Effectiveness of a Remote Intervention Program for Self-Management Behaviors in Adolescents and Young Adults With Inflammatory Bowel Disease Based on the Self-Determination Theory: Randomized Controlled Trial Across 2 Centers.

Abstract

The prevalence of inflammatory bowel disease (IBD) has been on the rise, with adolescents and young adults experiencing the highest incidence rates. For these young patients, self-management behaviors are critical to maintaining disease remission and improving quality of life and yet their current self-management status remains suboptimal. This study aimed to evaluate the impact of a remote and multicomponent intervention program (integrating health education, solution-focused intervention, peer support, and mindfulness training) on the self-management behaviors and related mental health outcomes in young adults and adolescents with IBD. From July 2024 to January 2025, we conducted a 2-arm, single-blind randomized controlled trial. Adolescents and young adults with IBD (aged 13-24 years) were recruited from gastroenterology wards of 2 tertiary hospitals in Chongqing, China, and randomized 1:1 to the intervention (extra multicomponent program) or control (routine care) group. Outcomes (self-management behaviors, perceived social support, basic psychological needs, anxiety, depression, and disease activity) were assessed postintervention (T1) and 12 weeks later (T2). Intention-to-treat analysis was used: normally distributed data via mixed-design analysis of variance, and nonnormal data via rank sum and Friedman tests. A total of 74 participants (mean age 18.95, SD 2.96 years; 53/74, 72% males) were enrolled (37 per group) with no baseline differences. Compared with the control group, the intervention group showed significantly higher self-management scores at both T1 (mean difference -16.676, 95% CI -24.370 to -8.982; P<.001, η²=0.206) and T2 (mean difference -14.189, 95% CI -22.594 to -5.784; P=.001, η²=0.136), along with higher perceived social support scores at T1 (mean difference -9.000, 95% CI -13.932 to -4.068; P=.001, η²=0.155) and T2 (mean difference -6.649, 95% CI -11.890 to -1.407; P=.01, η²=0.082). Basic psychological needs scores were also higher in the intervention group at T1 (mean difference -4.946, 95% CI -8.323 to -1.569; P=.005, η²=0.106) and T2 (mean difference -3.946, 95% CI -7.720 to -0.172; P=.04, η²=0.057), while anxiety (T1: P=.04; T2: P=.007) and depression (T1: P=.048; T2: P=.03) scores were lower. In addition, the intervention group had a higher disease activity remission rate at T2 (P=.03). This study extended the application of self-determination theory to adolescents and young adults with IBD, offering a novel theoretical basis for self-management practice in this population. It was shown that this multicomponent intervention was a valuable addition to standard care in enhancing self-management behaviors and related mental health outcomes while lowering disease activity. In addition, its alignment of intrinsic behavioral motivation with nurse-driven clinical settings boosted clinical operability of the intervention. Chinese Clinical Trial Registry ChiCTR2400086703; https://www.chictr.org.cn/showproj.html?proj=235313.