Peer Mentoring for Adolescents with Type 1 Diabetes
Clayton Velicer, MPH
Our blog has covered peer support in many populations around the world, but we rarely talk about adolescents and young adults. Traditionally, health interventions directed towards adolescents have struggled to produce positive behavior changes. However, there is reason to believe that peer support can succeed in engaging this population where other approaches have failed.
Diabetes care in adolescents is often compromised by non-adherence, a significant contributor to poor glycemic control that is related to anxiety or fears about being judged by peers and adolescent development issues. Previous research in this area has focused on peer support from friends without diabetes or group learning among patients of the same age.
This week, our blog looks at the research of Yang Lu and colleagues at the UCLA David Geffen School of Medicine, in which she examined the factors that may make adolescents and young adults with type 1 diabetes (T1D) become interested in peer support to improve their self-management.
In this feasibility study, participants were recruited from a Los Angeles clinic within a large tertiary children’s hospital that provides medical care for underrepresented groups, including those with public or no insurance. Prospective mentees were 13-18 year olds (N=54) who had been clinically diagnosed with T1D while prospective mentors were 19-25 (N=46) year olds who had been diagnosed with T1D for at least 3 years.
Both groups were given a 15-20 minute survey that measured their diabetes adherence, depression, and barriers to adherence related to school, work, vacation, and social situations. The participants were also given a number of questions to assess their levels of social support including the social connectedness scale, and level of interest and preferences for peer mentoring. Additionally, the participants were asked how frequently they would like to receive peer mentoring and the delivery/communication modes they preferred.
The most common barriers to diabetes control for the participants were social barriers with approximately one third of participants reporting experiencing social barriers. Examples of social barriers were embarrassment about blood glucose monitoring, doing an insulin injection in social situations, and the inability to be spontaneous in social situations. However, the authors noted these barriers impacted the potential mentees and mentors differently with the younger group reporting glucose monitoring and insulin as a barrier much more frequently (50% compared to 15%). Knowing the kinds of food consumed and portion sizes was an equal barrier for both age groups.
Overall, 57% of the participants (mentees and mentors combined) expressed in interest in participating in a peer mentoring program. Furthermore, it was found that social factors, such as having supportive friends that knew about their condition or living in a large (> 5 person) household was positively associated with interest in having a peer mentor. Among the variety of responses for preferred mentoring topics, diabetes management on one’s own and in college was mentioned most frequently. Many of the adolescents stated they wanted to learn about everything. All participants expressed interest in phone, email, text messaging, social media, and in person meetings.
Thoughts from the Author
In a feature on the Endocrine Today, Yang Lu, PhD, MPP of the UCLA David Geffen School of Medicine and the Los Angeles Biomedical Research Institute said, “Clinicians play a critical role in identifying and connecting youth with diabetes who seek peer support” and that:
“Adolescents who lack positive experiences communicating about their diabetes with friends may not have a frame of reference for understanding how a peer mentoring program could be beneficial. However, they may benefit as much, or more, from a peer mentoring program. Innovative incentives may be needed to reach prospective mentees who are less willing to share their diabetes experiences. Alternatively, other interventions not involving direct social interactions may be more suitable to improve adherence in these individuals.”
This feasibility study confirms that adolescents are open to and interested in receiving peer mentoring to help with their diabetes self-management. As the author notes, this is a vulnerable group that has unique challenges in adherence that may be best understand by a peer or someone with more experience with diabetes management.
We have seen an increase in the availability of peer support for college students with diabetes through the College Diabetes Network. Lu’s research indicates that there is a demand for peer support among young adults in the years leading up to college as well. The questions regarding types of barriers provides some particularly interesting data that suggest younger adolescents with diabetes are more concerned about measuring their glucose or using insulin compared to the older mentor group. This may be an area where peer mentoring would be particularly beneficial for this age group.
What do you think about peer support for adolescents with type 1 diabetes? How important is it? How do we help make it available to more adolescents?