title: Impact of a preconception counseling program for teens with type 1 diabetes (READY-Girls) on patient-provider interaction, resource utilization, and cost.
abstract: OBJECTIVE
  To evaluate the impact of a preconception counseling program tailored for teens with type 1 diabetes on cognitive, psychosocial, and behavioral outcomes and to assess its cost-effectiveness.
  
  
  METHODS
  A total of 88 teens with type 1 diabetes from two sites were randomized into the READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) intervention (IG) (n = 43) or standard care (SC) (n = 45) groups. During three diabetes clinic visits, IG subjects viewed a two-part CD-ROM, read a book, and met with a nurse. Program effectiveness was measured by knowledge, attitudes, intentions, and behaviors regarding diabetes, pregnancy, sexuality, and preconception counseling. Assessments occurred at baseline, before and after viewing program materials, and at 9 months. Economic analyses included an assessment of resource utilization, direct medical costs, and a break-even cost analysis.
  
  
  RESULTS
  Age range was 13.2-19.7 years (mean +/- SD 16.7 +/- 1.7 years); 6% (n = 5) were African American, and 24% (n = 21) were sexually active. Compared with baseline and SC subjects, IG subjects demonstrated a significant group-by-time interaction for benefit and knowledge of preconception counseling and reproductive health: increasing immediately after the first visit (P < 0.001) and being sustained for 9 months (P < 0.05 benefits; P < 0.001 knowledge). For IG subjects, preconception counseling barriers decreased over time (P < 0.001), and intention and initiation of preconception counseling and reproductive health discussions increased (P < 0.001). Costs of adverse reproductive outcomes are high. Direct medical costs of READY-Girls were low.
  
  
  CONCLUSIONS
  READY-Girls was beneficial and effects were sustained for at least 9 months. This low-cost self-instructional program can potentially empower young women with type 1 diabetes to make well-informed reproductive health choices, adding little time burden or cost to their diabetes management.
authors.affiliation: University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA.
authors.forename: Andrea F Rodgers
authors.initials: AF
authors.lastname: Fischl
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sereika
authors.forename: Margaret
authors.initials: M
authors.lastname: Hannan
authors.forename: Dorothy
authors.initials: D
authors.lastname: Becker
authors.forename: M Joan
authors.initials: MJ
authors.lastname: Mansfield
authors.forename: Linda L
authors.initials: LL
authors.lastname: Freytag
authors.forename: Kerry
authors.initials: K
authors.lastname: Milaszewski
authors.forename: Amanda N
authors.initials: AN
authors.lastname: Botscheller
authors.forename: Denise
authors.initials: D
authors.lastname: Charron-Prochownik
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling / Q000191:economics* / Q000193:education / Q000379:methods; D003922:Diabetes Mellitus, Type 1 / Q000191:economics*; D005260:Female; D006801:Humans; D016742:Preconception Care / Q000191:economics*; D015397:Program Evaluation / Q000191:economics*; D055815:Young Adult