title: Efficacy and implementation of an Internet psychoeducational program for teens with type 1 diabetes.
abstract: The purpose of the study was to evaluate the participation and preliminary efficacy of an Internet psychoeducational program (Teens.Connect) shown to be efficacious under controlled conditions compared with an open-access diabetes website for youth (Planet D) on the primary outcomes of A1C and quality of life (QoL), and secondary outcomes of psychosocial and behavioral factors.
  
  
  
  Teens with type 1 diabetes (n = 124, 11-14 yr) from two clinical sites were randomly prescribed one of the programs and completed baseline, 3-month and 6-month data. A1C was obtained from clinic records. Participation data included number of log ins, posts to the discussion board, and lessons completed (Teens.Connect only). Descriptive and mixed model analyses were used.
  
  
  
  Eighty-five percent (85%) of consented teens registered for their prescribed program. Satisfaction and log ins were similar between groups (satisfaction ranged 3.3-3.5/5; mean log ins = 14/teen). Posts to the discussion forum were higher in Planet D (mean = 28 vs. 19). Participation in the Teens.Connect lessons was low, with only 69% of teens completing any lesson. After 6 months there were no significant differences in A1C, QoL or secondary outcomes between groups. Teens in the Teens.Connect group reported lower perceived stress over time (p < 0.01).
  
  
  
  Teens do not actively participate in an Internet psychoeducational program when they do not have frequent reminders, which may have contributed to a lack of treatment effect. Teens have many competing demands. Strategic implementation that includes targeted reminders and family support may be necessary to assure participation and improvement in health outcomes.
authors.affiliation: Yale University School of Nursing, Orange, CT, USA. robin.whittemore@yale.edu.
authors.forename: Robin
authors.initials: R
authors.lastname: Whittemore
authors.affiliation: Yale University School of Nursing, Orange, CT, USA.
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Liberti
authors.affiliation: Yale University School of Nursing, Orange, CT, USA.
authors.forename: Sangchoon
authors.initials: S
authors.lastname: Jeon
authors.affiliation: Yale University School of Nursing, Orange, CT, USA.
authors.forename: Ariana
authors.initials: A
authors.lastname: Chao
authors.affiliation: Yale University School of Nursing, Orange, CT, USA.
authors.forename: Karl E
authors.initials: KE
authors.lastname: Minges
authors.affiliation: The Division of Endocrinology & Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Murphy
authors.affiliation: Yale University School of Nursing, Orange, CT, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Grey
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000502:physiology / Q000523:psychology; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D037001:Directive Counseling / Q000379:methods; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006284:Health Plan Implementation; D006801:Humans; D020407:Internet; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D011788:Quality of Life; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Internet; diabetes mellitus; psychoeducation; quality of life; randomized clinical trial; type 1