Title: THE DEVELOPMENT OF A CHATBOT TO SUPPORT SUCCESSFUL TRANSITION TO ADULT CARE OF YOUNG PEOPLE WITH TYPE 1 DIABETES MELLITUS
Funder: Department of Health and Social Care

Abstract: Type 1 Diabetes Mellitus (T1DM) is the second most common paediatric chronic health condition affecting 1 in 700 UK children and young people (YP). Transition from paediatric to adult healthcare starts around 11 years, with preparation for moving settings and care, finishing at around 21 years when YP are established in adult healthcare. YP with T1DM transitioning from paediatric to adult healthcare show a significant deterioration in their diabetes control, increasing their risk of complications and acute life-threatening illness. Current services/resources supporting transition for YP with T1DM are inadequate and do not sufficiently address their needs. Digital platforms have the ability to provide YP with holistic accessible educational/vocational support, not achieved during traditional clinical appointments. We aim to develop and evaluate the first NHS user-led clinically approved transition chatbot for YP with T1DM using IBM Watson as the AI platform to facilitate this. We will gather the views of YP and Healthcare Professionals (HCPs) to determine the information required in a chatbot and web-based materials, to support a seamless, well-informed and safe transition for YP with T1DM. Our multidisciplinary team will work with industry partners including IBM to develop a chatbot and multi-media resources on transition on the established DigiBete T1DM platform that can provide YP with information in an acceptable form. We will subsequently work with YP (aged 11-25) to ensure that the information and chatbot meets the needs of YP and modify the chatbot and media accordingly. In the last phase we will invite 32-40 YP to trial the chatbot and online transition materials, collating feedback through validated questionnaires and qualitative data collection from YP, HCPs and parents. During each phase of development we will embed behavioural change design led by an expert psychologist and create a framework for hard to reach and vulnerable groups to ensure inclusivity.

Lay abstract: Our team of expert doctors, nurses, young people, parents, researchers and technologists plan to create new ways of helping young people with Type 1 Diabetes to become confident at self-managing their diabetes when they move to adult healthcare. To do this we will develop a young-person friendly, diabetes chatbot (software for online chat), with avatars and linked videos. A chatbot is needed because 29,000 children and young people in the UK live with diabetes and is the second most common condition affecting young people. These young people will move to adult healthcare between 16-19 years of age; this is called transition . After transition YP need to be independent at self-management, diet and appointments without being reminded and know how to ask the adult team any questions about self-management. National guidance asks child teams to help young people begin self-managing their condition from the age of 11 so that they don't suffer complications after transition.Yet many teams do not have the time to help each young person in the way that is best for them. Therefore, many young people are not ready for transition when the time comes. For example, they may not take their medication or follow their diet properly, and may even stop attending clinic; this can make them very ill. One-third of young people have poor diabetes control by the time of their first adult-clinic visit. Chatbots can help people become confident at self-management but will never replace talking with the team. Therefore, we asked 30 young people if they would trust a diabetes self-management chatbot that was designed/programmed by their child-health team to help them with transition; almost all said that they would. In our research, we will first ask 40 young people aged 11-25 with diabetes to take part in one of two workshops to tell us what they would like in a chatbot; this is called co-design. Then, we will develop the chatbot and transition materials, giving answers to common health questions. Next, we will ask the young people and 6-8 health professionals in workshops what they think about the chatbot; then we will modify it based on this. Lastly, we will ask 40 young people aged 11-25 with diabetes to use the chatbot on a mobile phone or DigiBete website (https://www.digibete.org/) regularly for 6 weeks. We will ask them to fill in e-questionnaires before and after using the chatbot, and tell us afterwards what they thought of it, in group discussions. The results will tell us if using the chatbot helps young people feel better about self-management, and whether we should next test it with even more young people before making it available to all those with T1DM. Reviewed by lay experts/ young people

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: METABOLIC AND ENDOCRINE