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

项目总结/摘要 1型糖尿病（T1 D）管理在向青春期过渡期间特别具有挑战性，因为这 发展期的特点往往是对自我管理独立性的期望越来越高， 血糖和生活质量结果较差。在T1 D行为研究（主要针对青少年）中， 对依从性行为或血糖结果有意义的、持久的影响的证据有限。 需要新的、适合发展的方法来帮助青年实现“糖尿病复原力”--即， 参与高水平的自我管理行为，实现HbA 1c水平在目标范围内，以及 体验良好的生活质量-在重要的儿童晚期和青少年早期。预防 儿科健康状况的健康行为改变的科学和社会生态学理论认识到， 针对患有慢性疾病的儿童周围多个系统的早期干预的重要性， T1 D促进积极的行为，心理社会和医疗结果的轨迹。本研究的目的 是评估针对8-12岁患有T1 D和HbA 1c升高的青少年的新干预措施，该干预措施使用基于力量的方法 预防青少年经常出现的结果恶化的方法。在这个为期6个月的多模式 干预措施：（1）糖尿病护理提供者将使用青少年和父母关于青少年糖尿病优势的报告， 自我管理行为，以引导讨论在常规糖尿病期间，青少年对T1 D的表现如何 护理预约，（2）父母将使用应用程序来识别，跟踪和加强他们的孩子的积极T1 D- 相关行为，并将与他们的孩子就T1 D自我管理目标进行“3分钟会议”，以及（3） 青少年将使用一个应用程序与父母就他们的糖尿病优势进行积极的互动， 通过关于T1 D生活良好的视频与同龄人建立支持性的社会联系。干预策略 简短，低负担，并使用数字健康技术在现实世界的背景下提供干预 糖尿病活动（即，常规医疗预约和日常T1 D管理）。我们将测试这个 在德克萨斯州休斯顿，对250名种族/民族、社会经济和语言多样化的青年进行干预， 华盛顿，DC，他们被随机分配到干预或加强常规护理。我们的目标是评估 干预对关键T1 D结局的影响：HbA 1c、血糖时间在范围内的百分比、T1 D自我参与度 管理行为和健康相关的生活质量。我们还将研究社会心理和干预- 可能是干预作用机制的具体因素。数据将收集15个月。的 本研究的最终目的是测试多层次的，基于力量的预防干预对 健康行为，心理健康和T1 D健康结果在至关重要的， 未被充分研究的向青春期过渡的发展阶段。结果将为未来的干预提供信息 战略，以最大限度地提高T1 D青年的弹性成果，他们面临着不良结果的高风险。

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.