Check It! 2.0: Positive Psychology Intervention for Adolescents With T1D

The proposed study has the potential to improve adherence to the diabetes regimen in
adolescents with type 1 diabetes without compromising their quality of life. The potential
benefits include helping adolescents achieve better glycemic control, thereby reducing the
health risks and complications associated with diabetes.

The investigators will use a positive psychology framework, which emphasizes positive
emotions and strengths rather than problems, to promote adherence.

Positive affect, defined as feelings that reflect pleasurable engagement with the environment
(e.g., happy, cheerful,proud), have been linked with favorable health outcomes and increased
adherence to medical regimens. Further, positive affect has been shown to increase people's
ability to use complex coping strategies. Randomized controlled trials of positive psychology
interventions have been shown to successfully increase adults' adherence to medication and
physical activity recommendations. However, no studies have examined the effects of positive
psychology interventions on adherence behaviors in pediatric populations. Our ongoing work
suggests that positive affect in adolescents with type 1 diabetes is related to greater use
of adaptive coping strategies, lower levels of family conflict, and fewer depressive
symptoms, and demonstrates that a positive psychology intervention has the potential to
induce positive affect in adolescents. The investigators propose to pilot test a positive
psychology intervention for adolescents with type 1 diabetes. This low-cost, innovative
intervention is designed to induce positive affect in adolescents (age 13-17) through
tailored exercises in gratitude and self-affirmation. The investigators will also promote
positive parental involvement by asking caregivers to provide positive affirmation statements
to adolescents. Finally, the investigators will explore the use of technology by delivering
the intervention to adolescents and sending reminders to caregivers via text message using
the Twilio/REDCap system.

Blood glucose monitoring is one of the best indicators of adherence to the recommended
treatment regimen for type 1 diabetes, and frequency of blood glucose monitoring is strongly
related to glycemic control. Further, frequency of blood glucose monitoring has been shown to
decrease with age in adolescents, and parental reminders to check blood glucose are often a
source of conflict between adolescents and their parents. Therefore, blood glucose monitoring
represents a specific behavior that may be the best target for adherence interventions in
adolescents with type 1 diabetes.

Thus, the specific aims are as follows:

Aim 1: Adapt a positive psychology intervention for adolescents (age 13-17) with type 1
diabetes designed to increase the frequency of blood glucose monitoring. Aim 2: Evaluate the
feasibility, acceptability, and preliminary efficacy of a positive psychology intervention
for adolescents with type 1 diabetes and their caregivers delivered by text message with the
Twilio/REDCap system. The primary outcome is glycemic control, and secondary outcomes include
positive affect, coping, adherence (i.e., frequency of blood glucose monitoring), family
conflict, and quality of life.

Inclusion Criteria:

Adolescents will be eligible if they are:

1. between the ages of 13-17;

2. have been diagnosed with T1D for at least 1 year;

3. have no other major health problems;

4. are not currently participating in any other intervention studies;

5. have an A1C level between 7.5 - 12% on date of enrollment;

6. are patients of the Eskind Diabetes Clinic

7. must read and write in English

8. and must live the caregiver that is participating in the study with them

Exclusion Criteria: