Abstract: Exploring Motivation Behind Engagement in Mealtime Bolus Behavior in Adolescents with Type 1 Diabetes (T1D): A Behavioral Economics Approach
E. DeWit1, S. Tsai2,1, M. Clements2,1, B. Spartz1, L. Lartey1, K. Evans1, L. Sainz Y Diaz1, E. Hurley2,1
1Children’s Mercy Kansas City, Kansas City, United States, 2University of Missouri Kansas City, Pediatrics, Kansas City, United States
Introduction: This study involves a pilot behavioral economic intervention designed to promote engagement with mealtime bolusing among adolescents with Type 1 Diabetes (T1D).
Objectives: To understand perspectives of youth with T1D and their parents during study participation.
Methods: C2D was piloted over 14 months with 26 participants identified as high-risk for suboptimal T1D outcomes at a pediatric hospital in the U.S. Midwest. We conducted virtual focus groups (two with adolescent participants [n=6]) and one with their parents [n=4]) to explore:
- Motivators for adolescent mealtime bolus behavior within and beyond C2D and;
- Perceived strengths and weaknesses of C2D. Focus groups were audio-recorded, transcribed, and analyzed based on selected constructs from the consolidated framework for implementation research.
Results: Overall, adolescents felt C2D’s financial incentives and accompanying text notifications served as motivators for mealtime bolus engagement, with some identifying them as key in establishing habit. Parent perceptions on the appropriateness of financial incentives were mixed, as some had concerns that improvements may not be sustained. While some adolescents reported technical issues, all indicated they would participate in C2D again and recommend it to peers. Parents valued the technology within and outside of C2D that allowed their child’s real-time blood glucose data to be shared with their clinics, finding this data-sharing central to facilitating individualized care. Beyond motivators introduced by the intervention, participants emphasized the importance of social support from others with T1D, with some also mentioning previous parent-provided financial incentives and fear of negative health outcomes.
Conclusions: Behavioral economic interventions, coupled with text message reminders show promise for motivating mealtime bolusing in adolescents with T1D. Future iterations of the intervention may consider including a peer support component to enhance program satisfaction and mealtime bolusing.
Link: https://www.react-profile.org/upload/KIT/system/uploads/ISPAD2023_Abstracts.pdf