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

Abstract

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.