Development and Pilot of a Strengths-Based Behavioral mHealth Intervention to Promote Resilience in Adolescents with Type 1 Diabetes

项目总结/摘要 1型糖尿病（T1 D）是儿童期最常见的慢性疾病之一，其管理是 复杂而无情青少年血糖控制恶化的风险增加， 短期和长期并发症。随着日常T1 D管理任务的责任开始从父母转移 对青年人来说，父母-青少年的支持性团队合作可促进糖尿病的最佳结果。然而，青少年的 认知发展、对自主权的渴望以及不断变化的家庭和社会关系， 治疗建议困难和紧张的尝试，在父母和青少年的团队合作。我们的目标是开发 并试点测试一个基于移动的应用程序的行为干预，以促进积极的，支持性的父母-青少年 围绕T1 D管理的互动。拟议的研究有两个部分。首先，我们计划让青少年 与T1 D（12-17岁），他们的父母和糖尿病护理提供者一起设计智能手机应用程序， 父母认识到，跟踪，并加强他们的青少年特定的积极T1 D相关行为， 或者力量例如，优势包括在复杂的糖尿病任务中寻求帮助，与朋友谈论 糖尿病，并表达对T1 D管理的信心或乐观。一天中断断续续地， 应用程序将促使父母报告他们的青少年参与了哪些积极的T1 D行为。该应用程序 将生成每个青少年最常见的力量行为的每周总结报告，父母将 通过应用程序提醒他们赞扬青少年的这些模式。第二，我们计划对此进行试点测试 82个家庭的干预;父母将被随机分配到干预或对照条件。参与者 在干预条件下，将使用该应用程序6个月，并提供反馈，控制参与者将 接受常规护理，不会使用该应用程序。我们的主要目标是确定家庭的频率和方式 使用应用程序，无论他们是否喜欢它，并获得改进建议。我们还将评估以下趋势： 对重要糖尿病结局的影响，如父母-青少年关系的质量，T1 D治疗 依从性和血糖控制。数据-包括问卷调查、血糖依从性数据 血糖仪和血糖控制生物标志物-将在基线时采集，并在第3和第6次采集 月后这项试点研究的结果将有助于完善干预措施，以便全面评估- 规模随机对照试验。最终，本研究的目标是验证简单，方便， 所有T1 D青少年的家庭都可以使用有用的工具来加强积极的家庭团队合作， 最终促进最佳的糖尿病健康结果。

Project Summary/Abstract Type 1 diabetes (T1D) is among the most common chronic conditions of childhood and its management is complex and relentless. Adolescents have increased risk for worsening glycemic control, putting them at risk for short- and long-term complications. As responsibility for daily T1D management tasks begins to shift from parents to youth, supportive parent-adolescent teamwork promotes optimal diabetes outcomes. However, adolescents' cognitive development, desire for autonomy, and changing family and social relationships can make adherence to treatment recommendations difficult and strain attempts at parent-adolescent teamwork. We aim to develop and pilot test a mobile app-based behavioral intervention to facilitate positive, supportive parent-adolescent interactions around T1D management. The proposed study has two parts. First, we plan to involve adolescents with T1D (age 12-17), their parents, and diabetes care providers in designing a smartphone app that supports parents to recognize, keep track of, and reinforce their adolescents for specific positive T1D-related behaviors, or strengths. Example strengths include asking for help with complicated diabetes tasks, talking to friends about diabetes, and expressing confidence or optimism about T1D management. Intermittently throughout the day, the app will push parents a prompt to report which positive T1D behaviors their adolescent has engaged in. The app will generate weekly summary reports of each adolescent's most frequent strength behaviors, and parents will be reminded via the app to praise their adolescent for those patterns. Second, we plan to pilot test this intervention with 82 families; parents will be randomized to an intervention or a control condition. Participants in the intervention condition will use the app for 6 months and provide feedback, and control participants will receive usual care and will not use the app. Our main goal is to determine how often and in what ways families use the app, whether they like it, and to obtain suggestions for improvement. We will also evaluate trends for impact on important diabetes outcomes, such as quality of parent-adolescent relationships, T1D treatment adherence, and glycemic control. Data – including questionnaires, adherence data from blood glucose meters, and glycemic control biomarkers from a blood draw – will be collected at baseline and again 3 and 6 months later. The results of this pilot study will help refine the intervention so that it can be evaluated in a full- scale randomized controlled trial. Ultimately, the goal of this research is to validate brief, convenient, and helpful tools that families of all adolescents with T1D can use to strengthen positive family teamwork and ultimately promote optimal diabetes health outcomes.