Understanding the Roles of Romantic Partners and Parents in the Management of Type 1 Diabetes in Emerging Adults

Acceptability and feasibility of FAMS-T1D mHealth intervention to optimize self- and social regulation for emerging adults with type 1 diabetes

BACKGROUND

Among emerging adults with type 1 diabetes (T1D), self-regulation and social regulation skills can help avoid high A1c and diabetes distress. FAMS (Family/friend Activation to Motivate Self-care) is mobile phone-delivered intervention that supports development of these skills and is efficacious among adults with type 2 diabetes. However, the acceptability and feasibility of the FAMS intervention among emerging adults with T1D are unknown.

METHODS

Therefore, we adapted FAMS for in a new disease context and developmental stage and then conducted a 3-month mixed-methods pre-post pilot study. Participants were emerging adults with T1D and a friend/family member enrolled as a support person (optional). Feasibility/acceptability outcomes and associated progression thresholds were recruitment (≥ 70% eligible emerging adults), retention (≥ 85%), intervention engagement (≥ 70%), and satisfaction (≥ 70%). We also collected qualitative feedback to determine if the intervention addressed relevant needs and explored changes in outcomes of interest (family/friend involvement, self-efficacy, self-management, distress, A1c).

RESULTS

Recruitment rates indicate recruitment of emerging adults with T1D (n = 30) and their support persons (n = 20) is feasible - 79% of emerging adults who screened as eligible enrolled and 70% of enrolled emerging adults invited a support person. Emerging adults completed 98% of coaching sessions, and response rates to automated text messages were median 85% IQR [68%, 90%]. Changes in selected measures for outcomes of interest were in expected directions suggesting sensitivity to changes occasioned by the intervention in a future evaluative trial. Emerging adults said FAMS-T1D helped with setting realistic goals, motivated them to prioritize diabetes goals, and increased support, indicating acceptability of the intervention in this new disease and developmental context.

CONCLUSIONS

Findings suggest potential for FAMS-T1D to engage emerging adults and their support persons and feasibility for an evaluative trial examining effects on self-regulation (self-efficacy, self-management), social regulation (family/friend involvement), and outcomes (diabetes distress, A1c).

TRIAL REGISTRATION

We did not register this study on ClinicalTrials.gov because the purpose of the study was to assess the feasibility and acceptability of the intervention and study procedures and measures in preparation for a future trial. The purpose of that future trial will be to evaluate the effect of the intervention on health-related biomedical and behavioral outcomes, and that trial will be registered accordingly.

Goal change and goal achievement for emerging adults across the pilot FAMS-T1D intervention for type 1 diabetes

Objective

Interventions for emerging adults (EAs) with type 1 diabetes (T1D) focus on goal setting, but little is known about how goal achievement relates to intervention outcomes. We examined how goals change, how goal achievement relates to diabetes outcomes, and identified barriers and facilitators to goal achievement.

Method

EAs with T1D (N=29, M age=21.6 years, 57% female) were coached monthly to set a behavioral goal across a 3-month feasibility trial. Coaching notes were qualitatively coded regarding type, complexity, and changes in goals. Goal achievement was measured via daily responses to texts. HbA1c, self-efficacy, diabetes distress, and self-care were assessed pre- and post-intervention.

Results

EAs frequently set food goals (79%) in combination with other goals. EAs overwhelmingly changed their goals (90%), with most increasing goal complexity. Goal achievement was high (79% of days) and not affected by goal change or goal complexity. Goal achievement was associated with increases in self-efficacy and self-care across time. Qualitative themes revealed that aspects of self-regulation and social-regulation were important for goal achievement.

Conclusion

Meeting daily diabetes goals may enhance self-efficacy and self-care for diabetes.

Practice Implications

Assisting EAs to reduce self-regulation challenges and enhance social support for goals may lead to better diabetes outcomes.

Acceptability and Feasibility of FAMS-T1D mHealth intervention to optimize self- & social regulation for emerging adults with type 1 diabetes

Background

Among emerging adults with type 1 diabetes (T1D), self-regulation and social regulation skills can help avoid high A1c and diabetes distress. FAMS (Family/friend Activation to Motivate Self-care) is mobile phone-delivered intervention that supports development of these skills and is efficacious among adults with type 2 diabetes. However, the acceptability and feasibility of the FAMS intervention among emerging adults with T1D is unknown.

Methods

Therefore, we adapted FAMS for in a new disease context and developmental stage then conducted a 3-month mixed-methods pre-post pilot study. Participants were emerging adults with T1D and a friend/family member enrolled as a support person (optional). Feasibility/acceptability outcomes and associated progression thresholds were recruitment (≥ 70% eligible emerging adults), retention (≥ 85%), intervention engagement (≥ 70%) and satisfaction (≥ 70%). We also collected qualitative feedback to determine if the intervention addressed relevant needs and explored changes in outcomes of interest (family/friend involvement, self-efficacy, self-management, distress, A1c).

Results

Recruitment rates indicate recruitment of emerging adults with T1D and their support persons is feasible - 79% of emerging adults who screened as eligible enrolled and 70% of enrolled emerging adults invited a support person. Emerging adults completed 98% of coaching sessions, and response rates to automated text messages were median 85% IQR [68%, 90%]. Changes in selected measures for outcomes of interest were in expected directions suggesting sensitivity to changes occasioned by the intervention in a future evaluative trial. Emerging adults said FAMS-T1D helped with setting realistic goals, motivated them to prioritize diabetes goals, and increased support, indicating acceptability of the intervention in this new disease and developmental context.

Conclusions

Findings suggest potential for FAMS-T1D to engage emerging adults and their support persons and feasibility for evaluation of effects on hypothesized intervention targets and outcomes in a subsequent evaluative trial.

Trial Registration

We did not register this study on clinicaltrials.gov because the purpose of the study was to assess the feasibility and acceptability of the intervention and study procedures and measures in preparation for a future trial. The purpose of that future trial will be to evaluate the effect of the intervention on health-related biomedical and behavioral outcomes and that trial will be registered accordingly.

A shared love: reciprocity and hopefulness in romantic relationships of young adults with chronic pain

Introduction

Chronic pain (≥3 months) creates pain-related challenges that may negatively affect how young adults perceive themselves, and, indeed, they often report feeling different compared to peers and prospective romantic partners. Most studies of romantic relationships in young adults living with a long-term condition (including pain), do not consider the perspective of their partner. We present the findings of a qualitative, exploratory interview study (Phase 2 of a mixed methods study). This qualitative phase aimed to explore how young adults with chronic pain and their partners navigate romantic relationships. We focused on how young adults perceive and experience their romantic relationships and the impact, challenges, and benefits associated with living with chronic pain.

Methods

This study used remote (videoconferencing) photo-elicitation interviews with a convenience sample of young adults with chronic pain (aged 18-25 years, UK and Canada) and their partners. Recruitment occurred via social media, pain-related websites and organizations, and professional networks. Five young adults with chronic pain from the UK and Canada formed the e-Advisory Group and provided detailed advice throughout the study. Data analysis used the principles of inductive reflexive thematic analysis to explore the dimensions and meaning of romantic relationships from the views of young adults with chronic pain and their romantic partners.

Findings

Sixteen young adults participated (seven couples plus two young adults with pain who were interviewed without their partner). The young adults with chronic pain were ages 18-24 years (mean 21.88 years, SD 2.23). Four major interpretive themes were generated: Kindred spirits-we just sort of work; Loving in everyday acts-it's not above and beyond, it's concerned supportiveness; It's OK to be vulnerable with each other-we can talk it through; and You can't see over the horizon-hopes and fears for the future.

Discussion

Hopefulness and reciprocity were key to the stories shared by the young adults in the current study. Despite the challenges and limitations imposed by chronic pain, their relationships were characterized by partnership and reciprocity, and they were able to be vulnerable with each other and offer each other support.

Development of Peer Relationships From Adolescence into Emerging Adulthood: Comparing Males and Females With and Without Type 1 Diabetes

OBJECTIVE

Friendships and romantic relationships are important sources of support that contribute to well-being for youth across adolescence and emerging adulthood and may be especially important for those with a chronic illness. We examined gender differences in trajectories of peer relationships among those with type 1 diabetes (T1D) and how they differ from those without.

METHODS

Individuals with T1D (N = 132) and controls (N = 131) completed questionnaires across 11 years (M age = 12 years at baseline). Trajectories of friend support, conflict, and companionship were estimated from ages 11 to 23. Romantic support and conflict trajectories were estimated from ages 17 to 23.

RESULTS

Females experienced more friend support than males, especially in comparison to males with T1D. Control females experienced highest levels of romantic support and lowest levels of romantic conflict. In comparison to control males, males with T1D experienced less friend support in early adolescence and less companionship in late adolescence and emerging adulthood. In comparison to control females, females with T1D experienced less friend support in late adolescence and more romantic conflict in emerging adulthood.

CONCLUSIONS

Findings that males with T1D report less friend support and companionship compared to control males, and females with T1D report less friend support and more romantic conflict than control females are of concern as these results suggest those with T1D may be missing out on important aspects of peer relationships. Understanding the broader social network of peer relationships may be useful to clinicians as they assist individuals in garnering support in general and for their diabetes.