title: Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness.
abstract: 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.
authors.affiliation: Department of Economics, University of Surrey, Guildford GU2 7XH, UK. h.gage@surrey.ac.uk
authors.forename: Heather
authors.initials: H
authors.lastname: Gage
authors.forename: Sarah
authors.initials: S
authors.lastname: Hampson
authors.forename: T Chas
authors.initials: TC
authors.lastname: Skinner
authors.forename: Jo
authors.initials: J
authors.lastname: Hart
authors.forename: Lesley
authors.initials: L
authors.lastname: Storey
authors.forename: David
authors.initials: D
authors.lastname: Foxcroft
authors.forename: Alan
authors.initials: A
authors.lastname: Kimber
authors.forename: Sue
authors.initials: S
authors.lastname: Cradock
authors.forename: E Adele
authors.initials: EA
authors.lastname: McEvilly
mesh_terms: 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*