JMIR Publications

ABSTRACT

Background:

Delayed diagnosis of type 1 diabetes (T1D) in children can result in serious health complications. T1D autoantibody screening can identify children with preclinical T1D before complications arise and when treatment may be available to delay symptomatic onset. Although such screening is not currently widely performed, calls for population-level screening are increasing. As population-level screening for T1D is considered, it is essential to develop patient-centered communication strategies and materials to support informed decision-making. Patient-centered communication attending to parents’ psychosocial needs, while considering clinician knowledge and attitudes, has implications for how parents may evaluate T1D health risks and screening.

Objective:

This study aimed to optimize patient-facing, digital informational handouts focused on T1D autoantibody screening by understanding how parents and clinicians construct meaning surrounding risk, efficacy, and message framing.

Methods:

This study applies the Extended Parallel Process Model and Prospect Theory to examine how clinicians and parents perceived parent-facing T1D clinical resource messages related to threat (severity and susceptibility), efficacy (response and self-efficacy), and gain/loss framing. A health communications expert drafted three T1D screening handouts designed for various timepoints in a pediatric patient’s healthcare. Pediatric clinicians and parents of pediatric patients were invited to participate; those who consented were sent the informational handouts for review and participated in one-on-one qualitative interviews between March and September 2024. Participants were asked to provide feedback on handout content and suggest ideas for improvement. Through a theory-informed, constructivist thematic analysis, we investigated the communication elements that motivate T1D screening. Handouts were revised based on interview analysis and member checking was undertaken to assess participant agreement with modifications.

Results:

Interview analysis revealed participant preferences for communication strategies that aligned with principles of the Extended Parallel Process Model and Prospect Theory. Participants emphasized the importance of conveying the seriousness of T1D through clear descriptions of severity and susceptibility while avoiding overly alarming messages that could undermine engagement. Recommendations included providing actionable guidance about how and when to screen, insurance coverage information, and resources to support parent and clinician’s confidence in pursuing recommending screening. Participants favored gain-framed messages such as emphasizing the benefits of early risk identification, access to monitoring and treatment options, and prevention of severe complications compared to loss-frame messages that would focus on negative impacts of not screening. Additionally, clinicians described a need for educational resources and evidence-based protocols to support their screening discussions and management decisions.

Conclusions:

Findings suggest that communication materials designed to promote pediatric T1D autoantibody screening should balance threat information with actionable, efficacy-based guidance and emphasize the benefits of screening. Integrating EPPM and Prospect Theory principles may help create messages that convey urgency without provoking excessive fear, support parent and clinician confidence, and encourage screening uptake as T1D screening programs expand.