Late adolescence and early adulthood is a developmental period marked by increasing autonomy and heightened rates of health risk behaviors, and is typically accompanied by the transition from living at home to living independently of parents. This increased independence can be a risk factor for all adolescents, but may be even more detrimental for adolescents who are managing chronic diseases (i.e. type 1 diabetes) as they may experience prolonged periods of poor control leading to both short and long term health consequences. Little is known about the contextual factors and issues which this population faces, and even less is known about strategies that are used to overcome potential barriers to diabetes management. Dr. Stupiansky has extensive training in health behavior, including how contextual factors relate to health risk decision-making such as condomless sex and alcohol use. However, the current application will further specialize his training to understand the metabolic and clinical aspects of diabetes management so that he is better prepared to examine the role of contextual factors in facilitating or inhibiting proper disease management. Additionally, he seeks additional training to acquire skills to develop technology-based interventions that will be informed using strategies identified by participants in this research project. With mentorship from Dr. David Marrero and a panel of clinical, educational, and technological experts;Dr. Stupiansky intends to perform formative qualitative research using focus groups of pre- and post-transition adolescents with type 1 diabetes. Themes that are elicited and identified from the focus groups will then be used to develop an interactive, multi-media tool in which adolescents can view "stories" of diabetes management experiences as relayed by their peers. This important and innovative project will represent a significant contribution to research on diabetes management during late adolescence and early adulthood, and culminate in future research applications to perform technology-based interventions aimed at improving clinical care outcomes for all adolescents with diabetes. The training plan and research strategy in this application will give Dr. Stupiansky the time, resources, and mentorship that he needs to succeed as an independent researcher and allow him to make significant, translational contributions to the field.
The training and research findings gained from this project will improve future clinical care outcomes for adolescent patients with type 1 diabetes by identifying critical issues which impede or facilitate diabetes management during the transition to living independently. These research findings will inform technology- based interventions to assist clinicians educate their adolescent patients on strategies to maintain or improve diabetes management throughout the developmental process.