008-Sample Demographics and Cultural Responsiveness in Psychosocial and Behavioral Interventions with Adolescents with Type 1 Diabetes: A Systematic Review

Abstract

Background: The rate at which new cases of Type 1 diabetes (T1D) in youth <20 years old is increasing in the U.S. is a mounting pediatric public health concern; and age, race and ethnicity have significant impacts. Specific social determinants of health and sociodemographic (SD) characteristics –racial/ethnic minority, low SES, single parent home and underinsured—have consistently been associated with poorer glycemic control (GC) and self-management (SM) in adolescents with T1D. Purpose: The purpose of this systematic review was to evaluate sample demographics, and culturally responsive recruitment and reporting methods used in psychosocial and behavioral interventions focused on improving SM and GC in adolescents with T1D, to identify if studies were targeting these high risk groups and if current methods were being tailored to reach them. Description of Topic: Using a social determinants of health and health equity theoretical perspective, this review applied a culturally responsive research (CRR) framework to evaluate relevant interventions. Intervention studies, from 2006 to 2016, focused on adolescents (13–18yo) with T1D and improving SM and GC by psychosocial or behavioral methods, obtained from PsychInfo, PubMed and CINAHL, were evaluated using a CRR rubric. Twenty-eight studies met inclusion criteria; 14 reported on fewer than 3 of 7 SD categories. Of those that reported, overall study samples used convenience sampling methods, focused predominantly on white, middle-high income, moderately GC'd adolescents from two-parent households with private insurance. Majority of studies scored poorly in cultural responsiveness in reporting analysis and interpretation, and moderately in culturally responsive reporting of SD descriptions of participants. Overall, studies lacked detailed recruitment and sampling methods, as relates to cultural inclusivity, neglecting to apply deliberate recruitment efforts and use of culturally responsive assessments for difficult to reach high risk groups. Clinical Implications: Pediatric endocrinology nurse interventionists must increase targeted efforts towards recruiting and sampling more high risk groups, by devising successful, culturally responsive methods of recruitment and sampling through community based participatory research, and including expanded SD reporting. These efforts will engage high risk participants and improve existing and novel interventions by making them relevant to the unique needs, goals and priorities of highest risk SD groups within pediatric endocrinology.