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Codevelopment of a complex intervention to reduce inequalities in paediatric diabetes secondary care outcomes for

Aidan Searle¹, Jessica R Wheeler², Ian Litchfield³

¹NIHR Biomedical Research Centre - Diet and Physical Activity Theme, University of Bristol, Bristol, UK A.J.Searle@bristol.ac.uk.

|May 7, 2025

Insights

This study co-developed an intervention to improve diabetes control for underserved children and young people with diabetes (CYPD). The intervention includes peer support, health coaching, family support, and healthcare practitioner training to reduce health inequalities.

Area of Science:

Public Health
Health Services Research
Behavioural Science

Background:

Significant health outcome inequalities exist for children and young people with diabetes (CYPD) from underserved socioeconomic and ethnic groups.
Existing interventions often fail to address the complex, multifaceted needs of diverse CYPD populations, leading to disparities in diabetes management and future health.
Development of targeted interventions requires a co-design approach involving end-users and adherence to established frameworks for complex interventions.

Purpose of the Study:

To co-develop an intervention with CYPD and their families to improve diabetes control and future health outcomes in underserved populations.
To reduce inequalities in treatment outcomes between different socioeconomic and ethnic groups of CYPD.
To adhere to Medical Research Council guidance for complex interventions and the COM-B model for behaviour change.

Main Methods:

Utilized a phased approach, including literature reviews, semi-structured interviews with CYPD and carers, and analysis using the COM-B framework.
Evaluated intervention components through focus groups with CYPD and carers, and surveys with healthcare practitioners (HCPs) across England.
Assessed components using criteria including Acceptability, Practicability, Effectiveness, Affordability, Spill-Over Effects, and Equity.

Main Results:

The co-development process identified four key intervention elements: enhanced peer support/mentoring, a health and well-being coach, family/community support, and tailored HCP training.
HCP training focused on cultural competence, poverty-proofing, and improving communication sensitivity with underserved CYPD.
The intervention package addresses individual, community, and clinical levels, integrating sociocultural contexts and support options.

Conclusions:

The 'Diversity in Diabetes' co-development work yielded an intervention tailored to improve diabetes care for underserved CYPD.
The intervention reflects sociocultural contexts and offers plausible support mechanisms at multiple levels.
Future research will test the feasibility and refine the intervention package in additional paediatric diabetes centres.

Read full analysis

Abstract

Objectives:

To codevelop (with children and young people with diabetes (CYPD)) an intervention to improve diabetes control and future health outcomes of CYPD from 'underserved' groups, to reduce treatment outcome inequalities between different socioeconomic and ethnic groups. To follow Medical Research Council guidance for complex interventions and the COM-B (Capability, Opportunity, Motivation, Behaviour) model for behaviour change intervention development.

Design:

In phase 1 (previously reported), we established the evidence base, conducted literature reviews and analysed data from semistructured interviews with CYPD and their carers. In phase 2 (this report), we applied the COM-B framework to identify intervention components; in phase 3 (this report), we evaluated these components, including focus groups with CYPD, their carers' and healthcare practitioner (HCP) surveys, using the Acceptability, Practicability, Effectiveness, Affordability, Spill-Over Effects, Equity criteria.

Setting:

Secondary care; children, young people and their carers' were approached from two large paediatric diabetes services in England, both with socioeconomically and ethnically diverse underserved populations; paediatric diabetes HCPs were surveyed across four English regions.

Participants:

N=69 underserved CYPD (aged 5-19 years) and/or family members took part in interviews; N=48 paediatric diabetes HCP survey respondents (survey 1); N=34 paediatric diabetes HCP survey respondents (survey 2); N=3 young people's advisory group participants; N=17 underserved CYPD/carers focus group participants; N=9 wider stakeholder participants.

Results:

The codevelopment process and integration of COM-B established four elements for an intervention package: (1) an enhanced peer support/mentoring programme; (2) provision of a health and well-being coach to CYPD/families; (3) family/community support to address social and community issues and (4) training for HCPs, including cultural competence, poverty proofing and to emphasise the need for increased sensitivity and better supported communication in work with CYPD from underserved groups.

Conclusions:

The Diversity in Diabetes codevelopment work informed an intervention to improve diabetes care in underserved groups, reflecting sociocultural contexts and plausible support options at the individual, community and clinical levels. The 'Diversity in Diabetes' programme will next test feasibility and further refine the intervention package in two more paediatric diabetes centres in England.

Keywords:

Health Services Person-Centered Care Self-Management

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