Using Relational Agents to Promote Family Communication Around Type 1 Diabetes Self-Management in the Diabetes Family Teamwork Online Intervention: Longitudinal Pilot Study

Abstract

BackgroundFamily conflict can reduce adolescent adherence to type 1 diabetes management tasks. The Family Teamwork in-person intervention was shown to be efficacious in reducing conflict and low adherence to diabetes-related tasks. Its reach and potential impact, however, were limited by the need to deliver the intervention sessions in person. Relational agents (ie, computerized versions of humans) have been shown to appeal to diverse audiences and may be an acceptable replacement for a human in technology-based behavior change interventions.ObjectiveThe purpose of this paper is to present the results of a pilot study assessing feasibility and acceptability of Diabetes Family Teamwork Online, an adapted version of the Family Teamwork intervention, delivered over the internet and guided by a relational agent.MethodsParent-adolescent dyads were recruited through a diabetes care clinic at a large tertiary care hospital in the southwestern United States. A one-group design, with assessments at baseline, immediate postintervention, and 3 months later, was used to assess feasibility. A priori feasibility criteria included an assessment of recruitment, completion, attrition, program satisfaction, therapeutic alliance, attitudes toward the relational agent, and data collection. The institutional review board at Baylor College of Medicine approved the protocol (H-37245).ResultsTwenty-seven adolescents aged 10 to 15 years with type 1 diabetes and their parents were enrolled. Criteria used to assess feasibility were (1) recruitment goals were met (n=20), (2) families completed ≥75% of the modules, (3) attrition rate was ≤10%, (4) program satisfaction was high (≥80% of families), (5) therapeutic alliance was high (average score of ≥60/84), (6) families expressed positive attitudes toward the relational agent (average item score of ≥5 on ≥4 items), (7) ≥80% of data were collected at post 1 and post 2, and (8) few technical issues (≤10%) occurred during intervention delivery. All feasibility criteria were met. Qualitative data confirmed that adolescents and parents had positive reactions to both the content and approach.ConclusionsThe Diabetes Family Teamwork Online intervention proved to be a feasible and acceptable method for enhancing communication around diabetes management tasks in families with an adolescent who has type 1 diabetes.International Registered Report Identifier (IRRID)RR2-10.2196/resprot.5817

Digital Monitoring and Management of Patients With Advanced or Metastatic Non-Small Cell Lung Cancer Treated With Cancer Immunotherapy and Its Impact on Quality of Clinical Care: Interview and Survey Study Among Health Care Professionals and Patients (Preprint)

“…Mean ratings were consistently over 3.5, which, similar to previous studies, were assumed to indicate high agreement [60]. A pilot study assessing the Diabetes Family Teamwork Online intervention in patients with type 1 diabetes also used a Likert scale, but a 7-point scale rather than a 5-point scale [61]. However, similarly, the study deemed approximately 70% of the maximum score to equal high feasibility [61].…”

Digital Monitoring and Management of Patients With Advanced or Metastatic Non-Small Cell Lung Cancer Treated With Cancer Immunotherapy and Its Impact on Quality of Clinical Care: Interview and Survey Study Among Health Care Professionals and Patients

“…Mean ratings were consistently over 3.5, which, similar to previous studies, were assumed to indicate high agreement [ 60 ]. A pilot study assessing the Diabetes Family Teamwork Online intervention in patients with type 1 diabetes also used a Likert scale, but a 7-point scale rather than a 5-point scale [ 61 ]. However, similarly, the study deemed approximately 70% of the maximum score to equal high feasibility [ 61 ].…”

“…A pilot study assessing the Diabetes Family Teamwork Online intervention in patients with type 1 diabetes also used a Likert scale, but a 7-point scale rather than a 5-point scale [ 61 ]. However, similarly, the study deemed approximately 70% of the maximum score to equal high feasibility [ 61 ]. In this study, the symptom questionnaire and symptom alerts were the most commonly used functions of the DPMM tool among patients and HCPs, respectively, followed by the direct message communication function and the drug- and indication-specific educational material.…”

Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP): Protocol for a Randomized Clinical Trial to Test a Video-Based Telehealth Intervention

“…Current estimates suggest that 90% of American adults use the internet, 81% own smartphones, and 73% have high-speed internet access at home [ 31 , 32 ]. To date, most technology-based T1D interventions have focused on T1D management in adolescents and young adults versus families of young children, and the interventions have used email and text message support [ 33 - 35 ], websites and phone apps [ 36 - 44 ], and telephone counseling or video-based telehealth [ 45 - 51 ]. Yet these technology-based interventions suggest that it may be highly feasible and efficacious to use technology to intervene in families of youth with T1D.…”