544-P: Communication between Adolescents/Young Adults and Health Care Providers during Routine T1D Care

Background: Adolescents and young adults (AYAs) are at higher risk for diabetes self-care challenges and elevated A1c. Understanding AYA/health care provider (HCP) communication may provide insight to better support T1D management. The current study examined content and quality of AYA/HCP communication during routine T1D care.

Methods: Thirty-two AYAs (M age=20.5 ± 9.1 yrs; 53.1% male; 43.8% non-Hispanic Black; M A1c=8.± 1.4%) and 9 HCPs (100% female) participating in an RCT promoting AYA health communication had a routine T1D visit audio-recorded and transcribed. A coding framework was developed to assess communication content and quality, including: AYA initiation, self-disclosure, preparation, and future planning; HCP goal setting, supportive language, problem-solving, education/information sharing, and warnings/threats. Coders double and triple-coded transcripts until 90% agreement was reached. Chi square analyses evaluated associations among codes.

Results: Routine T1D visits were primarily attended by AYAs alone (78.1%), ranging from 8-45 min (M=30.3 ±9.3). AYAs and HCPs spoke 27.0% and 69.1% of the visit, respectively. T1D adherence, lifestyle adherence, and developmental issues were discussed in all visits (100%); insurance, mental health, and T1D support systems were each discussed in 53.1% of visits. AYA preparation (e.g., bringing glucose values, regimen knowledge) was positively associated with HCP supportive language (X²(1,N=32)=5.7, p=.02) and HCP education (X²(1,N=32)=8.3, p<.01). HCP warnings/threats were identified in 25% of visits; 75% of AYAs in these visits had A1c levels ≥7.0%.

Conclusion: Results highlight reciprocal AYA-HCP communication. Improving AYA preparation for T1D care visits may facilitate more efficient and informative AYA-HCP interactions, potentially leading to improved T1D outcomes. Future studies will evaluate associations among communication and T1D outcomes over time, including A1c and transition to adult care.