Selecting an intervention to prevent ketoacidosis at diabetes diagnosis in children using a behavior change framework

Abstract

Objective The rate of diabetic ketoacidosis (DKA), a preventable, life‐threatening complication of diabetes, at the time of diagnosis in children remains unacceptably high worldwide. We describe our initial approach to selecting a national DKA prevention strategy, to be implemented by the Canadian Pediatric Endocrine Group DKA Prevention Working Group, informed by a framework for behavior change interventions. Methods Existing interventions were identified from a systematic review and our own gray literature search. We then characterized interventions using the Behavior Change Wheel, a framework to inform and drive behavior change, and matched interventions to behavioral targets, audiences, and identified barriers and facilitators. Feedback from the CPEG DKA prevention working group was incorporated into the intervention plan. Results We identified 27 interventions. Our proposed target behaviors are: (1) prompt recognition of symptoms of diabetes in children; (2) urgent attendance to medical care with a request for an office‐based test for diabetes; and (3) rapid confirmation of diagnosis and urgent consultation with pediatric diabetes experts. We initially identified four possible intervention functions including education, training, environment restructuring, and enablement. Feedback from the working group favored education intervention functions including symptom recognition messages targeting parents, caregivers, teachers, and providers and messages about how to make a rapid diagnosis and need for urgent referral targeting providers. Conclusions The Behavior Change Wheel has been used successfully in selecting interventions in other clinical areas. We describe how we used this framework to provide a foundation for developing an intervention to prevent DKA at diabetes diagnosis in children.

Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic

“…These may include public and health care professional-facing awareness campaigns and addressing hesitancy to seek emergency care. 78,82…”

“…This knowledge is needed to inform the development and implementation of effective strategies to prevent DKA at diagnosis in children. These may include public and health care professional–facing awareness campaigns and addressing hesitancy to seek emergency care …”

Applying the behaviour change wheel to assess the theoretical underpinning of a novel smartphone application to increase physical activity in adults with spinal cord injuries

“…Specifically, the BCW synthesises 19 theoretical frameworks of behaviour change (59,60) identified in academic literature and arrived at by a consensus of behavioural theorists (65). At the core of the wheel is the capability, opportunity, motivation, and behaviour (COM-B) model (59,66), which postulates that changing behaviour is reliant upon three components: physical and psychological capability, physical and social opportunity, and reflective and automatic motivation (67,68). A mid ring on the BCW incorporates nine intervention functions (69,70), and the outer ring comprises seven policy options (71,72), which can support the delivery of the intervention functions (73).…”

Have interventions aimed at assisting general practitioners in facilitating earlier diagnosis of type 1 diabetes in children been successful? A systematic review protocol

“…A delay of more than 24 hours between the initial presentation to a GP and a diagnosis has been associated with an increased risk of DKA presentation 10. This is why timely confirmation of T1DM diagnoses with urgent referral to a paediatric team has been identified as a target DKA prevention strategy in another recent systematic review 11 12…”