Behavioral interventions for adolescents with type 1 diabetes - How effective are they?

OBJECTIVE - To evaluate the effectiveness of behavioral interventions for a dolescents with type 1 diabetes based on a systematic review of the literat ure. RESEARCH DESIGN AND METHODS - The literature was identified by searching 11 electronic databases, hand-searching 3 journals from their start dates, an d contacting individual researchers. Only articles that reported evaluation s of behavioral (including educational and psychosocial) interventions for adolescents (age range 9-21 years) with type 1 diabetes that included a con trol group were included in the present review. Data summarizing the key fe atures of the interventions and their effects were extracted from each arti cle. Where possible, effect sizes for the randomized control trials (RCTs) were calculated. RESULTS - The search process identified 64 reports of empirical studies. Of these, 35 studies included a control group, and 24 were RCTs. Effect sizes could be calculated for 18 interventions. The overall mean effect size cal culated across all outcomes was 0.33 (median 0.21), indicating that these i nterventions have a small- to medium-sized beneficial effect on diabetes ma nagement. Interventions that were theoretically based were significantly mo re effective than those that were not (P < 0.05, 1-tailed). CONCLUSIONS - Research to date indicates that these interventions are moder ately effective. Several methodological weaknesses to be avoided in future studies are noted. It is also recommended that investigators use the reach, efficacy, adoption, implementation, and maintenance (RE-AIM) framework to guide the design of future studies, which should result in more disseminabl e interventions. RE-AIM assesses the intervention's reach, or percent or re presentativeness of patients willing to participate; efficacy across a rang e of outcomes; adoption, or the percent and representativeness of settings willing to implement the intervention; implementation, or the consistency o f the delivery of the intervention as intended; and maintenance, or the ext ent to which delivery of the intervention becomes a routine part of health care in the medical setting.