Abstract: A mHealth App May Help Improve Family Conflict and Type 1 Diabetes Management for Parents Caring for their Child

◆ Bree E. Holtz, Michigan State University
◆ Katharine M. Mitchell, Michigan State University

Type 1 diabetes (T1D) is typically diagnosed in childhood. Due to the young age of the child at the time of diagnosis, parents typically take on the complex daily management of the disease. As the child matures, there is a transition from parent-management to parent-adolescent-team management. This is stressful and associated with a decrease in adherence to management and an increase in family conflict. Improving adherence and communication during this transition may be possible through the use of technology. Mobile phone health apps (mHealth) allow for the use of more engaging strategies, such as gamification and customization, which have been shown to improve adherence and reduce conflict. We have developed a mHealth intervention to help families during this time of transition. This study tested a mHealth intervention’s efficacy in reducing family conflict and improving adherence for parents of children with T1D.

Forty-nine adolescent-parent pairs were enrolled in a 12-week study and randomized using a 2:1 ratio to the intervention (I:mHealth app) or control group (C:standard care). While adolescents were included, the main focus of this study are the parents. Participants in the intervention group were provided with the mHealth intervention. The control group was instructed to continue with usual care. Pre-test survey measures were collected and at the conclusion of the intervention, post-test surveys were conducted. Survey measures included conflict and diabetes adherence. Paired-sample t-tests and ANOVAs were conducted to assess differences from pre- to post-study and between-subjects.

The final analysis included 33 families (23I:10C); 10 never completed post-test assessments (8I:2C). For both groups the majority of the participants were White (90%I:96%C) and the biological mothers of adolescents (82%I:80%C). The mean age of the adolescents was 12.5±1.45 years old.
The intervention group showed significant improvement in adherence (pre:M=3.67, SD=0.45; post:M=3.89,SD=0.44; t(19)=-2.431,p=.03) compared to the control group who had a non-significant decrease in adherence scores (pre:M=3.90,SD=0.58; post:M=3.75,SD=0.54; t(7)=1.54, p=0.17). However, there was no significant difference between groups at post-test, [F(1, 32)=1.23,p=0.28].
The intervention group had a decrease in conflict (pre:M=2.62,SD=0.38; post:M=2.61,SD=0.42; t(20)=.104, p=.92) and the control group also had a decrease in conflict (pre:M=2.61,SD=0.23; post:M=2.36,SD=0.57; t(8)=1.54,p=0.16), although neither were significant. There was no significant difference between groups at post-test[F(1, 32)=2.75,p=0.11].

This study provides some preliminary support for the efficacy of this intervention in improving health outcomes in adolescents with T1D. mHealth interventions developed to improve the management of T1D during the transition to adolescent self-care is a promising approach to improve health outcomes in this population.