Development and Validation of the Transition Readiness Assessment Instrument in Type 1 Diabetes “On TRAck”

Transition to adult care is challenging for youth with type 1 diabetes (T1D) and their caregivers. We have developed the diabetes-specific “On TRAck” transition readiness scale, and in this study we assess its reliability and validity compared with TRANSITION-Q, a generic transition readiness questionnaire. We systematically created 3 versions of On TRAck: adolescent, parent and health-care provider (HCP) versions (for case managers and physicians). Among adolescents 13 to 18 years of age with T1D at a single academic centre, we conducted an exploratory factor analysis and assessed interrater agreement, internal consistency and relationship with age; recent glycated hemoglobin (A1C); and recent diabetic ketoacidosis (DKA) with On TRAck and TRANSITION-Q. One hundred fifteen adolescents (aged 15.8±1.6 years and diabetes duration 6.7±4.1 years), their caregivers and diabetes HCPs participated. The final 24-item adolescent and parent scales (with 3 subscales: “Self-efficacy,” “Autonomy” and “Support & maturity”) and the 3-item HCP version had a Cronbach’s alpha of 0.86 to 0.93. Adolescent scores correlated with parents (r=0.64), case managers (r=0.39) and physicians (r=0.28). Mean adolescent score was 190.3±27.1 points out of 240. Adolescent scores were 3.4 points higher per year of age (p=0.03) and 4.4 points higher for every 1% lower A1C (p=0.01), but were not associated with DKA. TRANSITION-Q was associated with age. On TRAck HCP scores were associated with adolescent’s age, A1C and DKA. On TRAck represents a new psychometrically comprehensive diabetes-specific scale that can be used in adolescent diabetes clinics for measuring transition readiness. It is a multidimensional instrument with ease of use and high reliability scores. La transition vers les soins aux adultes est difficile pour les jeunes atteints du diabète de type 1 (DT1) et leurs soignants. Nous avons élaboré une échelle de préparation à la transition « On TRAck (de l’anglais, Transition Readiness Assessment) » propre au diabète. Dans la présente étude, nous évaluons sa fiabilité et sa validité par rapport au questionnaire générique de préparation à la transition TRANSITION-Q. Nous avons systématiquement créé 3 versions du questionnaire On TRAck : adolescents, parents et prestataires de soins de santé (PSS) (pour les responsables des cas et les médecins). Auprès des adolescents atteints du DT1 de 13 à 18 ans d’un seul centre universitaire, nous avons réalisé une analyse factorielle exploratoir