Evidence mapPaperPMID 40910693Full record

Trial reportJournal of medical Internet research2025

Insights Into How Digital Health Interventions Shape Outcomes for Emerging Adults Living With Type 1 Diabetes: Qualitative Realist Process Evaluation.

Ruoxi Wang, Balpreet Panesar, Mikayla Sonnenberg, Alanna Landry, Anne-Sophie Brazeau, Marley Greenberg, Meranda Nakhla, Ian Zenlea, Elise Mok, Jessica C Kichler and 5 more

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in Journal of medical Internet research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Ruoxi WangInstitute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.ORCID https://orcid.org/0000-0002-9695-0582
Balpreet PanesarInstitute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.ORCID https://orcid.org/0000-0002-5492-3615
Mikayla SonnenbergDivision of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.ORCID https://orcid.org/0009-0002-8389-0784
Alanna LandryCDE Oak Valley Health, Markham, ON, Canada.ORCID https://orcid.org/0000-0002-9222-8613
Anne-Sophie BrazeauSchool of Human Nutrition, McGill University, Montreal, QC, Canada.ORCID https://orcid.org/0000-0002-2699-2920
Marley GreenbergDiabetes Action Canada, Canadian Institutes for Health Research (CIHR) Strategy for Patient-Oriented Research Network in Chronic Disease, Toronto General Hospital, Toronto, ON, Canada.ORCID https://orcid.org/0000-0001-7678-8699
Meranda NakhlaMcGill University, Montreal Children's Hospital, Montreal, QC, Canada.ORCID https://orcid.org/0000-0001-5833-5303
Ian ZenleaInstitute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.ORCID https://orcid.org/0000-0001-9284-0872
Elise MokCentre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.ORCID https://orcid.org/0009-0005-3234-2296
Jessica C KichlerDepartment of Psychology, University of Windsor, Windsor, ON, Canada.ORCID https://orcid.org/0000-0003-0133-0194
Ellen B GoldbloomChildren's Hospital of Eastern Ontario, Ottawa, ON, Canada.ORCID https://orcid.org/0000-0002-6582-2924
Gillian L BoothTemerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.ORCID https://orcid.org/0000-0003-2769-6522
Mélanie HendersonDepartment of Pediatrics, Université de Montréal, Montreal, QC, Canada.ORCID https://orcid.org/0000-0002-0102-2389
Rayzel Shulman *Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.ORCID https://orcid.org/0000-0001-9943-1529
Laura Desveaux *Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.ORCID https://orcid.org/0000-0003-3429-1865

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEmerging adults living with type 1 diabetes (T1D) need targeted support to equip them with the knowledge and motivation required for self-management, particularly as they transition from pediatric to adult care. While multicomponent digital health interventions have shown promise in addressing their multifaceted needs, traditional effectiveness studies provide little, if any, insights into which components work effectively, how they function, and for whom.

objectiveThis study aims to explore the implementation of a multicomponent, text message-based digital intervention (Keeping in Touch; KiT) to provide early insights into which components may shape participants' transition experiences and how. The secondary objective was to explore which subgroups, defined by individual characteristics, may benefit most from the intervention.

methodsEmbedded within a broader randomized controlled trial, we conducted a qualitative realist evaluation with intervention-arm participants who had engaged with KiT for a minimum of 3 months. One-on-one semistructured realist interviews were conducted in a teacher-learner cycle to test the initial program theory. The initial program theory included several pathways through which the 5 intervention components (ie, T1D self-management information and suggestions, transition support information, problem-solving support, stress management strategies, and transition reminders) were hypothesized to influence a range of theorized outcomes.

resultsA total of 16 interviews were completed with intervention participants. All 5 KiT intervention components were reported to shape participants' transition experiences positively but to varying degrees. T1D self-management information and suggestions presented a universal positive impact across all participants. However, the effectiveness of problem-solving support and stress management strategies varied depending on participants' individual characteristics (eg, duration of diabetes, perceived access to information, and baseline diabetes distress). Rather than acting through parallel independent mechanisms, KiT appeared to support participants' transition experiences via multiple chains of interconnected mechanisms, often beginning with knowledge or reinforcement and contributing to changes in motivation (eg, self-efficacy and diabetes distress). Interview participants described tangible improvement in mechanisms and proximal outcomes (eg, diabetes knowledge and self-efficacy).

conclusionsA multicomponent, text message-based digital intervention could support emerging adults living with T1D during their transition to adult care by enhancing their knowledge and motivation for self-management. Participant subgroups responded differently to various intervention components, which highlights that one-size-fits-all approaches are likely inadequate. Digital interventions should be developed and studied in a variety of subgroups and contexts to optimize their reach. Interventions for emerging adults living with T1D might benefit from targeting those who are more recently diagnosed with relatively lower baseline levels of diabetes knowledge and self-efficacy or higher levels of diabetes distress. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/46115.

Indexed as

Diabetes Mellitus, Type 1Text MessagingAdolescentAdultDigital HealthFemaleHumansMaleQualitative ResearchSelf CareSelf-ManagementYoung Adultdigital healthemerging adultsrealist evaluationtransition caretype 1 diabetes

Identifiers

PMID40910693
PMCPMC12449673

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.