Objective
The main objectives for conducting this study are to:
1. Explore the usability and acceptability of the THRIVE app for AYAs with type 1 diabetes living in New Zealand and the United States and their caregivers or partners.
2. Explore the feasibility of conducting a larger randomized controlled trial (RCT) with which to evaluate the efficacy of the app (i.e. how well it works) in improving psychological and physical health of AYAs living with type 1 diabetes in New Zealand and the United States.
Background Rationale
Adolescents and young adults (AYAs) with type 1 diabetes (T1D) experience far greater rates of psychological problems, such as anxiety and depression, than their peers. These problems impede engagement with diabetes treatment and increase the risk of serious diabetes-related complications. Standard diabetes care does not usually provide adequate psychosocial support to prevent or reduce the psychological problems that usually appear in adolescence and often continue into young adulthood. Furthermore, despite the existence of effective psychological interventions, they are rarely used routinely in clinical practice due to lack of psychologists and the time and cost involved. To bridge this gap, a novel approach is needed where access to psychological care is not confined to clinics or specialised staff, but rather can occur outside of clinic hours and at the pace desired by people with diabetes.
Description of Project
Adolescents and young adults (AYAs) with type 1 diabetes experience far greater rates of psychological problems, such as anxiety and depression, than their peers. These problems impede engagement with diabetes treatment and increase the risk of serious diabetes-related complications. Standard diabetes care does not usually provide adequate psychosocial support to prevent or reduce the psychological problems that usually appear in adolescence and often continue into young adulthood. Furthermore, despite the existence of effective psychological interventions, they are rarely used routinely in clinical practice due to lack of psychologists and the time and cost involved. To bridge this gap, a novel approach is needed where access to psychological care is not confined to clinics or specialised staff, but rather can occur outside of clinic hours and at the pace desired by young people with diabetes.
This project aims to adapt and evaluate a wellbeing app for AYAs with type 1 diabetes. A previous version of the app was recently co-designed, evaluated and shown to achieve demonstrable benefits in well-being, anxiety, depression and stress in a healthy community sample of AYAs in New Zealand. Following a further study with adolescents and young adults with type 1 diabetes, we found that this app was liked by this group and that it could be even more useful to them, if adapted to address common issues related to their diabetes. We now wish to test this updated and diabetes-specific version of the app (called THRIVE) in New Zealand and the United States. We will recruit 60 AYAs with type 1 diabetes aged 16-25 years to test the app over three months, see how well the app is received by AYAs and their families or partners (who will be asked to support them to use the app), and to explore how frequently AYAs with type 1 diabetes use the app over 3 months. This information will help us plan a larger and more definitive randomised controlled trial (RCT) to evaluate how well THRIVE works to improve psychological and physical health outcomes in AYAs with type 1 diabetes.
Anticipated Outcome
We anticipate that AYAs with type 1 diabetes will find the THRIVE app engaging and useful and that they are also likely to give us further feedback to continue improving the app. We also anticipate that parents and partners of young people will enjoy using the app and be able to give us unique feedback on how to further improve the app before our future randomized controlled trial. Finally, we anticipate that the study design and outcome measures will be appropriate for use in the larger randomized controlled trial (RCT).
Relevance to T1D
Many psychological issues such as depression, low self-esteem, and anxiety are compounded in AYAs with type 1 diabetes. We know that poor psychological health has been shown to interfere with self-management in type 1 diabetes and increase diabetes-related complications, yet psychological support remains difficult to access for most adolescents and young adults with type 1 diabetes.
Our proposal addresses a clear clinical need for AYAs living with type 1 diabetes - to improve access to a digital evidence-based psychological intervention that can be used at any time and from anywhere to improve their wellbeing. We hope that by developing a tailored digital wellbeing intervention for young people with type 1 diabetes this will improve their psychological wellbeing and lead to improvements in quality of life and physical health outcomes in the future.