi-structured qualitative interviews with 62 emerging adults (age 18-24 years) with T1D using hybrid thematic analysis. Interviews queried about participants' perspectives on diabetes management challenges, how they overcome challenges, and diabetes resilience. RESULTS We categorized responses into three types of protective factors: (a) Social: Interpersonal strategies such as obtaining tangible support (especially from parents) and emotional support from friends, medical professionals, and community leaders. (b) Cognitive: Believing one can live a "normal" life with T1D, benefit-finding, and viewing diabetes management as an important part of life. (c) Behavioral: Proactively planning for diabetes challenges, maintaining a consistent routine while allowing for flexibility, balancing diabetes and non-diabetes activities, and using diabetes-specific and general technologies to support self-management. CONCLUSIONS The adaptive approaches emerging adults with T1D use to handle the challenges of diabetes include seeking interpersonal support, managing their thoughts about T1D, and taking specific actions to prevent or resolve challenges. Helping emerging adults identify and strengthen their protective factors has potential to affect clinical outcomes. Strengths-based assessment and clinical attention to protective factors may prepare adolescents to successfully manage the challenges of transition to adult care.
Collapse
Affiliation(s)
- Kyleigh K Skedgell
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Viena T Cao
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Katherine A Gallagher
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
19
|
Ladha S, Fox D, Bone JN, Amed S. An Analysis of Self-Reported Barriers to Type 1 Diabetes Care in a Pediatric Population in British Columbia, Canada. Can J Diabetes 2020; 45:383-389. [PMID: 33358268 DOI: 10.1016/j.jcjd.2020.10.015] [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: 07/02/2020] [Revised: 09/22/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Our aim in this study was to identify patient-level barriers to attending pediatric type 1 diabetes mellitus (T1DM) clinic and to better understand the demographic and clinical characteristics of these reporting barriers. METHODS Patients were recruited from pediatric T1DM clinics throughout British Columbia. Barriers to attending clinic were identified through a survey. Demographic and clinical characteristics of patients who reported difficulty attending clinic appointments were compared with those who did not. RESULTS Of the 197 study participants, 31% reported difficulty attending appointments. Commonly reported barriers were distance to clinic and missing work. Younger child age and residing in northern regions increased the odds of reporting a barrier, whereas residing on Vancouver Island decreased odds of reporting a barrier. There were no differences in glycated hemoglobin levels between the 2 groups. CONCLUSIONS Approximately 1 in 3 patients identified challenges in attending T1DM appointments in British Columbia. Further research is needed to determine whether similar challenges exist in other provinces.
Collapse
Affiliation(s)
- Safia Ladha
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Danya Fox
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jeffrey N Bone
- Department of Obstetrics and Gynecology, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
| |
Collapse
|
20
|
Brewster S, Bartholomew J, Holt RIG, Price H. Non-attendance at diabetes outpatient appointments: a systematic review. Diabet Med 2020; 37:1427-1442. [PMID: 31968127 DOI: 10.1111/dme.14241] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-attendance at diabetes outpatient appointments is a sizeable problem worldwide and has been associated with suboptimal health outcomes. We aimed to describe the characteristics, health outcomes and reasons given for non-attendance at doctor- or nurse-led diabetes appointments, and interventions to improve attendance. METHODS PubMed, EMBASE, CINAHL and PsychInfo were searched from database inception to February 2019. Included articles were peer-reviewed, published in English, related to adults or young people with type 1 or type 2 diabetes, and addressed one of the above aspects of non-attendance. Studies were excluded if reporting on other types of diabetes or reviewing attendance at structured education, retinal screening, paediatric, antenatal, podiatry or dietetic clinics. RESULTS Thirty-four studies of varied designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). The definition of non-attendance varied. Younger adults, smokers and those with financial pressures were less likely to attend. Non-attendance was associated with higher HbA1c ; other outcomes were varied but typically worse in non-attenders. Reasons for non-attendance in qualitative studies fell into three categories: balancing the costs and benefits of attendance, coping strategies, and the relationships between the person with diabetes and healthcare professionals. Interventions included appointment management strategies, service improvements, patient navigators and WebCam appointments. CONCLUSIONS Non-attendance is only partially explained by logistical issues. Qualitative studies suggest complex psychosocial factors are involved. Interventions have progressed from simple appointment reminders in an attempt to address some of the psycho-social determinants, but more work is needed to improve attendance.
Collapse
Affiliation(s)
- S Brewster
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
| | - J Bartholomew
- CRN Wessex, NIHR Clinical Research Network (CRN), University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - H Price
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
| |
Collapse
|
21
|
James S, Perry L, Gallagher R, Lowe J. A discussion of healthcare support for adolescents and young adults with long-term conditions: Current policy and practice and future opportunities. Int J Nurs Pract 2020; 26:e12882. [PMID: 32812309 DOI: 10.1111/ijn.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adolescence and young adulthood can be a period of significant and unique life changes in which competing demands and challenges distract from disease self-management. Specific challenges related to the way individual services are configured can also limit the support available. This paper presents a discussion of healthcare service support for adolescents and young adults, using type 1 diabetes as an exemplar. DESIGN Discussion paper. RESULTS A wide variety of issues at the biopsychosocial level of the individual, health services policy and practice pose challenges to effective health support for adolescents and young adults. Intersectoral, multilevel and multicomponent opportunities are available to engage and empower young people to be part of change and accountability mechanisms and to transform the support available and outcomes achievable. A priority research agenda can benefit patients, families and their communities. CONCLUSION Future policy and practice development may assist clinicians, service providers and managers, policymakers, non-governmental organizations and community groups to deliver more effective and efficient support to vulnerable adolescent and young adult populations.
Collapse
Affiliation(s)
- Steven James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,South Eastern Sydney Local Health District, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Robyn Gallagher
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Julia Lowe
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
22
|
Johansen CB, Pouwer F, Beck‐Nielsen H, Rothmann MJ. Positive facilitators of diabetes management in emerging adults with type 1 diabetes-A qualitative analysis of blogs. Endocrinol Diabetes Metab 2020; 3:e00161. [PMID: 32704575 PMCID: PMC7375054 DOI: 10.1002/edm2.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/16/2020] [Accepted: 05/09/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Emerging adults (18-30 years) with type 1 diabetes must manage a demanding chronic illness as well as navigate a life phase full of instability and transitions. Clinical care for this age group remains a challenge. An improved understanding of psychological facilitators of diabetes management may contribute to optimized clinical care to this age group. AIM To explore which individual strategies facilitated emerging adults' diabetes management and what kind of support they regard helpful from peers, family and healthcare providers. METHODS Qualitative analysis of web blogs. We identified personal blogs by emerging adults with type 1 diabetes through a search at the websites for diabetes associations in Denmark, UK and the USA, a snowball search at identified blogs and an internet search (Google). Blog posts from approximately the last year were analysed with thematic analysis as described by Braun and Clarke. RESULTS We included 16 blogs from UK, the USA, Australia and Denmark, focusing on blog entries from 2017 to 2018. Several psychological facilitators of management of type 1 diabetes were identified. Positive individual strategies involved: developing a balanced approach to blood glucoses, sharing diabetes with peers and making space for emotional reactions. Supportive involvement from peers, family and health care providers included: normalization, emotional backup and a nonjudgmental attitude. CONCLUSION Diabetes management in emerging adulthood can be facilitated by several individual strategies as well as by supportive involvement from peers, family and health care providers. It is worthwhile to further investigate how individual strategies as well as supportive involvement can be promoted in diabetes care.
Collapse
Affiliation(s)
| | - Frans Pouwer
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
| | | | - Mette Juel Rothmann
- Steno Diabetes Center OdenseOdense University HospitalOdenseDenmark
- Department of EndocrinologyOdense University HospitalOdenseDenmark
- Centre for Innovative Medical TechnologyOdense University HospitalUniversity of Southern DenmarkOdenseDenmark
| |
Collapse
|
23
|
Williams S, Newhook LAA, Power H, Shulman R, Smith S, Chafe R. Improving the transitioning of pediatric patients with type 1 diabetes into adult care by initiating a dedicated single session transfer clinic. Clin Diabetes Endocrinol 2020; 6:11. [PMID: 32518677 PMCID: PMC7275548 DOI: 10.1186/s40842-020-00099-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background Young adults with type 1 diabetes face potential health problems and disruptions in accessing care related to their move from pediatrics into adult care. At a medium-sized pediatric hospital with no formal transition support program, we developed and evaluated the use of a single-session transfer clinic as an initial quality improvement intervention to improve patient satisfaction, clinic attendance, and knowledge of transition related issues. Methods Following a jurisdictional scan of other diabetes programs, the pediatric diabetes program developed a half-day transfer clinic. After the first transfer clinic was held, evaluation surveys were completed by patients, parents, and healthcare providers. Based on the feedback received, we altered the structure and evaluated the revised clinic by surveying patients and parents. Results All patients and parents who attended reported high levels of satisfaction with the clinic. Providers were also mostly positive regarding their participation. Feedback from the first clinic was used to modify the structure of the second clinic to better meet the needs of participants and to allow the clinic to run more efficiently. The use of group sessions and adapting resources developed by other diabetes programs were viewed favourably by participants and lessened the burden on staff who delivered the clinic. Conclusions A half-day transfer clinic is a viable step towards improving patient and parent satisfaction during the transition into adult care without requiring additional staff or significant expenditures of new resources. This type of clinic can also be incorporated into a larger program of transition supports or be adopted by programs serving young adults with other chronic diseases.
Collapse
Affiliation(s)
- Sarah Williams
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Canada
| | - Leigh Anne Allwood Newhook
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Division of Children and Women's Health, Eastern Health, St. John's, Canada
| | - Heather Power
- Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Division of Children and Women's Health, Eastern Health, St. John's, Canada
| | - Rayzel Shulman
- Hospital for Sick Children, Toronto, Canada.,SickKids Research Institute, Toronto, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Canada
| | - Sharon Smith
- Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada
| | - Roger Chafe
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada
| |
Collapse
|
24
|
Harris M, James S, Perry L, Lowe J, Dunbabin J, Steinbeck K. Health care professionals talking: Are services for young adults with type 1 diabetes fit for purpose? J Eval Clin Pract 2020; 26:335-342. [PMID: 31287195 DOI: 10.1111/jep.13210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The challenges of becoming a mature adult may distract young adults with type 1 diabetes from disease self-management, increasing risks for premature morbidity and mortality. Despite the importance of young adults with type 1 diabetes engaging with preventative diabetes-related health care services, few studies report health care professionals' experiences and perceptions of the support that is available, including during the period of transition. This study sought to determine these factors across diverse contexts in one health jurisdiction. METHODS This qualitative study was undertaken in New South Wales, Australia. Recruitment was based on a snowball sampling technique, which began with members of an established diabetes service group. Data were collected by individual semistructured interviews with 16 health care professionals, most of whom were registered nurses (75%), working at differing levels of expertise and responsibility across metropolitan and regional/rural areas. Data were analysed using thematic analyses. RESULTS Participants overwhelmingly recognized the time and care needed to support young adults with type 1 diabetes to prepare them for adult self-management and to work with adult diabetes services, and the importance of youth-friendly services. They reported shortfalls and inequitous distribution in services for these young adults. Two themes, addressing the present and future possibilities, expressed their perceptions of services for this population: working with what is available and mapping a route to better services. CONCLUSION Findings identify opportunities for development in the planning and provision of specialist multidisciplinary health care support for this population. New ideas are needed for policy and practice innovation and for the infrastructure to facilitate this, to ensure that young adults with type 1 diabetes have access to consistent and coordinated diabetes health care services, particularly in nonmetropolitan settings.
Collapse
Affiliation(s)
- Margaret Harris
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Steven James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Lin Perry
- Faulty of Health, University of Technology Sydney/South East Sydney Local Health District, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Julia Lowe
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Janet Dunbabin
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Katharine Steinbeck
- Discipline of Paediatrics and Child Health, University of Sydney/The Children's Hospital, Westmead, New South Wales, Australia
| |
Collapse
|
25
|
Wong SKW, Smith HE, Chua JJS, Griva K, Cartwright EJ, Soong AJ, Dalan R, Tudor Car L. Effectiveness of self-management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta-analysis. Diabet Med 2020; 37:229-241. [PMID: 31769532 DOI: 10.1111/dme.14190] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
AIM Diabetes in young adulthood has been associated with poor outcomes. Self-management is fundamental to good diabetes care, and self-management interventions have been found to improve outcomes in older adults. We performed a systematic review and meta-analysis to assess the effectiveness of self-management interventions in young adults (aged 15-39 years) with type 1 or type 2 diabetes. METHODS We searched five databases and two clinical trial registries from 2003 to February 2019, without language restrictions. We included randomized controlled trials (RCTs) comparing the effectiveness of self-management interventions with usual care or enhanced usual care in young adults. Outcomes of interest included clinical outcomes, psychological health, self-care behaviours, diabetes knowledge and self-efficacy. Pairwise meta-analysis was conducted using a random effects model and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. We followed Cochrane gold standard systematic review methodology and reported this systematic review according to PRISMA guidelines. The protocol was registered with PROSEPRO (CRD42018110868). RESULTS In total, 13 studies (1002 participants) were included. Meta-analysis showed no difference between self-management interventions and controls in post-intervention HbA1c levels, BMI, depression, diabetes-related distress, overall self-care, diabetes knowledge and self-efficacy. Quality of evidence ranged from very low to moderate due to study limitations, inconsistency and imprecision. CONCLUSIONS Current self-management interventions did not improve outcomes in young adults with diabetes. Our findings, which contrast with those from systematic reviews in older adults, highlight the need for the development of more effective interventions for young adults with diabetes.
Collapse
Affiliation(s)
- S K W Wong
- Lee Kong Chian School of Medicine, Singapore
- National Healthcare Group Polyclinics, Singapore
| | - H E Smith
- Lee Kong Chian School of Medicine, Singapore
| | - J J S Chua
- Lee Kong Chian School of Medicine, Singapore
| | - K Griva
- Lee Kong Chian School of Medicine, Singapore
| | | | - A J Soong
- Lee Kong Chian School of Medicine, Singapore
| | - R Dalan
- Lee Kong Chian School of Medicine, Singapore
- Tan Tock Seng Hospital, Singapore
| | - L Tudor Car
- Lee Kong Chian School of Medicine, Singapore
| |
Collapse
|
26
|
Murphy J, McSharry J, Hynes L, Matthews S, Van Rhoon L, Molloy GJ. Prevalence and predictors of adherence to inhaled corticosteroids in young adults (15-30 years) with asthma: a systematic review and meta-analysis. J Asthma 2020; 58:683-705. [PMID: 31906744 DOI: 10.1080/02770903.2020.1711916] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Adherence to inhaled corticosteroids (ICS) is an essential part of asthma management throughout the lifespan; however, this may be particularly challenging during the transition into adulthood. This systematic review aimed to determine the prevalence and predictors of adherence to ICS in emerging adulthood.Data sources: MEDLINE, PsycINFO, EMBASE, Scopus, and CINAHL were searched with search terms for asthma, ICS, adherence, young adults, and predictors combined.Study selection: Studies with participants with diagnosed asthma, currently prescribed ICS, a mean age between 15 and 30 years and reporting the prevalence and/or assessing predictor(s) of adherence using quantitative methods were included.Results: Twenty-nine studies were identified for inclusion (K = 29, N = 187 401). A random effect meta-analysis revealed the pooled prevalence of adherence was 28% (95% CI = 20-38%, k = 16) in studies that provided quantitative information on adherence. Adherence was higher in studies with a mean age <18 years (36%; 95% CI = 36-37%, k = 4). Studies using self-report measures provided higher estimates of adherence (35%; 95% CI = 28-42%, k = 10) than studies using pharmacy refill data (20%; 95% CI = 9-38%, k = 6). A narrative review identified personality, illness perceptions, and treatment beliefs as potentially important predictors of adherence.Conclusion: Adherence is sub-optimal during emerging adulthood, particularly after age 18. More reliable and objective measures are needed to precisely characterize adherence. Greater research and practice attention to emerging adulthood are needed to guide self-management support in those living with asthma at this important lifespan stage.Systematic review registration number: CRD42018092401.
Collapse
Affiliation(s)
- Jane Murphy
- School of Psychology, NUI Galway, Galway, Ireland
| | | | - Lisa Hynes
- School of Medicine, NUI Galway, Galway, Ireland
| | | | | | | |
Collapse
|
27
|
Butalia S, Kaplan GG, Khokhar B, Haubrich S, Rabi DM. The Challenges of Identifying Environmental Determinants of Type 1 Diabetes: In Search of the Holy Grail. Diabetes Metab Syndr Obes 2020; 13:4885-4895. [PMID: 33328748 PMCID: PMC7734044 DOI: 10.2147/dmso.s275080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022] Open
Abstract
Type 1 diabetes is the result of autoimmune-mediated destruction and inflammation of the insulin-producing β-cells of the pancreas. The excess morbidity and mortality from its complications coupled with its increasing incidence emphasize the importance to better understand the etiology of this condition. It has a strong genetic component, but a genetic predisposition is not the sole contributor to disease development as only 30% to 50% of identical twins both develop the disease. In addition, there are multiple lines of evidence to support that environmental factors contribute to the pathogenesis of type 1 diabetes. Environmental risk factors that have been proposed include infections, dietary factors, air pollution, vaccines, location of residence, childhood obesity, family environment and stress. Researchers have conducted many observational studies to identify and characterize these potential environmental factors, but findings have been inconsistent or inconclusive. Many studies have had inherent methodological issues in recruitment, participation, defining cases and exposures, and/or data analysis which may limit the interpretability of findings. Identifying and addressing these limitations may allow for greatly needed advances in our understanding of type 1 diabetes. As such, the purpose of this article is to review and discuss the limitations of observational studies that aim to determine environmental risk factors for type 1 diabetes and propose recommendations to overcome them.
Collapse
Affiliation(s)
- Sonia Butalia
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Correspondence: Sonia ButaliaDivision of Endocrinology and Metabolism, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, AlbertaT2T 5C7, CanadaTel +1 403-955-8327Fax +1 403-955-8249 Email
| | - Gilaad G Kaplan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bushra Khokhar
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sydney Haubrich
- Ward of the 21st Century, University of Calgary, Calgary, Alberta, Canada
| | - Doreen M Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
28
|
Shulman R, Zenlea I, Shah BR, Clarson C, Harrington J, Landry A, Punthakee Z, Palmert MR, Mukerji G, Austin PC, Parsons J, Ivers N. Testing an audit and feedback-based intervention to improve glycemic control after transfer to adult diabetes care: protocol for a quasi-experimental pre-post design with a control group. BMC Health Serv Res 2019; 19:885. [PMID: 31766999 PMCID: PMC6878686 DOI: 10.1186/s12913-019-4690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When young adults transfer from pediatric to adult diabetes care they are at risk for deterioration of glycemic control, putting them at an increased risk of developing both acute and chronic complications. Despite increased awareness of these risks, there are gaps in care delivery during this vulnerable time and variability in the implementation of recommended transition practice. Audit and feedback (AF) interventions have a positive but variable effect on implementation of best practices. An expert group identified specific suggestions for optimizing the effectiveness of AF interventions. We aim to test an AF-based intervention incorporating these specific suggestions to improve transition practices and glycemic control in the first year after transfer from pediatric to adult diabetes care. METHODS This is a pragmatic quasi-experimental study; a series of three cohort studies (pre-implementation, early-implementation, and post-implementation) to compare the baseline adjusted hemoglobin A1c (HbA1c) in the 12 months after the final pediatric visit in five pediatric diabetes centres within the Ontario Pediatric Diabetes Network in Ontario, Canada. The intervention includes three components: 1) centre-level feedback reports compiling data from chart abstraction, linked provincial administrative datasets, and patient-reported experience measures; 2) webinars for facilitated conversations/coaching about the feedback; and 3) online repository of curated transition resources for providers. The primary outcome will be analyzed using a multivariable linear regression model. We will conduct a qualitative process evaluation to understand intervention fidelity and to provide insight into the mechanisms of action of our results. DISCUSSION There is a need to develop an innovative system-level approach to improve outcomes and the quality of care for young adults with type 1 diabetes during the vulnerable time when they transfer to adult care. Our research team, a collaboration of health services, implementation science, and quality improvement researchers, are designing, implementing, and evaluating an AF-based intervention using recommendations about how to optimize effectiveness. This knowledge will be generalizable to other care networks that aim to deliver uniformly high-quality care in diverse care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.
Collapse
Affiliation(s)
- Rayzel Shulman
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada. .,SickKids Research Institute, Toronto, Canada. .,ICES, Toronto, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Department of Pediatrics, University of Toronto, Toronto, Canada.
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Missisauga, Canada
| | - Baiju R Shah
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Cheril Clarson
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Jennifer Harrington
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Alanna Landry
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,Markham Stouffville Hospital, Markham, Canada
| | | | - Mark R Palmert
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,SickKids Research Institute, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Department of Medicine, University of Toronto, Toronto, Canada.,Women's College Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Janet Parsons
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Noah Ivers
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada.,Department of Family Medicine, Women's College Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
29
|
Addala A, Igudesman D, Kahkoska AR, Muntis FR, Souris KJ, Whitaker KJ, Pratley RE, Mayer-Davis E. The interplay of type 1 diabetes and weight management: A qualitative study exploring thematic progression from adolescence to young adulthood. Pediatr Diabetes 2019; 20:974-985. [PMID: 31392807 PMCID: PMC7196280 DOI: 10.1111/pedi.12903] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The impact of weight management in persons with type 1 diabetes (T1D) from childhood into adulthood has not been well described. The purpose of the study was to explore qualitative themes presented by young adults with T1D with respect to the dual management of weight and T1D. METHODS We analyzed focus group data from 17 young adults with T1D (65% female, age 21.7 ± 2.1 years, HbA1c 8.1% ± 1.5) via inductive qualitative analysis methods. Major themes were compared to themes presented by youth with T1D ages 13-16 years in previously published study in order to categorize thematic progression from early adolescence through adulthood. RESULTS Themes from young adults with T1D, when compared to those from youth were categorized as: (a) persistent and unchanged themes, (b) evolving themes, and (c) newly reported themes. Hypoglycemia and a sense of futility around exercise was an unchanged theme. Importance of insulin usage and a healthy relationship with T1D evolved to gather greater conviction. Newly reported themes are unique to integration of adulthood into T1D, such as family planning and managing T1D with work obligations. Young adults also reported negative experiences with providers in their younger years and desire for more supportive provider relationships. CONCLUSIONS Issues identified by youth regarding the dual management of T1D and weight rarely resolve, but rather, persist or evolve to integrate other aspects of young adulthood. Individualized and age-appropriate clinical support and practice guidelines are warranted to facilitate the dual management of weight and T1D in persons with T1D.
Collapse
Affiliation(s)
- Ananta Addala
- Department of Pediatric Endocrinology, Stanford University, Stanford, California
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Franklin R. Muntis
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Katherine J. Souris
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Keri J. Whitaker
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, Florida
| | - Richard E. Pratley
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, Florida
| | | |
Collapse
|
30
|
Ng AH, Crowe TC, Ball K, Rasmussen B. A mHealth Support Program for Australian Young Adults with Type 1 Diabetes: A Mixed Methods Study. Digit Health 2019; 5:2055207619882179. [PMID: 31662880 PMCID: PMC6796202 DOI: 10.1177/2055207619882179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022] Open
Abstract
Aims and Objectives Young adulthood is a life stage comprised of many turning points. For young adults with type 1 diabetes (T1DM), diabetes self-management support is crucial during this period. There is a lack of diabetes education programs and services tailored to this population. This paper presents the findings, according to the STROBE guidelines, on the usability and acceptability of a patient-informed mHealth support program (Diabetes YES) that was developed for young adults with T1DM. Methods A total of 34 young adults aged 18-35 years with T1DM participated in the Diabetes YES program over 12 weeks. Google analytics was used to tracked website use, while a website usability survey measured ease of use. Facebook analytics was used to measure peer support engagement. Evaluation of the program was completed using Likert scales and open-ended questions. Results Participants rated the website favourably for its ease of navigation and easy to understand information. Web page visits declined sharply while peer support group engagement through Facebook remained consistent throughout the intervention period. Participants utilised weekly discussion topics to generate conversation within the peer support group. Emotional support from peers was the highest regarded benefit reported by participants. Conclusions Diabetes YES is an example of an mHealth support program that was readily accepted by young adults living with T1DM. Feasibility studies are an important formative step in the implementation of mHealth programs within mainstream healthcare. Future work should focus on the adaptability of such programs to fit within larger consumer or healthcare organisations.
Collapse
Affiliation(s)
- Ashley H Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Bundoora, Australia
| | - Timothy C Crowe
- School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Bodil Rasmussen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Australia
| |
Collapse
|
31
|
Hart LC, Patel-Nguyen SV, Merkley MG, Jonas DE. An Evidence Map for Interventions Addressing Transition from Pediatric to Adult Care: A Systematic Review of Systematic Reviews. J Pediatr Nurs 2019; 48:18-34. [PMID: 31220801 DOI: 10.1016/j.pedn.2019.05.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/28/2022]
Abstract
PROBLEM Adolescents and young adults with chronic illnesses continue to face barriers as they transition from pediatric to adult care. An evidence map can help to identify gaps in the transition literature to determine targets for future research. ELIGIBILITY CRITERIA We searched PubMed, CINAHL, PsycInfo, and Cochrane for systematic reviews published through February 2018. Eligible reviews included at least one comparative study testing a youth-focused intervention for improving transition with at least one quantitative health-related outcome reported. SAMPLE We identified 431 unique reviews in our search, and 37 reviews (containing 71 eligible primary studies) met inclusion criteria. RESULTS Most reviews (20 of 37) summarized some aspect of transition across diagnoses. Type 1 diabetes was the most common diagnosis studied (7 of 37 reviews and 24 of 71 primary studies). Only 14 of 71 primary studies focused on care after transfer to adult care. CONCLUSIONS The literature on interventions to improve transition to adult care has focused on a limited number of diagnoses, most commonly Type 1 diabetes. Common pediatric conditions, such as asthma, have not been studied with regard to transition. Efforts have been mainly targeted on transition preparation, with less focus on transition needs after transfer to adult care. IMPLICATIONS There is a need for transition research focused on common pediatric conditions and transition needs after transfer to adult care.
Collapse
Affiliation(s)
- Laura C Hart
- Nationwide Children's Hospital, Columbus, OH, United States of America; The Ohio State University College of Medicine, Departments of Pediatrics and Medicine, United States of America; The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States of America.
| | | | | | - Daniel E Jonas
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States of America; University of North Carolina at Chapel Hill, Department of Medicine, United States of America.
| |
Collapse
|
32
|
Jewell RR, Gorey KM. Psychosocial Interventions for Emergent Adults With Type 1 Diabetes: Near-Empty Systematic Review and Exploratory Meta-Analysis. Diabetes Spectr 2019; 32:249-256. [PMID: 31462881 PMCID: PMC6695259 DOI: 10.2337/ds18-0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Risk for developing mental health concerns is increased for people with diabetes. Coupled with stressors related to the transition from adolescence to adulthood, emergent adults may be in greater need of psychosocial interventions to help them cope. This review summarizes the literature on interventions used with people with diabetes aged 15-30 years on psychosocial and biological (A1C) outcomes. Core databases were searched for both published and grey research. Studies completed between January 1985 and October 2018 using any psychosocial intervention and meeting age and diabetes type requirements were selected if they included a control or comparison group and findings reported in such a way that effect size was calculable. Two authors independently extracted relevant data using standard data extraction templates. Six studies with 450 participants met the broad inclusion criteria. Sample-weighted pooling of 12 outcomes, six each on glycemic control and psychosocial status, suggested the preventive potential (d = 0.31, 95% CI 0.17-0.45) and homogeneity (χ2 [11] = 11.15, P = 0.43) of studied interventions. This preliminary meta-analysis provides some suggestion that psychosocial interventions, including telephone-based case management, individualized treatment modules, and small-group counseling interventions, may diminish burden, depression, and anxiety and enhance glycemic control among emerging adults with type 1 diabetes as they transition from adolescence to adulthood.
Collapse
Affiliation(s)
- Rachel R Jewell
- School of Social Work, University of Windsor, Windsor, Ontario, Canada
| | - Kevin M Gorey
- School of Social Work, University of Windsor, Windsor, Ontario, Canada
| |
Collapse
|
33
|
Shulman R, Chafe R, Guttmann A. Transition to Adult Diabetes Care: A Description of Practice in the Ontario Pediatric Diabetes Network. Can J Diabetes 2019; 43:283-289. [DOI: 10.1016/j.jcjd.2018.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 11/16/2022]
|
34
|
Spaic T, Robinson T, Goldbloom E, Gallego P, Hramiak I, Lawson ML, Malcolm J, Mahon J, Morrison D, Parikh A, Simone A, Stein R, Uvarov A, Clarson C. Closing the Gap: Results of the Multicenter Canadian Randomized Controlled Trial of Structured Transition in Young Adults With Type 1 Diabetes. Diabetes Care 2019; 42:1018-1026. [PMID: 31010873 DOI: 10.2337/dc18-2187] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/08/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine if a structured transition program for young adults with type 1 diabetes improves clinic attendance, glycemic control, diabetes-related distress, quality of life, and satisfaction with care. RESEARCH DESIGN AND METHODS In this multicenter randomized controlled trial, young adults (17-20 years) with type 1 diabetes were randomly assigned to a transition program with a transition coordinator or to standard care. The intervention lasted 18 months (6 in pediatric and 12 in adult care). The primary outcome was the proportion of participants who failed to attend at least one adult diabetes clinic visit during the 12-month follow-up after completion of the intervention. RESULTS We randomized 205 participants, 104 to the transition program and 101 to standard care. Clinic attendance was improved in the transition program (mean [SD] number of visits 4.1 [1.1] vs. 3.6 [1.2], P = 0.002), and there was greater satisfaction with care (mean [SD] score 29.0 [2.7] vs. 27.9 [3.4], P = 0.032) and less diabetes-related distress (mean [SD] score 1.9 [0.8] vs. 2.1 [0.8], P = 0.049) reported than in standard care. There was a trend toward improvement in mean HbA1c (8.33% [68 mmol/mol] vs. 8.80% [73 mmol/mol], P = 0.057). During the 12-month follow-up, there was no difference in those failing to attend at least one clinic visit (P = 0.846), and the mean change in HbA1c did not differ between the groups (P = 0.073). At completion of follow-up, the groups did not differ with respect to satisfaction with care or diabetes-related distress and quality of life. CONCLUSIONS Transition support during this 18-month intervention was associated with increased clinic attendance, improved satisfaction with care, and decreased diabetes-related distress, but these benefits were not sustained 12 months after completion of the intervention.
Collapse
Affiliation(s)
- Tamara Spaic
- Division of Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada .,Department of Medicine, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Tracy Robinson
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Ellen Goldbloom
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Patricia Gallego
- Lawson Health Research Institute, London, Ontario, Canada.,Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.,Department of Paediatrics, Western University, London, Ontario, Canada
| | - Irene Hramiak
- Division of Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Margaret L Lawson
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Janine Malcolm
- University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jeffrey Mahon
- Division of Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Deric Morrison
- Division of Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada
| | - Amish Parikh
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Angelo Simone
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Robert Stein
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.,Department of Paediatrics, Western University, London, Ontario, Canada
| | - Artem Uvarov
- Department of Medicine, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | | | | |
Collapse
|
35
|
Bronczek GA, Vettorazzi JF, Soares GM, Kurauti MA, Santos C, Bonfim MF, Carneiro EM, Balbo SL, Boschero AC, Costa Júnior JM. The Bile Acid TUDCA Improves Beta-Cell Mass and Reduces Insulin Degradation in Mice With Early-Stage of Type-1 Diabetes. Front Physiol 2019; 10:561. [PMID: 31156453 PMCID: PMC6529580 DOI: 10.3389/fphys.2019.00561] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 04/24/2019] [Indexed: 01/12/2023] Open
Abstract
Type 1 diabetes (T1D) is characterized by impairment in beta-cell mass and insulin levels, resulting in hyperglycemia and diabetic complications. Since diagnosis, appropriate control of glycaemia in T1D requires insulin administration, which can result in side effects, such as hypoglycemia. In this sense, some bile acids have emerged as new therapeutic targets to treat T1D and T2D, as well as metabolic diseases. The taurine conjugated bile acid, tauroursodeoxycholic (TUDCA) reduces the incidence of T1D development and improves glucose homeostasis in obese and T2D mice. However, its effects in early-stage of T1D have not been well explored. Therefore, we have assessed the effects of TUDCA on the glycemic control of mice with early-stage T1D. To achieve this, C57BL/6 mice received intraperitoneal administration of streptozotocin (STZ, 40 mg/kg) for 5 days. Once diabetes was confirmed in the STZ mice, they received TUDCA treatment (300 mg/kg) or phosphate buffered saline (PBS) for 24 days. After 15 days of treatment, the STZ+TUDCA mice showed a 43% reduction in blood glucose, compared with the STZ group. This reduction was likely due to an increase in insulinemia. This increase in insulinemia may be explained, at least in part, by a reduction in hepatic IDE activity and, consequently, reduction on insulin clearance, as well as an increase in beta-cell mass and a higher beta-cell number per islet. Also, the groups did not present any alterations in insulin sensitivity. All together, these effects contributed to the improvement of glucose metabolism in T1D mice, pointing TUDCA as a potential therapeutic agent for the glycemic control in early-stage of T1D.
Collapse
Affiliation(s)
- Gabriela Alves Bronczek
- Laboratory of Endocrine Physiology and Metabolism, Biological Sciences and Health Center, Western Paraná State University (UNIOESTE), Cascavel, Brazil.,Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Jean Franciesco Vettorazzi
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Gabriela Moreira Soares
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mirian Ayumi Kurauti
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Cristiane Santos
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Maressa Fernandes Bonfim
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Everardo Magalhães Carneiro
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Sandra Lucinei Balbo
- Laboratory of Endocrine Physiology and Metabolism, Biological Sciences and Health Center, Western Paraná State University (UNIOESTE), Cascavel, Brazil
| | - Antonio Carlos Boschero
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - José Maria Costa Júnior
- Obesity and Comorbidities Research Center, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| |
Collapse
|
36
|
Papoutsi C, Colligan G, Hagell A, Hargreaves D, Marshall M, Vijayaraghavan S, Greenhalgh T, Finer S. Promises and Perils of Group Clinics for Young People Living With Diabetes: A Realist Review. Diabetes Care 2019; 42:705-712. [PMID: 31010940 DOI: 10.2337/dc18-2005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/22/2019] [Indexed: 02/03/2023]
Abstract
Group clinics are becoming popular as a new care model in diabetes care. This evidence synthesis, using realist review methodology, examined the role of group clinics in meeting the complex needs of young people living with diabetes. Following Realist And Meta-narrative Evidence Synthesis-Evolving Standards (RAMESES) quality standards, we conducted a systematic search across 10 databases. A total of 131 articles met inclusion criteria and were analyzed to develop theoretically informed explanations of how and why group clinics could work (or not) for young people with diabetes. Models of group-based care in the literature varied significantly and incorporated different degrees of clinical and educational content. Our analysis identified four overarching principles that can be applied in different contexts to drive sustained engagement of young people in group clinics: 1) emphasizing self-management as practical knowledge; 2) developing a sense of affinity between patients; 3) providing safe, developmentally appropriate care; and 4) balancing group and individual needs. Implementation of group clinics was not always straightforward; numerous adjustments to operational and clinical processes were required to establish and deliver high-quality care. Group clinics for young people with diabetes offer the potential to complement individualized care but are not a panacea and may generate as well as solve problems.
Collapse
Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K
| | - Grainne Colligan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, U.K
| | - Ann Hagell
- Association for Young People's Health, London, U.K
| | - Dougal Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, U.K
| | - Martin Marshall
- Department of Primary Care and Population Health, University College London, London, U.K
| | | | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K
| | - Sarah Finer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, U.K. .,Barts Health NHS Trust, London, U.K
| |
Collapse
|
37
|
Mc Morrow L, O' Hara MC, Hynes L, Cunningham Á, Caulfield A, Duffy C, Keighron C, Mullins M, Long M, Walsh D, Byrne M, Kennelly B, Gillespie P, Dinneen SF, Doherty E. The preferences of young adults with Type 1 diabetes at clinics using a discrete choice experiment approach: the D1 Now Study. Diabet Med 2018; 35:1686-1692. [PMID: 30175547 DOI: 10.1111/dme.13809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 11/29/2022]
Abstract
AIM Attending routine outpatient clinic appointments is a central self-management behaviour of individuals living with Type 1 diabetes. A large number of young adults with Type 1 diabetes disengage from diabetes services, which may contribute to poor psychosocial and diabetes outcomes. The aim of this study is to elicit preferences from young adults with Type 1 diabetes regarding clinic-related services to inform service delivery. METHODS A discrete choice experiment was developed to understand the preferences of young adults with Type 1 diabetes for clinic-related services. RESULTS Young adults recruited from young adult Type 1 diabetes clinics in 2016 completed the experiment (n = 105). Young adults with Type 1 diabetes showed a preference for shorter waiting times, seeing a nurse and a consultant, relative to a nurse alone, and a flexible booking system compared with fixed appointment times. Results suggest no preference for a nurse and a doctor, relative to a nurse alone, or other optional services (e.g. seeing dietitians or psychologists), type of HbA1c test and digital blood glucose diaries over paper-based diaries. CONCLUSION This study highlights aspects of routine clinic appointments that are valued by young adults living with Type 1 diabetes, namely shorter waiting times at clinic, the option to see both a nurse and consultant at each visit and a flexible clinic appointment booking system. These findings suggest young adults with Type 1 diabetes value convenience and should help services to restructure their clinics to be more responsive to the needs of young adults.
Collapse
Affiliation(s)
- L Mc Morrow
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M C O' Hara
- Research and Development, Strategic Planning and Transformation, Health Service Executive, Merlin Park University Hospital, Galway, Ireland
| | - L Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, VA, USA
| | - Á Cunningham
- Endocrinology and Diabetes Centre, Galway University Hospitals
| | | | | | | | | | | | - D Walsh
- Health Behaviour Change Research Group
- School of Medicine, NUI Galway
| | - M Byrne
- Health Behaviour Change Research Group
| | - B Kennelly
- Health Economics and Policy Analysis Centre, JE Cairnes School of Business and Economics, Galway, Ireland
| | - P Gillespie
- Health Economics and Policy Analysis Centre, JE Cairnes School of Business and Economics, Galway, Ireland
| | - S F Dinneen
- Endocrinology and Diabetes Centre, Galway University Hospitals
- School of Medicine, NUI Galway
| | - E Doherty
- Health Economics and Policy Analysis Centre, JE Cairnes School of Business and Economics, Galway, Ireland
| |
Collapse
|
38
|
Essaddam L, Kallali W, Jemel M, Kandara H, Kammoun I, Hsairi M, Ben Salem L, Ben Becher S. Implementation of effective transition from pediatric to adult diabetes care: epidemiological and clinical characteristics-a pioneering experience in North Africa. Acta Diabetol 2018; 55:1163-1169. [PMID: 30074090 DOI: 10.1007/s00592-018-1196-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/18/2018] [Indexed: 12/13/2022]
Abstract
AIMS Type 1 diabetes is increasing in children leading more T1D young adults to adult healthcare settings. This change is experienced as a tear and results in a disengagement from specialist services. This study reports on an implementation of an effective and pioneering program of transition in North Africa. METHODS A total of 65 teenagers with T1D were recruited for a structured program of transition. They attend transitional meetings involving both pediatric and adult team and were, when ready, welcomed in specialized consultations for adolescents with a special « passport ». Here we study their characteristics before and after structured transition and the benefit of this program. RESULTS 9 transition meetings took place (September 2012-December 2017). Mean age was 16.5 years. Mean age at onset of T1D was 7.5 years with average pediatric follow-up of 9 years.72% of young adults felt satisfied. After the transition meeting, 74% of patients wished to join directly adult unit. They were followed there for 28.4 ± 16.2 months. The glycaemic control improved significantly with a decrease in HbA1C of 0.93 ± 1.69% the first year of follow-up and the number of young adults achieving a HbA1C < 7.5% increased by 8%. CONCLUSION This program was beneficial for 75% of patients who demonstrated an improvement in their metabolic control the year following transition to adult care service. To our knowledge, this study is the first one in North Africa to report on the outcome of a structured transition program from pediatric to adult diabetes care.
Collapse
Affiliation(s)
- Leïla Essaddam
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia.
- Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia.
- , Tunis, Tunisia.
| | - Wafa Kallali
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Manel Jemel
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Hager Kandara
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Inès Kammoun
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Mohamed Hsairi
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Department of Epidemiology, Salah Azaiez Institute of Tunis, 1007, Tunis, Tunisia
| | - Leïla Ben Salem
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Saayda Ben Becher
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| |
Collapse
|
39
|
Kahkoska AR, Shay CM, Crandell J, Dabelea D, Imperatore G, Lawrence JM, Liese AD, Pihoker C, Reboussin BA, Agarwal S, Tooze JA, Wagenknecht LE, Zhong VW, Mayer-Davis EJ. Association of Race and Ethnicity With Glycemic Control and Hemoglobin A 1c Levels in Youth With Type 1 Diabetes. JAMA Netw Open 2018; 1:e181851. [PMID: 30370425 PMCID: PMC6203341 DOI: 10.1001/jamanetworkopen.2018.1851] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Health disparities in the clinical presentation and outcomes among youth with type 1 diabetes exist. Long-term glycemic control patterns in racially/ethnically diverse youth are not well described. OBJECTIVES To model common trajectories of hemoglobin A1c (HbA1c) among youth with type 1 diabetes and test how trajectory group membership varies by race/ethnicity. DESIGN SETTING AND PARTICIPANTS Longitudinal cohort study conducted in 5 US locations. The analysis included data from 1313 youths (aged <20 years) newly diagnosed in 2002 through 2005 with type 1 diabetes in the SEARCH for Diabetes in Youth study (mean [SD] age at diabetes onset, 8.9 [4.2] years) who had 3 or more HbA1c study measures during 6.1 to 13.3 years of follow-up. Data were analyzed in 2017. EXPOSURES Self-reported race/ethnicity. MAIN OUTCOMES AND MEASURES Hemoglobin A1c trajectories identified through group-based trajectory modeling over a mean (SD) of 9.0 (1.4) years of diabetes duration. Multinomial models studied the association of race/ethnicity with HbA1c trajectory group membership, adjusting for demographic characteristics, clinical factors, and socioeconomic position. RESULTS The final study sample of 1313 patients was 49.3% female (647 patients) with mean (SD) age 9.7 (4.3) years and mean (SD) disease duration of 9.2 (6.3) months at baseline. The racial/ethnic composition was 77.0% non-Hispanic white (1011 patients), 10.7% Hispanic (140 patients), 9.8% non-Hispanic black (128 patients), and 2.6% other race/ethnicity (34 patients). Three HbA1c trajectories were identified: group 1, low baseline and mild increases (50.7% [666 patients]); group 2, moderate baseline and moderate increases (41.7% [548 patients]); and group 3, moderate baseline and major increases (7.5% [99 patients]). Group 3 was composed of 47.5% nonwhite youths (47 patients). Non-Hispanic black youth had 7.98 higher unadjusted odds (95% CI, 4.42-14.38) than non-Hispanic white youth of being in the highest HbA1c trajectory group relative to the lowest HbA1c trajectory group; the association remained significant after full adjustment (adjusted odds ratio of non-Hispanic black race in group 3 vs group 1, 4.54; 95% CI, 2.08-9.89). Hispanic youth had 3.29 higher unadjusted odds (95% CI, 1.78-6.08) than non-Hispanic white youth of being in the highest HbA1c trajectory group relative to the lowest HbA1c trajectory group; the association remained significant after adjustment (adjusted odds ratio of Hispanic ethnicity in group 3 vs group 1, 2.24; 95% CI, 1.02-4.92). In stratified analyses, the adjusted odds of nonwhite membership in the highest HbA1c trajectory remained significant among male patients and youth diagnosed at age 9 years or younger, but not female patients and youth who were older than 9 years when they were diagnosed (P for interaction = .04 [sex] and .02 [age at diagnosis]). CONCLUSIONS AND RELEVANCE There are racial/ethnic differences in long-term glycemic control among youth with type 1 diabetes, particularly among nonwhite male patients and nonwhite youth diagnosed earlier in life.
Collapse
Affiliation(s)
- Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill
| | | | - Jamie Crandell
- School of Nursing, University of North Carolina at Chapel Hill
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Cate Pihoker
- Department of Pediatrics, University of Washington, Seattle
| | - Beth A. Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shivani Agarwal
- Department of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Janet A. Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lynne E. Wagenknecht
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Victor W. Zhong
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill
- Department of Medicine, University of North Carolina at Chapel Hill
| |
Collapse
|
40
|
Saylor J, Lee S, Ness M, Ambrosino JM, Ike E, Ziegler M, Roth CL, Calamaro C. Positive Health Benefits of Peer Support and Connections for College Students With Type 1 Diabetes Mellitus. DIABETES EDUCATOR 2018; 44:340-347. [PMID: 29949457 DOI: 10.1177/0145721718765947] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study is to examine the characteristics and health outcomes of college students with type 1 diabetes mellitus (T1DM) as it relates to membership in a local university-based diabetes student organization. Methods This descriptive, correlational research design is a secondary analysis of data. The sample consisted of nationally representative young adults in college (n = 317) between 18 and 30 years of age who were diagnosed with T1DM. Data were collected during April 2017 using a secure electronic diabetes management survey to inquire about self-reported barriers to diabetes management, hypoglycemia, and diabetic ketoacidosis of members of a diabetes organization. Results Students were evenly distributed from freshman to senior year of college with a slight decrease at the graduate level. Students who were affiliated members of a student-led diabetes student organization were less likely to report increased levels of isolation, depressive symptoms, and anxiety related to their diabetes than were general members. Conclusion Participation in a university-based diabetes student organization on campus and connecting with other college students with diabetes may have health benefits. In conclusion, the current study underscores the potential importance of peer-led, diabetes-specific support for adolescents emerging into adulthood.
Collapse
Affiliation(s)
| | - Sara Lee
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michelle Ness
- School of Nursing, University of Delaware, Newark, Delaware
| | - Jodie M Ambrosino
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Emily Ike
- The College Diabetes Network, Boston, Massachusetts
| | - Melissa Ziegler
- University of Delaware, College of Health Sciences, Biostatistics Core, Newark, Delaware
| | | | | |
Collapse
|
41
|
Calamaro CJ, Saylor J, Hanna KM. Health Care Experience of Young Adults Diagnosed With Type 1 Diabetes. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
42
|
Hyperglycemia in Young Adults With Types 1 and 2 Diabetes Seen in the Emergency Department: A Health Records Review. Can J Diabetes 2018; 42:296-301.e5. [DOI: 10.1016/j.jcjd.2017.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 11/22/2022]
|
43
|
Blæhr EE, Væggemose U, Søgaard R. Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics. BMJ Open 2018; 8:e019969. [PMID: 29654019 PMCID: PMC5988103 DOI: 10.1136/bmjopen-2017-019969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Fines have been proposed as means for reducing non-attendance in healthcare. The empirical evidence of the effect of fines is however limited. The objective of this study is to investigate the effectiveness and cost-effectiveness of fining non-attendance at outpatient clinics. DESIGN, PARTICIPANTS AND SETTING 1:1 randomised controlled trial of appointments for an outpatient clinic, posted to Danish addresses, between 1 May 2015 and 30 November 2015. Only first appointment for users was included. Healthcare professionals and investigators were masked. INTERVENTION A fine of DKK250 (€34) was issued for non-attendance. Users were informed about the fine in case of non-attendance by the appointment letter, and were able to reschedule or cancel until the appointment. A central administration office administered the fine system. MAIN OUTCOME MEASURES The main outcome measures were non-attendance of non-cancelled appointments, fine policy administration costs, net of productivity consequences and probability of fining non-attendance being cost-effective over no fining for a range of hypothetical values of reduced non-attendance. RESULTS All of the 6746 appointments included were analysed. Of the 3333 appointments randomised to the fine policy, 130 (5%) of non-cancelled appointments were unattended, and of the 3413 appointments randomised to no-fine policy, 131 (5%) were unattended. The cost per appointment of non-attendance was estimated at DKK 56 (SE 5) in the fine group and DKK47 (SE 4) in the no-fine group, leading to a non-statistically significant difference of DKK10 (95% CI -9 to 22) per appointment attributable to the fine policy. The probability of cost-effectiveness remained around 50%, irrespective of increased values of reduced non-attendance or various alternative assumptions used for sensitivity analyses. CONCLUSIONS At a baseline level of around 5%, fining non-attendance does not seem to further reduce non-attendance. Future studies should focus on other means for reduction of non-attendance such as nudging or negative reinforcement. TRIAL REGISTRATION NUMBER ISRCTN61925912.
Collapse
Affiliation(s)
| | | | - Rikke Søgaard
- Demartment of Public Health, Aarhus Universitet, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| |
Collapse
|
44
|
Walsh DMJ, Hynes L, O'Hara MC, Mc Sharry J, Dinneen SF, Byrne M. Embedding a user-centred approach in the development of complex behaviour change intervention to improve outcomes for young adults living with type 1 diabetes: The D1 Now Study. HRB Open Res 2018. [PMID: 32002502 DOI: 10.12688/hrbopenres.12803.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Type 1 diabetes (T1D) is an auto-immune condition which requires intensive self-management. Diabetes self-management is challenging, especially during young adulthood. Effective interventions to improve outcomes for young adults with T1D are needed. This paper describes the development of the D1 Now intervention, employing a user-centred approach to engage with stakeholders in parallel with the application of theory. Methods: Intervention development consisted of 4 phases: 1) the formation of a public and patient involvement (PPI) Young Adult Panel (YAP); 2) a systematic review to synthesise evidence regarding the effectiveness of interventions aimed at improving outcomes for young adults with T1D; 3) understand young adults' diabetes self-management behaviour through engagement with key stakeholders; and 4) an expert consensus meeting to discuss self-management strategies identified in Phase 1 and 3 that would form the core components of the D1 Now intervention. Results: The YAP resulted in meaningful involvement between young adults, researchers and service providers. The systematic review highlighted a lack of quality intervention studies. Qualitative findings highlighted how young adult self-management is driven by complex interactions between external resources, which influence capability, and motivation. The expert panel in Phase 4 highlighted focus areas to improve outcomes for young adults and implementation strategies. Subsequent to these 4 phases, 3 intervention components have been identified: 1) a key worker to liaise with the young adult; 2) an online portal to facilitate relationship building between staff and young adults; and 3) an agenda setting tool to facilitate joint decision-making. Conclusions: This study described the systematic development of an intervention underpinned by theoretical frameworks and PPI, and has identified components for the D1 Now intervention. The resulting intervention content will now be subject to an intervention optimisation process.
Collapse
Affiliation(s)
- Deirdre M J Walsh
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland.,School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland
| | - Lisa Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, WV, 26506, USA
| | - Mary Clare O'Hara
- Research and Development, Strategic Planning and Transformation, Health Service Executive, Dublin 8, D08 W2A8, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
| | | | - Séan F Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland.,Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, H91 YR71, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
| |
Collapse
|
45
|
Walsh DMJ, Hynes L, O'Hara MC, Mc Sharry J, Dinneen SF, Byrne M. Embedding a user-centred approach in the development of complex behaviour change intervention to improve outcomes for young adults living with type 1 diabetes: The D1 Now Study. HRB Open Res 2018; 1:8. [PMID: 32002502 PMCID: PMC6973524 DOI: 10.12688/hrbopenres.12803.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Type 1 diabetes (T1D) is an auto-immune condition which requires intensive self-management. Diabetes self-management is challenging, especially during young adulthood. Effective interventions to improve outcomes for young adults with T1D are needed. This paper describes the development of the D1 Now intervention, employing a user-centred approach to engage with stakeholders in parallel with the application of theory. Methods: Intervention development consisted of 4 phases: 1) the formation of a public and patient involvement (PPI) Young Adult Panel (YAP); 2) a systematic review to synthesise evidence regarding the effectiveness of interventions aimed at improving outcomes for young adults with T1D; 3) understand young adults' diabetes self-management behaviour through engagement with key stakeholders; and 4) an expert consensus meeting to discuss self-management strategies identified in Phase 1 and 3 that would form the core components of the D1 Now intervention. Results: The YAP resulted in meaningful involvement between young adults, researchers and service providers. The systematic review highlighted a lack of quality intervention studies. Qualitative findings highlighted how young adult self-management is driven by complex interactions between external resources, which influence capability, and motivation. The expert panel in Phase 4 highlighted focus areas to improve outcomes for young adults and implementation strategies. Subsequent to these 4 phases, 3 intervention components have been identified: 1) a key worker to liaise with the young adult; 2) an online portal to facilitate relationship building between staff and young adults; and 3) an agenda setting tool to facilitate joint decision-making. Conclusions: This study described the systematic development of an intervention underpinned by theoretical frameworks and PPI, and has identified components for the D1 Now intervention. The resulting intervention content will now be subject to an intervention optimisation process.
Collapse
Affiliation(s)
- Deirdre M J Walsh
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland.,School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland
| | - Lisa Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, WV, 26506, USA
| | - Mary Clare O'Hara
- Research and Development, Strategic Planning and Transformation, Health Service Executive, Dublin 8, D08 W2A8, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
| | | | - Séan F Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland.,Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, H91 YR71, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
| |
Collapse
|
46
|
Byrne M, O’Connell A, Egan AM, Dinneen SF, Hynes L, O’Hara MC, Holt RIG, Willaing I, Vallis M, Hendrieckx C, Coyne I. A core outcomes set for clinical trials of interventions for young adults with type 1 diabetes: an international, multi-perspective Delphi consensus study. Trials 2017; 18:602. [PMID: 29258565 PMCID: PMC5735534 DOI: 10.1186/s13063-017-2364-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achieving consensus from a range of relevant stakeholders about an agreed set of core outcomes to be measured and reported as a minimum in clinical trials has the potential to enhance evidence synthesis and make findings more relevant and applicable. Intervention research to improve outcomes for young adults with type 1 diabetes (T1DM) is hampered by inconsistent use of outcome measures. This population frequently struggles to manage their condition and reports suboptimal clinical outcomes. Our aim was to conduct an international, e-Delphi consensus study to identify a core outcome set (COS) that key stakeholders (young adults with T1DM, diabetes health professionals, diabetes researchers and diabetes policy makers) consider as essential outcomes for future intervention research. METHODS Using a list of 87 outcomes generated from a published systematic review, we administered two online surveys to a sample of international key stakeholders. Participants in the first survey (survey 1; n = 132) and the second survey (survey 2; n = 81) rated the importance of the outcomes. Survey 2 participants received information on total mean rating for each outcome and a reminder of their personal outcome ratings from Survey 1. Survey 2 results were discussed at a consensus meeting and participants (n = 12: three young adults with T1DM, four diabetes health professionals, four diabetes researchers and one diabetes policy maker) voted on outcomes. Final core outcomes were included provided that 70% of consensus group participants voted for their inclusion. RESULTS Eight core outcomes were agreed for inclusion in the final COS: measures of diabetes-related stress; diabetes-related quality of life; number of severe hypoglycaemic events; self-management behaviour; number of instances of diabetic ketoacidosis (DKA); objectively measured glycated haemoglobin (HbA1C); level of clinic engagement; and perceived level of control over diabetes. CONCLUSIONS This study is the first to identify a COS for inclusion in future intervention trials to improve outcomes for young adults with T1DM. Use of this COS will improve the quality of future research and increase opportunities for evidence synthesis. Future research is necessary to identify the most robust outcome measure instruments.
Collapse
Affiliation(s)
- Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Anthony O’Connell
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Aoife M. Egan
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Sean F. Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
- Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland
| | - Lisa Hynes
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Mary Clare O’Hara
- School of Medicine, National University of Ireland, Galway, Ireland
- Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland
| | - Richard I. G. Holt
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS Canada
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC Australia
| | - Imelda Coyne
- Trinity College Dublin, School of Nursing and Midwifery, Dublin, Ireland
| |
Collapse
|
47
|
O’Hara MC, Hynes L, O’Donnell M, Keighron C, Allen G, Caulfield A, Duffy C, Long M, Mallon M, Mullins M, Tonra G, Byrne M, Dinneen SF. Strength in Numbers: an international consensus conference to develop a novel approach to care delivery for young adults with type 1 diabetes, the D1 Now Study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2017; 3:25. [PMID: 29214056 PMCID: PMC5713095 DOI: 10.1186/s40900-017-0076-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Abstract
PLAIN ENGLISH SUMMARY Many young adults with type 1 diabetes struggle with the day-to-day management of their condition. They often find it difficult to find the time to attend their clinic appointments and to meet with their diabetes healthcare team. Young adults living with type 1 diabetes are not routinely involved in research that may help improve health services other than being invited to take part in studies as research participants. A 3-day international conference was held in Galway in June 2016 called "Strength In Numbers: Teaming up to improve the health of young adults with type 1 diabetes". It aimed to bring together people from a broad variety of backgrounds with an interest in young adults with type 1 diabetes. Young people with type 1 diabetes came together with healthcare professionals, researchers, software developers and policy makers to come up with and agree on a new approach for engaging young adults with type 1 diabetes with their health services and to improve how they manage their diabetes.The people involved in the conference aimed to reach agreement (consensus) on a fixed set of outcome measures called a core outcome set (COS) that the group would recommend future studies involving young adults with type 1 diabetes to use, to suggest a new approach (intervention) for providing health services to young adults with type 1 diabetes, and to come up with health technology ideas that could help deliver the new intervention. Over the 3 days, this diverse international group of people that included young adults living with type 1 diabetes, agreed on a COS, 3 key parts of a new intervention and 1 possible health technology idea that could help with how the overall intervention could be delivered.Involving young adults living with type 1 diabetes in a 3-day conference along with other key groups is an effective method for coming up with a new approach to improve health services for young adults with type 1 diabetes and better support their self-management. ABSTRACT Background A 3-day international consensus meeting was hosted by the D1 Now study team in Galway on June 22-24, 2016 called "Strength In Numbers: Teaming up to improve the health of young adults with type 1 diabetes". The aim of the meeting was to bring together young adults with type 1 diabetes, healthcare providers, policy makers and researchers to reach a consensus on strategies to improve engagement, self-management and ultimately outcomes for young adults living with type 1 diabetes. Methods This diverse stakeholder group participated in the meeting to reach consensus on (i) a core outcome set (COS) to be used in future intervention studies involving young adults with type 1 diabetes, (ii) new strategies for delivering health services to young adults and (iii) potential digital health solutions that could be incorporated into a future intervention. Results A COS of 8 outcomes and 3 key intervention components that aim to improve engagement between young adults with type 1 diabetes and service providers were identified. A digital health solution that could potentially compliment the intervention components was proposed. Conclusion The outputs from the 3-day consensus conference, that held patient and public involvement at its core, will help the research team further develop and test the D1 Now intervention for young adults with type 1 diabetes in a pilot and feasibility study and ultimately in a definitive trial. The conference represents a good example of knowledge exchange among different stakeholders for health research and service improvement.
Collapse
Affiliation(s)
- M. C. O’Hara
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Health and Wellbeing Division, Health Service Executive, Merlin Park University Hospital, 2nd Floor, Block A H91 N973, Galway, Ireland
| | - L. Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, USA
| | - M. O’Donnell
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - C. Keighron
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - G. Allen
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - A. Caulfield
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - C. Duffy
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Long
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Mallon
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Mullins
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - G. Tonra
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Byrne
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - S. F. Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - with the D1 Now Type 1 Diabetes Young Adult Study Group
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Health and Wellbeing Division, Health Service Executive, Merlin Park University Hospital, 2nd Floor, Block A H91 N973, Galway, Ireland
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, USA
- Member of the D1 Now Young Adult Panel, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| |
Collapse
|
48
|
O'Hara MC, Hynes L, O'Donnell M, Nery N, Byrne M, Heller SR, Dinneen SF. A systematic review of interventions to improve outcomes for young adults with Type 1 diabetes. Diabet Med 2017; 34:753-769. [PMID: 27761951 PMCID: PMC5484309 DOI: 10.1111/dme.13276] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Many young adults with Type 1 diabetes experience poor outcomes. The aim of this systematic review was to synthesize the evidence regarding the effectiveness of interventions aimed at improving clinical, behavioural or psychosocial outcomes for young adults with Type 1 diabetes. METHODS Electronic databases were searched. Any intervention studies related to education, support, behaviour change or health service organizational change for young adults aged between 15-30 years with Type 1 diabetes were included. A narrative synthesis of all studies was undertaken due to the large degree of heterogeneity between studies. RESULTS Eighteen studies (of a possible 1700) were selected and categorized: Health Services Delivery (n = 4), Group Education and Peer Support (n = 6), Digital Platforms (n = 4) and Diabetes Devices (n = 4). Study designs included one randomized controlled trial, three retrospective studies, seven feasibility/acceptability studies and eight studies with a pre/post design. Continuity, support, education and tailoring of interventions to young adults were the most common themes across studies. HbA1c was the most frequently measured outcome, but only 5 of 12 studies that measured it showed a significant improvement. CONCLUSION Based on the heterogeneity among the studies, the effectiveness of interventions on clinical, behavioural and psychosocial outcomes among young adults is inconclusive. This review has highlighted a lack of high-quality, well-designed interventions, aimed at improving health outcomes for young adults with Type 1 diabetes.
Collapse
Affiliation(s)
- M. C. O'Hara
- School of MedicineNUI GalwayGalwayIreland
- Endocrinology and Diabetes CentreGalway University HospitalsGalwayIreland
| | - L. Hynes
- School of PsychologyNUI GalwayGalwayIreland
| | | | - N. Nery
- School of MedicineNUI GalwayGalwayIreland
| | - M. Byrne
- School of PsychologyNUI GalwayGalwayIreland
| | - S. R. Heller
- Department of Human MetabolismAcademic Unit of DiabetesEndocrinology and MetabolismUniversity of SheffieldSheffieldUK
| | - S. F. Dinneen
- School of MedicineNUI GalwayGalwayIreland
- Endocrinology and Diabetes CentreGalway University HospitalsGalwayIreland
| | | |
Collapse
|
49
|
Papavarnavas NS, Manning K, Conrad F, Govender M, Maartens G. Factors associated with loss to follow-up after occupational HIV exposure in Cape Town, South Africa: a retrospective cohort study. AIDS Res Ther 2017; 14:23. [PMID: 28431556 PMCID: PMC5401471 DOI: 10.1186/s12981-017-0149-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/13/2017] [Indexed: 11/17/2022] Open
Abstract
Background There is limited data on factors associated with loss to follow-up (LTFU) of health care workers (HCWs) following occupational exposure to HIV, and most studies were conducted in an era when poorly tolerated antiretrovirals like zidovudine were used. Methods A retrospective cohort study was conducted of HCWs attending a referral hospital’s Occupational Health Clinic in Cape Town, South Africa for post-exposure prophylaxis (PEP) during a period when tenofovir was available. Our primary outcome was LTFU at the 3-month visit. We selected seven variables a priori for our logistic regression model and ensured there were at least 10 outcome events per variable to minimize bias. Results Two hundred and ninety-three folders were evaluated for descriptive analysis. LTFU worsened with successive visits: 36% at 6 weeks, 60% at 3 months, and 72% at 6 months. In multivariate analysis at the 3-month visit LTFU was associated with age (adjusted odds ratio (aOR), 0.6 per 10-year increase [95% CI, 0.5–0.9]), HCW category of doctor (aOR 2.7 [95% CI, 1.3–5.5]), and time from exposure to receiving PEP of more than 24 h (aOR 5.9 [95% CI, 1.3–26.9]). Conclusion We identified factors associated with LTFU of HCWs after occupational HIV exposure, which could be used to target interventions to improve follow-up.
Collapse
|
50
|
Schultz AT, Smaldone A. Components of Interventions That Improve Transitions to Adult Care for Adolescents With Type 1 Diabetes. J Adolesc Health 2017; 60:133-146. [PMID: 27939878 DOI: 10.1016/j.jadohealth.2016.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/15/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022]
Abstract
Adolescents with type 1 diabetes struggle with glycemic control with decline further exacerbated by transfer from pediatric to adult care. The purpose of this systematic review/meta-analysis was to examine which components of transition programs are effective in improving outcomes following transfer. We searched six databases for studies that assessed the efficacy of a transition program on diabetes outcomes. Studies reporting hemoglobin A1c (HbA1c) or its change for the intervention versus control group pretransition and posttransition were pooled using a random effects meta-analysis model. Of 4,689 studies identified, 18 (1 randomized control trial, 6 quasi-experimental, 1 prospective, and 10 retrospective cohort) met inclusion criteria. Findings represent data from 3,382 youth with type 1 diabetes (52% male, age 16-23 years) undergoing transition. Programs varied and included transition coordinators (n = 7), transition clinics (n = 10), and group education meetings (n = 5). Average age of transfer was 17.7 years. All but one study reported improvement/maintenance of HbA1c posttransition. However, pooling data from four studies with a control group (418 youth), there were no differences in HbA1c at 12 months (-.11 [95% confidence interval: -.31, .08]). Of other outcomes studied (clinic attendance [n = 12], severe hypoglycemia [n = 8], and diabetic ketoacidosis [n = 7]), transition programs showed greatest consistency in reducing diabetic ketoacidosis episodes. Findings suggest that transition interventions may be effective in maintaining glycemic control and reducing diabetic ketoacidosis episodes posttransition. Further research is needed to determine which program types are most effective.
Collapse
Affiliation(s)
- Alan T Schultz
- Columbia University School of Nursing, New York, New York
| | - Arlene Smaldone
- Columbia University School of Nursing, New York, New York; College of Dental Medicine, Columbia University Medical Center, New York, New York.
| |
Collapse
|