A Self-Compassion Chatbot to Improve the Wellbeing of Adolescents with Type 1 Diabetes During the COVID-19 Pandemic: What do Adolescents and their Healthcare Professionals Want?

BACKGROUND

Prior to the coronavirus (COVID-19) pandemic, adolescents with type 1 diabetes (T1D) already experienced far greater rates of psychological distress than their peers. With the pandemic further challenging mental health and increasing the barriers to maintaining optimal diabetes self-management, it is vital this population has access to remotely deliverable, evidence-based interventions to improve psychological and diabetes outcomes. Chatbots, defined as digital conversational agents, offer these unique advantages, as well as the ability to engage in empathetic and personalized conversations 24/7. Building on previous work developing a self-compassion program for adolescents with T1D, a self-compassion chatbot was developed for adolescents with T1D to address these concerns. However, the acceptability and potential clinical usability of a chatbot to deliver self-compassion coping tools to adolescents with T1D remained unknown.

OBJECTIVE

This qualitative study was designed to evaluate the acceptability and potential clinical utility of a novel self-compassion chatbot (called 'COMPASS') among adolescents aged 12 to 16 years with T1D and their diabetes healthcare professionals.

METHODS

Potential adolescent participants were recruited from previous participant lists, and online and in-clinic study flyers, whereas healthcare professionals were recruited from clinic emails and diabetes research special interest groups. Qualitative Zoom interviews exploring views on a newly developed self-compassion chatbot were conducted with 19 adolescents (in 4 focus groups), and 11 diabetes healthcare professionals (in 2 focus groups and 6 individual interviews), from March to April 2022. Transcripts were analyzed using directed content analysis to examine the features and content of greatest importance to both groups.

RESULTS

Adolescents were broadly representation of the youth population living with T1D in Aotearoa (58% female, 68% Aotearoa New Zealand European, 11% Māori). Healthcare professionals represented a range of disciplines including Diabetes Nurse Specialists (n = 3), Health Psychologists (n = 3), Dieticians (n = 3), and Endocrinologists (n = 2). Findings offer early insight into what adolescents with T1D and their healthcare professionals see as shared advantages of COMPASS and desired future additions, such as personalization (mentioned by all 19 adolescents), self-management support (mentioned by 13 of 19 adolescents), clinical utility (mentioned by all 11 healthcare professionals), and breadth and flexibility of tools (mentioned by 10 of 11 healthcare professionals).

CONCLUSIONS

Early data suggest that a self-compassion chatbot for adolescents with T1D is acceptable, relevant to common difficulties, and offers clinical utility during the COVID-19 pandemic. However, shared desired features amongst both groups, including problem-solving and integration with diabetes technology to support self-management, creating a safe peer-to-peer sense of community, and broadening the representation of different cultures, lived experience stories, and diabetes challenges, could further improve the potential of the chatbot. Based on these findings, the COMPASS chatbot is currently being improved to be tested in a future feasibility study.

CLINICALTRIAL

Well-being app to support young people during the COVID-19 pandemic: randomised controlled trial

OBJECTIVES

To evaluate the efficacy and acceptability of 'Whitu: seven ways in seven days', a well-being application (app) for young people.

DESIGN

Prospective randomised controlled trial of Whitu against waitlist control, with 45 participants in each arm.

PARTICIPANTS

90 New Zealand young people aged 16-30 recruited via a social media advertising campaign.

SETTING

Participants' homes.

INTERVENTIONS

Developed during the COVID-19 pandemic, and refined from a prototype version that was evaluated during a smaller qualitative study, 'Whitu: seven ways in seven days' is a well-being app that, as its name suggests, contains seven modules to help young people (1) recognise and rate emotions, (2) learn relaxation and mindfulness, (3) practice self-compassion and (4) gratitude, (5) connect with others, (6) care for their physical health and (7) engage in goal-setting. It can be completed within a week or as desired.

MAIN OUTCOME MEASURES

Primary outcomes were changes in well-being on the WHO 5-item Well-Being Index and Short Warwick-Edinburgh Mental Well-Being Scale. Secondary outcomes were changes in depression on the Centre for Epidemiological Studies Depression Scale, anxiety on the Generalised Anxiety Disorder 7-item Scale, self-compassion on the Self Compassion Scale-Short Form, stress on the 10-item Perceived Stress Scale, sleep on the single-item Sleep Quality Scale and user engagement on the end-user version of the Mobile Application Rating Scale and via qualitative feedback during an online survey. Outcomes were evaluated at baseline, 4 weeks (primary study endpoint) and 3 months, and analysed using linear mixed models with group, time and a group-time interaction.

RESULTS

At 4 weeks, participants in the Whitu group experienced significantly higher emotional (Mean difference (md) 13.19 (3.96 to 22.42); p=0.005) and mental (md 2.44 (0.27 to 4.61); p=0.027) well-being, self-compassion (md 0.56 (0.28 to 0.83); p<0.001) and sleep (md 1.13 (0.24 to 2.02); p=0.018), and significantly lower stress (md -4.69 (-7.61 to -1.76); p=0.002) and depression (md -5.34 (-10.14 to -0.53); p=0.030), compared with the waitlist controls. Group differences remained statistically significant at 3 months for all outcomes. Symptoms of anxiety were also lower in the intervention group at 4 weeks (p=0.096), with statistically significant differences at 3 months (md -2.31 (-4.54 to -0.08); p=0.042). Usability of Whitu was high (subjective ratings of 4.45 (0.72) and 4.38 (0.79) out of 5 at 4 weeks and 3 months, respectively) and qualitative feedback indicated individual and cultural acceptability of the app.

CONCLUSIONS

Given the evolving psychological burden of the COVID-19 pandemic, Whitu could provide a clinically effective and scalable means of improving the well-being, mental health and resilience of young people. Replication of current findings with younger individuals and in other settings is planned.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12620000516987).

Investigating the effect of an online self-compassion for weight management (SC4WM) intervention on self-compassion, eating behaviour, physical activity and body weight in adults seeking to manage weight: protocol for a randomised controlled trial

INTRODUCTION

Individual weight management, defined as engaging in behaviours to maintain or lose weight, can improve health and well-being. However, numerous factors influence weight management outcomes, such as genetics, biology, stress, the social and physical environment. Consequently, weight management can be hard. Self-compassion, described as treating oneself kindly in times of failure or distress, has shown promise in improving weight management outcomes. The objectives of this study are twofold: (1) to examine the efficacy of an online self-compassion for weight management (SC4WM) intervention coupled with an online commercial weight management programme (WW Weight Watchers reimagined) with increasing self-compassion and improving weight management outcomes (eating behaviour, physical activity and body weight) in comparison with the WW programme only and (2) to explore whether improvements in weight management outcomes are moderated by eating restraint, weight self-stigma, perceived stress and psychological coping.

METHODS AND ANALYSIS

To achieve these objectives, 240 participants seeking to manage their weight were randomised to either an online behavioural commercial weight management programme (WW) or the online WW +SC4 WM intervention. Validated measures of self-compassion, stress, weight self-stigma, eating restraint, psychological coping and weight management outcomes were administered online at baseline, 4 weeks and at a 12-week follow-up.

ETHICS AND DISSEMINATION

Ethics has been granted by the University of Auckland Health Research Ethics committee. Results will be communicated in peer-review journals, conferences and a doctoral thesis. If effective in increasing self-compassion and improving weight management outcomes, the intervention could be made more widely available to supplement behavioural weight management programmes.

TRIAL REGISTRATION NUMBER

ACTRN12621000580875; Pre-results.

A brief self-compassion intervention for adolescents with type 1 diabetes and disordered eating: a feasibility study

AIM

To examine the feasibility and acceptability of a brief self-compassion intervention for adolescents with type 1 diabetes and disordered eating behaviour.

METHODS

Twenty-seven adolescents with type 1 diabetes were recruited and randomized to receive the brief (two 2.5-h sessions) self-compassion intervention, either in the intervention group (n=11) or in a waitlist control group (n=8). The intervention was adapted from the standardized eight-session 'Making Friends with Yourself' programme, and sessions were delivered 1 week apart. Acceptability was assessed through qualitative questionnaires and feasibility was assessed based on session attendance and recruitment metrics. Possible changes to disordered eating behaviour, self-care behaviours, diabetes-related distress, self-compassion, stress and glycaemic control were also assessed.

RESULTS

Nineteen participants completed the study, and they reported an increased sense of common humanity (acknowledging that we are not alone), mindfulness, and coping resources. In terms of feasibility, recruitment took longer than expected (8 months) and not all participants were able to attend both sessions (nine could only attend one of the two sessions).

CONCLUSIONS

While self-compassion is a strong conceptual fit for the issues of type 1 diabetes and disordered eating behaviour in adolescence, and the intervention content appears acceptable, feasibility issues were such that brief self-compassion programmes will probably need to be adapted into digital interventions for future research. (Trial registration number: ANZCTR 12619000541101).

A pilot randomized controlled trial of a gratitude intervention for adolescents with Type 1 diabetes

AIM

Cost-effective psychosocial interventions that can feasibly be implemented into busy clinical settings are needed to improve psychological and physical health outcomes in adolescents with Type 1 diabetes. We examined the efficacy of a gratitude journalling intervention to improve psychological well-being and glycaemic control in adolescents aged 10-16 years with Type 1 diabetes.

METHODS

Eighty adolescents were randomized to the 8-week gratitude intervention (N = 40) or standard care (N = 40). Self-reported measures of stress, quality of life, self-care, depression and gratitude were assessed at baseline and 8 weeks after baseline. Glycaemic control (HbA_1c ) was assessed at baseline and 12 weeks after baseline. A per-protocol analysis was conducted with the adolescents who completed all questionnaires (N = 60). Analysis of covariance (ANCOVA) was used to examine differences between treatment arms at follow-up adjusting for baseline scores.

RESULTS

There was no evidence of any between-group differences in the psychological or behavioural measures at follow-up (all P-values > 0.05). Glycaemic control slightly increased in the control group while remaining stable in the gratitude group, with a between-group difference of 6.1 mmol/mol [95% confidence interval (CI) -2.6 to 14.7; 0.6%, 95% CI -0.2 to 1.3] at 12 weeks after baseline. After adjusting for baseline HbA_1c , this between-group difference was significant (P = 0.048).

CONCLUSIONS

This is the first randomized trial of a gratitude journalling intervention for adolescents with Type 1 diabetes. Gratitude journalling interventions represent a clinically usable approach. If and how it helps to stabilise glycaemic control in adolescents with Type 1 diabetes remains to be confirmed in future research.

Cumulative effects of negative life events and family stress on children's mental health: the Bergen Child Study

PURPOSE

Numerous studies have documented that lower socioeconomic status (SES) is associated with increased mental health problems in children. One proposed pathway for this association has been differential exposure to accumulated risk factors in children of lower SES. The aim of the current study was to investigate the socioeconomic distribution of exposure to negative life events and family stress and to examine the direct and interactive association between lower SES and exposure to life events and family stress in relation with mental health problems.

METHODS

Using cross-sectional data from the second wave of the Bergen Child Study (conducted in 2006), the current study investigated the association between lower SES and exposure to negative life events, family life stressors, and mental health problems in a sample of 2043 Norwegian 11-13 years and their parents. Information about mental health was self-reported by the children using the Strengths and Difficulties Questionnaire, whereas information about SES and exposure to negative life events and family stressors were provided by their parents.

RESULTS

The findings showed that lower SES was associated with more symptoms of emotional-, conduct-, hyperactivity/inattention-, and peer problems and that exposure to life events and family stress explained some of this association (10-29% of the total effects).

CONCLUSIONS

Low SES and higher prevalence of negative life events and family stressors were associated with more symptoms of mental health problems. Overall, the effect sizes were smaller than previous investigations (f ²s = 0.015-0.031), perhaps suggesting a buffering effect of the social safety net in place in Norway.