Annie K. W. Yip

Aims: To evaluate a mobile app that delivers mental health support to adults with type 1 diabetes (T1D) living in rural and remote communities using the Reach, Effectiveness, Adoption, Intervention fidelity, Maintenance (RE‐AIM) framework.Methods: This study recruited 46 adults to participate in a 6‐month intervention using REACHOUT, a mobile app that delivers peer‐led mental health support (one‐on‐one, group‐based texting and face‐to‐face virtual). Baseline and 6‐month assessments measured diabetes distress (DD), depressive symptoms and perceived support (from family/friends, health care team and peers) along with other RE‐AIM metrics.Results: Calculations for reach and adoption found that 3% of eligible adults enrolled in REACHOUT and 55% of diabetes education centres participated in recruitment efforts. Maintenance metrics revealed 56% and 24% of peer supporters and participants, respectively, became peer supporters for a subsequent randomized controlled trial of REACHOUT. Post‐intervention reductions were observed for overall distress (p = 0.007), powerlessness (p = 0.009), management distress (p = 0.001), social perception distress (p = 0.023), eating distress (p = 0.032) and depressive symptoms (p = 0.009); and elevations in support from family/friends and peers. After adjusting for sex and age, only support‐related improvements persisted. When analysing women and men groups separately, women reported lower levels of overall distress, three distress subscales, and higher levels of family/friends and peer support whereas men did not.Conclusions: While reach was relatively low, metrics for adoption and maintenance are promising. Improvements in distress were observed for the total sample, but these changes were reduced when controlling for sex and age, with significance maintained only for women. Digital health‐enabled peer support may be instrumental in the delivery of mental health support to geographically isolated communities.

Aims: While peer support research is growing in the Type 1 diabetes (T1D) community, the peer supporter training (PST) process is rarely documented in detail. This study provides a comprehensive description of PST and evaluation for the REACHOUT mental health support intervention, and examines the feasibility and perceived utility of PST.Methods: Fifty‐three adults with T1D were recruited to participate in a 6‐hour, zoom‐based PST program for mental health support. The program was structured in three parts: (1) internal motivation, resilience and empathy; (2) mindfulness, emotions and diabetes distress; and (3) active listening and deferring clinical questions to professionals. Candidates were evaluated based on eight pre‐established competency criteria during a 5‐day support trial with an assigned standardized T1D participant. Perceived usefulness of training skills was also assessed 3 months into the REACHOUT mental health support intervention.Results: Fifty‐one of the fifty‐three candidates who completed training achieved the criteria to graduate. Mean scores for the eight competency domains were: listens actively (4.55); asks open‐ended questions (4.12); expresses empathy (4.42); avoids passing judgment (4.67); sits with strong emotions (4.44); refrains from giving advice (4.38); makes reflections (4.5); and defers medical questions (4.58). Of the skills learned during the PST, 95% rated interpreting and discussing diabetes distress profile and expressing empathy as moderately to extremely useful.Conclusions: Findings demonstrate that it is feasible to recruit and graduate the number of trainees needed using a rigorous process. Only by making training protocols available can the PST be replicated and translated to other T1D populations (e.g. adolescents, parents of children with T1D).