Maintaining an effective communication structure is essential for efficient interaction among care providers, patients and their caregivers . Developments in the internet and mobile telephony are creating diverse approaches to achieving such interaction. The evidence base for their effectiveness and impact is limited. The current review evaluates communication technologies between patient and healthcare professionals within the context of young people who live with diabetes. Such technologies allow transfer of digital information between separate geographic locations, using physical or 'wireless' connections, for example: social networking sites (e.g., Facebook, MySpace); mobile telephony; Voice over Internet Protocol (VoIP) system (e.g. Skype); forums; email; short message service (SMS); multi-media message service (MMS); and N3 communications. Although these technologies are subject to change as new technologies are developed, the common feature is that they all allow remote access to a service (e.g. practitioner, nurse and specialist) and provide a means of supporting the provision of healthcare self management, education, communication and support. The review explores the comparative effects of different communication technologies, active interventions whose delivery may be facilitated by technology and technology-enabled remote interaction between health professional and patient, including passive monitoring with biofeedback or two-way dialogical communication or tailored information and support.
A growing number of young people experiencing concerns about their health may seek support from the internet and social network sites [2, 3] but it remains unclear how their experiences of these sites affect their communication with health professionals, health behaviours and everyday living. UK data show approximately 90% of 16- to 24-year-olds had used the internet within the last three months and 70% report daily use (only 4% had never used it) . Households with children are more likely to have access to the internet, especially if they are teenagers .
Childhood type 1 diabetes is a potentially life-threatening condition which is diagnosed in 15,000 children and young people under the age of 15 each year, and the total number is predicted to rise to 160,000 by 2020 across Europe . Although type 2 diabetes is still less common than type 1 diabetes in children, the frequency of type 2 diabetes appears to be increasing . Difficulties with controlling diabetes among adolescents and young adults are common , resulting in increased risks of long-term complications . Poor control of diabetes has been related to the changes during puberty , problems of treatment compliance  and attendance at outpatient visits , reflecting a range of physiological, psychological and social factors. Several key priorities in the care of young adults with diabetes have been proposed . First, to develop a strong relationship that will ensure continued follow-up to promote change in self-care behaviour. Second, to work in partnership with the patient to establish treatment goals that will foster a sense of success, self-efficacy, and engagement in self-care. Third, to ensure that high-risk adolescents with psychological problems have continuity of psychological care into the young-adult period. During the transition between adolescence and adulthood, maturational changes and life-long routines of self-care are frequently established. Communication technologies may provide several opportunities for supporting younger people to improve the frequency of contact and their relationship with healthcare professionals, thus supporting the transition of care between adolescent and adulthood.
A review of the effectiveness of psychological interventions on glycaemic control and psychological status found no statistical association between HbA1c and duration of follow-up (p =.275) or duration of therapy (p =.488) . However, an association was found between improvements in HbA1c and an increased number of sessions (p =.001). Communication technologies therefore have the potential to increase contact between patients and health care professionals.
Recent reviews [15, 16] evaluated interventions promoting information and communication technologies (ICTs) with health professionals and patients with chronic disease, but none have looked specifically at diabetes and young people. A significant effect on continuous behavioural outcomes and a non-significant effect on binary behavioural outcomes have been found . In contrast, further research identified very limited evidence on the effectiveness of interventions promoting the adoption of ICTs by healthcare professionals . While patients may find ICTs useful, healthcare professionals appear to be more resistant to adopting new means of communicating with their patients. This suggests that successful implementation is likely to require careful consideration and action to address the barriers to the adoption of these types of technology.
The review will assess the effectiveness and impact of technology-supported packages versus usual packages for the healthcare needs, support and education of young people with diabetes. We have chosen to focus on diabetes as it appears to be a transferable model for care of many chronic diseases . Unlike previous reviews [15, 16] we cover a specific age range, condition and communications technologies between patient and health professional and do not restrict the type of study included. It had the following specific aims: a) to describe the types of communication technologies available; b) to present the evidence for the effectiveness (RCTs) and impact (non-RCTs) on clinical, behavioural, psycho-social and care coordination outcomes; c) to describe the personal, family, educational, health service, broader societal costs and benefits associated with communication technologies for meeting healthcare needs for young people with diabetes; and d) to explore the theoretical underpinning of communication technologies with specific consideration of frequency of contact.
We utilised a pathway of action to understand the working of communication technologies in the diabetes healthcare context  coupled with several forms of communication technologies [18, 19] or other self-management interventions . Health communication technologies may act by combining information with additional services (peer support, decision support, behaviour change support) to allow interpretation of the information and internalisation; a combination of knowledge and enhanced self-efficacy with motivation enable users to change their health behaviours, leading to changes in clinical outcomes . Social cognitive theory states that health behaviours are influenced by self-efficacy, or the belief in one's ability to perform actions that will influence outcomes , which, in turn, is influenced by goal setting and social support [22, 23]. This can lead to changes in knowledge for improved health or health behaviours, affective parameters and self-efficacy. The combination of enhanced self-efficacy with motivation and knowledge may enable adolescents and young adults to change their health behaviours, which in turn, may change some clinical outcomes (e.g. HbA1c).