• Development and psychometric testing of the online Adolescent Diabetes Needs Assessment Tool (ADNAT)

      Cooper, Helen; Spencer, Joy; Lancaster, Gillian A.; Titman, Andrew; Johnson, Mark; Wheeler, Sarah; Lwin, Rebekah; University of Chester ; University of Chester ; Lancaster University ; Lancaster University ; Bolton University ; University of Chester ; University of Chester (Wiley, 2013-09-03)
      Aim: To report on the development and psychometric testing of the Adolescent Diabetes Needs Assessment Tool. Background: The UK has the fifth largest paediatric diabetes population in the world, but one of the poorest levels of diabetes control, highlighting the need for intervention development. Design: Mixed methods following recommendations for questionnaire design and validation. Methods: A total of 171 young people (12–18 years) participated between 2008– 2011. Methods included item selection using secondary framework analysis, item review, pre-testing, piloting and online transfer. Statistical tests assessed reliability using item-total correlations, interitem consistency and test–retest reliability; and validity using blood glucose (HbA1c) levels and the Self-Management of type 1 Diabetes in Adolescence questionnaire. Results: The Adolescent Diabetes Needs Assessment Tool consists of 117 questions divided between six domains of educational and psychosocial support needs. It combines reflective questioning with needs assessment to raise self-awareness to support adolescent decision-making in relation to diabetes self-care. Thirty-six of the questions provide self-care and psychosocial health assessment scores. Face and content validity of the scoring items were all positively evaluated in terms of appropriateness and readability and tests for validity found significant correlations with Self-Management of type 1 Diabetes in Adolescence and weak correlation with HbA1c, which compared favourably with Self-Management of type 1 Diabetes in Adolescence, the only comparable (USA) tool. Item response analysis validated the use of simple additive scores. Conclusions: The Adolescent Diabetes Needs Assessment Tool combines reflective learning with needs assessment to support patient-centred clinical consultations.
    • Development and psychometric testing of the online Adolescent Diabetes Needs Assessment Tool (ADNAT)

      Cooper, Helen; Spencer, Joy; Lancaster, Gillian A.; Titman, Andrew; Johnson, Mark; Lwin, Rebekah; Wheeler, Sarah; University of Chester ; University of Chester ; Lancaster University ; Lancaster University ; Bolton University ; University of Chester ; University of Chester (World Biomedical Frontiers, 2015-01-16)
      World Biomedical Frontiers provides a platform for the exchange of the latest research progress, including strategic and emerging research areas such as diabetes. Their aim is to accelerate understanding of human health and improvetreatment of a variety of human diseases. Our article, published in the Journal of Advanced Nursing, was selected for their web based publication. It provides an abstract plus supplementary information on the research work associated with ADNAT.
    • A mixed methods study to evaluate the feasibility of using the Adolescent Diabetes Needs Assessment Tool App in paediatric diabetes care in preparation for a longitudinal cohort study

      Cooper, Helen; Lancaster, Gillian A.; Gichuru, Phillip K.; Peak, Matthew; University of Chester; Keele University; Lancaster University; NIHR Alder Hey Clinical Research Facility; Alder Hey Children’s NHS Foundation Trust (BioMed Central, 2017-07-06)
      An evaluation study was carried out to determine the feasibility of integrating the Adolescent Diabetes Needs Assessment Tool (ADNAT) App into UK paediatric diabetes care, to ascertain best practice standards and to determine methodological recommendations for a future cohort study. Methods A non-randomised, cohort, mixed methods study design was used to ensure equality of access to ADNAT for all participants at three sites in the North West of England. Following UK Medical Research Council guidance, the RE-AIM (reach, effectiveness (potential and perceived), adoption, implementation, maintenance) framework was used to guide study objectives and feasibility outcomes. Patients who completed ADNAT (completers) were compared with those who failed to complete (non-completers). Patients’ glycaemic control (HbA1c) was accessed from their clinical data at baseline and at 6 months, alongside their ADNAT scores which were correlated with changes in HbA1c levels. The diabetes teams (respondents) completed a web-based survey and attended focus group interviews. Results Eighty-nine patients were recruited. Withdrawal rates were low at 4.5% (n = 4). Forty-four patients (49.4%) completed ADNAT, leaving 45 (50.6%) non-completers. There were large baseline differences in HbA1c and variable rates of change at 6 months. After adjusting for baseline HbA1C and site in an analysis of covariance, completers had a lower post-ADNAT mean HbA1C level than non-completers at 6 months (-5.42 mmol/mol, 95% CI −11.48, 0.64). Patients’ glycaemic control (HbA1c) at 6 months correlated reasonably well with their ADNAT scores (Spearman’s rho = 0.46). Survey and focus group data showed that ADNAT was judged to be an effective clinical tool by the diabetes teams. Value to patients was perceived by the teams to be linked to parental support, age and previous diabetes education. The combined data triangulated. It served to capture different dimensions which were used to define changes to achieve practice standards and methodological recommendations. Conclusions The combined data showed that ADNAT has the potential to be a clinically viable tool. It has demonstrated the need for a randomised design that is tailored for a ‘hard to reach’ adolescent population. A cluster randomised controlled trial that involves sequential but random rollout of ADNAT over multiple time periods may be the most appropriate and is currently being considered for the larger study.
    • A mixed methods study to evaluate the feasibility of using the Adolescent Diabetes Needs Assessment Tool App in paediatric diabetes care in preparation for a longitudinal cohort study

      Cooper, Helen; Lancaster, Gillian A.; Gichuru, Phillip K.; Peak, Matthew; University of Chester; University of Lancaster; Alder Hey Children’s NHS Foundation Trust (BioMed Central, 2017-07-06)
      Background. An evaluation study to determine the feasibility of integrating the Adolescent Diabetes Needs Assessment Tool (ADNAT) App into UK paediatric diabetes care, to ascertain best practice standards, and to determine methodological recommendations for a future cohort study. Methods A non-randomised, cohort, mixed methods study design was used to ensure equality of access to ADNAT for all participants at three sites in the North West of England. Patients who completed ADNAT (completers) were compared with those who failed to complete (non-completers). Following UK Medical Research Council guidance, a logic model and the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework were used to define study objectives. Patients’ glycaemic control (HbA1c) was accessed from their clinical data at baseline and at 6 months, alongside their ADNAT scores which were correlated with changes in HbA1c levels. The diabetes teams (respondents) completed a web-based survey and attended focus group interviews. Results 89 patients were recruited. Withdrawal rates were low at 4.5% (n=4). Forty-four patients (49.4%) completed ADNAT, leaving 45 (50.6%) non-completers. There were large baseline differences in HbA1c and variable rates of change at 6 months. After adjusting for baseline HbA1C and site in an Analysis of Covariance, completers had a lower post-ADNAT mean HbA1C level than non-completers at 6 months, suggesting improvement for those using ADNAT (95% CI -11.48, 0.64). Patients’ glycaemic control (HbA1c) at 6 months correlated reasonably well with their ADNAT scores (Spearman’s rho=0.46). Survey and focus group data showed that ADNAT was judged to be an effective clinical tool by the diabetes teams. Value to patients was perceived to be linked to parental support, age and previous diabetes education. The combined data triangulated suggesting validity of the study. It served to capture different dimensions which were used to define best practice standards and methodological recommendations including the need for a team based approach to implementation, broader patient-based outcomes, and non-participant clinic observations. Conclusions The combined data showed that ADNAT was a clinically viable tool and that a future mixed methods, non-randomised, longitudinal cohort study would be feasible following MRC guidance for process evaluation of complex interventions, including use of the piloted logic model and the RE-AIM framework.