Testing and refining the e-health component of a complex intervention to improve outcomes for young adults with Type 1 Diabetes: D1 Now
By Artur Direito, on 3 August 2018
By Dr. Deirdre Walsh & Dr. Blathin Casey, on behalf of the D1 Now study team, Health Behaviour Change Research Group, NUI Galway.
Young adulthood can be a challenging time for Type 1 Diabetes (T1D) self-management as individuals navigate this time of transition. Despite this, current interventions do not address many of the needs of this population. The D1 Now study, funded through a Definitive Intervention and Feasibility Award from the Health Research Board, Ireland, aims to develop and evaluate a complex intervention to improve outcomes for young adults with type 1 diabetes in Ireland. Three components of the D1 Now intervention have been identified: 1) an Online/Interactive Tool (i.e., Florence which is an interactive telehealth intervention that sends patients reminders and health tips tailored to their individual needs using a short messaging service (SMS)to aid diabetes self-management), 2) a key worker to introduce the young adult to the diabetes service and flexibly address the needs of young adults within the clinic; and 3) an Agenda Setting Tool for use in consultations. See here for more information on the D1 Now intervention development process.
In order to ensure that the intervention is acceptable and relevant to the young adult population, a public and patient involvement (PPI) approach has been embedded within D1 Now. The D1 Now team has worked with a youth mental health organisation (Jigsaw, Galway) to enable the voice of the young adult to influence the research being undertaken through the recruitment of a PPI Young Adult Panel (YAP) of 18-25 year olds with T1D. Members of the YAP act as co-researchers; they participate in Study Steering Group meetings and help with decision-making around all aspects of the research. This has been a hugely rewarding aspect of the work and continues to generate new knowledge and insights. Another PPI YAP was established in Dublin in Spring 2018 to work collaboratively with the Galway YAP and research team.
Current work is focused on exploring the feasibility and acceptability of the three potential D1 Now intervention components including the telehealth component(i.e., Florence). Florence is an interactive telehealth intervention that sends patients reminders and health tips tailored to their individual needs using a short messaging service. During this intervention optimisation phase, the operationalisation of the Florence will be further developed based on iterative cycles of feedback from young adults and healthcare professionals to refine the text message protocols and decision support systems including protocols based on blood glucose monitoring, motivational messages, responsible alcohol consumption and sick day rules reminders. Three rounds of testing and refining will take place in one diabetes hospital clinic. Approximately 20-24 patients will take part in focus groups (n=5-6 per round) followed by a feasibility study in an independent site.
Currently, 4-week pilot data is being analysed with a specific focus on issues of acceptability, feasibility and satisfaction with Florence. The findings will inform the optimisation of the D1 Now intervention,prior to the feasibility testing phase and future randomised pilot. Key preliminary findings around the ‘nuts and bolts’ suggest message tailoring to core content of blood glucose monitoring with emphasis on how ‘we are all different’, while the theme ‘who’s in charge’ reflected considerations of responsibility around the monitoring of blood glucose measurements from both young adults and health care professionals with wide acceptance of the usefulness of leveraging technology to aid self-management.
Moving forward with the telehealth component of D1 Now intervention, we need to consider various aspects of how the component can impact on young adult care, in particular how it can alter existing engagement levels and enhance:
- How do we define and measure engagement with the intervention components, in particular the Florence text messaging service?
- How do we best combine the role of Florence with other ‘in-clinic’ intervention components?
Programme Manager, D1 Now study, School of Medicine and Health Behaviour Change Research Group, School of Psychology, NUI Galway.
Deirdre (@deirdremwalsh1) is currently involved in the D1 Now study which includes the development, feasibility and piloting of a complex intervention to improve outcomes for young adults with type 1 diabetes in Ireland. Deirdre completed an MSc in Positive Psychology (University of East London) where her interest in health psychology emerged. Deirdre’s subsequently completed a structured PhD in Psychology and Health. Following her PhD, Deirdre worked as a post-doctoral researcher in the Insight Centre for Data Analytics and the School of Health and Human Performance, Dublin City University. She worked across three funded programmes (H2020, Science Foundation Ireland and AAL) focusing on health behaviour change, eHealth and chronic illness. Her research interests include qualitative research methods, eHealth, PPI and intervention design.
Post-Doctoral Researcher, D1Now Study, School of Medicine and Health Behaviour Change Research Group, School of Psychology, NUI Galway.
Bláthín (@BlathinCasey) is a Post-Doctoral research with the D1-Now study team at the HBCRG at NUI Galway. Blathín graduated from the University of Limerick (UL) in 2013 with a BSc, 1st class honours degree in physiotherapy. She completed a structured PhD programme [funded by MS Ireland] at the University of Limerick (UL) under Prof Susan Coote and the MS Research team at UL. Bláthín’s PhD aimed to change physical activity behaviour in people with MS through a body of work entitled ‘Activity Matters’. ‘Activity Matters’ aimed to develop a web-based physical activity resource to enable people with MS to become more active. Blathin’s research interests include working with individuals with long-term conditions and changing health behaviours within these populations.