Using the Web to Help Teens With Diabetes
Margaret Grey, DrPH, RN, FAAN
Margaret Grey, DrPH, RN, FAAN
Pediatric Nurse and, Behavioral Scientist,Yale University School of Nursing
Type 1 Diabetes
|ADA Research Funding|
ADA–Sanofi-Aventis U.S. Award in Health Services Research in Clinical Care Delivery
The teenage years are tough enough without the added stress of managing a disease like diabetes. They're a time of transition, when kids are turning into adults and learning to navigate the world on their own.
For kids with diabetes, that often means taking responsibility for treating their disease without as much help from their parents. Unfortunately, the typical teen push for independence can put them at risk for worse health. "Teenagers know exactly what they should do, but life intervenes and they make decisions that are not good for their diabetes, or for their health generally," says Margaret Grey, dean of the Yale University School of Nursing. "Teens assert their independence by not taking as good care of their diabetes as they should."
Basic biology makes the situation even more precarious—the surges of hormones associated with adolescence and the body's need for energy to grow can wreak havoc on glucose control. "Research has shown that puberty is a tricky time, when insulin resistance increases and insulin control starts to worsen," Grey says.
Education can make a big difference. Nearly two decades ago, when Grey started studying how best to help teens with diabetes, she found that many of them saw caring for their condition as a liability. "They told us they could either take good care of their diabetes and look like a jerk, or not take care of their diabetes and be accepted," Grey says.
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Grey has spent 17 years developing strategies to help convince teens that's not the case. To help teens make the right choices, Grey says they need more than just information. They need the skills to overcome peer pressure and the feeling that taking care of their diabetes is uncool.
That takes a mix of assertiveness training, social-skills coaching, and positive thinking. Grey's research has shown that one-on-one coaching makes a big difference in health outcomes. Teens who were given coping-skills training in one Yale study were able to manage their diabetes better, reported a higher quality of life, and, in some cases, lost more weight than peers in a control group that was given only basic information on diabetes management.
But Grey's program, which involves hours of group meetings, isn't cost effective for most kids with diabetes. Instead, she's trying to reach kids where they're most comfortable—on the Internet. "This generation is way more computer-savvy than any of us, and also very, very busy," she says. "We asked, could we adapt skills training to an Internet format?"
The team members spent a year developing a website they call TeenCope. "The content is the same [as the coaching], but the delivery is different," Grey says. The site is a mix of interactive quizzes, streaming video, moderated discussion boards, and other approaches designed to appeal to teens with lots of entertainment options.
To measure TeenCope's effectiveness, Grey randomly assigned teens to either TeenCope or a "control" program called Managing Diabetes that offers lots of information about how to deal with the disease but less emphasis on social skills and self-esteem. "It's less interactive and focused not on behavioral skills but on topics such as carb counting and healthy eating"—an approach Grey sums up as "flat-screen." The kids in TeenCope showed "similar outcomes to what we've seen before," Grey says. "Lower A1C, better quality of life, and higher participation rates."
The next step is to see if clinicians in diabetes centers will prescribe the use of such sites and if that results in better outcomes. With a grant from the American Diabetes Association, Grey set up an experiment that involves 120 kids between 11 and 14. They're given a prescription that leads them to either the American Diabetes Association's Planet D website, where the content is mostly basic information on diabetes plus a discussion board, or the Yale-designed TeensConnect, which combines content from TeenCope and Managing Diabetes, including an emphasis on social and coping skills.
After six months of teens' using one program or the other, Grey's team measures the kids' A1C levels and quality of life to see if they've improved. So far, she's optimistic that the Internet can deliver the goods to teens in an effective way. "Teenagers vote with their feet," she says, "and the fact that they're eager to participate shows they're really hungry for something like this."