Keeping in Touch

Supporting young adults in their transition from pediatric to adult care.

When people living with Type 1 Diabetes (T1D) turn 18, they are required to transition from a pediatric diabetes care setting to an adult care setting. During this transition to adult diabetes care, young adults with T1D are at risk of experiencing deterioration in their diabetes control, gaps in establishing adult care, and of developing life-threatening complications.

The approach

We conducted over 50 needs assessment interviews and three co-design workshops to better understand the transition process. Interviews and workshops engaged people living with T1D as well as diabetes healthcare providers to ensure we holistically identified existing challenges and opportunities in the transition process to inform the design and development of the chatbot.

"It might be nice to have sort of a support for how to handle stress and transitioning not just from peds to adult care, but maybe because this is sort of the age where everything new happens. "

Pre-Transition Patient

The three phases of KiT

We conducted over 50 needs assessment interviews and three co-design workshops to better understand the transition process. Interviews and workshops engaged people living with T1D as well as diabetes healthcare providers to ensure we holistically identified existing challenges and opportunities in the transition process to inform the design and development of the chatbot.
We are designing a text-message based chatbot tool with the aim of providing educational and care navigation support during the transition process. Key areas of focus for the chatbot design include ensuring a fun and engaging tone and structure of messaging for the target population, and allowing for customization to fit the needs and preferences of the population.
This was done while maintaining clinical accuracy and relevance of messaging within the scope of identified barriers and challenges to the transition process. Development of this chatbot system is being done through partnership with Memotext, a Toronto-based digital patient engagement platform.
We will be conducting a randomized control trial to implement and evaluate the impact of the developed chatbot on patient-level dia- betes management and transition readiness, as well as healthcare utilization and costs. In the trial, the chatbot will be used for a one- year period by young adults living with T1D who are between the ages of 17 and 19 and transitioning from pediatric to adult diabetes care. We aim to engage approximately 212 participants from 6 healthcare sites across Ontario and Quebec.

"If there almost was, like, some sort of navigator to sort of, like, as a reminder, almost like a calendar reminder like “hey your insulin is due is here” and “your glucagon expires here”, and kind of a home base for a lot of that – a lot of that boring stuff, but it’s necessary"

Adult Diabetes Care Provider
"And yeah so I mean I think like just everything that has to do with self-management - like there's so many components of [diabetes] management right? And like you don't know that you don't know something until you need to do it and don't know how. And then like it's super awkward and weird to be like halfway through my 20s and not know how to do any of this. So yeah, there's definitely like a little bit of tension with that, that I think would be good to kind of have all of that information up front.” "

Post-Transition Patient

Chatbot feature set

Care coordination

Prompting for adult clinic referral and sending
information on adult clinic, to avoid gaps in care
Programming and sending appointment reminders to support expanded patient responsibilities in adult care
Providing reflection opportunities to empower patient
self-advocacy

Educational support

Q&A feature with a validated bank of T1D resources
for users to access

Providing users with tailored educational information
to ensure gaps in knowledge are addressed

Using what we learned in Phase One of the study, we translated key gaps in education and care navigation skills amongst people living with T1D as opportunities to address within the chatbot tool. Memotext has been an integral partner in supporting the development and administration of the chatbot. Decided through multiple iterations of user feedback and stakeholder engagement, the final feature set for the chatbot includes:

Keeping in Touch with Young Adults as they Transition from Pediatric to Adult Care (KiT) aims to design and develop a bilingual text message-based chatbot tool to better support young adults living with T1D through this transition period.

Dr. Rayzel Shulman
Pediatric endocrinologist and
health services researcher

In partnership with SickKids hospital and a multidisciplinary team of investigators collaborators across Ontario and Quebec.

Partners