Ian Zenlea

BACKGROUND Multicomponent digital health interventions are increasingly used to support type 1 diabetes (T1D) self-management and are generally acceptable to patients. However, existing evaluations primarily report average effects at the group level, with limited understanding of how outcomes arise across individuals, intervention components, and engagement patterns. OBJECTIVE To identify the contextual profiles under which favourable self-efficacy was observed within a multicomponent digital health intervention for emerging adults living with T1D. METHODS We conducted an embedded evaluation using Coincidence Analysis, a configurational method that examines how combinations of factors are associated with outcomes in complex interventions. The analysis was embedded within a randomised controlled trial of Keeping in Touch (KiT), a 12-month personalised text message-based intervention for emerging adults living with T1D in Canada. Self-efficacy was dichotomised as favourable or unfavourable based on baseline level and change over 12 months. We first examined contextual profiles associated with outcomes in the full sample, including the role of overall intervention exposure within these profiles. Among intervention-group participants, we further examined how patterns of exposure to intervention components and participant engagement were associated with outcomes. RESULTS Among 168 participants in the full-sample analysis and 89 intervention-group participants in the engagement analysis, multiple distinct profiles were associated with favourable and unfavourable outcomes. Exposure to the intervention was associated with favourable outcomes only within a specific profile characterized by shorter diabetes duration (<10 years) and lower baseline HbA1c (<9.0%). Higher engagement, characterised by a higher prompt response rate (≥Q2) and use of optional features, featured in favourable profiles, whereas lower engagement featured in unfavourable profiles. However, engagement alone was neither necessary nor sufficient for benefit. Instead, its association with outcomes depended on personal context, including diabetes duration, sex, and exposure to specific educational topics. CONCLUSIONS For emerging adults with T1D, a one-size-fits-all approach may be insufficient, and evaluations focus solely on average intervention effect may obscure important differences in effectiveness across subgroups. By identifying the multiple context-dependent pathways associated with both outcomes, the findings underscore the need for context‑responsive, person‑centred approaches that tailor intervention content and engagement strategies to diverse population. INTERNATIONAL REGISTERED REPORT RR2-10.2196/46115

Introduction: Despite technological advances, managing type 1 diabetes (T1D) and achieving a high quality of life remain challenging for adolescents. Their caregivers also experience anxiety, stress, and burnout from management responsibilities. Peer support is an approach to help alleviate these challenges, yet most interventions are not co-designed with lived experience and may not be culturally relevant or aligned with patient or caregiver priorities. This paper describes the application of human-centred design (HCD) and community-based participatory research (CBPR) to co-design peer support intervention prototypes for adolescents and young adults (AYAs) with T1D and their caregivers. Methods: The project unfolded in three stages: (1) empathize and define – AYAs with T1D and their caregivers created digital stories to share first-person narratives; (2) ideate – a community event showcased the digital stories to diverse diabetes shareholders to generate and prioritize ideas for peer support interventions; (3) prototype – a Hackathon brought together AYAs with T1D and caregivers to co-design peer support solutions based on priority ideas. Results: Seven AYAs and four caregiver digital stories were produced in stage 1. In stage 2, 52 unique ideas were generated at the community event and refined into six Hackathon challenge statements. In stage 3, six peer support prototypes were developed during the Hackathon, with the winning designs focusing on addressing diabetes-related stigma in schools and supporting caregivers of newly diagnosed youth. Conclusion: Integrating CBPR and HCD, alongside innovative co-design methods, can effectively centre lived experience to generate actionable, community-informed peer support prototypes for adolescents with T1D and their caregivers.

Background: Emerging 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. Objective: This 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. Methods: Embedded 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. Results: A 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). Conclusions: A 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

Family violence is a social issue that impacts families and communities every day in Canada and around the world. As family violence rates continue to increase there is an urgent need for cross-sectoral collaboration to codesign social work and social service systems, in partnership with those experiencing family violence. This article will share learnings from a two-year community-based participatory research study that worked alongside survivors and witnesses of family violence, community partners from diverse social service agencies, and researchers, to understand experiences of family violence in racialized communities in Peel region, Ontario, Canada. An intersectional-trauma-informed approach guided the work that included establishing a community advisory board, hiring peer research assistants, Photovoice, and holding a knowledge exchange event (KEE) with survivors and witnesses of family violence, researchers, and community partners to rapidly generate ideas for intervention areas through a 25/10 crowdsourcing activity and codesign preliminary solutions through a mini hackathon. Key findings from the photovoice highlighted systemic failures and gaps experienced by those facing family violence. As we shifted into ideation, this preliminary focus on systems solidified and top ideas identified included barrier-free, culturally aware provision of services ranging from mental health supports, safe housing, financial independence, and accessing wrap-around services. Our work concluded with the collaborative development of preliminary solutions to these ideas and emphasized the need for cross-sectoral partnerships and lived experience engagement to change systems. Centering the voices of those who have experienced FV in system-level change and advocacy is necessary to ensure services and supports meet the needs of service users.

BACKGROUND Emerging 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. OBJECTIVE This 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. METHODS Embedded 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. RESULTS A 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). CONCLUSIONS A 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 RR2-10.2196/46115

INPLASY202490056 Interventions, Programs, and Policies for Enhancing Mental Well-Being of Immigrant and Refugee Communities in the Region of Peel in Ontario, Canada: A Rapid Scoping Review Protocol…

Summary: Objective: A systematic review of value and preference studies conducted in children and their caregivers related to the estimated benefits and harms of interventions for managing paediatric obesity.Methods: We searched Ovid Medline (1946–2022), Ovid Embase (1974–2022), EBSCO CINAHL (inception to 2022), Elsevier Scopus (inception to 2022), and ProQuest Dissertations & Theses (inception to 2022). Reports were eligible if they included: behavioural and psychological, pharmacological, or surgical interventions; participants between (or had a mean age within) 0–18 years old with overweight or obesity; systematic reviews, primary quantitative, qualitative, or mixed/multiple methods studies; and values and preferences as main study outcomes. At least two team members independently screened studies, abstracted data, and appraised study quality.Results: Our search yielded 11 010 reports; eight met the inclusion criteria. One study directly assessed values and preferences based on hypothetical pharmacological treatment for hyperphagia in individuals with Prader‐Willi Syndrome. Although not having reported on values and preferences using our a priori definitions, the remaining seven qualitative studies (n = 6 surgical; n = 1 pharmacological) explored general beliefs, attitudes, and perceptions about surgical and pharmacological interventions. No studies pertained to behavioural and psychological interventions.Conclusion: Future research is needed to elicit the values and preferences of children and caregivers using the best available estimates of the benefits and harms for pharmacological, surgical, and behavioural and psychological interventions.