Securing structured transitional care for adolescents with type 1 diabetes: a qualitative study of implementation barriers and facilitators prior to implementation– the STEPSTONES-Implement project

BACKGROUND: Adolescents and young adults with type 1 diabetes (T1D) face challenges during the transition from pediatric to adult healthcare, including gaps in care and deteriorating health outcomes. Although structured transition programs have demonstrated effectiveness, few components of transitional care are implemented in practice. Swedish Transition Effects Project Supporting Teenagers with chrONic mEdical conditions (STEPSTONES) is a person-centered, multicomponent intervention developed to support adolescents with chronic conditions during this transition. Prior to implementation in pediatric diabetes care, there is a need to understand the implementation context that might influence program adoption. The aim of this study was to explore healthcare professionals' perspectives on barriers to and facilitators for implementing the STEPSTONES transition program for adolescents with T1D in two pediatric diabetes outpatient settings in Sweden prior to implementation. METHODS: Qualitative inductive design was employed. Data was collected during 2024 - 2025 through three focus group interviews with registered nurses (n = 8), physicians (n = 3) and individual interviews with healthcare managers (n = 2) and the chair for a national patient organization for youth with T1D (n = 1). Participants were recruited from two pediatric diabetes outpatient clinics at a university hospital in Sweden prior to program implementation. Data was analyzed using thematic analysis. RESULTS: An overarching theme, Conceptualizations of structured transitional care, was identified, encompassing three themes: openness to changes in the transition care processes, ensuring dedicated responsibility for transitional care and supporting a youth-oriented approach. Key facilitators included a strong perceived need for structured transition support, alignment of the program with existing practices, leadership engagement, and the appointment of a dedicated transition coordinator. Barriers were related primarily to contextual constraints, such as limited resources, challenges in collaboration between pediatric and adult care, and healthcare professionals' uncertainty regarding how to discuss sensitive topics and psychosocial support. healthcare professionals' uncertainty regarding CONCLUSIONS: These findings indicate favorable preconditions for implementing the STEPSTONES transition program in pediatric diabetes care. However, successful implementation will depend on addressing cross-organizational contextual barriers, strengthening recipients' competence in adolescent-centered care, and investing in active and sustained facilitation. In accordance with the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework that we used as a post hoc interpretative framework, the findings highlight that implementation success requires alignment between the innovation, recipients, and context, with facilitation playing a pivotal role. These insights may inform the implementation of structured transition programs for adolescents with chronic conditions in routine healthcare.