Department of Psychological Science, University of Vermont, Burlington, VT, United States.
Division of Endocrinology, Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, United States.
JMIR Form Res. 2024 Oct 21;8:e59246. doi: 10.2196/59246.
Family dynamics play an important role in determining the glycemic outcomes of type 1 diabetes (T1D) in children. The time interval immediately following T1D diagnosis is particularly stressful for families, and interventions to support families in adjusting their family practices to support adjustment to and management of T1D in the months following diagnosis may improve glycemic outcomes. Self-guided digital interventions offer a sustainable model for interventions to support caregivers in learning evidence-based family management skills for adjustment to and management of T1D.
We hypothesized that a self-guided, web-based, family skills management program (addressing caregiver social support as well as family problem-solving, communication, and supportive behavior change strategies) initiated at the time of T1D diagnosis would improve glycemic outcomes in children with T1D. In this study, we report on the feasibility and acceptability of this program.
We prospectively evaluated a sample of 37 children newly diagnosed with T1D recruited from a pediatric endocrinology clinic. Parent participants were asked to complete web-based modules addressing social support, family problem-solving, communication, and supportive behavior change strategies. Module completion was analyzed for percentage completion, patterns of completion, and differences in completion rates by coparenting status. Qualitative open-ended feedback was collected at the completion of each module.
A total of 31 (84%) of the 37 participants initiated the web-based program. Of those 31 participants, 25 (81%) completed some content and 15 (48%) completed all 5 modules. Completion rates were higher when coparenting partners engaged in the intervention together (P=.04). Of the 18 participants given a choice about the spacing of content delivery, 15 (83%) chose to have all sessions delivered at once and 3 (17%) chose to space sessions out at 2-week intervals. Qualitative feedback supported the acceptability of the program for delivery soon after T1D diagnosis. Families reported on positive benefits, including requesting future access to the program and describing helpful changes in personal or family processes for managing T1D.
In this study, we found that a self-guided digital family support intervention initiated at the time of a child's T1D diagnosis was largely feasible and acceptable. Overall, rates of participation and module completion were similar to or higher than other self-guided digital prevention interventions for mental and physical health outcomes. Self-guided digital programs addressing family management skills may help prevent challenges common with T1D management and can decrease cost, increase access, and add flexibility compared to traditional interventions.
ClinicalTrials.gov NCT03720912; https://clinicaltrials.gov/study/NCT03720912.
家庭动态在决定 1 型糖尿病（T1D）患儿的血糖控制结果方面起着重要作用。在确诊 T1D 后，家庭会面临巨大的压力。在确诊后几个月内，通过干预来支持家庭调整其家庭实践，以支持 T1D 的适应和管理，可能会改善血糖控制结果。自我指导的数字干预为支持护理人员学习适应和管理 T1D 的基于证据的家庭管理技能的干预措施提供了一种可持续的模式。
我们假设在 T1D 确诊时启动自我指导的、基于网络的家庭技能管理计划（针对护理人员的社会支持以及家庭解决问题、沟通和支持行为改变策略），将改善 T1D 患儿的血糖控制结果。在这项研究中，我们报告了该计划的可行性和可接受性。
我们前瞻性地评估了 37 名新诊断为 T1D 的儿童，这些儿童均来自儿科内分泌科诊所。家长参与者被要求完成网络模块，内容涉及社会支持、家庭解决问题、沟通和支持行为改变策略。分析模块完成百分比、完成模式以及共同养育状况差异对完成率的影响。在完成每个模块后收集定性的开放式反馈。
共有 37 名参与者中的 31 名（84%）启动了基于网络的计划。在这 31 名参与者中，有 25 名（81%）完成了部分内容，15 名（48%）完成了所有 5 个模块。当共同养育的伴侣共同参与干预时，完成率更高（P=.04）。在 18 名参与者中，有 15 名（83%）选择一次性接收所有课程，有 3 名（17%）选择间隔两周的时间接收课程。定性反馈支持该计划在 T1D 诊断后不久即可用于交付。家庭报告了积极的好处，包括要求未来获得该计划的访问权限，并描述了在管理 T1D 方面个人或家庭流程的有益变化。
在这项研究中，我们发现，在儿童 T1D 诊断时启动的自我指导的数字家庭支持干预措施在很大程度上是可行和可接受的。总体而言，参与率和模块完成率与其他用于心理健康和身体健康结果的自我指导的数字预防干预措施相似或更高。自我指导的数字程序可以帮助预防与 T1D 管理相关的常见挑战，并降低成本、增加获取途径，与传统干预相比，还能增加灵活性。
ClinicalTrials.gov NCT03720912；https://clinicaltrials.gov/study/NCT03720912。
