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Title: Using relational agents to promote family communication around type 1 diabetes self-management in the diabetes Family Teamwork Online intervention: Longitudinal pilot study

item Thompson, Deborah - Debbe
item CALLENDER, CHISHINGA - Children'S Nutrition Research Center (CNRC)
item GONYNOR, CAROLINE - Baylor College Of Medicine
item CULLEN, KAREN - Children'S Nutrition Research Center (CNRC)
item REDONDO, MARIA - Baylor College Of Medicine
item BUTLER, ASHLEY - Baylor College Of Medicine
item ANDERSON, BARBARA - Baylor College Of Medicine

Submitted to: Journal of Medical Internet Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/13/2019
Publication Date: 9/12/2019
Citation: Thompson, D.J., Callender, C., Gonynor, C., Cullen, K.W., Redondo, M.J., Butler, A., Anderson, B. 2019. Using relational agents to promote family communication around type 1 diabetes self-management in the diabetes Family Teamwork Online intervention: Longitudinal pilot study. Journal of Medical Internet Research. 21(9):e15318.

Interpretive Summary: Family conflict around type 1 diabetes management can decrease self-management in teens who have type 1 diabetes. Decreased self-management can lead to health complications associated with type 1 diabetes. We adapted an in-person program that was successful in decreasing family conflict in families that have a teen with type 1 diabetes for delivery over the internet. A pilot study established its feasibility and acceptability with parents and teens with type 1 diabetes. If proven to be effective at establishing more optimal communication in families, this program has the potential to improve self-management in teens with type 1 diabetes, thus decreasing health complications associated with type 1 diabetes in teens.

Technical Abstract: Family 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. The 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. Parent-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). Twenty-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. The 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.