NIHR CLAHRC for South Yorkshire

Sheffield, United Kingdom

NIHR CLAHRC for South Yorkshire

Sheffield, United Kingdom
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Ayling K.,University of Sheffield | Ayling K.,University of Nottingham | Brierley S.,University of Sheffield | Johnson B.,University of Sheffield | And 3 more authors.
British Journal of Health Psychology | Year: 2015

Purpose. Theory-based behaviour change interventions have been recommended to improve outcomes for young people with type 1 diabetes. However, theory has exclusively been considered in a simplistic all-or-none fashion. We therefore (1) examined the nature and extent of explicit theory use in published interventions involving young people with type 1 diabetes and (2) the relationship between how theory is used and intervention outcomes. Methods. We conducted systematic searches for randomized controlled trials (RCTs) published between 1999 and 2012. We used a detailed structured framework to code how theory was used and meta-analytic techniques to examine the relationships between theory use and intervention efficacy. Results. We identified 34 articles comprising 27 RCTs. Thirty per cent (k = 8) did not use theory in any of the ways assessed. Where present, the most common use of theory was providing evidence that a targeted theoretical construct predicted behaviour (k = 15; 56%). Trials that used theory to some extent had marginally larger pooled effect sizes for both medical and psychological outcomes than those that did not. However, in meta-regression models, use of theory did not significantly predict intervention outcomes. Conclusions. Theory is under-utilized in intervention development for young people with type 1 diabetes. When employed, theory appears to be advantageous, but not necessarily predictive of intervention success. We argue that greater emphasis is needed on choosing appropriate theory, which should then become central to the process of intervention development. © 2014 The British Psychological Society.


Ayling K.,University of Nottingham | Ayling K.,University of Sheffield | Brierley S.,University of Sheffield | Johnson B.,University of Sheffield | And 3 more authors.
Psychology and Health | Year: 2015

Objective: Poor descriptions of standard care may compromise interpretation of results in randomised controlled trials (RCTs) of health interventions. We investigated quality of standard care in RCTs of behaviour change interventions for young people with type 1 diabetes and consider implications for evaluating trial outcomes.Design: We conducted systematic searches for articles published between 1999 and 2012. We extracted standard care descriptions and contacted trial authors to complete a checklist of standard care activities. The relationship between standard care quality and outcomes was examined via subgroup meta-analyses and meta-regression.Main outcome measures: Standard care descriptions, standard care quality, and relationships between standard care quality with medical and psychological outcomes.Results: We identified 20 RCTs described across 26 articles. Published descriptions of standard care were limited to service-level features. Author responses indicated standard care provision extended beyond published accounts. Subgroup analyses suggested control groups receiving higher standard care quality showed larger improvements in both medical and psychological outcomes, although standard care quality did not predict outcomes significantly.Conclusion: The quality of care delivered to control group participants can influence outcomes of RCTs. Inadequate reporting exacerbates this issue by masking variations between trials. We argue for increased clarity in reporting standard care in future trials. © 2014, © 2014 The Author(s). Published by Taylor & Francis.


Johnson B.,NIHR CLAHRC for South Yorkshire | Johnson B.,University of Sheffield | Eiser C.,NIHR CLAHRC for South Yorkshire | Eiser C.,University of Sheffield | And 6 more authors.
Diabetic Medicine | Year: 2013

Aims To determine: (1) prevalence of depression among young people with Type 1 diabetes compared with control groups or population norms; (2) implications of depression for HbA1c level; and (3) the relationship between history of depressive symptoms and future depressive symptoms. Background Among adults with Type 1 diabetes depression is higher than the general population, and has been associated with adverse implications for self-care and HbA1c level. The last published review of depression among young people with Type 1 diabetes only included studies up to 1999. Method Systematic searches were conducted for articles published from January 1999 to December 2011 including young people (up to 25years old) with Type 1 diabetes. Results Twenty-three articles met the inclusion criteria. Of five studies that reported prevalence of depression compared with control groups, three found no differences. Of the three studies that investigated prevalence of depression making reference to population norms, all three showed higher rates of depressive symptoms. Fourteen of 15 studies found associations between more depressive symptoms and higher HbA1c level either cross-sectionally or longitudinally. Past depressive symptoms were associated with later depressive symptoms. Conclusions Current evidence is inconclusive about whether there is increased prevalence of depression among young adults with Type 1 diabetes, as established among adults, but those who are more depressed have higher HbA1c level. This review is limited by methodological problems and no identified work in the UK met the inclusion criteria. Given the adverse clinical outcomes, we conclude there is a case for routine mental health screening for young adults with Type 1 diabetes. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.


Young V.,University of Sheffield | Eiser C.,University of Sheffield | Johnson B.,University of Sheffield | Brierley S.,University of Sheffield | And 5 more authors.
Diabetic Medicine | Year: 2013

Aims We report a systematic review to determine (1) prevalence of eating problems compared with peers and (2) the association between eating problems and glycaemic control in young adults with Type1 diabetes. Method We conducted a systematic literature search via electronic databases and meta-analysis. Cohen's d (the mean difference score between Type1 diabetes and comparison groups) was calculated for 13 studies that met inclusion criteria. Results Eating problems [both disordered eating behaviour (39.3 and 32.5%; d=0.52, 95%CI 0.10-0.94) and eating disorders (7.0 and 2.8%; d=0.46, 95%CI 0.10-0.81)] were more common in adolescents with Type1 diabetes compared with peers and both were associated with poorer glycaemic control (d=0.40, 95%CI 0.17-0.64). In restricted analyses involving measures adapted for diabetes, associations between eating problems and poorer glycaemic control remained (d=0.54, 95%CI 0.32-0.76). Disordered eating behaviour (51.8 and 48.1%; d=0.06, 95%CI -0.05 to 0.21) and eating disorders (6.4 and 3.0%; d=0.43, 95%CI -0.06 to 0.91) were more common in adolescents with Type1 diabetes compared with peers, but differences were non-significant. Conclusions Eating problems are common among this age group. Future work in populations with Type1 diabetes should develop sensitive measures of eating problems and interventions, and establish predictors of eating problems. Screening in clinics is recommended. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.


Johnson B.,University of Sheffield | Elliott J.,University of Sheffield | Scott A.,Northern General Hospital | Heller S.,NIHR CLAHRC for South Yorkshire | And 2 more authors.
Diabetic Medicine | Year: 2014

Aim: To assess medical and psychological outcomes among young people with Type 1 diabetes and to compare medical outcomes with a previous audit. Methods: An observational study in two diabetes clinics for young adults (aged 16-21 years) in Sheffield, UK. Young people (n = 96: 81.4% response rate) with Type 1 diabetes (diagnosed > 6 months) completed measures of depressive symptoms, anxiety and disordered eating and consented for their medical records to be consulted. Results: Mean HbA1c (86 ± 23 mmol/mol; 10.0 ± 2.1%); was comparable with that reported previously and considerably higher than recommended (< 58 mmol/mol or 7.5%). Screening rates were improved and non-attendance was lower than previously reported, but levels of non-proliferative retinopathy have increased. Microvascular complications are present in 46.9% of those diagnosed more than 7 years. Elevated levels of disordered eating were reported by 35.1%. Those scoring above cut-off levels for clinical anxiety (26.6%) and depression (10.9%) are comparable with other work with young people with Type 1 diabetes. Conclusions: Despite technological advances and improvements to delivery of care, HbA1c remain above recommended levels in a significant proportion of young people, many of whom already have microvascular complications. We need to learn from European centres who achieve better results, improve transition from paediatric care, integrate mental health support with diabetes care provision and take into account young people's views about clinic. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.

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