Advertisement

Development and Validation of the Transition Readiness Assessment Instrument in Type 1 Diabetes “On TRAck”

Published:February 11, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.02.005

      Abstract

      Objectives

      Transition to adult care is challenging for youth with type 1 diabetes (T1D) and their caregivers. We have developed the diabetes-specific “On TRAck” transition readiness scale, and in this study we assess its reliability and validity compared with TRANSITION-Q, a generic transition readiness questionnaire.

      Methods

      We systematically created 3 versions of On TRAck: adolescent, parent and health-care provider (HCP) versions (for case managers and physicians). Among adolescents 13 to 18 years of age with T1D at a single academic centre, we conducted an exploratory factor analysis and assessed interrater agreement, internal consistency and relationship with age; recent glycated hemoglobin (A1C); and recent diabetic ketoacidosis (DKA) with On TRAck and TRANSITION-Q.

      Results

      One hundred fifteen adolescents (aged 15.8±1.6 years and diabetes duration 6.7±4.1 years), their caregivers and diabetes HCPs participated. The final 24-item adolescent and parent scales (with 3 subscales: “Self-efficacy,” “Autonomy” and “Support & maturity”) and the 3-item HCP version had a Cronbach’s alpha of 0.86 to 0.93. Adolescent scores correlated with parents (r=0.64), case managers (r=0.39) and physicians (r=0.28). Mean adolescent score was 190.3±27.1 points out of 240. Adolescent scores were 3.4 points higher per year of age (p=0.03) and 4.4 points higher for every 1% lower A1C (p=0.01), but were not associated with DKA. TRANSITION-Q was associated with age. On TRAck HCP scores were associated with adolescent’s age, A1C and DKA.

      Conclusions

      On TRAck represents a new psychometrically comprehensive diabetes-specific scale that can be used in adolescent diabetes clinics for measuring transition readiness. It is a multidimensional instrument with ease of use and high reliability scores.

      Résumé

      Objectifs

      La transition vers les soins aux adultes est difficile pour les jeunes atteints du diabète de type 1 (DT1) et leurs soignants. Nous avons élaboré une échelle de préparation à la transition « On TRAck (de l’anglais, Transition Readiness Assessment) » propre au diabète. Dans la présente étude, nous évaluons sa fiabilité et sa validité par rapport au questionnaire générique de préparation à la transition TRANSITION-Q.

      Méthodes

      Nous avons systématiquement créé 3 versions du questionnaire On TRAck : adolescents, parents et prestataires de soins de santé (PSS) (pour les responsables des cas et les médecins). Auprès des adolescents atteints du DT1 de 13 à 18 ans d’un seul centre universitaire, nous avons réalisé une analyse factorielle exploratoire et évalué la concordance entre observateurs, la constance interne et la relation entre l’âge, l’hémoglobine glyquée (A1c) récente et la récente acidocétose diabétique (ACD) grâce à l’échelle On TRAck et au questionnaire TRANSITION-Q.

      Résultats

      Cent quinze adolescents (de 15,8 ±1,6 ans et durée du diabète de 6,7 ±4,1 ans), leurs soignants et PSS en diabète y ont participé. Les échelles finales de 24 items destinées aux adolescents et aux parents (en 3 sous-échelles : « Auto-efficacité » « Autonomie » et « Soutien et maturité ») et la version de 3 items destinée aux PSS avaient un coefficient alpha de Cronbach de 0,86 à 0,93. Les scores des adolescents étaient en corrélation avec ceux des parents (r = 0,64), des responsables des cas (r = 0,39) et des médecins (r = 0,28). Le score moyen des adolescents était de 190,3 ±27,1 points sur 240. Les scores des adolescents étaient supérieurs de 3,4 points par année d’âge (p = 0,03) et supérieurs de 4,4 points pour chaque diminution de 1 % de l’A1c (p = 0,01), mais n’étaient pas associés à l’ACD. Le questionnaire TRANSITION-Q était associé à l’âge. Les scores des PSS à l’échelle On TRAck étaient associés à l’âge, à l’A1c et à l’ACD des adolescents.

      Conclusions

      La nouvelle échelle propre au diabète On TRAck qui est exhaustive sur le plan psychométrique peut être utilisée dans les cliniques de diabète pour adolescents pour évaluer la préparation à la transition. C’est un instrument multidimensionnel qui présente une facilité d’utilisation et des scores de fiabilité élevés.

      Keywords

      Mots clés

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Anderson B.J.
        • Holmbeck G.
        • Iannotti R.J.
        • et al.
        Dyadic measures of the parent-child relationship during the transition to adolescence and glycemic control in children with type 1 diabetes.
        Fam Syst Health. 2009; 27: 141-152
        • Lewis K.
        All grown up: Moving from pediatric to adult diabetes care.
        Am J Med Sci. 2013; 345: 278-283
        • van Staa A.L.
        • Jedeloo S.
        • van Meeteren J.
        • Latour J.M.
        Crossing the transition chasm: Experiences and recommendations for improving transitional care of young adults, parents and providers.
        Child Care Health Dev. 2011; 37: 821-832
        • Tremblay E.S.
        • Ruiz J.
        • Buccigrosso T.
        • Dean T.
        • Garvey K.
        Health care transition in youth with type 1 diabetes and an A1c >9%: Qualitative analysis of pre-transition perspectives.
        Diabetes Spectrum. 2020; 33: 331-338
        • Garvey K.C.
        • Wolpert H.A.
        • Rhodes E.T.
        • et al.
        Health care transition in patients with type 1 diabetes: Young adult experiences and relationship to glycemic control.
        Diabetes Care. 2012; 35: 1716-1722
        • Nakhla M.
        • Daneman D.
        • To T.
        • Paradis G.
        • Guttmann A.
        Transition to adult care for youths with diabetes mellitus: Findings from a universal health care system.
        Pediatrics. 2009; 124: e1134-e1141
        • Butalia S.
        • McGuire K.A.
        • Dyjur D.
        • Mercer J.
        • Pacaud D.
        Youth with diabetes and their parents' perspectives on transition care from pediatric to adult diabetes care services: A qualitative study.
        Health Sci Rep. 2020; 3: e181-e
        • Schultz A.T.
        • Smaldone A.
        Components of interventions that improve transitions to adult care for adolescents with type 1 diabetes.
        J Adolesc Health. 2017; 60: 133-146
        • Cameron F.J.
        • Garvey K.
        • Hood K.K.
        • Acerini C.L.
        • Codner E.
        ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes in adolescence.
        Pediatr Diabetes. 2018; 19: 250-261
        • Peters A.
        • Laffel L.
        Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: A position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society).
        Diabetes Care. 2011; 34: 2477-2485
        • Kelly C.S.
        • Berg C.A.
        • Ramsey M.A.
        • et al.
        Relationships and the development of transition readiness skills into early emerging adulthood for individuals with type 1 diabetes.
        Child Health Care. 2018; 47: 308-325
        • Gutierrez-Colina A.M.
        • Corathers S.
        • Beal S.
        • Baugh H.
        • Nause K.
        • Kichler J.C.
        Young adults with type 1 diabetes preparing to transition to adult care: Psychosocial functioning and associations with self-management and health outcomes.
        Diabetes Spectr. 2020; 33: 255-263
        • Goethals E.R.
        • Commissariat P.V.
        • Volkening L.K.
        • Markowitz J.T.
        • Laffel L.M.
        Assessing readiness for independent self-care in adolescents with type 1 diabetes: Introducing the RISQ.
        Diabetes Res Clin Pract. 2020; 162108110
        • Sawicki G.S.
        • Lukens-Bull K.
        • Yin X.
        • et al.
        Measuring the transition readiness of youth with special healthcare needs: Validation of the TRAQ—Transition Readiness Assessment Questionnaire.
        J Pediatr Psychol. 2011; 36: 160-171
        • Klassen A.F.
        • Grant C.
        • Barr R.
        • et al.
        Development and validation of a generic scale for use in transition programmes to measure self-management skills in adolescents with chronic health conditions: The TRANSITION-Q.
        Child Care Health Dev. 2015; 41: 547-558
        • Beal S.J.
        • Riddle I.K.
        • Kichler J.C.
        • et al.
        The associations of chronic condition type and individual characteristics with transition readiness.
        Acad Pediatr. 2016; 16: 660-667
        • Corathers S.D.
        • Yi-Frazier J.P.
        • Kichler J.C.
        • et al.
        Development and implementation of the Readiness Assessment of Emerging Adults With Type 1 Diabetes Diagnosed in Youth (READDY) tool.
        Diabetes Spectr. 2020; 33: 99-103
        • Bandura A.
        Self-efficacy: Toward a unifying theory of behavioral change.
        Psychol Rev. 1977; 84: 191-215
        • Hanna K.M.
        • Weaver M.T.
        • Stump T.E.
        • Slaven J.E.
        • Fortenberry J.D.
        • DiMeglio L.A.
        Readiness for living independently among emerging adults with type 1 diabetes.
        Diabetes Educator. 2013; : 92-99
        • Chih A.-H.
        • Jan C.-F.
        • Shu S.-G.
        • Lue B.-H.
        Self-efficacy affects blood sugar control among adolescents with type I diabetes mellitus.
        J Formos Med Assoc. 2010; 109: 503-510
        • Grossman H.Y.
        • Brink S.
        • Hauser S.T.
        Self-efficacy in adolescent girls and boys with insulin-dependent diabetes mellitus.
        Diabetes Care. 1987; 10: 324-329
        • McPherson M.
        • Thaniel L.
        • Minniti C.P.
        Transition of patients with sickle cell disease from pediatric to adult care: Assessing patient readiness.
        Pediatr Blood Cancer. 2009; 52: 838-841
        • Zijlstra M.
        • Bie C.D.
        • Breij L.
        • et al.
        Self-efficacy in adolescents with inflammatory bowel disease: A pilot study of the “IBD-yourself,” a disease-specific questionnaire.
        J Crohn Colitis. 2013; 02: 017
        • Fredericks E.M.
        • Dore-Stites D.
        • Well A.
        • et al.
        Assessment of transition readiness skills and adherence in pediatric liver transplant recipients.
        Pediatr Transplant. 2010; 8: 944-953
        • Wita M.D.
        • Winterdijk P.
        • Aanstoot H.-J.
        • et al.
        Assessing diabetes-related quality of life of youth with type 1 diabetes in routine clinical care: The MIND Youth Questionnaire (MY-Q).
        Pediatr Diabetes. 2012; : 638-646
        • Gilleland J.
        • Amaral S.
        • Mee L.
        • Blount R.
        Getting ready to leave: Transition readiness in adolescent kidney transplant recipients.
        J Pediatr Psychol. 2012; 37: 85-96
        • Ferris M.E.
        • Harward D.H.
        • Bickford K.
        • et al.
        A clinical tool to measure the components of health-care transition from pediatric care to adult care: The UNC TRxANSITION scale.
        Renal Failure. 2012; 34: 744-753
        • The Hospital for Sick Children
        MyHealth Passport.
        (Accessed April 20, 2022.)
        • Benchimol E.I.
        • Walters T.D.
        • Kaufman M.
        • et al.
        Assessment of knowledge in adolescents with inflammatory bowel disease using a novel transition tool.
        Inflamm Bowel Dis. 2011; 17: 1131-1137
      1. Greco P, LaGreca A, Ireland S, Wick P, Freeman C, Agramonte R, Gutt M, Skyler J. Assessing adherence in IDDM: a comparison of two methods (abstract). Diabetes. 40. 1990;(Suppl 1):A165

        • Lewin A.B.
        • LaGreca A.M.
        • Geffken G.R.
        • et al.
        Validity and reliability of an adolescent and parent rating scale of type 1 diabetes adherence behaviors: The Self-Care Inventory (SCI).
        J Pediatr Psychol. 2009; 34: 999-1007
        • The Endocrine Society
        Self-assessment of Worries, Concerns, and Burdens Related to Diabetes and Preparation for Transitioning. 2013.
        (Accessed April 20, 2022)
        • The National Alliance to Advance Adolescent Health
        Got Transition - Sample Transition Readiness Assessment for Youth. 2020.
        (Accessed Apr 20, 2022)
        • Streiner D.L.
        • Norman G.R.
        • Cairney J.
        Health Measurement Scales: A Practical Guide to Their Development and Use.
        5th ed. Oxford University Press, New York2015
        • Onwuegbuzie A.J.
        • Collins K.M.T.
        A typology of mixed methods sampling designs in social science research.
        The Qualitative Report. 2007; 12: 281-316
        • Johanson G.A.
        • Brooks G.P.
        Initial scale development: Sample size for pilot studies.
        Educ Psychol Meas. 2010; 70: 394-400
        • Boateng G.O.
        • Neilands T.B.
        • Frongillo E.A.
        • Melgar-Quiñonez H.R.
        • Young S.L.
        Best practices for developing and validating scales for health, social, and behavioral research: A primer.
        Front Public Health. 2018; 6: 149
        • Cauffman E.
        • Steinberg L.
        (Im)maturity of judgment in adolescence: Why adolescents may be less culpable than adults.
        Behav Sci Law. 2000; 18: 741-760
        • Alwadiy F.
        • Mok E.
        • Dasgupta K.
        • Rahme E.
        • Frei J.
        • Nakhla M.
        association of self-efficacy, transition readiness and diabetes distress with glycemic control in adolescents with type 1 diabetes preparing to transition to adult care.
        Can J Diabetes. 2021; 45: 490-495
        • Mundfrom D.J.
        • Shaw D.G.
        • Ke T.L.
        Minimum sample size recommendations for conducting factor analyses.
        Int J Test. 2005; 5: 159-168