Table 4 Study characteristics

Pembroke et al. 2021 Ireland [22]

Qualitative study

(Focus group, One-to one interviews, Two workshops)

n = 13 T1DM participants ages 11 to 17 years. n = 14 parents n = 7 HCP 3-months study

3 FG

24 Interviews

2 Workshops

Topic guide, demographic survey

Interative development of a video

Developing a video intervention to improve youth question-asking and provider education during paediatric diabetes clinic encounters: The Promoting Adolescents Communication and Engagement study

1. Engagement

2. Communication with HCP

1. Message of empowerment

2. Important role of clinic visits and HCP

3. Promoting independence

4. Communication with HCP and Engagement through reassurances

5. Development of trust and relationships

6. Practical advice on preparing questions

Ayar et al. 2021 Turkey [21]

RCT

n = 62 T1DM participants ages 12 to 18. 6-months study

E: n = 30

C: n = 32

E: Web-based diabetes education

Tools: powerpoint, quizzes and blogs. 2 × per week to update the blog, write comments or share experiences

C: Diabetes education in clinical setting (tools: pamphlets and/or posters)

Measurements:

HbA1c Level

QoL

Self-efficacy scale

The Effect of Web-based Diabetes Education on the Metabolic Control, Self-efficacy and Quality of Life of Adolescents with Type 1 Diabetes Mellitus in Turkey

1. Metabolic control

2. Self-efficacy

3. QoL

Metabolic control A1C: no significant difference between E and C (P > 0.05)

Self-efficacy and QoL: statistically significant difference between E and C

Döğer et al. 2019 Turkey [23]

Observational study

(Longitudinal cross-sectional study)

n = 82 T1DM participants ages

2 to 18

8-months study

Measurements based on:

Communication features

People wo contacted the HCP

Call frequency

HCP members consulted

Counselling topics

HbA1c Level

Effect of Telehealth System on Glycemic Control in Children and Adolescents with Type 1 Diabetes

1. Patient – HCP relationship and communication

Communication features used:

Whatsapp: 57.3%

Phone: 29.3%

Short message service: 13.4%

Malik et al. 2019 USA [24]

Qualitative study

(Focus group)

n = 45 T1DM participants ages 13 to 19 years

3-months study

5 Focus group with 8 to 19 participants per group

110 to 120 min

Semistructured questions

Qualitative content analysis

Emergent themes in 4 domains: acceptability, demand, implementation, practicality

Adolescent Perspectives on the Use of Social Media to Support Type 1 Diabetes Management: Focus Group Study

1. Collaboration with diabetes care team

Domain 1: Acceptability and demand

1. Improved communication outside of clinic visits

2. Independence in diabetes Self-Management

3. Delivery of timely and personalised diabetes care

4. Connection to other youth with diabetes

Domain 2: Implementation and practicality

5. Ensure patient privacy

6. Maintain Provider-Patient relationship

7.Recognise that social media is not currently used

Troncone et al. 2019 Italy [26]

Qualitative study

n = 161 T1DM participants ages 12 to 18 years

10-months study

Session of chat conversation with specific topic 60 min

Analysis with two coding schemes: social support (all messages) and conversations skills (messages written by moderators)

Psychological support for adolescents with type 1 diabetes provided by adolescents with type 1 diabetes: The chat line experience

1. Examining the extent to which posted messages provide social support

2. describing qualitatively the social support provided

3. describing quantitatively and qualitatively the conversational skills of moderators

37 chat sessions during study period, 17 025 individual posts (10 735 by participants, 6290 by moderators)

Topics: management of the disease, diabetes-related problems, nutrition, and the emotional impact of diabetes

Emotional support: Participants: 79.97%, Moderators: 34.56%

Information support: Participants: 16.21%, Moderators: 52.89%

Sap et al. 2019 Cameroon [25]

Non-randomized controlled clinical trial

n = 54 T1DM participants ages 13 to 26 years

6-months study

E: n = 25

C: n = 29

FG, weekly session of 60 to 90 min for 4 weeks

Themes: Definitions of diabetes, insulin, blood glucose objectives, HbA1C; short- and long-term complications; the use of insulin and self-monitoring of glycemia; diet

Measurements:

- Knowledge questionnaire

Patient education through social network helped to improve knowledge on T1DM and to reduce acute complications without an improvement of glycemic

Evaluation:

Glycemic control

Knowledge

Complications after education

Knowledge: Results increase significantly in E. (P < 0.01). Results decrease in C. (P = 0.33)

Acute complications decrease in E (P = 0.46) and increase in C. (P = 0.01)

No improvement in HbA1c in E and C

Vaala et al. 2018 USA [27]

Quantitative Study

(Online Survey)

n = 134 T1DM participants ages 12 to 18 years

Measurements:

Glycemic control

Experience to help

Perception about social resources

Sharing and helping beliefs

Willingness to share information

Statistical analyses: SPSS v23

Sharing and helping: predictors of adolescents’ willingness to share diabetes personal health information with peers

Sharing information and helping others:

Participation

Engagement

Participants:

willingness to share personal health information with peers (6 of 10 types)

Particularly receptive to share about diabetes tasks

Less willing to share information with others wenn poorer glycemic control

Henkemans et al. 2017 Netherlands [18]

RCT

n = 27 T1DM participants ages

7 to 14 years

18-weeks study

3 Sessions:

C: n = 11

E1: n = 9 (personal robot)

E2: n = 7 (neutral robot)

Measurements:

SCI: Self-care inventory

HrQoL: Health related quality of life

SDT: determinants of self-determination

CRI: Child-robot interaction

DK: Diabetes knowledge

Motivation, fun

Design and evaluation of a personal robot playing a self-management education game with children with diabetes type 1

1. "Learning by playing with a robot”

2. Effects of personalisation on child-robot interaction in a clinical setting

Knowledge: Results increase in E1 and E2 but not in C. (P = .001)

SDT: higher score in E1 than E2 (P = .02)

Pleasurable (P = .04), more questions correctly answered (P = .02), more motivation to play a fourth time (P = .03) with the robots

More engagement, attention, more social and positive with E1 (P < .05)

Frøisland & Årsand 2015 Norway [6]

Qualitative study

(Semistructured interview)

n = 12 T1DM participants ages 13 to 19 years

3-months study

Introduction of a smart-phone and 2 software application

Semistructured interviews after 3 months

30 to 60 min

Deductive approach based on empowerment theory

Predefined empowerment factors:

Comprehension and management

Meaning of life and influence

Recognition (self-treatment and self-medication)

Coping experience (include access and ability to exploit knowledge, social resources or equipment)

Changes to improve the situation

Integrating Visual Dietary Documentation in Mobile-Phone-Based Self-Management Application for Adolescents With Type 1 Diabetes

1. User experiences related to patient empowerment

Empowerment factors:

Improvement in comprehension and feeling of managing the self-treatment

Increasing social acceptance

Positive feedback and SMS solution to give a sense of „being in charge“

Improvement in knowledge and understanding

Integration of knowledge and resources to take rational decisions

Ability to evaluate the effectiveness of decisions

Newton & Ashley 2013 USA [19]

RCT

(Pilot Study)

n = 59 T1DM participants ages 13 to 18 years

7-weeks study

Mixed model design

E: log in encouraged 3x/week

Measurements:

QoL for Youths

Self-efficacy

Outcome expectations

Statistical analyses: SPSS

Pilot study of a web-based intervention for adolescents with type 1 diabetes

1. QoL for Youths

2. Self-efficacy

3. Outcome expectations

QoL: no significant differences between E and C (P = 0.63)

Self-efficacy: no significant differences between E and C (P = 0.53)

Negative Outcome Expectations (P = 0.31)

Nordfeldt et al. 2013 Sweden [28]

Qualitative study

(Focus group)

n = 24 T1DM participants ages 10 to 17 years

8 Focus group

60 to 90 min

Qualitative content analysis

Questions focused on the participants’ experiences and need for contact with other adolescents with T1DM

As Facts and Chats Go Online, What Is Important for Adolescents with Type 1 Diabetes?

To understand:

1. Information-seeking behaviour

2. Internet use

3. Social networking online

3 main categories: 1) Aspect of Security 2) Updating 3) Plainness

Sub-categories: 1) seriousness, integrity and identity; 2) news value, facts and eye-catching; 3) layout, content and congeniality

Nkhoma et al. 2021 Taiwan [29]

Systematic Review and Meta-Analysis

T1DM and T2DM

Range age: 13 – 70

Inclusion criteria:

2010 – 2019

RCTs in English

T1DM or T2DM

DHI: mobile health, social media or web-based (e-health)

Measurements: Glycemic control, HrQoL, Knowledge

Digital interventions self-management education for type 1 and 2 diabetes: A systematic review and meta-analysis

Impact on:

1. Metabolic Control (HbA1c)

2. Diabetes knowledge

3. HrQoL

35 of 4295 articles identified

1. Mobile Health: Mobile Apps and text messages:

Mobile Apps: Educational materials, Diabetes education and support

Text messages: Information or motivation; involving dialogue with HCP about educational information

2. Web-based (e-health): educational and motivational information. Portals to facilitate dialogue with HCP

3. Social media: education, self-management, medical adherence, coping and problem-solving

Zhao et al. 2021 China [2]

Systematic Review

Children and Adolescents with T1DM < 20 years

Inclusion criteria:

1989 – 2020

RTCs in English and Chinese

DHI: phone call, text message, web, application or app, telemedicine, Skype or other social media

Effectiveness of Internet and Phone-Based Interventions on Diabetes Management of Children and Adolescents With Type 1 Diabetes: A Systematic Review

Impact of:

1. Metabolic control

2. Self-management behaviour changes

3. Psychological effect

23 of 780 articles identified

Non-significant improvement in adherence (behaviour changes)

Non-significant improvement in QoL

Improving metabolic control

Improving Self-efficacy

Rewolinski et al. 2020 USA [5]

Literature Review

Children and Adolescents with T1DM

Inclusion criteria:

2010 – 2018

T1DM

Peer-reviewed

DHI: Game-based intervention (Serious Game, Gamification)

Evaluation/outcomes: knowledge, behaviour or engagement

Type I Diabetes Self-management With Game-Based Interventions for Pediatric and Adolescent Patients

Impact on:

1. Knowledge

2. Behaviour

3. Engagement

9 of 217 articles identified

Serious Games: knowledge outcomes and engagement

Gamification and Serious Game (combination): behavioural outcomes and engagement

Duke et al. 2018 USA [13]

Literature review with narrative synthesis

Adolescents and adults with T1DM

Inclusion criteria:

2005 – 2016

T1DM

DHI: Distal technologies

Distal technologies and type 1 diabetes management

Distal technologies to improve T1DM Management:

1. Identification about effectiveness

2. Highlighting potential complications

3. Identification of barriers

80 of 10,325 articles identified

Distal technologies: telehealth, mHealth, game-based support, social platforms, patient portals

Chaves et al. 2017 Brazil [20]

Integrative Literature Review

Adolescents with T1DM

Inclusion criteria:

2012 – 2017

Application for Adolescent with T1DM

What are the features in mobile applications for self care of adolescents with type 1 diabetes mellitus reported on in the literature?

Features of mobile application for self-care

12 of 248 articles identified

Social relationships:

Health professionals (message sending)

Peers (chat rooms) context

Swartwout et al. 2016 USA [30]

Literature Review

Adolescents with T1DM and T2DM

Inclusion criteria:

2001 – 2016

T1DM or T2DM

DHI: Serious Game

Self-care, Self-management

Use of Gaming in Self-Management of Diabetes in Teens

Examination of the current gaming application

Impact on:

1. Knowledge

2. Self-efficacy

3. Communication

4. BG monitoring (Metabolic control)

11 articles identified

- BG Monitoring: 4 studies showed improvement

- Knowledge (diabetes-related): 4 studies showed improvement

Lazem et al. 2015 UK [31]

Brief Review

Children and Adolescents with T1DM and T2DM

Inclusion criteria:

2010 – 2015

English-language OHCs for T1DM

Design and/or evaluation of games

Games and Diabetes: A Review Investigating Theoretical Frameworks, Evaluation Methodologies, and Opportunities for Design Grounded in Learning Theories

1. Understanding of the current landscape of digital games

2. Usability

3. Impact of well-established learning theories

18 of 35 articles identified

Discussion of 3 examples: content, theoretical framework, methods to evaluate

7/18: educational topic related to diabetes

McDarby et al. 2015 Ireland [32]

Narrative Review

Adolescents with DM

NR

An Overview of the Role of Social Network Sites in the Treatment of Adolescent Diabetes

1. Evidence of the efficacy of SNS

Lack of evidence:

- Knowledge improvement: increasingly debated and few evidence

- Health and behavioural outcomes often not examined

- Lack of control misinformation

Pal 2014 UK [34]

Narrative Review

NR

NR

Social Media for Diabetes Health Education—Inclusive or Exclusive?

Highlighting the issues of using social media

Impact of:

1. Self-education

2. Self-management

3. Education for staff

Advantages: deep learning, active involvement, involving cognitive skills, active participation in discovering knowledge, ‘Peer learning’, platform for self-education

Disadvantages: need a high level of health literacy

Ho et al. 2014 USA [7]

Brief review

Adolescents with T1DM

Inclusion criteria: (Website)

Search in March 2013

English-language OHCs for T1DM

Features of Online Health Communities for Adolescents With Type 1 Diabetes

OHCs:

1. Identification and characterisation of features

18 of 50 (Search hits of more than 22 million results) OHCs analysed

Social learning and networking (forum or discussion board, one-to-one communication via private messaging, sharing personal stories)

Information (staff-written articles, blog, email newsletter, videos, product reviews)

Guidance („Ask the experts“

Engagement (gamification, social recognition)

Personal health data sharing (tools for monitoring own health data)

Dougherty et al. 2014 USA [33]

Brief review

Adolescents with T1DM

13 – 18 years

Inclusion criteria:

2006 – 2013

In English, available online

13 – 18 years old

Telemedicine for Adolescents With Type 1 Diabetes

1. Define telemedicine intervention to be used for T1DM

2. Impact of telemedicine interventions on diabetes control

15 of 90 articles identified

Communication with provider

Education between clinic visits