DOI: 10.2337/db23-215-or ISSN: 0012-1797

215-OR: Barriers and Facilitators of Implementing a Pediatric Type 1 Diabetes Psychosocial Intervention—Provider and Leader Perspectives

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Introduction: Behavioral Family Systems Therapy for Diabetes (BFST-D) is an efficacious, family-based pediatric psychosocial type 1 diabetes (T1D) intervention that improves family conflict and glycemic levels. A briefer group-based version (bBFST-D) has some evidence of effectiveness. However, few families receive this care. Using the Consolidated Framework for Implementation Research, this national qualitative study examined T1D provider and hospital leader perspectives on barriers and facilitators of implementing bBFST-D.

Methods: Psychosocial (n = 10) and medical T1D providers (n = 10), clinical leaders (n = 11), and billing/practice managers (n = 9) were recruited from 5 children's hospitals across the US. Across these 4 stakeholder groups, participants (M age = 42.22 - 55.10 yrs, SD Age = 9.15 - 12.98 yrs) largely identified as female (55-100%), White (67-100%), and non-LatinX (90-100%). A minority were African American (0-22%) or Asian (0-11%). Each participant completed a qualitative phone interview, which was recorded, transcribed, and analyzed using a rapid analysis approach.

Results: Stakeholder groups identified multi-level factors that influence implementation of bBFST-D, such as those specific to the intervention (delivery format, required evidence of effectiveness), the providers (knowledge, beliefs about bBFST-D), the hospital setting (leadership engagement, available resources), and factors outside of the hospital (family needs, billing, national performance guidelines). The most important factors among leaders were evidence bBFST-D improves health outcomes and among providers were buy-in from hospital leadership and hospital resources (staffing, space, scheduling).

Conclusions: Study findings offer foundational knowledge on factors that influence implementation of evidence-based pediatric psychosocial T1D care, which can be used to develop and then test strategies to increase delivery of this care.


J.Price: None. C.Thomas: None. J.A.Deatrick: None. K.Okonak: None. A.Kazak: None.


National Institutes of Health (1K23DK125666)

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