Health Communication Experiences of Youth with Type 1 Diabetes

Background: Effective communication between adolescents/young adults (AYAs) with type 1 diabetes (T1D) and healthcare providers (HCPs) is essential to optimize health outcomes. Understanding AYA preferences for healthcare interactions can help HCPs more effectively engage AYA patients. Objective: To gain insight into AYA-HCP communication and identify factors that AYAs with T1D value when working with HCPs. Methods: As part of a longitudinal study, 20 AYAs (M age=18.8±1.5 yrs; 70% female; 65% Caucasian) with T1D receiving care in a pediatric diabetes clinic (n=5 HCPs) participated in a qualitative interview and completed the Patient Assessment of Chronic Illness Care (PACIC). Interviews (M length=13.9±5.1 min) were recorded, transcribed, and coded by two independent coders to identify themes. Hemoglobin A1c (M=8.5±1.7%) was taken from medical records. Results: Themes emerged related to HCP interaction style, support for autonomy, comfort with disclosure, and difficulties when glycemic control was poor. AYAs valued a straightforward approach to T1D care, with HCPs who encouraged shared decision-making and were directed towards AYAs instead of parents. AYAs perceived higher quality communication when HCPs took interest in their lives beyond T1D. Most AYAs were comfortable disclosing risky behavior (e.g. sexual activity, alcohol use) but preferred HCPs to initiate these conversations. Most participants had not discussed transition to adult care with their HCP but reported general confidence in planning for transition. AYAs with A1c \u3e8.5% endorsed external stressors affecting T1D management and some felt HCPs were less supportive when glycemic control was poor. On the PACIC, participant satisfaction with T1D care was generally high (M PACIC score=3.57±.57). Higher A1c was associated with lower decision support by HCPs (r=-.49, p\u3c.05). Participants who changed HCPs during the study (n=4) also reported lower decision support (p\u3c.05) and were more likely to describe their HCP as impersonal or punitive. Conclusions: Results suggest AYAs desire collaborative, consistent HCP relationships, but need HCPs to initiate discussions about risky behavior and healthcare transition. Given low decision support among AYAs with higher A1cs or HCP inconsistency, HCPs working with these patients should encourage self-efficacy and promote organization of care. Results should be replicated in a more diverse sample of AYAs with T1D to further inform key themes related to HCP relationships in youth