Do attachment security, self-esteem and emotional distress predict metabolic control and quality of life in adolescents with Type 1 diabetes? Will ‘wellbeing’ text-messaging support improve outcomes?
Objectives: Systematic review: This article presents a systematic review of studies evaluating the evidence for mobile phone-based interventions with adolescents who have Type 1diabetes. Studies were critically appraised and findings synthesised with the aim of answering the question: do mobile phone technologies facilitate improved outcomes in adolescents who have Type 1diabetes? Empirical research study: Diabetes research has indicated an association between attachment security and metabolic control as well as increased prevalence of mental health difficulties in diabetes populations. There is limited research with an adolescent Type 1 diabetes population. The current study aimed to examine attachment, emotional distress and self-esteem in an adolescent Type 1 diabetes population in relation to metabolic control and quality of life. The current study also aimed to evaluate the impact of ‘wellbeing text-messaging support’ with the same population. Method: Systematic review: A systematic search strategy was employed to identify relevant studies. An electronic database search, combined with a hand search of key journals and reference sections of key papers, was undertaken. Methodological quality was determined using an idiosyncratic measure including information relating to study design, sample size, interventions and statistical analyses. A narrative synthesis was performed due to the heterogeneity of the sample. Empirical research study: 60 participants aged between 12-18 years old who had a diagnosis of Type 1 diabetes for over 12 months took part. A longitudinal questionnaire design was used to collect data using five validated psychological measures. HbA1c was used as a measure of metabolic control. Text-messaging comprised a wellbeing module delivered daily over a three-week period. Results: Systematic review: 12 eligible studies were identified. One achieved a rating of ‘very good’, two a rating of ‘good’ and the remaining nine were pilot and/or feasibility studies, of whom four received a rating of ‘fair’ and ‘five received a rating of ‘poor’ methodological quality. Results indicated limited good quality evidence which included improved adherence and self-efficacy and mixed results in relation to metabolic control. Limitations identified included the use of small, convenience samples and short study duration. Empirical research study: High levels of fearful attachment security predicted poorer metabolic control and poorer quality of life, and high levels of emotional distress predicted poorer quality of life. ‘Wellbeing text-messaging support’ resulted in significantly improved quality of life. Conclusion: Systematic review: There is limited evidence that mobile phone technology has consistently improved outcomes in adolescents with Type 1 diabetes. Due to the number of pilot or feasibility studies and predominantly poor/fair quality of the current literature, and the heterogeneity of the sample, only tentative conclusions can be drawn, thus highlighting the need for further research. Empirical research study: Adolescent attachment style and emotional distress may be assessed as part of routine diabetes care in order to identify individuals who are potentially most at risk of failing to engage with diabetes health care. This can subsequently impact negatively on metabolic control and/or quality of life. These findings highlight the importance of clinical psychology input in paediatric diabetes teams. Further research in relation to text-messaging support was recommended.