Adolescents with type 1 diabetes (T1D) are at high risk for poor adherence and glycemic control. Some of the most prevalent barriers to adherence in adolescents are psychosocial in nature, such as stress, stigma, time pressures, social situations, and communication with peers and parents. Diabetes research and professional organizations support the development of problem solving skills to resolve barriers to adolescent adherence. In order to address the needs of adolescents with T1D, parents, and clinics, we created an Internet adherence problem solving intervention, named YourWay. Initial results indicated moderate impact on adherence but variable engagement with the intervention. Based on our preliminary studies, we propose substantially advancing our intervention through three new design features: 1) a mobile data collection system using ecological momentary assessment (EMA) to populate the intervention with behavioral adherence data and multimedia content and improve awareness of adherence barriers, 2) a new homepage that integrates EMA data, BG values, and adolescent-generated multimedia content into personal adherence stories, and 3) social learning activities with peers focused on adherence problem solving. These enhanced features will provide more objective and more engaging data to guide and motivate adherence problem solving and provide intrinsically motivated social interactions with peers about adherence.
Our aims i nclude 1) establishing current behaviors and beliefs regarding adolescent use of health information technology for diabetes, and specifically those related to sharing personal health information with peers, 2) focused iterative design cycles for each of these features to identify the most engaging and acceptable interface and adherence data sharing activities, and 3) a pilot randomized trial to assess the impact of the intervention on glycemic control (A1C). There are currently no resources for this population that integrate social interactions with peers with skill building activities to improve adherence. The proposed Internet intervention will innovatively combine these features into a personal story format. The intervention has a high potential for engaging adolescents in adherence problem solving, improving adherence, and reducing the serious medical consequences related to poor glycemic control.

Public Health Relevance

Adolescents with type 1 diabetes are at risk for inadequate self-care and glycemic control, which may lead to serious health consequences. The proposed research will design and test an intervention to support adolescent self-care through teaching problem solving skills and providing peer-based educational activities through the Internet and mobile phones. The research will contribute to our understanding of adolescent adoption of technology-based educational tools for diabetes and how to engage adolescents in adherence education.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type 1 Diabetes Targeted Research Award (DP3)
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Special Emphasis Panel (ZDK1-GRB-9 (O1))
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Hunter, Christine
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Vanderbilt University Medical Center
Schools of Nursing
United States
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Vaala, Sarah E; Lee, Joyce M; Hood, Korey K et al. (2017) Sharing and helping: predictors of adolescents' willingness to share diabetes personal health information with peers. J Am Med Inform Assoc :
Kumah-Crystal, Yaa A; Hood, Korey K; Ho, Yu-Xian et al. (2015) Technology Use for Diabetes Problem Solving in Adolescents with Type 1 Diabetes: Relationship to Glycemic Control. Diabetes Technol Ther 17:449-54
Ho, Yun-Xian; O'Connor, Brendan H; Mulvaney, Shelagh A (2014) Features of online health communities for adolescents with type 1 diabetes. West J Nurs Res 36:1183-98
Kumah-Crystal, Yaa; Mulvaney, Shelagh (2013) Utilization of blood glucose data in patient education. Curr Diab Rep 13:886-93