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Goldstein KM, Voils CI, Bastian LA, Heisler M, Olsen MK, Woolson S, White-Clark C, Zervakis J, Oddone EZ. An Innovation to Expand the Reach of Peer Support: A Feasibility and Acceptability Study. Mil Med 2023; 188:e1569-e1575. [PMID: 36226850 DOI: 10.1093/milmed/usac295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Peer support is a well-established part of veteran care and a cost-effective way to support individuals pursuing health behavior change. Common models of peer support, peer coaching, and mutual peer support have limitations that could be minimized by building on the strengths of each to increase the overall reach and effectiveness. We conducted a 12-week, proof-of-concept study to test the acceptability and feasibility of a hybrid model of peer support which supplements dyadic mutual peer support with as-needed peer coaching. MATERIALS AND METHODS We tested our novel peer support model within the context of cardiovascular disease (CVD) risk reduction as a support mechanism for the promotion of heart-healthy diet and exercise behaviors. We recruited peer buddies (participants who would be matched with each other to provide mutual support) with at least one uncontrolled CVD risk factor (i.e., blood pressure, weight, or diabetes) and peer coaches (individuals who would provide additional, as-needed support for peer buddies) with a recent history of CVD health behavior improvement. We aimed for 50% of peer buddies to be women to assess for potential gender differences in intervention engagement. Participants received didactic instruction during three group sessions, and peer dyads were instructed to communicate weekly with their peer buddy to problem-solve around action plans and behavioral goals. We tracked frequency of dyadic communication and conducted semi-structured interviews at the intervention's end to assess acceptability. RESULTS We recruited three peer coaches and 12 peer buddies. Ten buddies (five dyads) met at the first group session, and all were still in weekly contact with each other at week 12. Peer buddies had a mean of 8.75 out of 12 possible weekly peer buddy communications (range 6-15 in total). Peer coaches provided additional support to four participants over 12 weeks. Participants reported liking the intervention, including mixed-gender groups. Clarity and expectation setting around the role of peer coaches were important. CONCLUSIONS The supplementation of mutual peer support with as-needed peer coaching is an acceptable and feasible way to expand the potential reach and effectiveness of peer support for behavior change among veterans.
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Affiliation(s)
- Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC 27701, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC 27701, USA
| | - Corrine I Voils
- William S Middleton Memorial Veterans Hospital, Madison, WI 53705, USA
- Department of Surgery, University of Wisconsin, Madison, WI 53792, USA
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Department of Medicine, Yale University, New Haven, CT 06520, USA
| | - Michele Heisler
- Ann Arbor VA Medical Center, Ann Arbor, MI 48015, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48019, USA
| | - Maren K Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC 27701, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, USA
| | - Sandra Woolson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC 27701, USA
| | - Courtney White-Clark
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC 27701, USA
| | - Jennifer Zervakis
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC 27701, USA
| | - Eugene Z Oddone
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC 27701, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC 27701, USA
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Pollock MD, Stauffer N, Lee HJ, Chow SC, Satoru I, Moats L, Swan-Nesbit S, Li Y, Roberts JK, Ellis MJ, Diamantidis CJ, Docherty SL, Chambers ET. MyKidneyCoach, Patient Activation, and Clinical Outcomes in Diverse Kidney Transplant Recipients: A Randomized Control Pilot Trial. Transplant Direct 2023; 9:e1462. [PMID: 36935874 PMCID: PMC10019211 DOI: 10.1097/txd.0000000000001462] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/17/2023] [Accepted: 02/01/2023] [Indexed: 03/17/2023] Open
Abstract
Kidney transplant (KT) recipients who are not actively engaged in their care and lack self-management skills have poor transplant outcomes, which are disproportionately observed among Black KT recipients. This pilot study aimed to determine whether the MyKidneyCoach app, an mHealth intervention that provides self-management monitoring and coaching, improved patient activation, engagement, and nutritional behaviors in a diverse KT population. Methods This was a randomized, age-stratified, parallel-group, attention-control, pilot study in post-KT patients. Participants were randomized into the attention-control with access to MyKidneyCoach for education and self-management (n = 9) or the intervention with additional tailored nurse coaching (n = 7). Feasibility, acceptability, and clinical outcomes were assessed. Results The acceptability of MyKidneyCoach by System Usability Scale was 67.5 (95% confidence interval [CI], 59.1-75.9). Completion rates based on actively using MyKidneyCoach were 81% (95% CI, 57%-93%) and study retention rate of 73%. Patient activation measure significantly increased overall by a mean of 11 points (95% CI, 3.2-18.8). Additionally, Black patients (n = 7) had higher nutrition self-efficacy scores of 80.5 (95% CI, 74.4-86.7) compared with 75.6 (95% CI, 71.1-80.1) in non-Black patients (n = 9) but lower patient activation measure scores of 69.3 (95% CI, 56.3-82.3) compared with 71.8 (95% CI, 62.5-81) in non-Black patients after 3 mo. Conclusions MyKidneyCoach was easy to use and readily accepted with low attrition, and improvements were demonstrated in patient-reported outcomes. Both Black and non-Black participants using MyKidneyCoach showed improvement in self-management competencies; thus, this intervention may help reduce healthcare inequities in KT.
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Affiliation(s)
| | - Nicolas Stauffer
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Ito Satoru
- Department of Surgery, Duke University, Durham, NC
| | | | | | - Yan Li
- Department of Pathology, Duke University, Durham, NC
| | | | | | | | | | - Eileen T. Chambers
- Department of Surgery, Duke University, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
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Tarfa A, Nordin J, Mott M, Maurer M, Shiyanbola O. A qualitative exploration of the experiences of peer leaders in an intervention to improve diabetes medication adherence in African Americans. BMC Public Health 2023; 23:144. [PMID: 36670394 PMCID: PMC9862861 DOI: 10.1186/s12889-023-15059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND African Americans chronically managing their diabetes benefit from receiving support from peers with shared experiences. Peer support is known to improve the well-being of individuals receiving support, however, there is limited literature on the experiences of those providing the support. The Peers Supporting Health Literacy, Self-efficacy, Self-Advocacy, and Adherence (Peers LEAD) program pairs Peer Ambassadors who are adherent to their diabetes medication, with Peer Buddies who need support with their medication adherence. Peer Ambassadors engage with Peer Buddies as they receive diabetes information, develop the skills and motivation to address identified psychosocial/sociocultural issues to enhance their diabetes medication adherence. This study qualitatively explores the experiences of African Americans who provided peer support in the Peers LEAD medication adherence intervention. METHODS Two focus groups were conducted with twelve Peer Ambassadors to explore their experiences of providing peer support in the Peers LEAD medication adherence intervention. Qualitative content analysis was conducted using an inductive open coding approach. RESULTS Emergent themes provided insight into Peer Ambassador' rationale for providing peer support and the benefits and challenges they experienced in their roles. Themes regarding their rationale included: their desire to receive support for their diabetes self-management as well as to contribute to their communities in reducing the stigma associated with diabetes. The perceived benefits they gained centered on creating interpersonal connections, experiencing personal growth as they adapted to their roles, and experiencing opportunities to contribute to an intervention regardless of professional training. Peer Ambassadors reflected on the challenges which included difficulties on coming to terms with their role as Peer Ambassadors, seeing African Americans experience complications associated with diabetes, and navigating supporting Peer Buddies who are also burdened with the challenges their family members are experiencing with managing their diabetes. CONCLUSIONS This study provides unique insight to what motivates individuals to provide peer support and what they gain from these experiences despite the challenges. Understanding the experiences of peers participating in such interventions may help inform the structure and content of programs that use peer support to focus on the benefits of and the motivation for participating in the program.
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Affiliation(s)
- Adati Tarfa
- grid.14003.360000 0001 2167 3675University of Wisconsin School of Pharmacy, Madison, WI USA
| | - Jenna Nordin
- grid.14003.360000 0001 2167 3675University of Wisconsin School of Pharmacy, Madison, WI USA
| | - Mattigan Mott
- grid.14003.360000 0001 2167 3675University of Wisconsin School of Pharmacy, Madison, WI USA
| | - Martha Maurer
- grid.14003.360000 0001 2167 3675University of Wisconsin School of Pharmacy, Madison, WI USA
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Lee S, Niakosari Hadidi N, Lindgren BR, Kelley R, Lindquist R. Peer Group Support Intervention to Reduce Cardiovascular Disease Risk for African American Men According to Life's Simple 7 in Faith-Based Communities. Res Theory Nurs Pract 2022; 36:RTNP-2021-0111.R1. [PMID: 35705256 DOI: 10.1891/rtnp-2021-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Adverse cardiovascular health disparities persist for African American men. Although changing health behaviors is perhaps one of the most effective methods to prevent cardiovascular disease (CVD)-related deaths, previous behavior change programs targeting single or multiple CVD risk factors in target groups have had mixed success. The purpose of this pilot study was to determine whether a multi-faceted peer group intervention model based on American Heart Association's Life's Simple 7 was feasible, safe, acceptable, and efficacious in producing meaningful risk reduction for African American men. METHODS A convenience sample of 24 African American men with at least one CVD risk factor participated quasi-experimental study having peer intervention vs. nonequivalent comparison groups, with pretest-posttests at two church sites in Minneapolis, MN (MPLS) and Washington, D.C. (DC). Feasibility, safety, acceptability, and potential efficacy were assessed by examining completion of peer group sessions, adverse events, attendance, attrition, within and between-group changes in measures using nonparametric statistics. RESULTS All twenty-four men completed the study with no study-related adverse symptoms and medical events. The peer groups had moderate to high attendance, and the peer program evaluation was highly positive among participants. Between baseline and 6-months, there were significant differences between the intervention and the comparison group in cholesterol levels and weights (p = .041, p = .034, respectively) at one site (DC). There were no significant between-group changes at the other site (MPLS). IMPLICATION FOR PRACTICE The multi-faceted peer support intervention was feasible, acceptable, and shown to have potential efficacy to reduce CVD risk for highly motivated African American men. Future studies with a larger sample size are needed to test the effectiveness of this intervention model to reduce CVD risk among African American men.
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Affiliation(s)
- Sohye Lee
- Assistant Professor, University of Memphis, Loewenberg College of Nursing, 4055 North Park Loop, Memphis, TN 38152, USA
| | - Niloufar Niakosari Hadidi
- Associate Professor, University of Minnesota, School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Bruce R Lindgren
- Senior Biostatistician, University of Minnesota, Masonic Cancer Center, 425 E River Pkwy, Minneapolis, MN 55455, USA
| | | | - Ruth Lindquist
- Professor Emeritus, University of Minnesota, School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE,, Minneapolis, MN 55455, USA
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Heisler M, Kullgren J, Richardson C, Stoll S, Alvarado Nieves C, Wiley D, Sedgwick T, Adams A, Hedderson M, Kim E, Rao M, Schmittdiel JA. Study protocol: Using peer support to aid in prevention and treatment in prediabetes (UPSTART). Contemp Clin Trials 2020; 95:106048. [PMID: 32497783 PMCID: PMC8059966 DOI: 10.1016/j.cct.2020.106048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is an urgent need to develop and evaluate effective and scalable interventions to prevent or delay the onset of type 2 diabetes mellitus (T2DM). METHODS In this randomized controlled pragmatic trial, 296 adults with prediabetes will be randomized to either a peer support arm or enhanced usual care. Participants in the peer support arm meet face-to-face initially with a trained peer coach who also is a patient at the same health center to receive information on locally available wellness and diabetes prevention programs, discuss behavioral goals related to diabetes prevention, and develop an action plan for the next week to meet their goals. Over six months, peer coaches call their assigned participants weekly to provide support for weekly action steps. In the final 6 months, coaches call participants at least once monthly. Participants in the enhanced usual care arm receive information on local resources and periodic updates on available diabetes prevention programs and resources. Changes in A1c, weight, waist circumference and other patient-centered outcomes and mediators and moderators of intervention effects will be assessed. RESULTS At least 296 participants and approximately 75 peer supporters will be enrolled. DISCUSSION Despite evidence that healthy lifestyle interventions can improve health behaviors and reduce risk for T2DM, engagement in recommended behavior change is low. This is especially true among racial and ethnic minority and low-income adults. Regular outreach and ongoing support from a peer coach may help participants to initiate and sustain healthy behavior changes to reduce their risk of diabetes. TRIAL REGISTRATION The ClinicalTrials.gov registration number is NCT03689530.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America.
| | - Jeffrey Kullgren
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States of America; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States of America.
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Shelley Stoll
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Cristina Alvarado Nieves
- University of Michigan, Department of Internal Medicine- Metabolism, Endocrinology and Diabetes, United States of America.
| | - Deanne Wiley
- Kaiser Permanente Northern California, United States of America.
| | - Tali Sedgwick
- Kaiser Permanente Northern California Division of Research, United States of America.
| | - Alyce Adams
- Kaiser Permanente Northern California, United States of America.
| | | | - Eileen Kim
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Megan Rao
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Julie A Schmittdiel
- Kaiser Permanente Northern California Division of Research, United States of America.
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Matthias MS, Daggy J, Ofner S, McGuire AB, Kukla M, Bair MJ. Exploring peer coaches' outcomes: Findings from a clinical trial of patients with chronic pain. PATIENT EDUCATION AND COUNSELING 2020; 103:1366-1372. [PMID: 32044190 DOI: 10.1016/j.pec.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/08/2020] [Accepted: 02/04/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Although peer coaching can help patients manage chronic conditions, few studies have evaluated the effects of peer coaching on coaches, and no studies have systematically examined these effects in the context of chronic pain coaching. METHODS Peer coach outcomes were assessed as part of a randomized trial of peer coaching for chronic pain. In this exploratory analysis, linear mixed models were used to evaluate changes in peer coaches' pain and related outcomes from baseline to 6 and 9 months. The Šidák method was used to account for multiple comparisons. RESULTS Peer coaches (N = 55) experienced statistically significant increases in anxiety and pain catastrophizing from baseline to 6 months, which were no longer significant after adjustment. All other changes were not statistically significant. CONCLUSIONS Despite prior studies suggesting that peer coaches benefit from serving as a coach, the current study failed to support that conclusion. PRACTICE IMPLICATIONS Peer coaching remains a promising model, with high potential for implementation, for a number of chronic conditions requiring self-management. However, to maximize the benefits of such interventions, it is essential to monitor both those being coached and the coaches themselves, and not to assume that serving as a coach is inherently beneficial.
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Affiliation(s)
- Marianne S Matthias
- US Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA; Department of Communication Studies, Indiana University-Purdue University, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Joanne Daggy
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Susan Ofner
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alan B McGuire
- US Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Marina Kukla
- US Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Matthew J Bair
- US Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Volunteers' experiences of providing telephone-based breast-feeding peer support in the RUBY randomised controlled trial. Public Health Nutr 2020; 23:3005-3015. [PMID: 32600489 DOI: 10.1017/s136898002000124x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Ringing Up About Breastfeeding earlY (RUBY) randomised controlled trial (RCT) found that a telephone-based peer volunteer support intervention increased breast-feeding duration in a setting with high breast-feeding initiation. This sub-study of the RUBY RCT describes the motivation, preparation and experiences of volunteers who provided the peer support intervention. DESIGN An online survey was completed by 154 (67 %) volunteers after ceasing volunteering. SETTING Volunteers provided peer support to primiparous women (n 574) who birthed at one of three public hospitals in Melbourne, Australia, between February 2013 and December 2015. PARTICIPANTS Volunteers (n 230) had themselves breastfed for at least 6 months and received 4 h of training for the role. RESULTS The median number of mothers supported was two (range 1-11), and two-thirds of respondents supported at least one mother for 6 months. Volunteers were motivated by a strong desire to support new mothers to establish and continue breast-feeding. Most (93 %) considered the training session adequate. The majority (60 %) reported following the call schedule 'most of the time', but many commented that 'it depends on the mother'. Overall, 84 % of volunteers were satisfied with the role and reported that the experience was enjoyable (85 %) and worthwhile (90 %). Volunteers agreed that telephone support for breast-feeding was valued by women (88 %) and that the programme would be effective in helping women to breastfeed (93 %). CONCLUSIONS These findings are important for those developing similar peer support programmes in which recruiting volunteers and developing training requirements are an integral and recurrent part of volunteer management.
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Islam SJ, Kim JH, Topel M, Liu C, Ko YA, Mujahid MS, Sims M, Mubasher M, Ejaz K, Morgan-Billingslea J, Jones K, Waller EK, Jones D, Uppal K, Dunbar SB, Pemu P, Vaccarino V, Searles CD, Baltrus P, Lewis TT, Quyyumi AA, Taylor H. Cardiovascular Risk and Resilience Among Black Adults: Rationale and Design of the MECA Study. J Am Heart Assoc 2020; 9:e015247. [PMID: 32340530 PMCID: PMC7428584 DOI: 10.1161/jaha.119.015247] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Cardiovascular disease incidence, prevalence, morbidity, and mortality have declined in the past several decades; however, disparities persist among subsets of the population. Notably, blacks have not experienced the same improvements on the whole as whites. Furthermore, frequent reports of relatively poorer health statistics among the black population have led to a broad assumption that black race reliably predicts relatively poorer health outcomes. However, substantial intraethnic and intraracial heterogeneity exists; moreover, individuals with similar risk factors and environmental exposures are often known to experience vastly different cardiovascular health outcomes. Thus, some individuals have good outcomes even in the presence of cardiovascular risk factors, a concept known as resilience. Methods and Results The MECA (Morehouse‐Emory Center for Health Equity) Study was designed to investigate the multilevel exposures that contribute to “resilience” in the face of risk for poor cardiovascular health among blacks in the greater Atlanta, GA, metropolitan area. We used census tract data to determine “at‐risk” and “resilient” neighborhoods with high or low prevalence of cardiovascular morbidity and mortality, based on cardiovascular death, hospitalization, and emergency department visits for blacks. More than 1400 individuals from these census tracts assented to demographic, health, and psychosocial questionnaires administered through telephone surveys. Afterwards, ≈500 individuals were recruited to enroll in a clinical study, where risk biomarkers, such as oxidative stress, and inflammatory markers, endothelial progenitor cells, metabolomic and microRNA profiles, and subclinical vascular dysfunction were measured. In addition, comprehensive behavioral questionnaires were collected and ideal cardiovascular health metrics were assessed using the American Heart Association's Life Simple 7 measure. Last, 150 individuals with low Life Simple 7 were recruited and randomized to a behavioral mobile health (eHealth) plus health coach or eHealth only intervention and followed up for improvement. Conclusions The MECA Study is investigating socioenvironmental and individual behavioral measures that promote resilience to cardiovascular disease in blacks by assessing biological, functional, and molecular mechanisms. REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03308812.
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Affiliation(s)
- Shabatun J Islam
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Jeong Hwan Kim
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Matthew Topel
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Chang Liu
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Mahasin S Mujahid
- Division of Epidemiology School of Public Health University of California Berkeley CA
| | - Mario Sims
- Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Mohamed Mubasher
- Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA
| | - Kiran Ejaz
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Jan Morgan-Billingslea
- Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA
| | - Kia Jones
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Edmund K Waller
- Department of Hematology and Oncology Winship Cancer Institute Emory University School of Medicine Atlanta GA
| | - Dean Jones
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine Department of Medicine Emory University School of Medicine Atlanta GA
| | - Karan Uppal
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine Department of Medicine Emory University School of Medicine Atlanta GA
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta GA
| | - Priscilla Pemu
- Department of Medicine Morehouse School of Medicine Atlanta GA
| | - Viola Vaccarino
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Charles D Searles
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA.,National Center for Primary Care Morehouse School of Medicine Atlanta GA
| | - Tené T Lewis
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Arshed A Quyyumi
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Herman Taylor
- Department of Medicine Morehouse School of Medicine Atlanta GA
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Callus E, Pravettoni G. The Role of Clinical Psychology and Peer to Peer Support in the Management of Chronic Medical Conditions - A Practical Example With Adults With Congenital Heart Disease. Front Psychol 2018; 9:731. [PMID: 29899714 PMCID: PMC5989349 DOI: 10.3389/fpsyg.2018.00731] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 04/26/2018] [Indexed: 01/23/2023] Open
Abstract
Clinical psychology services and peer to peer support can both contribute in increasing the psychological wellbeing of patients with chronic medical conditions. In this perspective paper, indications are given about the provision these services for the specific case of adults with congenital heart disease. These patients are at an increased risk of psychological distress, neurocognitive deficits, and social challenges. The psychosocial characteristics and mental health treatment preferences of these patients are briefly described, followed by guidelines and indications for the implementation of clinical psychology services. The most structured peer to peer program available for this population is subsequently illustrated and finally, specific benefits and challenges when it comes to the integration of both services are reported.
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Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia s.r.l., Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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10
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Goldstein KM, Zullig LL, Oddone EZ, Andrews SM, Grewe ME, Danus S, Heisler M, Bastian LA, Voils CI. Understanding women veterans' preferences for peer support interventions to promote heart healthy behaviors: A qualitative study. Prev Med Rep 2018; 10:353-358. [PMID: 29868391 PMCID: PMC5984244 DOI: 10.1016/j.pmedr.2018.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/23/2018] [Accepted: 04/21/2018] [Indexed: 11/25/2022] Open
Abstract
Peer support may be an effective strategy to improve heart healthy behaviors among populations who have a strong communal identity, such as women veterans. Women veterans are a particularly important group to target as they are the fastest growing sub-population within the Veterans Affairs healthcare system. Our goal was to identify aspects of peer support and modalities for providing peer support that are preferred by women veterans at risk for cardiovascular disease (CVD). In 2016, we conducted 25 semi-structured individual interviews with women veterans from the Durham VA Healthcare System aged 35–64 who were at risk of CVD, defined as presence of at least one of the following: hypertension, hyperlipidemia, obesity (BMI ≥ 30), non-insulin dependent diabetes or prediabetes, or current smoking. Interview guide design and data analysis involved conventional content analysis. Important themes for effective peer partnerships included sharing a common behavior change goal, the need for trust between peers, compatibility around level of engagement, maintaining a positive attitude, and the need for accountability. Peer support interventions may prove beneficial to address the burden of common and preventable conditions such as CVD. Among women veterans, peer support interventions should account for individual preferences in peer matching and provide opportunities for peers to engage in relationship building in-person initially through trust-building activities. Women veterans endorsed peer support to promote heart healthy behaviors. Women Veterans prefer peers with similar health goals and level of engagement. Developing trust is key to facilitate emotional support with peers.
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Affiliation(s)
- Karen M Goldstein
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, USA
| | - Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA.,Department of Population Health Sciences, Duke University, 2200 West Main Street, Suite 720A, Durham, NC 27707, USA
| | - Eugene Z Oddone
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, USA
| | - Sara M Andrews
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA
| | - Mary E Grewe
- Cooperative Studies Program Epidemiology Center - Durham, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA
| | - Susanne Danus
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA
| | - Michele Heisler
- Ann Arbor VA Medical Center, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48015, USA.,University of Michigan, Institute for Healthcare Policy & Innovation, 2800 Plymouth Road, Ann Arbor, MI 48019, USA
| | - Lori A Bastian
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA.,Department of Medicine, Yale University, 330 Cedar Street, New Haven, CT 06520, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace (151), Madison, WI 53705, USA.,Department of Surgery, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, K6/100 CSC, Madison, WI 53792-1690, USA
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11
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Colón-Semenza C, Latham NK, Quintiliani LM, Ellis TD. Peer Coaching Through mHealth Targeting Physical Activity in People With Parkinson Disease: Feasibility Study. JMIR Mhealth Uhealth 2018; 6:e42. [PMID: 29449201 PMCID: PMC5832905 DOI: 10.2196/mhealth.8074] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/30/2017] [Accepted: 12/14/2017] [Indexed: 01/06/2023] Open
Abstract
Background Long-term engagement in exercise and physical activity mitigates the progression of disability and increases quality of life in people with Parkinson disease (PD). Despite this, the vast majority of individuals with PD are sedentary. There is a critical need for a feasible, safe, acceptable, and effective method to assist those with PD to engage in active lifestyles. Peer coaching through mobile health (mHealth) may be a viable approach. Objective The purpose of this study was to develop a PD-specific peer coach training program and a remote peer-mentored walking program using mHealth technology with the goal of increasing physical activity in persons with PD. We set out to examine the feasibility, safety, and acceptability of the programs along with preliminary evidence of individual-level changes in walking activity, self-efficacy, and disability in the peer mentees. Methods A peer coach training program and a remote peer-mentored walking program using mHealth was developed and tested in 10 individuals with PD. We matched physically active persons with PD (peer coaches) with sedentary persons with PD (peer mentees), resulting in 5 dyads. Using both Web-based and in-person delivery methods, we trained the peer coaches in basic knowledge of PD, exercise, active listening, and motivational interviewing. Peer coaches and mentees wore FitBit Zip activity trackers and participated in daily walking over 8 weeks. Peer dyads interacted daily via the FitBit friends mobile app and weekly via telephone calls. Feasibility was determined by examining recruitment, participation, and retention rates. Safety was assessed by monitoring adverse events during the study period. Acceptability was assessed via satisfaction surveys. Individual-level changes in physical activity were examined relative to clinically important differences. Results Four out of the 5 peer pairs used the FitBit activity tracker and friends function without difficulty. A total of 4 of the 5 pairs completed the 8 weekly phone conversations. There were no adverse events over the course of the study. All peer coaches were “satisfied” or “very satisfied” with the training program, and all participants were “satisfied” or “very satisfied” with the peer-mentored walking program. All participants would recommend this program to others with PD. Increases in average steps per day exceeding the clinically important difference occurred in 4 out of the 5 mentees. Conclusions Remote peer coaching using mHealth is feasible, safe, and acceptable for persons with PD. Peer coaching using mHealth technology may be a viable method to increase physical activity in individuals with PD. Larger controlled trials are necessary to examine the effectiveness of this approach.
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Affiliation(s)
- Cristina Colón-Semenza
- Center for Neurorehabilitation, Department of Physical Therapy & Athletic Training, College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Nancy K Latham
- Boston Claude D Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Lisa M Quintiliani
- School of Medicine, Department of Medicine, Section of General Internal Medicine, Boston University, Boston, MA, United States
| | - Terry D Ellis
- Center for Neurorehabilitation, Department of Physical Therapy & Athletic Training, College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
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12
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MacLellan J, Surey J, Abubakar I, Stagg HR, Mannell J. Using peer advocates to improve access to services among hard-to-reach populations with hepatitis C: a qualitative study of client and provider relationships. Harm Reduct J 2017; 14:76. [PMID: 29179765 PMCID: PMC5704434 DOI: 10.1186/s12954-017-0202-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/16/2017] [Indexed: 12/02/2022] Open
Abstract
Background Peer support programmes use individuals with specific experiences to improve engagement and outcomes among new clients. However, the skills and techniques used to achieve this engagement have not been mapped. This potentially restricts the development and replication of successful peer advocate models of care. This study explored how a group of peer advocates with experience of homelessness, alcohol and drug misuse made and sustained relationships with their client group. For the purposes of this project, the client group were located among a hepatitis C-positive cohort of people who have a history of injecting drug use and homelessness. Methods Five self-selecting advocates gave a narrative interview lasting 40–90 min. These interviews were double transcribed using both thematic analysis and narrative analysis in order to triangulate the data and provide a robust set of findings about the unique skills of peer advocates in creating and sustaining relationships with clients from hard-to-reach populations. Results Peer advocates build rapport with clients through disclosing personal details about their lives. While this runs counter to assumptions about the need to maintain distance in client-patient relationships, the therapeutic benefits appear to outweigh the potential costs of this engagement. Conclusion We conclude the therapeutic benefits of self-disclosure between peer advocates and their clients offer a moral grounding for self-disclosure as a means of building relationships with key hard-to-reach populations.
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Affiliation(s)
| | - Julian Surey
- Institute for Global Health, UCL, 30 Guilford Street, London, WC1N 1EH, UK
| | - Ibrahim Abubakar
- Institute for Global Health, UCL, 30 Guilford Street, London, WC1N 1EH, UK
| | - Helen R Stagg
- Institute for Global Health, UCL, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jenevieve Mannell
- Institute for Global Health, UCL, 30 Guilford Street, London, WC1N 1EH, UK.
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13
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Moore C, Westwater-Wood S, Kerry R. Academic performance and perception of learning following a peer coaching teaching and assessment strategy. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:121-130. [PMID: 26143145 DOI: 10.1007/s10459-015-9618-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 06/19/2015] [Indexed: 06/04/2023]
Abstract
Peer coaching has been associated with positive effects on learning. Specifically, these associations have been explored in complex healthcare professions. A social theory of learning has been proposed as a key component of the utility of peer coaching. Further, within the peer coaching model, assessment has been considered as an important driver. Empirical support for these dimensions of the model is lacking. To quantify assessment achievements and explore emergent attitudes and beliefs about learning related to a specific peer coaching model with integrated assessment. A longitudinal study based in a UK Higher Education Institute recorded assessment achievements and surveyed attitudes and beliefs in consecutive Year 1 undergraduate (physiotherapy) students (n = 560) between 2002 and 2012. A 6% improvement in academic achievement was demonstrated following the introduction of a peer coaching learning model. This was increased by a further 5% following the implementation of an integrated assessment. The improvement related to an overall averaged increase of one marking band. Students valued the strategy, and themes relating to the importance of social learning emerged from survey data. Peer coaching is an evidence-based teaching and learning strategy which can facilitate learning in complex subject areas. The strategy is underpinned by social learning theory which is supported by emergent student-reported attitudes.
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Affiliation(s)
- Catherine Moore
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Sarah Westwater-Wood
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Roger Kerry
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK.
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14
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Hartzler AL, Taylor MN, Park A, Griffiths T, Backonja U, McDonald DW, Wahbeh S, Brown C, Pratt W. Leveraging cues from person-generated health data for peer matching in online communities. J Am Med Inform Assoc 2016; 23:496-507. [PMID: 26911825 DOI: 10.1093/jamia/ocv175] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/26/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Online health communities offer a diverse peer support base, yet users can struggle to identify suitable peer mentors as these communities grow. To facilitate mentoring connections, we designed a peer-matching system that automatically profiles and recommends peer mentors to mentees based on person-generated health data (PGHD). This study examined the profile characteristics that mentees value when choosing a peer mentor. MATERIALS AND METHODS Through a mixed-methods user study, in which cancer patients and caregivers evaluated peer mentor recommendations, we examined the relative importance of four possible profile elements: health interests, language style, demographics, and sample posts. Playing the role of mentees, the study participants ranked mentors, then rated both the likelihood that they would hypothetically contact each mentor and the helpfulness of each profile element in helping the make that decision. We analyzed the participants' ratings with linear regression and qualitatively analyzed participants' feedback for emerging themes about choosing mentors and improving profile design. RESULTS Of the four profile elements, only sample posts were a significant predictor for the likelihood of a mentee contacting a mentor. Communication cues embedded in posts were critical for helping the participants choose a compatible mentor. Qualitative themes offer insight into the interpersonal characteristics that mentees sought in peer mentors, including being knowledgeable, sociable, and articulate. Additionally, the participants emphasized the need for streamlined profiles that minimize the time required to choose a mentor. CONCLUSION Peer-matching systems in online health communities offer a promising approach for leveraging PGHD to connect patients. Our findings point to interpersonal communication cues embedded in PGHD that could prove critical for building mentoring relationships among the growing membership of online health communities.
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Affiliation(s)
| | - Megan N Taylor
- Human Centered Design and Engineering, University of Washington, Seattle, USA
| | - Albert Park
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, USA
| | - Troy Griffiths
- The Information School, University of Washington, Seattle, USA
| | - Uba Backonja
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, USA
| | - David W McDonald
- Human Centered Design and Engineering, University of Washington, Seattle, USA
| | - Sam Wahbeh
- The Information School, University of Washington, Seattle, USA
| | - Cory Brown
- The Information School, University of Washington, Seattle, USA
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, USA
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Abstract
BACKGROUND The National Committee for Quality Assurance patient-centered medical home recognition program provides practices an opportunity to implement medical home activities. Understanding the costs to apply for recognition may enable practices to plan their work. METHODS Practice coaches identified 5 exemplar practices (3 pediatric and 2 family medicine practices) that received level 3 recognition. This analysis focuses on 4 that received recognition in 2011. Clinical, informatics, and administrative staff participated in 2- to 3-hour interviews. We determined the time required to develop, implement, and maintain required activities. We categorized costs as (1) nonpersonnel, (2) developmental, (3) those used to implement activities, (4) those used to maintain activities, (5) those to document the work, and (6) consultant costs. Only incremental costs were included and are presented as costs per full-time equivalent (pFTE) provider. RESULTS Practice size ranged from 2.5 to 10.5 pFTE providers, and payer mixes ranged from 7% to 43% Medicaid. There was variation in the distribution of costs by activity by practice, but the costs to apply were remarkably similar ($11,453-15,977 pFTE provider). CONCLUSION The costs to apply for 2011 recognition were noteworthy. Work to enhance care coordination and close loops were highly valued. Financial incentives were key motivators. Future efforts to minimize the burden of low-value activities could benefit practices.
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17
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MacLellan J, Surey J, Abubakar I, Stagg HR. Peer Support Workers in Health: A Qualitative Metasynthesis of Their Experiences. PLoS One 2015; 10:e0141122. [PMID: 26516780 PMCID: PMC4627791 DOI: 10.1371/journal.pone.0141122] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/05/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Peer support models, where an individual has a specific illness or lifestyle experience and supports others experiencing similar challenges, have frequently been used in different fields of healthcare to successfully engage hard-to-reach groups. Despite recognition of their value, the impact of these roles on the peer has not been systematically assessed. By synthesising the qualitative literature we sought to review such an impact, providing a foundation for designing future clinical peer models. METHODS Systematic review and qualitative metasynthesis of studies found in Medline, CINAHL or Scopus documenting peer worker experiences. RESULTS 1,528 papers were found, with 34 meeting the criteria of this study. Findings were synthesised to reveal core constructs of reframing identity through reciprocal relations and the therapeutic use of self, enhancing responsibility. CONCLUSIONS The ability of the Peer Support Worker to actively engage with other marginalised or excluded individuals based on their unique insight into their own experience supports a therapeutic model of care based on appropriately sharing their story. Our findings have key implications for maximising the effectiveness of Peer Support Workers and in contributing their perspective to the development of a therapeutic model of care.
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Affiliation(s)
- Jennifer MacLellan
- University College London, Research Department of Infection and Population Health, 4 floor Mortimer Market, off Capper Street, London, United Kingdom
| | - Julian Surey
- University College London, Research Department of Infection and Population Health, 4 floor Mortimer Market, off Capper Street, London, United Kingdom
| | - Ibrahim Abubakar
- University College London, Research Department of Infection and Population Health, 4 floor Mortimer Market, off Capper Street, London, United Kingdom
| | - Helen R. Stagg
- University College London, Research Department of Infection and Population Health, 4 floor Mortimer Market, off Capper Street, London, United Kingdom
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18
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Goldman ML, Ghorob A, Eyre SL, Bodenheimer T. How do peer coaches improve diabetes care for low-income patients?: a qualitative analysis. DIABETES EDUCATOR 2013; 39:800-10. [PMID: 24168838 DOI: 10.1177/0145721713505779] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the study was to explore the perspectives and roles of peer coaches, who are patients with diabetes trained to provide diabetes self-management support (DSMS) to other patients. METHODS A focus group and 17 qualitative semi-structured interviews were conducted with community-based peer coaches in San Francisco in order to better understand the process by which these coaches engaged with their patients. Transcripts were coded and analyzed using methods based on grounded theory to develop a theoretical model of peer coach roles. RESULTS Peer coaches play 3 principal roles in providing DSMS: advisor, supporter, and role model. While working with patients, peer coaches had different approaches to setting emotional boundaries and to allocating responsibility for implementing health behavior changes. Peer coaches were more consistent in how they sought resources from providers. Peer coaches also became empowered to better manage their own diabetes. CONCLUSION Peer coaches are a highly motivated potential workforce uniquely positioned to teach and empower patients by building trust through shared experiences. The variability in coaching styles suggests an inherent diversity among peer coaches that must be accounted for in future strategies for design, recruitment, training, and oversight of peer coaching programs.
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Affiliation(s)
- Matthew L Goldman
- The University of California Berkeley–University of California San Francisco Joint Medical Program, Berkeley, California (Mr Goldman, Dr Eyre)
| | - Amireh Ghorob
- The Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, California (Ms Ghorob, Dr Bodenheimer)
| | - Stephen L Eyre
- The University of California Berkeley–University of California San Francisco Joint Medical Program, Berkeley, California (Mr Goldman, Dr Eyre)
| | - Thomas Bodenheimer
- The Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, California (Ms Ghorob, Dr Bodenheimer)
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Turner BJ, Hollenbeak CS, Liang Y, Pandit K, Joseph S, Weiner MG. A randomized trial of peer coach and office staff support to reduce coronary heart disease risk in African-Americans with uncontrolled hypertension. J Gen Intern Med 2012; 27:1258-64. [PMID: 22570108 PMCID: PMC3445668 DOI: 10.1007/s11606-012-2095-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 02/29/2012] [Accepted: 04/12/2012] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Adopting features of the Chronic Care Model may reduce coronary heart disease risk and blood pressure in vulnerable populations. We evaluated a peer and practice team intervention on reduction in 4-year coronary heart disease risk and systolic blood pressure. DESIGN AND SUBJECTS A single blind, randomized, controlled trial in two adjacent urban university-affiliated primary care practices. Two hundred eighty African-American subjects aged 40 to 75 with uncontrolled hypertension. INTERVENTION Three monthly calls from trained peer patients with well-controlled hypertension and, on alternate months, two practice staff visits to review a personalized 4-year heart disease risk calculator and slide shows about heart disease risks. All subjects received usual physician care and brochures about healthy cooking and heart disease. MAIN MEASURES Change in 4-year coronary heart disease risk (primary) and change in systolic blood pressure, both assessed at 6 months. KEY RESULTS At baseline, the 136 intervention and 144 control subjects' mean 4-year coronary heart disease risk did not differ (intervention=5.8 % and control=6.4 %, P=0.39), and their mean systolic blood pressure was the same (140.5 mmHg, p=0.83). Endpoint data for coronary heart disease were obtained for 69 % of intervention and 82 % of control subjects. After multiple imputation for missing endpoint data, the reduction in risk among all 280 subjects favored the intervention, but was not statistically significant (difference -0.73 %, 95 % confidence interval: -1.54 % to 0.09 %, p=0.08). Among the 247 subjects with a systolic blood pressure endpoint (85 % of intervention and 91 % of control subjects), more intervention than control subjects achieved a >5 mmHg reduction (61 % versus 45 %, respectively, p=0.01). After multiple imputation, the absolute reduction in systolic blood pressure was also greater for the intervention group (difference -6.47 mmHg, 95 % confidence interval: -10.69 to -2.25, P=0.003). One patient died in each study arm. CONCLUSIONS Peer patient and office-based behavioral support for African-American patients with uncontrolled hypertension did not result in a significantly greater reduction in coronary heart disease risk but did significantly reduce systolic blood pressure.
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Affiliation(s)
- Barbara J Turner
- ReACH Center and Department of Medicine and Department of Family and Community Medicine, University of Texas Health Science Center San Antonio and University Health System, 7410 John Smith Road, Suite 1050, San Antonio, TX 78229, USA.
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