Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness.
Diabetes incurs heavy personal and health system costs. Self-management is required if complications are to be avoided. Adolescents face particular challenges as they learn to take responsibility for their diabetes. A systematic review of educational and psychosocial programmes for adolescents with diabetes was undertaken. This aimed to: identify and categorise the types of programmes that have been evaluated; assess the cost-effectiveness of interventions; identify areas where further research is required. Sixty-two papers were identified and subjected to a narrative review. Generic programmes focus on knowledge/skills, psychosocial issues, and behaviour/self-management. They result in modest improvements across a range of outcomes but improvements are often not sustained, suggesting a need for continuous support, possibly integrated into normal care. In-hospital education at diagnosis confers few advantages over home treatment. The greatest returns may be obtained by targeting poorly controlled individuals. Few studies addressed resourcing issues and robust cost-effectiveness appraisals are required to identify interventions that generate the greatest returns on expenditure.
Gage
Heather
H
Department of Economics, University of Surrey, Guildford GU2 7XH, UK. h.gage@surrey.ac.uk
Hampson
Sarah
S
Skinner
T Chas
TC
Hart
Jo
J
Storey
Lesley
L
Foxcroft
David
D
Kimber
Alan
A
Cradock
Sue
S
McEvilly
E Adele
EA
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D001294:Attitude to Health; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000517:prevention & control / Q000523:psychology; D005069:Evaluation Studies as Topic; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033262:Narration; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D010353:Patient Education as Topic / Q000458:organization & administration*; D015397:Program Evaluation; D000297:Psychology, Adolescent; D012107:Research Design; D012648:Self Care / Q000523:psychology; D012657:Self-Help Groups / Q000458:organization & administration*