Computer Motivational Interventions to Improve Diabetes Care in Minority Youth

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DESCRIPTION (provided by applicant): Studies of illness management conducted over the past twenty years suggest that substantial percentages of adolescents and their families do not follow recommendations given to them by physicians for the treatment of chronic medical conditions. Poor illness management in youth with type 1 diabetes leads to poor metabolic control, which in turn leads to diabetes complications. African-American adolescents in particular have been found to be at significantly higher risk for problems with treatment adherence and metabolic control. Despite such findings, research to develop effective interventions to improve illness management among minority adolescents with type 1 diabetes is extremely limited. Few studies targeting adolescents have demonstrated that behavioral interventions can improve metabolic control. However, facilitating parental involvement in diabetes care may be a more fruitful path. Recent research by our group has shown that parental supervision and monitoring of adolescents' daily diabetes care is a significant predictor of illness management and metabolic control. There have been no published clinical trials of interventions that have directly targeted parental monitoring as a means of improving illness management in adolescents with diabetes. The purpose of the present study is to develop and preliminarily validate an intervention to increase parental motivation for supervision and monitoring of youth illness management behaviors that can be provided to parents of young, urban, high-risk African American adolescents who are beginning to transition to independent self-care. A companion intervention will be developed to increase youth motivation for improving diabetes care. The proposed intervention is brief (three sessions), opportunity-driven (presented to parents at the time of their child's regularly scheduled clinic follow-up visits), based on the principles of Motivational Interviewing, and delivered via a proven, engaging, and easy-to-use computer-based approach. The proposed study includes a development phase (development of the intervention with expert feedback, followed by feasibility testing with parents) and a pilot validation phase (pilot clinical trial using a sample of 90 parents of young African American adolescents aged 10-13 with type 1 diabetes). Families will be recruited from a large, urban teaching hospital that serves a diverse population. Participants in the RCT will be randomly assigned to parent plus youth condition (both receive three computer-delivered motivational sessions plus standard multidisciplinary medical care) parent only condition (parent receives motivational session and youth receives attention control plus standard care) or an attention control (parent and youth receive attention control plus standard care). If successful, the intervention has the potential to improve quality of life of minority adolescents with diabetes at relatively low cost and to have wide reach to such youth through integration into routine medical appointments in diabetes clinics. PUBLIC HEALTH RELEVANCE: Studies of illness management conducted over the past twenty years suggest that substantial percentages of youth and families do not follow recommendations given to them by physicians for the treatment of medical conditions. Many studies have demonstrated the importance of parental involvement for promoting optimal adolescent diabetes management, but to date there have been no published clinical trials of interventions that directly targeted parental monitoring. If successful, our computer-delivered intervention aimed at improving parental monitoring has the potential to improve quality of life of minority adolescents with diabetes at relatively low cost and to have wide reach to such youth and families through integration into routine medical appointments in diabetes clinics.