Implementing a behavioural intervention for paediatric type 1 diabetes: Key informant perspectives of multilevel barriers and facilitators

AIMS: A 4-session multiple family group version of Behavioral Family Systems Therapy for Diabetes (bBFST-D) is associated with decreased glycemic levels among adolescents with type 1 diabetes; however, few families receive this care. Using the Consolidated Framework for Implementation Research 2.0, this national qualitative study examined perspectives on barriers and facilitators of implementing bBFST-D across six key informant groups.

METHODS: Psychosocial (n = 10) and medical professionals (n = 10), clinical (n = 11) and business leaders (n = 9), and adolescents (n = 8) and caregivers (n = 8) were recruited from 5 children's hospitals across the United States. Professional participants (Mage = 42.2-55.1 years) largely identified as female (55%-100%) and White (67%-100%). Most adolescents (6 females, Mage = 14.0 years; MHbA1c = 10.3) and caregivers (8 females, Mage = 41.3 years) identified as White (62.5%). Each participant completed a qualitative interview, which was recorded, transcribed, and analyzed using a rapid analysis approach.

RESULTS: All groups found bBFST-D content helpful and relevant and all identified evidence that bBFST-D improves health outcomes as the most important factor for implementing bBFST-D. Each group described additional key implementation factors. Healthcare leaders noted the influence of US News and World Report rankings, whereas professionals highlighted buy-in from leadership, staffing, space, and scheduling. Caregivers and adolescents reported critical factors for engaging families in care, including evening/weekend scheduling, referrals from trusted medical professionals, and professional characteristics (empathetic, encouraging).

CONCLUSION: Study findings offer foundational knowledge on factors that influence implementation of evidence-based psychosocial type 1 diabetes care, which can be used to develop and test strategies to increase delivery of this care.