Exploring the Usability and Acceptability of a Well-Being App for Adolescents Living with Type 1 Diabetes: A Qualitative Study (Preprint)

Abstract

Adolescents living with either type 1 diabetes (T1D) or type 2 diabetes (T2D) have an increased risk of psychological disorders due to the demands of managing a chronic illness and the challenges of adolescence. Psychological disorders during adolescence increase the risk of suboptimal glycaemic outcomes and may lead to serious diabetes-related complications. Research shows digital health interventions may increase both access to psychological support for adolescents as well as improving physical and mental health outcomes for youth with diabetes. To our knowledge there are no evidence-based, publicly available mental health apps with a focus on improving psychological well-being in adolescents with diabetes.

To explore the acceptability and usability of our evidence-based well-being app for New Zealand adolescents ‘Whitu: 7 Ways in 7 Days’ (Whitu), to allow us to further tailor it for youth with diabetes. We interviewed adolescents with T1D and T2D, their parents, and healthcare professionals to explore their views on the Whitu app and suggestions for tailoring the app for adolescent with diabetes. We also explored the cultural acceptability of the Whitu app for Māori and Pacific adolescents.

Thirty-four participants, comprising 13 adolescents aged 12-16 years (11 with T1D and 2 with T2D), 10 parents, and 11 healthcare professionals were recruited from a specialist diabetes outpatient clinic and Facebook diabetes groups. Each participant attended one 1-hour focus group on Zoom, in person, or via phone. Researchers gathered general feedback on what makes an effective and engaging app for adolescents with diabetes, as well as specific feedback about Whitu. Transcribed audio recordings of the focus groups were analysed using directed content analysis. Due to the small number of participants with T2D and insufficient data to understand their perspectives of Whitu, the data presented in the results pertains to adolescents with T1D only.

Adolescents with T1D, their parents, and healthcare professionals found Whitu to be acceptable and usable. Adolescents with T1D and parents signalled a preference for more diabetes-specific content. Healthcare professionals expressed less awareness and trust of digital health interventions and, as such, recommended that they be used with external support. Due to challenges in recruitment and retention, we were unable to include the views of adolescents with T2D in this qualitative study.

There appears to be sufficient openness to the use of an app like Whitu for supporting the well-being of adolescents with T1D, albeit that some modifications to make its content more diabetes-specific are required. We are currently planning a qualitative study to explore the views of youth with T2D and their perspectives on Whitu, where we are using alternative research approaches to recruit and engage with adolescents with T2D and their families.

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