Idalski Carcone April, Holtz Bree E, Reardon Madeleine, Vesey Dariane, Ellis Deborah A, Parks Michael
Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States.
Department of Advertising + Public Relations, College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, United States.
JMIR Form Res. 2024 Aug 7;8:e55650. doi: 10.2196/55650.
Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D.
This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management.
EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs' experiences living in a rural community with T1D and discussed EAs' impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis.
In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56% men; 8, 89% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities ("everyone knows") and community members' lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging.
mHealth interventions aligned with EAs' needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited.
N/A, not a clinical trial.
与其他年龄组相比，1型糖尿病（T1D）的青年成年人（EAs；18 - 30岁）在糖尿病管理和血糖控制方面面临更多挑战。由于获得专科护理和辅助支持服务的机会有限，生活在农村社区会带来额外独特的糖尿病护理挑战。然而，针对改善农村地区患有T1D的青年成年人糖尿病管理的干预措施却很少。
本研究旨在了解生活在农村地区的患有T1D的青少年和青年成年人（16 - 25岁）的糖尿病管理经历，并评估他们对4种支持糖尿病管理的全自动移动健康（mHealth）干预措施可接受性的看法。
临床工作人员通过便利抽样确定了青年成年人。共有8名青年成年人参加了1个焦点小组，1名青年成年人完成了个人访谈；所有数据均通过Zoom收集。主持人探讨了青年成年人在农村社区患有T1D的经历，并讨论了青年成年人对4种mHealth干预措施的印象、反馈以及改进建议，以满足农村社区患有T1D的青年成年人的特定需求。讨论内容进行了转录，并使用传统内容分析法进行分析。
共有9名青年成年人（年龄18.8岁，标准差2.7岁；5名，56%为男性；8名，89%为白人）参与，糖尿病病程为8.6（标准差4.3）年。他们描述了在农村社区中遭遇糖尿病污名化（将糖尿病归因于不良生活方式选择）和自觉意识（过度警觉）的经历。他们将这些经历归因于社区规模小（“每个人都知道”）以及社区成员对糖尿病缺乏了解（无法区分1型和2型糖尿病）。相比之下，青年成年人报告称，家人、朋友和其他社区成员对糖尿病和糖尿病护理给予了高度的社会支持，但对医疗需求的支持较低。他们的糖尿病护理提供者的位置以及当地社区中糖尿病特定和一般医疗服务的可及性有限，营造了具有挑战性的医疗环境。总体而言，青年成年人认为mHealth干预措施因其数字化交付方式而具有吸引力，并强调了提高可及性的功能（语音旁白和简单、无行话的语言）、个性化（能够定制干预内容和交付方式）以及对他们自己的生活和其他患有T1D的青年成年人的适用性（案例和其他内容的相关性）。青年成年人对改进干预措施的建议包括有更多机会根据他们的偏好定制干预措施（更高的频率和持续时间，能够根据新出现的需求调整内容），增加干预措施中同伴支持的机会（朋友和重要他人作为指定的支持人员，与当地社区以外的同伴建立联系），以及使干预组件的语气更加随意和引人入胜。
与青年成年人的需求和偏好相一致的mHealth干预措施是在社会支持和资源可能有限的社区中支持青年成年人的一种有前景的策略。
无，非临床试验。
