Background The UK has the fifth largest paediatric diabetes population in the world, but one of the poorest levels of diabetes control. Only 15.8% of young people (YP) with Type I diabetes achieve recommended glycaemic targets, putting the majority at high risk of future complications. We describe a programme of research over an 8 year period to develop a unique tool that concurs with YPs’ diabetes lifestyles and integral use of technology set within an educational framework.
Methods Aims: (1) to overview the methodological development of a diabetes needs assessment tool designed to guide the delivery of care and individual needs of YP with Type I diabetes; (2) to demonstrate its reliability and validity; (3) to evaluate how ADNAT can be used effectively in clinical practice as an App.
A 5 stage mixed methods approach incorporating identification of a pool of potential items from previous studies (qualitative study, systematic review); selection of items using the Delphi method with experts; systematic item reduction with cognitive interviews, pre-testing, piloting, reliability and validity (n = 155); transference to IT format; followed by a pilot evaluation of its implementation in 3 Paediatric Diabetes Units in NW England (n = 45).
Results The ADNAT APP has been developed, psychometrically tested and evaluated for 12–18 year olds. It consists of 117 questions divided between 6 domains (all about me, physical activity, eating, monitoring blood glucose, medication taking, living with diabetes) with 36 of the questions, hidden amongst the total, providing 2 scored ‘Needs Assessment Ratings’ relating to self-care and psychosocial health. The tool uses traffic light labelling to highlight problem areas. Face/content validity were positively evaluated, Kappa statistics showed good reliability (0.42–0.82), and tests for validity found significant correlations with SMOD-A (r = 0.41, IC: < 0.001), and HbA1c levels (r = 0.16, IC: = 0.056). Item total polyserial correlations and item response analysis validated the use of simple additive scores (r = 0.87). Evaluation (using the REAIM framework) produced recommendations for successful implementation.
Conclusion The ADNAT App has been developed and tested in collaboration with YP, their carers and health professionals. ADNAT allows the YP to see how their domains and HbA1c inter-relate and impact on their personal diabetes fitness. It combines reflective questioning with needs assessment to raise self-awareness to support adolescent decision making. ADNAT has been included in the National Paediatric Diabetes Improvement Plan for 2013–2018.