February 19, 2010

New tool helps adolescents manage diabetes

Shelagh Mulvaney, PhD

New tool helps adolescents manage diabetes

Adolescents with type 1 diabetes have a new tool to help improve self-management — an Internet-based program called YourWay.
Vanderbilt University School of Nursing's Shelagh Mulvaney, Ph.D., led the study of a Web-based intervention to improve glycemic control among adolescents with type 1 diabetes.

The study was recently published in the journal, Diabetes Care, and the results were presented at the annual meeting of the International Society for Research on Internet Interventions in Amsterdam.

Shelagh Mulvaney, Ph.D.

Shelagh Mulvaney, Ph.D.

“It is very challenging to cope with diabetes as a teenager,” said Mulvaney. “We wanted to take an approach that used real-world experiences and translate them into a meaningful and effective intervention while capitalizing on the interest and excitement many teens have for the Internet and new technologies.”

Mulvaney enlisted help from colleagues at the Vanderbilt Eskind Pediatric Diabetes Clinic, securing 72 study participants age 13 to 17 who had been diagnosed with type 1 diabetes for at least six months.

One group received conventional care and the other received conventional care plus access to YourWay.

A multidisciplinary team of diabetes professionals, researchers, young patients and volunteers wrote and edited Web site content that included six multi-media stories on common scenarios that adolescents often face that make proper self-management difficult.

The stories focused on key psychosocial barriers to self-management such as time pressures, competing demands such as school and social goals, embarrassment and modeled approaches to coping and problem solving.

“We put a lot of thought and time into developing what we hoped would be helpful scenarios. It was important that they be authentic, real-world situations that can and do arise,” said Mulvaney.

The YourWay site also included a personalized homepage, guided problem solving, a peer forum, social comparison of responses with other adolescents, help from a problem-solving expert and weekly e-mails to encourage participation.

Participants still attended regular clinic visits throughout the study, but did not interact with clinicians or parents through the Web site.

“Dealing with a chronic disease is difficult for anyone,” said Mulvaney. “It is particularly daunting for teens diagnosed with type 1 diabetes, and transition to successful self-management is critical for the rest of their lives.”

The results are promising as glycemic control, problem solving, and self-management adherence improved. Most of the adolescents viewed all stories at least once and completed the problem-solving activities.

“A lot of clinicians, researchers and families worked together for this study,” said Mulvaney. “It's gratifying for us all to see that we may have found a feasible and engaging way to help adolescents. Given the fact that we had many more families interested than we could actually enroll in the study was encouraging as well.”

Mulvaney and collaborator Russell Rothman, M.D., have now created a parallel problem-solving Web site for parents of teenagers with diabetes, and adapted the YourWay site for adolescents with type 2 diabetes.

Based on feedback from adolescents, and to address situational barriers to self-management more directly, Mulvaney, along with Kevin Johnson, M.D., has now designed a text messaging intervention that will be tested this spring.

“The Internet and mobile technologies provide patients unprecedented access to learning tools and supports. They also readily integrate learning experiences into everyday situations, and allow researchers innovative ways to teach, motivate and prompt successful health behaviors,” Mulvaney said.