Dr. Hood directs NIH- and foundation-funded clinical research aimed at promoting health and quality of life outcomes for people with diabetes. There are two main threads to his work: 1) construct prevention and treatment programs to address modifiable psychological and family factors that create barriers to optimal management of type 1 diabetes, and 2) optimize the use of diabetes devices and technologies to improve outcomes. With regard to the first thread, Dr. Hood has successfully implemented depression screening programs in tertiary pediatric diabetes clinics within a Quality Improvement framework, and is currently conducting a large scale clinical trial on a depression prevention program for teens with type 1 diabetes. From a device and technology standpoint, Dr. Hood coordinates the Human Factors assessments in Drs. Buckingham and Ly’s closed loop studies and is recognized as one of the experts in this area nationally and internationally. In addition, he has implemented Human Factors assessments in local and national (e.g., T1D Exchange) studies and registries. These assessments focus on uptake of devices and technologies, and determining strategies to promote uptake and optimize their use. Dr. Hood and his research team have published over 70 scientific articles on these topics and are active presenters at diabetes, behavioral medicine, and advocacy conferences.
Dr. Hood also works closely with people with diabetes in clinical and service settings. Dr. Hood is a licensed clinical psychologist and is part of the diabetes care team at Stanford. He is also the chair of the American Diabetes Association’s Behavioral Medicine and Psychology Interest Group, is on editorial boards for Diabetes Care and the Journal of Pediatric Psychology, and assists with programming for JDRF and Children With Diabetes events. Dr. Hood is the author of a book entitled Type 1 Teens: A Guide to Managing Your Life with Diabetes and an ADA book (with Drs. Harris and Weissberg-Benchell) for clinicians working with teens with diabetes. All of these efforts are aimed at improving the quality of life and health outcomes of people with diabetes and their families.
Complete List of Published Work in My Bibliography (may need to copy and paste link in your browser):
University of Florida College of Medicine (2003) FL
Fellowship:Joslin Diabetes Center (2005) MA
Internship:Children's Hospital BostonMA
Initiation of Continuous Glucose Monitoring at Diagnosis of Type 1 Diabetes
The purpose of this study is to learn about the impact of continuous glucose monitoring (CGM) on families with newly diagnosed children with type 1 diabetes (T1D). The investigators hope to learn about how continuous glucose monitoring affects glycemic variables and diabetes-related distress.
Remote Monitoring of Diabetes in Young Children With Type 1 Diabetes
The primary objective of this project is to examine the impact of a continuous glucose monitoring (CGM) intervention on health and psychological outcomes in young children with type 1 diabetes (T1D).
PsychDT Working Group: Report Psychosocial Aspects of Artificial Pancreas Systems.
Journal of diabetes science and technology
2015; 9 (4): 925-928
Diabetes technology is a cornerstone of diabetes management in the 21st century, with advances in available devices over recent years playing a central role in the way that health care has progressed. Psychosocial interventions have been shown to have a positive impact on glycemic control, reduce psychological distress and reduce costs of health care. Addressing and improving psychosocial outcomes that complement biomedical improvements and looking to the future are crucial to enhance patient acceptance of artificial pancreas (AP) systems.To achieve closer collaboration and comparability across different AP research trials, a working group was established.Existing measures fail to adequately capture the extent to which human and psychological factors play a role in the uptake and efficient use of AP systems. Understanding these factors will ultimately lead to the most benefit for users. Reliable measures of the psychosocial impact of AP systems for users is crucial to ensure that (1) regulatory authorities are able to robustly consider these aspects as part of their approval process, (2) government and private payers are able to factor these aspects into their decisions regarding reimbursement, and (3) persons with diabetes maximize benefits in terms of both glycemic control and quality of life to minimize the burden of diabetes in everyday life.This working group will serve as a platform to foster exchange, identify research needs, and guide and initiate collaborative research laying the groundwork for optimal utilization of diabetes technology in clinical diabetes care. A close collaboration among all key stakeholders is crucial to ensure that devices are designed, trialed, approved, and provided with minimal user burden and maximum beneficial effect.
View details for DOI 10.1177/1932296815588332
View details for PubMedID 26085567
- Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control PEDIATRIC DIABETES 2017; 18 (3): 204-212
Expectations and Attitudes of Individuals With Type 1 Diabetes After Using a Hybrid Closed Loop System
2017; 43 (2): 223-232
Purpose The first hybrid closed loop (HCL) system, which automates insulin delivery but requires user inputs, was approved for treatment of type 1 diabetes (T1D) by the US Food and Drug Administration in September 2016. The purpose of this study was to explore the benefits, expectations, and attitudes of individuals with T1D following a clinical trial of an HCL system. Methods Thirty-two individuals with T1D (17 adults, 15 adolescents) participated in focus groups after 4 to 5 days of system use. Content analysis generated themes regarding perceived benefits, hassles, and limitations. Results Some participants felt misled by terms such as "closed loop" and "artificial pancreas," which seemed to imply a more "hands-off" experience. Perceived benefits were improved glycemic control, anticipated reduction of long-term complications, better quality of life, and reduced mental burden of diabetes. Hassles and limitations included unexpected tasks for the user, difficulties wearing the system, concerns about controlling highs, and being reminded of diabetes. Conclusion Users are willing to accept some hassles and limitations if they also perceive health and quality-of-life benefits beyond current self-management. It is important for clinicians to provide a balanced view of positives and negatives to help manage expectations.
View details for DOI 10.1177/0145721717697244
View details for Web of Science ID 000397980900009
View details for PubMedID 28340542
Quality of Life of College Students Living With Type 1 Diabetes: A Qualitative View.
Western journal of nursing research
2016; 38 (12): 1595-1610
The purpose of this phenomenological qualitative study was to examine the quality of life among college students living with Type 1 diabetes (T1D). Inclusion criteria included age 18 to 24, current college student, and a diagnosis of T1D for at least 1 year. Semi-structured interviews were conducted, in-person and by phone. During these interviews, college students shared stories of living with T1D and its impact on their quality of life. Three major themes emerged, which included "planning ahead," "thinking positive," and "seeking support." These findings provide a better understanding of the transitional experience of living with T1D and the impact on perceived quality of life while attending college. Techniques and strategies aimed at the enhancement of perceived quality of life for college students living with T1D were identified. These findings will provide valuable insight for professionals working with this population.
View details for PubMedID 27230752
- Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association DIABETES CARE 2016; 39 (12): 2126-2140
Diabetes Technology: Uptake, Outcomes, Barriers, and the Intersection With Distress.
Journal of diabetes science and technology
2016; 10 (4): 852-858
Patients managing type 1 diabetes have access to new technologies to assist in management. This manuscript has two aims: 1) to briefly review the literature on diabetes technology use and how this relates to psychological factors and 2) to present an example of human factors research using our data to examine psychological factors associated with technology use. Device/technology uptake and use has increased over the years and at present day is a common clinical practice. There are mixed results in terms of health and psychosocial outcomes, with specific subgroups doing better than others with technology. Our data demonstrated that patients have moderately elevated diabetes distress across differing types of technology used, from low-tech to high-tech options, possibly meaning that technology does not add or take away distress. In addition, users on multiple daily injections compared to all other technology groups have less positive attitudes about technology. Finally, we discuss implications for clinical practice and future research.
View details for DOI 10.1177/1932296816650900
View details for PubMedID 27234809
A randomized clinical trial aimed at preventing poor psychosocial and glycemic outcomes in teens with type 1 diabetes (T1D).
Contemporary clinical trials
2016; 49: 78-84
Adolescents with type 1 diabetes have an increased risk for a variety of emotional and behavioral challenges as well as negative diabetes outcomes. This study was designed to compare the effectiveness of a depression-prevention, resilience promotion program with an advanced diabetes education program. Each program consisted of 9 group-based sessions. There were 264 adolescents enrolled in this multi-site randomized clinical trial. The primary outcomes were depressive symptoms and glycemic control; secondary outcomes included resilience skills, diabetes management and adherence, and diabetes-specific distress. The goal of the present paper is to describe the study design, the intervention, and the baseline characteristics of the sample. Preliminary data suggests that enrollment, randomization and retention were successful. Longitudinal follow-up and examination of mechanisms of action as they relate to psychosocial and glycemic outcomes will be explored in the future.
View details for DOI 10.1016/j.cct.2016.05.006
View details for PubMedID 27267154
View details for PubMedCentralID PMC4969210
Whose quality of life is it anyway? Discrepancies between youth and parent health-related quality of life ratings in type 1 and type 2 diabetes
QUALITY OF LIFE RESEARCH
2016; 25 (5): 1113-1121
Health-related quality of life (HRQOL) is a critical diabetes outcome, yet differences between youth and parent-proxy ratings can make interpretation difficult. This study aims to explore potential differences between self- and parent-reports of Pediatric Quality of Life Inventory (PedsQL) scores from youth with type 1 (T1D) or type 2 diabetes (T2D) and to evaluate associations between discrepancies, PedsQL scores, and glycemic control (HbA1c).Youth and parents in the SEARCH for Diabetes in Youth Study (T1D: age 5-18, n = 3402; T2D: age 8-18, n = 353) completed the PedsQL Generic and Diabetes Modules, and youth provided a blood sample to assess HbA1c. Discrepancies (youth minus parent PedsQL ratings) were calculated and examined by age and diabetes type, and associations with youth PedsQL scores and HbA1c were evaluated.Discrepancies existed between youth and parent-proxy reports of generic and diabetes PedsQL scores in T1D and T2D (all p values < 0.01). Higher (more favorable) ratings were reported by youth except for those 5-7-years old, where parents' scores were higher. When parent-proxy scores were higher, discrepancies were largest when the child reported low PedsQL scores. Higher HbA1c was associated with larger discrepancies (youth scores higher) for adolescents with T1D.Discrepant PedsQL ratings suggest that parents may often underestimate youths' HRQOL except in the youngest children. Although examining both reports is optimal, the youth report should be prioritized, particularly for young children with T1D and for adolescents with either T1D or T2D.
View details for DOI 10.1007/s11136-015-1158-5
View details for Web of Science ID 000374866600004
View details for PubMedID 26466834
Toward Development of Psychosocial Measures for Automated Insulin Delivery.
Journal of diabetes science and technology
2016; 10 (3): 799-801
The INSPIRE study working group launched its initial workshop in February 2015 to facilitate collaboration among key stakeholders interested in automated insulin delivery (AID) systems and the psychosocial outcomes of individuals who may use these new technologies. Specifically, the INSPIRE team's goal is to facilitate measure development assessing the psychosocial factors associated with AID systems. A second working group was held to foster exchange among key stakeholders in AID system development. Patient, health care provider, engineering, industry, academic, regulatory and payer perspectives were presented. The INSPIRE working group will continue to serve as a platform to encourage open dialogue among all stakeholders with the aim of facilitating technology that offers minimal user burden and maximum benefit from both a psychological and physiologic perspective.
View details for DOI 10.1177/1932296815619637
View details for PubMedID 26645792
Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control.
Declining glycemic control in type 1 diabetes (T1D) during adolescence persists despite treatment advances. Non-adherence, peer relations, diabetes burnout, risk taking, transition to autonomy, family conflict, and poor quality of life (QOL) are recognized barriers. Shared medical appointments (SMAs) in adolescent T1D may offer benefits, but data are limited. Our objective was to determine whether SMAs, with multi-component interventions utilizing multidisciplinary teams, improve glycemic control and psychosocial outcomes in poorly controlled adolescent T1D.SMAs focused on self-management, communication skills, goal setting, glucose pattern recognition, and peer/diabetes team support. SMAs included: individual history and physical, labs, surveys, multidisciplinary educational ice breakers, group session, and individual wrap up. Outcomes were QOL, adherence, and retrospective and prospective glycemic control. Three to six subjects and families came to 3 SMAs and 1 individual appointment every 3 months over 9 months.A total of 37 English speaking subjects, ages 12-16 yrs, with T1D ≥ 1 year, and hemoglobin A1c (HbA1c) 7.5-11% enrolled. Thirty-two subjects attended 75% of visits, meeting inclusion criteria.HbA1c worsened in the 9 months before study (ΔHbA1c= 0.7 ± 1.2; p < 0.01), but remained stable during study (ΔHbA1c = 0.01 ± 1.2; p > 0.05). There were significant improvements in overall QOL (p = 0.005), school function (p = 0.006), psychosocial function (p = 0.008), barriers (p = 0.02), adherence (p = 0.01), and communication (p = 0.02). Improvements in school function and communication reached clinical significance.SMAs are feasible replacements to individual appointments in adolescent T1D, stabilizing glycemic control and improving QOL. Randomized controlled trials with optimizations are needed to further explore and refine this intervention.
View details for DOI 10.1111/pedi.12373
View details for PubMedID 26919322
Resilience in Youth and Families Living With Pediatric Health and Developmental Conditions: Introduction to the Special Issue on Resilience.
Journal of pediatric psychology
2015; 40 (9): 835-839
This special issue of the Journal of Pediatric Psychology showcases a growing area of research with a collection of 16 contemporary studies of resilience in youth with chronic medical or developmental conditions and their families. The research reported in this special issue covers a broad range of pediatric populations, including cancer, type 1 diabetes, and chronic pain, among others, ranging in age from early childhood through early adulthood. This introduction to the special issue reviews the various ways the articles' authors conceptualize and define risk and resilience; most analyze protective processes in relation to resilient outcomes, including both achievement of explicitly positive experiences and avoidance of dysfunction or disruption. Challenges with measurement of resilience-related constructs is reviewed. Finally, the special issue editors offer a definition of resilience in the context of pediatric and health psychology.
View details for DOI 10.1093/jpepsy/jsv072
View details for PubMedID 26275974
From Individuals to International Policy: Achievements and Ongoing Needs in Diabetes Advocacy
CURRENT DIABETES REPORTS
2015; 15 (9)
Diabetes impacts tens of millions of people in the United States of America and 9 % of the worldwide population. Given the public health implications and economic burden of diabetes, the needs of people with diabetes must be addressed through strategic and effective advocacy efforts. Diabetes advocacy aims to increase public awareness about diabetes, raise funds for research and care, influence policy impacting people with diabetes, and promote optimal individual outcomes. We present a framework for diabetes advocacy activities by individuals and at the community, national, and international levels and identify challenges and gaps in current diabetes advocacy. Various groups have organized successful diabetes advocacy campaigns toward these goals, and lessons for further advancing diabetes advocacy can be learned from other health-related populations. Finally, we discuss the role of healthcare providers and mental/behavioral health professionals in advocacy efforts that can benefit their patients and the broader population of people with diabetes.
View details for DOI 10.1007/s11892-015-0636-z
View details for Web of Science ID 000377953300003
View details for PubMedID 26194156
Depressive Symptoms in a Trial Behavioral Family Systems Therapy for Diabetes: A Post Hoc Analysis of Change
2015; 38 (8): 1435-1440
The objective was to test whether Behavioral Family Systems Therapy for Diabetes (BFST-D), an evidence-based family therapy, produces individual changes in depressive symptoms for adolescents with type 1 diabetes in suboptimal glycemic control (HbA1c ≥9.0% [≥74.9 mmol/mol]).Data were from a randomized controlled trial (RCT) comparing two modes of BFST-D delivery: in clinic versus Internet videoconferencing. There were no significant differences between groups in the RCT, so groups were collapsed into a within-group prepost design for secondary analyses. A multiple regression analysis was performed to test for mediation of treatment outcomes by changes in family processes.Significant improvements in glycemic control, depressive symptoms, and family functioning were found from pre- to posttreatment. A multiple regression analysis for within-subject mediation indicated that improvements in depressive symptoms were partially mediated by improvements in parent-youth conflict; however, family process changes did not mediate diabetes health outcomes.In addition to improving treatment adherence and glycemic control, BFST-D has collateral benefits on depressive symptoms.
View details for DOI 10.2337/dc14-2519
View details for Web of Science ID 000358673200018
View details for PubMedID 26015558
Perceptions about professionally and non-professionally trained hypoglycemia detection dogs
DIABETES RESEARCH AND CLINICAL PRACTICE
2015; 109 (2): 389-396
Patients with diabetes increasingly have questions about diabetes alert dogs. This study evaluated perceptions about dogs trained professionally or otherwise to detect glucose levels.A link to a survey about glucose detecting dogs was announced on diabetes websites.135 persons responded, with 63 answering about their child with diabetes. Most respondents obtained their dog from a professional trainer (n=54) or trained it themselves (n=51). Owners of self- and professionally-trained dogs were very positive about dogs' abilities to alert them to low and high glucose levels, while owners of dogs that learned entirely on their own (n=15) reported lower frequencies of alerts and more missed hypoglycemic episodes, p<.01. Regardless of how dogs learned, perceptions about managing diabetes were improved during periods of dog ownership relative to times without, p<.001. Self-reported rates of diabetes-related hospitalizations, assistance from others for treating hypoglycemia, and accidents or near accidents while driving reduced during periods of dog ownership compared to periods without dogs, ps<.01.These data suggest potential effectiveness of and high satisfaction with glucose-detecting dogs. Clinicians can use these results to address pros and cons of dog ownership with patients who inquire about them.
View details for DOI 10.1016/j.diabres.2015.05.023
View details for Web of Science ID 000358554800026
Technology Use for Diabetes Problem Solving in Adolescents with Type 1 Diabetes: Relationship to Glycemic Control
DIABETES TECHNOLOGY & THERAPEUTICS
2015; 17 (7): 449-454
This study examines technology use for problem solving in diabetes and its relationship to hemoglobin A1C (A1C).A sample of 112 adolescents with type 1 diabetes completed measures assessing use of technologies for diabetes problem solving, including mobile applications, social technologies, and glucose software. Hierarchical regression was performed to identify the contribution of a new nine-item Technology Use for Problem Solving in Type 1 Diabetes (TUPS) scale to A1C, considering known clinical contributors to A1C.Mean age for the sample was 14.5 (SD 1.7) years, mean A1C was 8.9% (SD 1.8%), 50% were female, and diabetes duration was 5.5 (SD 3.5) years. Cronbach's α reliability for TUPS was 0.78. In regression analyses, variables significantly associated with A1C were the socioeconomic status (β=-0.26, P<0.01), Diabetes Adolescent Problem Solving Questionnaire (β=-0.26, P=0.01), and TUPS (β=0.26, P=0.01). Aside from the Diabetes Self-Care Inventory-Revised, each block added significantly to the model R(2). The final model R(2) was 0.22 for modeling A1C (P<0.001).Results indicate a counterintuitive relationship between higher use of technologies for problem solving and higher A1C. Adolescents with poorer glycemic control may use technology in a reactive, as opposed to preventive, manner. Better understanding of the nature of technology use for self-management over time is needed to guide the development of technology-mediated problem solving tools for youth with type 1 diabetes.
View details for DOI 10.1089/dia.2014.0422
View details for Web of Science ID 000363943000004
View details for PubMedID 25826706
Psychosocial Assessment of Artificial Pancreas (AP): Commentary and Review of Existing Measures and Their Applicability in AP Research
DIABETES TECHNOLOGY & THERAPEUTICS
2015; 17 (4): 295-300
This study aimed to systematically review the evidence base for the use of existing psychological and psychosocial measures suitable for use in artificial pancreas (AP) research.This systematic review of published literature, gray literature, previous systematic reviews, and qualitative and economic studies was conducted using terms and abbreviations synonymous with diabetes, AP, and quality of life (QoL).Two hundred ninety-two abstracts were identified that reported psychosocial assessment of diabetes-related technologies. Of these, nine met the inclusion criteria and were included. Only four of 103 ongoing trials evaluated psychosocial aspects as an outcome in the trial. Of these, treatment satisfaction, acceptance and use intention of AP, fear of hypoglycemia episodes, satisfaction with AP, and an unspecified QoL measure were used.A better understanding of the psychosocial side of AP systems and the extent to which human factors play a role in the uptake and efficient use of these systems will ultimately lead to the most benefit for people with diabetes.
View details for DOI 10.1089/dia.2014.0305
View details for Web of Science ID 000351057300011
View details for PubMedID 25549042