Strengths-Based Multi-Level Behavioral Intervention to Promote Resilience and Self-Management in Youth with Type 1 Diabetes

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PROJECT SUMMARY/ABSTRACT Type 1 diabetes (T1D) management is particularly challenging during the transition to adolescence, as this developmental period is often marked by increasing expectations for independence in self-management and poorer glycemic and quality of life outcomes. In behavioral T1D research (largely conducted with adolescents), there has been limited evidence of meaningful, lasting impact on adherence behaviors or glycemic outcomes. Novel, developmentally appropriate approaches are needed to help youth achieve “diabetes resilience” – i.e., engage in high levels of self-management behaviors, achieve HbA1c levels within the target range, and experience good quality of life – during the important late childhood and early adolescent years. Prevention science and social-ecological theories of health behavior change for pediatric health conditions recognize the importance of early interventions that target multiple systems surrounding a child with a chronic condition like T1D to promote trajectories of positive behavioral, psychosocial, and medical outcomes. The goal of this study is to evaluate a new intervention for youth age 8-12 with T1D and elevated HbA1c that uses strengths-based methods to prevent the deterioration in outcomes often observed in adolescence. In this 6-month, multi-modal intervention: (1) diabetes care providers will use youth- and parent-reports of youth’s diabetes strengths and self-management behaviors to lead a discussion of what youth are doing well for T1D during a routine diabetes care appointment, (2) parents will use an app to recognize, track, and reinforce their children’s positive T1D- related behaviors and will have “3 minute meetings” with their child about a T1D self-management goal, and (3) youth will use an app to have positive interactions with parents about their diabetes strengths and build supportive social connections with peers through videos about living well with T1D. The intervention strategies are brief, low-burden, and use digital health technologies to deliver the intervention in the context of real-world diabetes activities (i.e., routine medical appointments and everyday T1D management). We will test this intervention with 250 racially/ethnically, socioeconomically, and linguistically diverse youth in Houston, TX and Washington, DC, who are randomly assigned to the intervention or enhanced usual care. Our goal is to evaluate the intervention’s impact on key T1D outcomes: HbA1c, % glucose time in range, engagement in T1D self- management behaviors, and health-related quality of life. We will also examine psychosocial and intervention- specific factors that may be mechanisms of the intervention’s effect. Data will be collected for 15 months. The ultimate goal of this research is to test the effects of a multi-level, strengths-based preventive intervention on health behaviors, psychosocial well-being, and T1D health outcomes during the critically important and understudied developmental stage of the transition to adolescence. Results will inform future intervention strategies to maximize resilient outcomes for youth with T1D who are at elevated risk for poor outcomes.