A preliminary evaluation of a novel education model for young people with Type 1 diabetes: the Youth Empowerment Skills programme

Authors

  • Dulmini Kariyawasam St. Thomas’ Hospital Diabetes Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
  • Darren Marsh Division of Care in Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
  • Siobhan Pender St. Thomas’ Hospital Diabetes Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
  • Marie Jones St. Thomas’ Hospital Diabetes Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
  • Rebecca Rogers Division of Care in Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
  • Simon Chapman Paediatric Diabetes, King’s College Hospital NHS Foundation Trust, London, UK
  • Stephanie Singham St. Thomas’ Hospital Diabetes Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
  • Stephanie Lamb St. Thomas’ Hospital Diabetes Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
  • Rahila Bhatti St. Thomas’ Hospital Diabetes Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
  • Suzannah Walker Division of Care in Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
  • Judith Parsons Division of Care in Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK https://orcid.org/0000-0002-9656-5940
  • Rita Forde Division of Care in Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK; & Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK https://orcid.org/0000-0003-1906-2431
  • Angus Forbes Division of Care in Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK https://orcid.org/0000-0003-3331-755X

DOI:

https://doi.org/10.57177/idn.v15.325

Keywords:

adolescent, diabetes mellitus, Type 1, education, patient, evaluation study

Abstract

Background: Adolescence is a challenging time for young people with Type 1 diabetes, associated with worsening glycaemia and disengagement with care. To improve support, we co-designed with young people a novel psychosocially modelled programme of diabetes education (the Youth Empowerment Skills [YES] programme). This study aimed to estimate the clinical impact and feasibility (recruitment, retention and participant experiences) of this programme.

Methods: A pilot study using mixed-methods was conducted to assess process and outcomes, involving a pre- and post-exposure assessment of glycaemic control, programme participation data, service utilisation and qualitative semi-structured interviews (analysed using Framework Analysis). Participants were recruited from two hospital diabetes centres in Southeast London. The intervention was conducted in local community centres. Participants were young people with Type 1 diabetes aged 15–21 years. The YES programme involves contact with an outreach youth worker and attending a 3-day psychologically modelled course encompassing social learning, peer facilitation and simulation exercises. The primary outcome was change in HbA1c at 6 and 12-months post-intervention. Secondary outcomes included diabetes-related hospital admissions and incident diabetic ketoacidosis (DKA).

Results: Twenty-six young people participated in the programme, mean age 18 (±1.7) years. Uptake was 34% (n = 26) of those approached, with 96% (n = 25) programme completion. Pre-exposure (12 month mean) HbA1c was 93.5 (±29.7) mmol/mol (10.7%), and at 12 months post-exposure, it was 85.1 (±25.4) mmol/mol (10%) (P = 0.01), with 46% (n = 12) of participants achieving a reduction in their HbA1c ≥5.5 mmol/mol (0.5%). Unplanned hospital admissions and DKA rates reduced by 38 and 30%, respectively. The qualitative data identified positive psychosocial impacts including increased diabetes engagement and activation. Active ingredients were social learning, peer support and experiential learning. Participants emphasised the importance of the youth worker in engaging with the programme.

Conclusion: The evaluation indicates that the YES programme helps improve young people’s self-confidence in managing diabetes, enhances diabetes engagement and improves clinical outcomes.

Downloads

Download data is not yet available.

References

Hamilton J, Daneman D. Deteriorating diabetes control during adolescence: physiological or psychological? J Pediatr Endocrinol Metab 2002; 15: 115–26. doi: 10.1515/JPEM.2002.15.2.115

Northam EA, Lin A, Finch S, Werther GA, Cameron FJ. Psychosocial well-being and functional outcomes in youth with type 1 diabetes 12 years after disease onset. Diabetes Care 2010; 33: 1430–7. doi: 10.2337/dc09-2232

NPDA. National paediatric diabetes audit report 2013–14. London: Royal College of Paediatrics and Child Health; 2014.

Gibb F, Teoh W, Graham J, Lockman A. Risk of death following admission to a UK hospital with diabetic ketoacidosis. Diabetologia 2016; 59(10): 2082–7. doi: 10.1007/s00125-016-4034-0

Monaghan M, Helgeson V, Wiebe D. Type 1 diabetes in young adulthood. Curr Diabetes Rev 2015; 11(4): 239–50. doi: 10.2174/1573399811666150421114957

Luyckx K, Seiffge-Krenke I, Schwartz SJ, Goossens L, Weets I, Hendrieckx C, et al. Identity development, coping, and adjustment in emerging adults with a chronic illness: The sample case of type 1 diabetes. J Adolesc Health 2008; 43: 451–8. doi: 10.1016/j.jadohealth.2008.04.005

Palladino DK, Helgeson VS, Reynolds KA, Becker DJ, Siminerio LM, Escobar O. Emerging adults with type 1 diabetes: a comparison to peers without diabetes. J Pediatr Psychol 2003; 38: 506–17. doi: 10.1093/jpepsy/jst002

Herzer M, Hood K. Anxiety symptoms in adolescents with type 1 diabetes: association with blood glucose monitoring and glycemic control. J Pediatr Psychol 2010; 35(4): 415–25. doi: 10.1093/jpepsy/jsp063

National Diabetes Audit 2012–2013. Report 2: complications and mortality. Leeds: Health and Social care Information Centre; 2015.

Hains AA, Berlin KS, Davies WH. Attributions of adolescents with type 1 diabetes in social situations: relationship with expected adherence, diabetes stress, and metabolic control. Diabetes Care 2006; 29: 818–22. doi: 10.2337/diacare.29.04.06.dc05-1828

Christie D, Thompson R, Sawtell M, Allen E, Cairns J, Smith F, et al. Structured, intensive education maximising engagement, motivation and long-term change for children and young people with diabetes: A cluster randomised controlled trial with integral process and economic evaluation – The CASCADE study. Health Technol Assess 2014; 18: 202–8. doi: 10.3310/hta18200

Johnson B, Norman P, Sanders T, Elliott J, Whitehead V, Campbell F, et al. Working with Insulin, Carbohydrates, Ketones and Exercise to Manage Diabetes (WICKED): evaluation of a self-management course for young people with Type 1 diabetes. Diabet Med 2019; 36(11): 1460–7. doi: 10.1111/dme.14077

Coates V, Chaney D, Bunting B, Shorter GW, Shevlin M, McDougall A, et al. Evaluation of the Effectiveness of a Structured Diabetes Education Programme (CHOICE) on clinical outcomes for adolescents with type 1 diabetes: a randomised controlled trial. J Diabetes Metab 2013; 4: 280–7.

Bandura A. Social learning theory. New York: General Learning Press; 1977.

Leventhal H, Nerenz DR, Steele DJ, Taylor SE, Singer JE. Illness representation and coping with health threats. New Jersey: LEA Publishers; 1984, pp. 219–25.

Chaiken S, Wood W, Eagly A. Principles of persuasion. In: Higgins ET, Kruglansksi AW, eds. Social psychology: handbook of basic principles. New York: Guilford Press; 1996, pp. 702–44.

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: 1655. doi: 10.1136/bmj.a1655

Moore G. Process evaluation of complex interventions: Medical Research Council guidance. BMJ 2015; 350: 1258. doi: 10.1136/bmj.h1258

Baxter M, Hudson R, Mahon J, Bartlett C, Samyshkin Y, Alexiou D, et al. Estimating the impact of better management of glycaemic control in adults with Type 1 and Type 2 diabetes on the number of clinical complications and the associated financial benefit. Diabet Med 2016; 33: 1575–81. doi: 10.1111/dme.13062

Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, eds. Analyzing qualitative data. London: Routledge; 1994, pp. 173–94.

Martinez K, Frazer SF, Dempster M, Hamill A, Fleming H, McCorry NK. Psychological factors associated with diabetes self-management among adolescents with Type 1 diabetes: a systematic review. J Health Psychol 2018; 23(13): 1749–65. doi: 10.1177/1359105316669580

Commissariat PV, Kenowitz JR, Trast J, Heptulla RA, Gonzalez JS. Developing a personal and social identity with type 1 diabetes during adolescence: a hypothesis generative study. Qual Health Res 2016; 26(5): 672–84. doi: 10.1177/1049732316628835

Peacock A, Guest M, Cropper J, Trentham S, Clarke M, Yong J, et al. Assessing the impact of a youth worker on diabetes care in adolescents with type 1 diabetes. Endocr Abstr 2016; 45: 35. doi: 10.1530/endoabs.45.P35

Randall L, Begovic J, Hudson M, Smiley D, Peng L, Pitre N, et al. Recurrent diabetic ketoacidosis in inner-city minority patients. Diabetes Care 2011; 34: 1891–6. doi: 10.2337/dc11-0701

Cook S, Harold K, Edidin D, Briars R. Increasing problem solving in adolescents with Type 1 diabetes: the Choices Diabetes Programme. Diabetes Educ 2002; 28(8): 115–25. doi: 10.1177/014572170202800113

Jaye P, Thomas L, Reedy G. ‘The Diamond’: a structure for simulation debrief. Clin Teach 2015; 12(3): 171–5. doi: 10.1111/tct.12300

Grey M. Coping skills training for youths with diabetes. Diabetes Spectr 2011; 24(20): 74–5. doi: 10.2337/diaspect.24.2.70

Coates VE, Horigan G, Davies M, Davies MT. Exploring why young people with Type 1 diabetes decline structured education with a view to overcoming barriers. Diabet Med 2017; 24(8): 1092–9. doi: 10.1111/dme.13368

Datye KA, Moore DJ, Russell WE, Jaser SS. A review of adolescent adherence in type 1 diabetes and the untapped potential of diabetes providers to improve outcomes. Curr Diab Rep 2015; 15(8): 621. doi: 10.1007/s11892-015-0621-6

Downloads

Published

2022-11-14

How to Cite

Kariyawasam, D. ., Marsh, D., Pender, S., Jones, M., Rogers, R., Chapman, S., Singham, S., Lamb, S., Bhatti, R., Walker, S., Parsons, J. ., Forde, R., & Forbes, A. (2022). A preliminary evaluation of a novel education model for young people with Type 1 diabetes: the Youth Empowerment Skills programme. International Diabetes Nursing, 15. https://doi.org/10.57177/idn.v15.325

Issue

Vol. 15 (2022)

Section

Original Articles

License

Copyright (c) 2022 Dulmini Kariyawasam, Darren Marsh, Siobhan Pender, Marie Jones, Rebecca Rogers, Simon Chapman, Stephanie Singham, Stephanie Lamb, Rahila Bhatti, Suzannah Walker, Judith Parsons, Rita Forde, Angus Forbes

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Most read articles by the same author(s)

1 2 > >>