Piloting an Intervention to Improve Outcomes in Young Adults Living With Type 1 Diabetes: The Experience of the D1 Now Support Worker

Abstract

IntroductionD1 Now is a novel intervention which aims to support self-management and clinic engagement and improve outcomes in young adults (18-25 years) living with type 1 diabetes in Ireland. It has been developed using a systematic, theoretical, user-centred approach. The specific role of the Support Worker, one of three components of the D1 Now intervention, was developed to provide continuity and build relationships between young adults and their diabetes team.MethodsA Support Worker - an Occupational Therapist, who had a background in youth mental health - was hired as part of the D1 Now pilot randomised controlled trial and was based in one intervention site to join the existing diabetes team.DiscussionThe Support Worker aimed to provide an accessible and consistent point of contact for young adults, facilitated conversations about distress, and encouraged graded goal setting and collaborative problem solving. The role afforded her with a unique window into the lived experiences of young adults with type 1 diabetes where she observed the ongoing negotiation of life and living alongside diabetes care and management. The prevalence of diabetes distress was high in the study cohort with particular challenges associated with ‘all or nothing’ thinking patterns as well as disordered eating behaviours. The Support Worker also played an advocacy role in supporting the diabetes team’s awareness of young adults’ needs and explored current barriers to care. Preliminary findings from the D1 Now pilot have identified that the role of the Support Worker was viewed positively from the perspective of young adults with type 1 diabetes.

Reimagining care for young adults living with type 1 diabetes

“…They work by shifting the focus of the encounter from the biomedical to the wider medical and personal contexts. The support worker aims to develop a collaborative and holistic relationship with the young adult, and advocate for their needs in the clinic 12 . The agenda setting tool is intended to promote a shared decision‐making approach to the clinic consultation; it includes sections that are filled in by the young adult before their consultation, and sections that are filled in jointly with their clinician during the consultation.…”