4-year PhD Studentship: Addressing reasons for disparities in technology use for diabetes self-management by children and young people from minoritised or socio-economically disadvantaged groups

Care outcomes for children and young people (CYP) living with diabetes in England and Wales continue to improve. One of the key outcomes is glycated haemoglobin (HbA1c) with internationally recognised target levels to prevent potentially life-limiting complications. While there has been an overall improvement in HbA1c levels achieved by CYP living with diabetes, there are marked disparities in outcomes related to social deprivation and ethnicity. Those living in more deprived areas continue to lag behind those in the least deprived areas and minority ethnic CYP are less likely to achieve optimal HbA1c targets or be using diabetes technologies that support improved self-management.[1]

Technology, such as continuous glucose monitoring, closed-loop insulin pump systems to autonomously modify insulin administration [2] and digital interventions [3] delivering health education, prompts and motivating messaging, has revolutionised the care of CYP living with diabetes. However, recent data show that nearly 40% of White CYP are using an insulin pump compared to only 28% of Black CYP. Furthermore, in the least deprived areas, 44.3% of CYP use an insulin pump, compared to 31.7% in the most deprived areas. This disparity in pump usage is widening with time and is particularly pronounced in Bristol.

Aims and Objectives

This studentship will generate new evidence to support equality of access to and engagement with technology among CYP living with diabetes. The aim is to identify individual, organisational and societal factors that impact upon the use of technology and achievement of good glycaemic control among CYP from minoritised or socio-economically disadvantaged groups. Objectives are to:

• Identify barriers to access, uptake and use of technology from the perspective of families and CYP, healthcare professionals (HCP), and developers of technical or digital devices.
• Co-produce potential solutions to address these barriers aimed at individuals and families, HCP and healthcare devices regulatory bodies.

Methodology

The overarching approach for this studentship is co-production [4], a model of collaborative research where researchers work with those who will use findings, have the ability and authority to implement recommendations, and/or benefit from them. It integrates knowledge translation the research process to increase the relevance and impact of findings. The approach is underpinned by an empirically derived framework describing conditions and roles to optimise research partners’ input [5] especially CYP and their families in the target groups.

The candidate will be trained in the use of qualitative social scientific methods including semi-structured interviews, focus groups and ‘think aloud’ interviews [6]. Qualitative data will be analysed using thematic analysis [7] to identify underlying causes for inequality in access related to CYP and their families, HCP and care organisations, and developers. Consensus methods will be used with a wide group of stakeholders to co-produce recommendations.

Keywords

Health inequalities, diabetes mellitus, children/young people, technology use, self-management

How to apply for this project

This project will be based in Bristol Medical School - Population Health Sciences in the Faculty of Health Sciences at the University of Bristol.

Please visit the Faculty of Health Sciences website for details of how to apply