552-P: Barriers and Enablers to Diabetic Ketoacidosis (DKA) Prevention in Adults with Type 1 Diabetes—An Implementation Science Study

Introduction & Objective: DKA prevention depends strongly on patient knowledge and self-management skills, but educational tools are inconsistent and complex. To co-create a new tool with people living with T1D, we first aimed to determine key barriers and enablers to DKA prevention through identification of the perspectives of people living with T1D, their caregivers, and healthcare providers.

Methods: We conducted a qualitative study involving three independent focus groups. The focus group design and analysis were informed by the Action, Actor, Context, Target, and Time Framework (AACTT) to carefully define the key targeted behaviours for change and the Theoretical Domains Framework (TDF) to understand their determinants. The targeted behaviours related to testing ketone levels, acting upon ketone testing results, and seeking emergency medical care. Deductive coding and thematic analysis were used to categorize and describe barriers and enablers for each targeted behaviour.

Results: A total of 9 people living with T1D, 1 caregiver, and 12 healthcare providers participated in our focus groups. Five key themes relating to six TDF domains emerged that influenced one’s ability to engage in the targeted behaviours. Key barriers included: 1) a fundamental lack of understanding of the clinical relevance of ketones and DKA (knowledge, beliefs about consequences); 2) negative experiences with the healthcare system and lack of access to supplies (environmental context and resources); 3) inability to retain ketone knowledge among numerous self-management burdens (memory). Key enablers included: 1) reminders from physicians and/or technology (reinforcement); 2) community supports and accessible resources (social influences).

Conclusion: These key barriers and enablers to DKA prevention will inform the development of an educational tool co-created with people living with T1D designed to more effectively prevent DKA than do existing resources.