1
|
Woodard N, Chen C, Huq MR, He X, Knott CL. Prior health promotion experience and intervention outcomes in a lay health advisor intervention. HEALTH EDUCATION RESEARCH 2022; 37:266-277. [PMID: 35726480 PMCID: PMC9340964 DOI: 10.1093/her/cyac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/26/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
Training lay community members to implement health promotion interventions is an effective method to educate medically underserved populations. Some trainings are designed for individuals who already have a health-related background; however, others are developed for those with no previous health promotion experience. It is unknown whether those with backgrounds in health promotion are more effective in this role than those without. This study assessed the relationship between health promotion experience among trained community health advisors (CHAs) and their self-efficacy to implement an evidence-based cancer control intervention, as well as cancer knowledge and screening behavior outcomes among intervention participants. Data were collected from 66 trained CHAs and 269 participants in CHA-led cancer awareness and early detection workshops. CHAs reported high self-efficacy to implement the intervention independent of their health promotion experience. CHA health promotion experience was neither indicative of differences in participant colorectal or breast cancer knowledge at 12 months, nor of changes in participant-reported cancer screening. However, participant prostate cancer knowledge at 12 months was greater when taught by CHAs with previous health promotion experience (P < 0.01). Prior health promotion experience of trained health advisors may not be pivotal across all contexts, but they may affect specific knowledge outcomes.
Collapse
Affiliation(s)
| | - Chang Chen
- Department of Epidemiology and Biostatistics, University of Maryland, SPH Building, 4200 Valley Drive, Rm 2234, College Park, MD 20742-2611, USA
| | - Maisha R Huq
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, SPH Building, 4200 Valley Drive, Rm 1234, College Park, MD 20742-2611, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, University of Maryland, SPH Building, 4200 Valley Drive, Rm 2234, College Park, MD 20742-2611, USA
| | - Cheryl L Knott
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, SPH Building, 4200 Valley Drive, Rm 1234, College Park, MD 20742-2611, USA
| |
Collapse
|
2
|
El-Khayat Y, Franco N, Miller L. Community Conversations About COVID-19. Med Ref Serv Q 2022; 41:223-235. [PMID: 35980632 DOI: 10.1080/02763869.2022.2095815] [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: 10/15/2022]
Abstract
"Community Conversations About COVID-19" was a multi-group program designed to address the need for culturally sensitive health information about COVID-19 for Latinx and Native American communities. Three medical librarians worked closely with Latinx and/or Spanish-speaking promotores, also known as community health workers (CHWs), and native patient navigators (NPNs) from Native American communities in Tucson, Arizona. In addition, the librarians collaborated with second-year medical students from the University of Arizona College of Medicine - Phoenix. The focus was to train the CHWs, NPNs, and students on how to access health information resources from the National Library of Medicine, National Institutes of Health, Centers for Disease Control and Prevention, and other reliable agencies. The second segment of the program provided the opportunity for the groups to learn from each other's experiences working with health information through this pandemic, which is especially important given the fact the CHWs and NPNs live in, care for, and were brought up in these communities.
Collapse
Affiliation(s)
| | - Nora Franco
- ZSFG Library, University of California San Francisco, USA
| | - Lara Miller
- Oxford College Library, Emory University, Georgia, USA
| |
Collapse
|
3
|
Chen S, Qian D, Burström B. Shifting the Care of Type 2 Diabetes Mellitus from Hospital to Primary Health Care Institutions through an Educational Intervention for Health Care Professionals: An Example from Rural China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062076. [PMID: 32245060 PMCID: PMC7142594 DOI: 10.3390/ijerph17062076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
This study assessed the impact of an educational intervention on the knowledge, attitudes, and practice regarding Type 2 Diabetes Mellitus (T2DM) of Primary Health Care (PHC) professionals, as well as on the types of T2DM care services which they were able to provide. The intervention was carried out in collaboration with county hospitals. The study was conducted from 2015 to 2016 among 241 health care professionals in 18 township health centers and 55 village clinics in three counties in Jiangsu Province, randomly divided into an intervention group and a control group. Participants in the intervention group received professional skills training sessions and team communication and were involved in regular meetings. The control group followed the routine work plan. At one-year follow up, the diabetes knowledge score, practice score, and attitudes score were significantly higher in the intervention group than in the control group. A significantly higher proportion of health care professionals in the intervention group was able to provide services compared with the control group, for all types of services, except T2DM emergency treatment. The intervention among health care professionals in PHC had a positive impact on their professional diabetes skills, knowledge, attitudes, practices, and types of services they were able to provide, at one-year follow-up.
Collapse
Affiliation(s)
- Shaofan Chen
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, SE-17177 Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, SE-17177 Stockholm, Sweden;
- School of Health Policy and Management, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing 211166, China
- Correspondence: (S.C.); (D.Q.)
| | - Dongfu Qian
- School of Health Policy and Management, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing 211166, China
- Correspondence: (S.C.); (D.Q.)
| | - Bo Burström
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, SE-17177 Stockholm, Sweden;
- Centre for Health Policy Studies, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing 211166, China
| |
Collapse
|
4
|
Vaughn LM, Whetstone C, Boards A, Busch MD, Magnusson M, Määttä S. Partnering with insiders: A review of peer models across community-engaged research, education and social care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:769-786. [PMID: 29512217 DOI: 10.1111/hsc.12562] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
Within community-engaged research, education and social care, peer models that partner with local "insiders" are increasingly common. Peer models are composed of insider "lay" community members who often share similarities or background with a project's target population. Peers are not academically trained, but work alongside researchers and professionals to carry out specific tasks within a project, or in the truest sense of partnership, peers collaborate throughout the project from start to finish as an equal member of the team. Although peer models are used widely, the literature lacks consistency and clarity. This systematic review of literature used a qualitative thematic synthesis to examine and report how, where and why peer models have been used in research, education and social care. We examined the language and titles used to describe the peers, details of their involvement in community-engaged projects, the setting, content/topic of study, level of engagement and related benefits/outcomes of such models. Focusing on the last 10 years, we conducted a comprehensive literature search twice between September 2016 and June 2017. The search resulted in 814 articles which were assessed for eligibility. Overall, 251 articles met our inclusion criteria and were categorised into three categories: empirical (n = 115); process/descriptive (n = 93); and "about" peers (n = 43). Findings suggest that there is a wide variety of peers, titles and terminology associated with peer models. There is inconsistency in how these models are used and implemented in research studies and projects. The majority of articles used an employment peer model, while only a handful involved peers in all phases of the project. The results of this literature review contribute to understanding the use, development and evolution of peer models. We highlight potential benefits of peer models for peers, their communities and community-engaged work, and we offer recommendations for future implementation of peer models.
Collapse
Affiliation(s)
- Lisa M Vaughn
- Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Alicia Boards
- Educational and Community-Based Action Research, University of Cincinnati, Cincinnati, OH, USA
| | - Melida D Busch
- Edward L. Pratt Research Library, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Sylvia Määttä
- Department of Healthcare Improvement, Western Region, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
5
|
Molina Y, San Miguel LG, Tamayo L, Robledo C, Díaz CS, Lucio A, Coronado N, Ferrans CE. The "Empowering Latinas to Obtain Breast Cancer Screenings" study: Rationale and design. Contemp Clin Trials 2018; 71:1-8. [PMID: 29803815 DOI: 10.1016/j.cct.2018.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/08/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Latinas suffer disproportionately from breast cancer (BC) in part due to lower guideline-concordant screening. Multiple intervention approaches have been developed to promote screening through direct patient education and empowerment approaches (i.e., training community members to share BC information). This study compares the relative effects of these approaches on: 1) women's BC screening; and, 2) women's dissemination of BC information within their social networks. DESIGN/METHODS Our quasi-experimental trial is being implemented in community venues in two predominantly Latino neighborhoods in South and West Chicago. Eligible participants: 1) are female; 2) are 52-74 years old; 3) have not obtained a mammogram in the past 2 years; and, 4) have not previously participated in health-related volunteerism. Based on their geographic location, participants are assigned to one of two group-based interventions. Both interventions consist of three two-hour sessions, which includes BC early detection education. The education intervention sessions also covers BC prevention (diet, physical activity), whereas the empowerment intervention covers sharing information with family/friends, and health volunteerism. Navigation is provided for all women who wish to obtain mammograms. Primary outcomes include: 1) receipt of BC screening; and, 2) participants' dissemination of BC information. Secondary outcomes include positive changes in 1) participants' self-reported psychosocial facilitators; and, 2) social network members' BC behaviors. DISCUSSION The design of our program allows for a preliminary comparison of the effectiveness of these two approaches. This work will inform larger comparativeness trials and offers a new approach to intervention evaluation via social network analysis.
Collapse
|
6
|
Peimani M, Monjazebi F, Ghodssi-Ghassemabadi R, Nasli-Esfahani E. A peer support intervention in improving glycemic control in patients with type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2018; 101:460-466. [PMID: 29055655 DOI: 10.1016/j.pec.2017.10.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/18/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study aims to assess the effectiveness of a peer support intervention, in which patients with T2DM were provided ongoing self-management support by trained peers with diabetes directed at improving self-care behaviors, self-efficacy and life quality. METHODS In this randomized controlled trial, 200 patients referred to a diabetes specialty clinic were allocated to peer support or control group. Participants in both groups received usual education by diabetes educators. Intervention participants worked with the trained volunteer peers who encouraged participants to engage in daily self-management and to discuss and share their experiences and challenges of diabetes management. The primary outcomes were HbA1c, BMI, self-care behaviors, self-efficacy and life quality RESULTS: After 6 months, patients in the peer support group experienced a significant decline in mean A1c value (P=0.045). Also, mean diabetes self-management scores, mean self-efficacy scores and mean quality of life scores significantly improved in peer support group compared to control group (P values <0.001). CONCLUSION Peer support activities can be successfully applied in diabetes self-management, especially in areas with a shortage of professionals and economic resources. PRACTICE IMPLICATIONS Peer support strategies should be integrated into our healthcare system to meet minimum needs of people with T2DM in Iran.
Collapse
Affiliation(s)
- Maryam Peimani
- Department of Health Education & Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Monjazebi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Robabeh Ghodssi-Ghassemabadi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
7
|
Skeels SE, Pernigotti D, Houlihan BV, Belliveau T, Brody M, Zazula J, Hasiotis S, Seetharama S, Rosenblum D, Jette A. SCI peer health coach influence on self-management with peers: a qualitative analysis. Spinal Cord 2017; 55:1016-1022. [PMID: 28994415 DOI: 10.1038/sc.2017.104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A process evaluation of a clinical trial. OBJECTIVES To describe the roles fulfilled by peer health coaches (PHCs) with spinal cord injury (SCI) during a randomized controlled trial research study called 'My Care My Call', a novel telephone-based, peer-led self-management intervention for adults with chronic SCI 1+ years after injury. SETTING Connecticut and Greater Boston Area, MA, USA. METHODS Directed content analysis was used to qualitatively examine information from 504 tele-coaching calls, conducted with 42 participants with SCI, by two trained SCI PHCs. Self-management was the focus of each 6-month PHC-peer relationship. PHCs documented how and when they used the communication tools (CTs) and information delivery strategies (IDSs) they developed for the intervention. Interaction data were coded and analyzed to determine PHC roles in relation to CT and IDS utilization and application. RESULTS PHCs performed three principal roles: Role Model, Supporter, and Advisor. Role Model interactions included CTs and IDSs that allowed PHCs to share personal experiences of managing and living with an SCI, including sharing their opinions and advice when appropriate. As Supporters, PHCs used CTs and IDSs to build credible relationships based on dependability and reassuring encouragement. PHCs fulfilled the unique role of Advisor using CTs and IDSs to teach and strategize with peers about SCI self-management. CONCLUSION The SCI PHC performs a powerful, flexible role in promoting SCI self-management among peers. Analysis of PHC roles can inform the design of peer-led interventions and highlights the importance for the provision of peer mentor training.
Collapse
Affiliation(s)
- S E Skeels
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - D Pernigotti
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT, USA
| | - B V Houlihan
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - T Belliveau
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,Hospital for Special Care, New Britain, CT, USA
| | - M Brody
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - J Zazula
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - S Hasiotis
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT, USA
| | - S Seetharama
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,Hartford Hospital, Hartford, CT, USA
| | - D Rosenblum
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT, USA
| | - A Jette
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
8
|
Rashidi K, Safavi M, Yahyavi H, Farahani H. The impact of peers’ support on the hemoglobin A1C and fasting blood sugar level of patients with type 2 diabetes. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2017. [DOI: 10.1016/j.injms.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
9
|
The effectiveness of peer support in encouraging dietary behaviour change in adults: a systematic review. Proc Nutr Soc 2017. [DOI: 10.1017/s0029665117001847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
10
|
Baumann LC, Frederick N, Betty N, Jospehine E, Agatha N. A demonstration of peer support for Ugandan adults with type 2 diabetes. Int J Behav Med 2015; 22:374-83. [PMID: 24733698 DOI: 10.1007/s12529-014-9412-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND By 2030, 80% of people with diabetes will be living in developing countries. PURPOSE The purpose of this pre-post quasi-experimental study was to test the feasibility of a peer intervention to improve the following: (1) diabetes self-care behaviors, (2) glycemic control, (3) social support and emotional well-being, (4) linkages to health care providers, and (5) to assess the sustainability of the intervention 18 months later. METHOD Participants were adults with type 2 diabetes who resided in rural Uganda. Participants (n = 46) attended a 1-day diabetes education program and agreed to make weekly contacts over 4 months with each other by phone or in person to assist with daily management, provide social and emotional support, and encourage appropriate contact with health care providers. RESULTS Results indicated improvement in glycosylated hemoglobin (A1C), diastolic blood pressure, and eating behaviors. CONCLUSIONS A short-term peer support program was a feasible intervention to improve diabetes care in rural Uganda. Participants were successfully recruited and retained, and they experienced positive behavioral and physiologic outcomes. Elements of the intervention were sustained 18 months after the intervention.
Collapse
Affiliation(s)
- Linda C Baumann
- School of Nursing, University of Wisconsin-Madison, Madison, WI, 53792-2455, USA,
| | | | | | | | | |
Collapse
|
11
|
Abstract
BACKGROUND A 2.5-month diabetes education training for community health workers (CHWs) was developed, implemented, and evaluated. METHODS Training methods used included case studies, role-playing, and lectures. Exams were used throughout the training for its evaluation. Teaching was delivered by different ways: a one day American Diabetes Association (ADA) course; a five day Diabetes Self-Management Program (DSMP); Conversation Maps; and a series of seven National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) diabetes education booklets. RESULTS Qualitative and quantitative evaluative methods were used during and after the training. The CHWs' diabetes knowledge was evaluated by a pre- and post-test Diabetes Knowledge Questionnaire (DKQ). The post-test was conducted one week after completing the training. The findings showed that the diabetes knowledge of the CHWs increased. CONCLUSIONS Diabetes competencies and evaluative tools need to be developed specific for CHWs as a way to standardize all CHW diabetes trainings.
Collapse
Affiliation(s)
- Judith Aponte
- Hunter College, Hunter-Bellevue School of Nursing, New York, New York, USA
| |
Collapse
|
12
|
Goldman ML, Ghorob A, Hessler D, Yamamoto R, Thom DH, Bodenheimer T. Are Low-Income Peer Health Coaches Able to Master and Utilize Evidence-Based Health Coaching? Ann Fam Med 2015; 13 Suppl 1:S36-41. [PMID: 26304970 PMCID: PMC4648140 DOI: 10.1370/afm.1756] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE A randomized controlled trial found that patients with diabetes had lower HbA1c levels after 6 months of peer health coaching than patients who did not receive coaching. This paper explores whether the peer coaches in that trial, all low-income patients with diabetes, mastered and utilized an evidence-based health coaching training curriculum. The curriculum included 5 core features: ask-tell-ask, closing the loop, know your numbers, behavior-change action plans, and medication adherence counseling. METHODS This paper includes the results of exams administered to trainees, exit surveys performed with peer coaches who completed the study and those who dropped out, observations of peer coaches meeting with patients, and analysis of in-depth interviews with peer coaches who completed the study. RESULTS Of the 32 peer coach trainees who completed the training, 71.9% lacked a college degree; 25.0% did not graduate from high school. The 26 trainees who passed the exams attended 92.7% of training sessions compared with 80.6% for the 6 trainees who did not pass. Peer coaches who completed the study wanted to continue peer coaching work and had confidence in their abilities despite their not consistently employing the coaching techniques with their patients. Quotations describe coaches' perceptions of the training. CONCLUSIONS Of low-income patients with diabetes who completed the evidenced-based health coaching training, 81% passed written and oral exams and became effective peer health coaches, although they did not consistently use the techniques taught.
Collapse
Affiliation(s)
- Matthew L Goldman
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Amireh Ghorob
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Danielle Hessler
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Russell Yamamoto
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - David H Thom
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Thomas Bodenheimer
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| |
Collapse
|
13
|
Ku GMV, Kegels G. Integrating chronic care with primary care activities: enriching healthcare staff knowledge and skills and improving glycemic control of a cohort of people with diabetes through the First Line Diabetes Care Project in the Philippines. Glob Health Action 2014; 7:25286. [PMID: 25361726 PMCID: PMC4212076 DOI: 10.3402/gha.v7.25286] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/25/2014] [Accepted: 09/21/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study investigated the effects of integrating primary chronic care with current healthcare activities in two local government health units (LGHU) of the Philippines on knowledge and skills of the LGHU staff and clinical outcomes for people with diabetes. DESIGN Integration was accomplished through health service reorganization, (re)distribution of chronic care tasks, and training of LGHU staff. Levels of the staff's pre- and post-training diabetes knowledge and of their self-assessment of diabetes care-related skills were measured. Primary diabetes care with emphasis on self-care development was provided to a cohort of people with diabetes. Glycosylated hemoglobin (HbA1c) and obesity measures were collected prior to and one year after full project implementation. RESULTS The training workshop improved diabetes knowledge (p<0.001) and self-assessed skills (p<0.001) of the LGHU staff. Significant reductions in HbA1c (p<0.001), waist-hip ratio (p<0.001) and waist circumference (p=0.011) of the cohort were noted. Although the reduction in HbA1c was somewhat greater among those whose community-based care providers showed improvement in knowledge and self-assessed skills, the difference was not statistically significant. CONCLUSIONS Primary care for chronic conditions such as diabetes may be integrated with other healthcare activities in health services of low-to-middle-income countries such as the Philippines, utilizing pre-existing human resources for health, and may improve clinical endpoints.
Collapse
Affiliation(s)
- Grace Marie V Ku
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;
| | - Guy Kegels
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
14
|
Woodbury MG, Botros M, Kuhnke JL, Greene J. Evaluation of a peer-led self-management education programme PEP Talk: Diabetes, Healthy Feet and You. Int Wound J 2013; 10:703-11. [PMID: 26074389 PMCID: PMC7950439 DOI: 10.1111/iwj.12188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PEP (Peer Education Programme) Talk: Diabetes, Healthy Feet and You is a peer-led self-management programme developed to address the problems of growing prevalence of diabetes and its complications, and limited health care dollars. An evaluation of the programme, how it might be situated within a public health perspective and potential bridges for its implementation in communities throughout Canada and worldwide, are presented. The programme consisted of workshops that were conducted by volunteer peer leaders and health care professionals in 12 communities in 10 Canadian provinces; the volunteers were supported through monthly mentoring teleconferences, on-line tips and discussion board conversations. A web portal was developed to be used by the team, volunteers and community participants. Workshop curriculum was developed based on diabetes footcare and self-management best practise guidelines. Community participants answered pre-and post-workshop statements that indicated that learning occurred, as indicated by an increase in the number of statements answered correctly. Participants' feedback about the workshops was positive. In telephone follow-up interviews, 97% of respondents reported having changed their foot self-management behaviours. The portal was commonly used according to website visits, but not as much as expected for registration of community participants. It is recommended that this programme be made widely available and tailored to the specific needs of the communities and that further evaluation be conducted.
Collapse
Affiliation(s)
- M Gail Woodbury
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Mariam Botros
- Diabetic Foot Canada, Canadian Association of Wound Care, Toronto, ON, Canada
- Wound Healing Clinic, Women's College Hospital, Toronto, ON, Canada
| | - Janet L Kuhnke
- BSN Collaborative Program, St. Lawrence/Laurentian University's, Cornwall, ON, Canada
| | - Julie Greene
- Diabetes and Tobacco Programs, Public Health Agency of Canada, Toronto, Ontario, Canada
| |
Collapse
|
15
|
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.
Collapse
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)
| |
Collapse
|
16
|
Paul G, Keogh K, D'Eath M, Smith SM. Implementing a peer-support intervention for people with type 2 diabetes: a qualitative study. Fam Pract 2013; 30:593-603. [PMID: 23836093 DOI: 10.1093/fampra/cmt027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This qualitative study aimed to explore participants', peer supporters' and practice nurses' experience of the implementation of a peer-support intervention for people with type 2 diabetes. METHODS The study was conducted in family practice in Ireland. Participants were selected from the patients, peer supporters and practice nurses who participated in a 2-year randomized controlled trial of peer support in type 2 diabetes. The sample consisted of 6 practice nurses, 15 peer supporters and 33 intervention participants. Data were collected using focus groups and semi-structured interviews and transcribed verbatim. Key themes and concepts were identified using framework analysis. RESULTS The following themes emerged: who gets invited to be a peer supporter?; training and support for peer supporters; and peer-support meetings and challenges of delivering a peer-support programme. Recruiting peer supporters via the general practices was successful. Although some peer supporters were hesitant to participate initially, they were satisfied in their role and felt well trained and supported. Participants were overwhelmingly positive about the peer-support meetings. They welcomed the fact that the meetings were led by a peer; however, some participants reported that they would have liked occasional input from health professionals. The 'Frequently Asked Questions' element of the intervention was very popular with both participants and peer supporters. CONCLUSIONS This study revealed that it was feasible to implement a peer-support intervention in the general practice setting. Challenges of delivering such an intervention were identified, particularly in relation to meeting attendance, and should be considered in further research in the area.
Collapse
Affiliation(s)
- Gillian Paul
- Faculty of Nursing and Midwifery, Royal College of Surgeons, Dublin
| | | | | | | |
Collapse
|
17
|
Lucio RL, Zuniga GC, Seol YH, Garza N, Mier N, Trevino L. Incorporating what promotoras learn: becoming role models to effect positive change. J Community Health 2013; 37:1026-31. [PMID: 22160747 DOI: 10.1007/s10900-011-9526-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Promotoras (community health workers) play an important health promotion role and must be continuously trained, but little is known about how much of their learning they actually put into practice. This non-randomized, longitudinal study examined knowledge and home environmental outcomes of an asthma and healthy homes training offered to promotoras using a train-the-trainer model. Eighty-five promotoras received the training and pre- and post-test surveys were used to measure training outcomes. Results showed a statistically significant increase in asthma and healthy home-related knowledge (P < .001). At 12-months post-intervention, a majority of the promotoras (69%) reported they made household changes to improve their indoor environment as a result of the training. This study suggests that effective trainings can improve promotoras knowledge and behaviors for the promotion of healthy homes in the community. Further evaluation is needed to investigate whether these trainings allow promotoras to serve as role models within their communities "by educating through example" and thereby enhance their credibility as health educators.
Collapse
Affiliation(s)
- Rose L Lucio
- School of Rural Public Health, Texas A&M Health Science Center, 2101 South McColl Road, McAllen, TX 78503, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Tang TS, Funnell MM, Gillard M, Nwankwo R, Heisler M. Training peers to provide ongoing diabetes self-management support (DSMS): results from a pilot study. PATIENT EDUCATION AND COUNSELING 2011; 85:160-8. [PMID: 21292425 PMCID: PMC3783215 DOI: 10.1016/j.pec.2010.12.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 10/22/2010] [Accepted: 12/14/2010] [Indexed: 05/23/2023]
Abstract
OBJECTIVE This study determined the feasibility of training adults with diabetes to lead diabetes self-management support (DSMS) interventions, examined whether participants can achieve the criteria required for successful graduation, and assessed perceived efficacy of and satisfaction with the peer leader training (PLT) program. METHODS We recruited nine African-American adults with diabetes for a 46-h PLT pilot program conducted over 12 weeks. The program utilized multiple instructional methods, reviewed key diabetes education content areas, and provided communication, facilitation, and behavior change skills training. Participants were given three attempts to achieve the pre-established competency criteria for diabetes knowledge, empowerment-based facilitation, active listening, and self-efficacy. RESULTS On the first attempt 75%, 75%, 63%, and 75% passed diabetes knowledge, empowerment-based facilitation, active listening, and self-efficacy, respectively. Those participants who did not pass on first attempt passed on the second attempt. Participants were highly satisfied with the program length, balance between content and skills development, and preparation for leading support activities. CONCLUSION Findings suggest that it is feasible to train and graduate peer leaders with the necessary knowledge and skills to facilitate DSMS interventions. PRACTICAL IMPLICATIONS With proper training, peer support may be a viable model for translating and sustaining DSMS interventions into community-based settings.
Collapse
Affiliation(s)
- Tricia S Tang
- Department of Medical Education and the Michigan Diabetes Research and Training Center, University of Michigan Medical School, Ann Arbor, USA.
| | | | | | | | | |
Collapse
|
19
|
Tang TS, Funnell MM, Gillard M, Nwankwo R, Heisler M. The development of a pilot training program for peer leaders in diabetes: process and content. THE DIABETES EDUCATOR 2011; 37:67-77. [PMID: 21220362 PMCID: PMC4117387 DOI: 10.1177/0145721710387308] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The goal of this study is to describe the process of developing a program that trains peers to facilitate an empowerment-based diabetes self-management support intervention. METHODS To guide and advise the development process, the authors formed a peer leader training action committee. The committee was an interdisciplinary group (principal investigator, nurse-certified diabetes educators, dietitian-certified diabetes educators, nutritionist, physician, and 3 community members) that met every 3 months over a 1-year period for continuous quality improvement meetings. During meetings, the committee reviewed and supervised the curriculum development, provided feedback, and informed modifications and improvements. RESULTS The resulting peer leader training program is a 46-hour program with 2 training sessions conducted per week over a 12-week period. The competency-based training program is based on the theory of experiential learning, and it consists of 3 major components--namely, building a diabetes-related knowledge base, developing skills (communication, facilitation, and behavior change), and applying skills in experiential settings. All components are integrated within each training session using a range of instructional methods, including group brainstorming, group sharing, role-play, peer leader simulations, and group facilitation simulations. CONCLUSION Through the process described above, the authors developed a training program that equips peer leaders with the knowledge and skills to facilitate empowerment-based diabetes self-management support interventions. Future directions include conducting and evaluating the peer training program.
Collapse
Affiliation(s)
- Tricia S Tang
- The University of Michigan Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center; Department of Internal Medicine, University of Michigan Medical School and Health Behavior and Health Education, School of Public Health, Ann Arbor, Michigan
| | - Martha M Funnell
- The University of Michigan Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center; Department of Internal Medicine, University of Michigan Medical School and Health Behavior and Health Education, School of Public Health, Ann Arbor, Michigan
| | - Marylou Gillard
- The University of Michigan Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center; Department of Internal Medicine, University of Michigan Medical School and Health Behavior and Health Education, School of Public Health, Ann Arbor, Michigan
| | - Robin Nwankwo
- The University of Michigan Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center; Department of Internal Medicine, University of Michigan Medical School and Health Behavior and Health Education, School of Public Health, Ann Arbor, Michigan
| | - Michele Heisler
- The University of Michigan Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center; Department of Internal Medicine, University of Michigan Medical School and Health Behavior and Health Education, School of Public Health, Ann Arbor, Michigan
| |
Collapse
|
20
|
Biesenbach G, Bodlaj G, Sedlak M, Pieringer H, Kiesling G. Exercise program for older patients with insulin-treated type 2 diabetes: long-term effects on metabolic control and BMI. Z Gerontol Geriatr 2009; 42:465-9. [PMID: 19806293 DOI: 10.1007/s00391-009-0048-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 05/18/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Exercise is an important treatment for diabetes. In our study, we evaluated the acceptance of an exercise program and investigated the long-term effects of exercise on metabolic control and body mass index in older, insulin-treated type 2-diabetic patients. PATIENTS AND METHODS A total of 72 type 2 diabetic patients, aged >or=50 years, participated in an exercise program. At the beginning of the study and after 3 and 12 months, patients completed a questionnaire concerning current activity. Finally, the patients were divided into two groups: those with and without regular exercise. Metabolic control was compared in both groups. RESULTS Even during the first workout, blood glucose levels fell. No patient suffered from severe hypoglycemia. Motivation for regular exercise increased from 33 to 77%, decreasing slightly to 65% at 12 months. The mean HbA 1c levels were similar in both groups. However, in the exercise group no weight gain was observed in contrast to 2.5% weight gain in the other group. Moreover, insulin requirements were considerably lower in the exercise group. CONCLUSION The acceptance of regular exercise is also high in older patients with newly insulin-treated type 2 diabetes. Metabolic control was significantly improved in patients with and without regular exercise; however, in the exercise group, body weight did not increase and insulin requirements were significantly lower.
Collapse
Affiliation(s)
- G Biesenbach
- Abt. Interne 2, Allgemeines Krankenhaus Linz, Krankenhausstrasse 9, 4021, Linz, Osterreich.
| | | | | | | | | |
Collapse
|