JMIR Publications

ABSTRACT

Background:

Adolescents and young adults (AYAs) with type 1 diabetes (T1D) face heightened risk for care gaps and preventable complications during the transition from pediatric to adult care. AYAs from low-income families are more likely to experience poor outcomes. Care guidelines for T1D now recommend a transition program beginning several years prior to anticipated independence. However, existing transition programs often require substantial resources, limiting scalability and accessibility. Existing transition programs often require substantial resources, limiting scalability.

Objective:

We used a human-centered design approach to develop and refine a low-cost, virtual intervention to support T1D transitions among publicly-insured AYAs.

Methods:

Guided by IDEO’s “3I” model (Inspiration, Ideation, Implementation), we conducted semi-structured interviews with 26 providers and staff across four University of California medical centers to identify challenges and opportunities for improving transition care. We then completed customer discovery interviews with 36 adopters and influencers, including AYAs, endocrinologists, and diabetes educators, to identify priorities and needs and create value propositions. The resulting intervention was tested with three cohorts (N=25) of publicly insured AYAs ages 17–21 receiving pediatric diabetes care at an academic medical center. The intervention consisted of two 75-minute virtual group sessions led by a diabetes educator and peer mentors with lived experience. Feasibility, acceptability, and appropriateness were assessed via validated surveys and qualitative interviews.

Results:

Core functions of the intervention included education and discussion on “adulting with diabetes” and navigating the healthcare system, interactive creation of a transition plan, mentors sharing their experiences with diabetes, open discussion among peers, opportunities to ask questions, and provision of resources based on individual needs. Implementers and participants rated the intervention highly on feasibility, acceptability, and appropriateness. Qualitative interviews highlighted peer support and lived-experience mentorship as core drivers of engagement. Attendance was highest among participants enrolled closer to session dates. Participant feedback informed ongoing adaptations to content and delivery across cohorts, including timing of the intervention, use of the chat function, multiple text reminders before intervention sessions, and specific topics of interest.

Conclusions:

This human-centered, low-resource intervention was feasible and well-received among low-income AYAs with T1D. Findings support further evaluation of its effectiveness and scalability in diverse settings. Clinical Trial: Not applicable