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Leiter RE, Varas MTB, Miralda K, Muneton-Castano Y, Furtado G, Revette A, Cronin C, Soares HP, Lopez A, Hayman LL, Lindsay AC, Schrag D, Enzinger AC. Adaptation of a Multimedia Chemotherapy Educational Intervention for Latinos: Letting Patient Narratives Speak for Themselves. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1353-1362. [PMID: 36773178 PMCID: PMC10772955 DOI: 10.1007/s13187-023-02270-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
This study aims to adapt a video-based, multimedia chemotherapy educational intervention to meet the needs of US Latinos with advanced gastrointestinal malignancies. A five-step hybrid adaptation process involved (1) creating a multidisciplinary team with diverse Latino subject experts, (2) appraising the parent intervention, (3) identifying key cultural considerations from a systematic literature review and semi-structured Latino patient/caregiver interviews, (4) revising the intervention, highlighting culturally relevant themes through video interviews with Latino cancer patients, and (5) target population review with responsive revisions. We developed a suite of videos, booklets, and websites available in English and Spanish, which convey the risks and benefits of common chemotherapy regimens. After revising the English materials, we translated them into Spanish using a multi-step process. The intervention centers upon conversations with 12 Latino patients about their treatment experiences; video clips highlight culturally relevant themes (personalismo, familismo, faith, communication gaps, prognostic information preferences) identified during the third adaptation step. The adapted intervention materials included a new section on coping, and one titled "how to feel the best you can feel," which reviews principles of side effect management, self-advocacy, proactive communication, and palliative care. Ten Latinos with advanced malignancies reviewed the intervention and found it to be easily understandable, relatable, and helpful. A five-step hybrid model was successful in adapting a chemotherapy educational intervention for Latinos. Incorporation of video interviews with Latino patients enabled the authentic representation of salient cultural themes. Use of authentic patient narratives can be useful for cross-cultural intervention adaptations.
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Affiliation(s)
- Richard E Leiter
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Jimmy Fund 805A, MA, 02215, Boston, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Maria Teresa Bejarano Varas
- Department of Oncology Hospital Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Keysha Miralda
- Department of Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Grace Furtado
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Anna Revette
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christine Cronin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Heloisa P Soares
- Division of Oncology, Huntsman Cancer Institute at University of Utah, Salt Lake City, UT, USA
| | - Athalia Lopez
- Department of Patient Care Services, Brigham and Women's Hospital, Boston, MA, USA
| | - Laura L Hayman
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Ana Cristina Lindsay
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Deborah Schrag
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea C Enzinger
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Jimmy Fund 805A, MA, 02215, Boston, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Britton LE, Arcia A, Kaur G, Sontan O, Marshall CJ, George M. "A patient should not have to ask": Women's experiences of patient education about preconception care for type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2023; 112:107739. [PMID: 37094436 PMCID: PMC10399209 DOI: 10.1016/j.pec.2023.107739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To characterize perspectives and experiences regarding preconception care (PCC) patient education among women with type 2 diabetes. METHOD Descriptive, qualitative research design. Thirty-two English-speaking women with type 2 diabetes identifying as Black and/or Latina, ages 18-40 years old, participated. We conducted semi-structured interviews about PCC perspectives and experiences which we analyzed with conventional content analysis. To enhance rigor, we collected freelisting data from which we calculated salience scores. We triangulated our qualitative findings with salience scores. RESULTS We identified three themes. Our first theme concerned mismatch between women's desires for PCC counseling to be frequent in contrast with their experiences of its infrequency. Our second theme captured how women felt responsible for initiating care in the clinical encounter but uncertain about what they "should" be asking for. Our third theme characterized women's perspectives on receiving information about PCC and pregnancy planning. CONCLUSIONS Young adult women with type 2 diabetes who are Black and/or Latina welcome more education about how PCC can prevent obstetrical complications associated with diabetes, which disproportionately affect their communities. PRACTICE IMPLICATIONS Our findings provide actionable suggestions for improving acceptability and accessibility of PCC patient education in the United States where PCC awareness and uptake are low.
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Affiliation(s)
| | - Adriana Arcia
- University of San Diego, Hahn School of Nursing and Health Science, USA
| | - Guneet Kaur
- University of California Los Angeles David Geffen School of Medicine, David Geffen School of Medicine, USA
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Peer Support as Part of Scaling-Up Integrated Care in Patients with Type 2 Diabetes and Arterial Hypertension at the Primary Healthcare Level: A Study Protocol. Zdr Varst 2023. [DOI: 10.2478/sjph-2023-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
ABSTRACT
Introduction
Type 2 diabetes (T2D) and arterial hypertension (AH) are among the greatest challenges facing health systems worldwide and require comprehensive patient-centred care. The key to successful management in chronic patients is self-management support, which was found to be only weakly implemented in Slovenia. The aim of the study is to develop an evidence-based model of peer support for people with T2D and AH at the primary healthcare level in Slovenia, which could represent a potential solution for upgrading integrated care for these patients.
Methods
A prospective interventional, mixed-methods pilot study will begin by recruiting approximately 40 eligible people with T2D and AH through purposive sampling. The participants will receive structured training, led by a specialist nurse, to become trained peer supporters. Each will voluntarily share their knowledge and experience at monthly group meetings with up to 10 people with T2D and AH over a three-month period in the local community. Data will be collected through interviews and focus groups and questionnaires about socio-demographic and clinical data, knowledge about T2D and AH, participants’ quality of life, level of empowerment and acceptability of the intervention.
Expected results
The study will provide an evidence-based model for integrating peer support into the local community. It is expected that the intervention will prove feasible and acceptable with educational, psychosocial and behavioural benefits.
Conclusion
Peer support through empowerment of people with T2D and AH, family members and other informal caregivers in the local community could scale-up the integrated care continuum and contribute to sustainability of the healthcare system.
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Litchfield I, Barrett T, Hamilton-Shield JP, Moore THM, Narendran P, Redwood S, Searle A, Uday S, Wheeler J, Greenfield S. Developments in the design and delivery of self-management support for children and young people with diabetes: A narrative synthesis of systematic reviews. Diabet Med 2023; 40:e15035. [PMID: 36576331 DOI: 10.1111/dme.15035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/22/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
AIMS Facilitated self-management support programmes have become central to the treatment of chronic diseases including diabetes. For many children and young people with diabetes (CYPD), the impact on glycated haemoglobin (HbA1c ) and a range of self-management behaviours promised by these programmes remain unrealised. This warrants an appraisal of current thinking and the existing evidence to guide the development of programmes better targeted at this age group. METHODS Create a narrative review of systematic reviews produced in the last 3 years that have explored the impact on CYPD of the four key elements of self-management support programmes: education, instruction and advice including peer support; psychological counselling via a range of therapies; self-monitoring, including diaries and telemetric devices; and telecare, the technology-enabled follow-up and support by healthcare providers. RESULTS Games and gamification appear to offer a promising means of engaging and educating CYPD. Psychological interventions when delivered by trained practitioners, appear to improve HbA1c and quality of life although effect sizes were small. Technology-enabled interactive diaries can increase the frequency of self-monitoring and reduce levels of HbA1c . Telecare provided synchronously via telephone produced significant improvements in HbA1c . CONCLUSIONS The cost-effective flexibility of increasing the reliance on technology is an attractive proposition; however, there are resource implications for digital connectivity in underserved populations. The need remains to improve the understanding of which elements of each component are most effective in a particular context, and how to optimise the influence and input of families, caregivers and peers.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timothy Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Julian P Hamilton-Shield
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The Royal Hospital for Children in Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - T H M Moore
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Queen Elizabeth Hospital, Birmingham, UK
| | - Sabi Redwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aidan Searle
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Suma Uday
- Department of Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Jess Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Mullard JCR, Kawalek J, Parkin A, Rayner C, Mir G, Sivan M, Greenhalgh T. Towards evidence-based and inclusive models of peer support for long covid: A hermeneutic systematic review. Soc Sci Med 2023; 320:115669. [PMID: 36708608 PMCID: PMC9840228 DOI: 10.1016/j.socscimed.2023.115669] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/14/2022] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
Since the first wave of COVID-19 in March 2020 the number of people living with post-COVID syndrome has risen rapidly at global pace, however, questions still remain as to whether there is a hidden cohort of sufferers not accessing mainstream clinics. This group are likely to be constituted by already marginalised people at the sharp end of existing health inequalities and not accessing formal clinics. The challenge of supporting such patients includes the question of how best to organise and facilitate different forms of support. As such, we aim to examine whether peer support is a potential option for hidden or hardly reached populations of long COVID sufferers with a specific focus on the UK, though not exclusively. Through a systematic hermeneutic literature review of peer support in other conditions (57 papers), we evaluate the global potential of peer support for the ongoing needs of people living with long COVID. Through our analysis, we highlight three key peer support perspectives in healthcare reflecting particular theoretical perspectives, goals, and understandings of what is 'good health', we call these: biomedical (disease control/management), relational (intersubjective mutual support) and socio-political (advocacy, campaigning & social context). Additionally, we identify three broad models for delivering peer support: service-led, community-based and social media. Attention to power relations, social and cultural capital, and a co-design approach are key when developing peer support services for disadvantaged and underserved groups. Models from other long-term conditions suggest that peer support for long COVID can and should go beyond biomedical goals and harness the power of relational support and collective advocacy. This may be particularly important when seeking to reduce health inequalities and improve access for a potentially hidden cohort of sufferers.
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Affiliation(s)
- Jordan C R Mullard
- Durham University and University of Leeds, UK; University of Johannesburg, South Africa.
| | | | | | - Clare Rayner
- University of Leeds LOCOMOTION Patient Advisory Group (Co-Lead), UK.
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Tang TS, Afshar R, Elliott T, Kong J, Gill S. From clinic to community: A randomized controlled trial of a peer support model for adults with type 2 diabetes from specialty care settings in British Columbia. Diabet Med 2022; 39:e14931. [PMID: 36052812 DOI: 10.1111/dme.14931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/12/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022]
Abstract
AIMS To examine the impact of a 12-month peer-led diabetes self-management support intervention delivered via telephone amongst adults with type 2 diabetes (T2D) from specialty care settings in British Columbia (BC). METHODS One-hundred ninety-six adults with T2D were randomly assigned to either a 12-month Peer-Led, Empowerment-based, Approach, to Self-management Efforts in Diabetes (PLEASED) intervention or a usual care condition. PLEASED involved weekly telephone contacts from a peer leader (PL) in the first 3 months followed by bi-weekly telephone contacts in the last 9 months. Assessments were conducted at baseline, 3 and 12 months. The primary outcome was HbA1c ; secondary outcomes included diabetes distress (DD), ApoB, systolic and diastolic blood pressure (BP), body mass index, waist circumference and depressive symptoms. RESULTS No within or between group changes were observed for HbA1c at 3 or 12 months. However, amongst participants with HbA1c ≥ 69 mmol/mol (8.5%), the PLEASED group significantly lowered their HbA1c at 12 months [-11.7 mmol/mol (-1.07%); 95% CI: -20.7, -2.5 (-1.89, -0.23); p = 0.016] compared to usual care. Amongst secondary outcomes, within-group improvements in overall DD were found at 3 months (-0.21; 95% CI: -0.35, -0.08; p = 0.002) for the PLEASED group and at 12 months for both groups (PLEASED: -0.35; 95% CI: -0.49, -0.21; p < 0.001 and control: -0.33; 95% CI: -0.47, -0.19; p < 0.001), however, no between-group differences were observed. The PLEASED group improved systolic BP at 12 months (-5.4 mm Hg; 95% CI: -10.0, -0.8; p = 0.023) compared to usual care. CONCLUSIONS Participation in a peer support intervention in diabetes delivered via telephone leads to long-term improvements in HbA1c amongst high-risk adults with T2D living in BC. TRIAL REGISTRATION The study was registered on clinicaltrials.gov (NT02804620).
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Affiliation(s)
- Tricia S Tang
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rowshanak Afshar
- Department of Family Medicine, University of British Columbia, West Vancouver, British Columbia, Canada
| | - Thomas Elliott
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Kong
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina Gill
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Lu S, Leduc N, Moullec G. Type 2 diabetes peer support interventions as a complement to primary care settings in high-income nations: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:3267-3278. [PMID: 36038395 DOI: 10.1016/j.pec.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Inadequate social support make way for peer support initiatives to complement the health system delivery of diabetes self-management education programs for type 2 diabetes (T2D). This review synthesizes knowledge about T2D peer support in terms of their various models and impact, endorsement, and contextual information in high-income nations. METHODS A scoping review was conducted on published and grey literature in four electronic bibliographic databases between January 2007 to December 2021. RESULTS 76 records were included. Face-to-face self-management programs and telephone-based peer support seem the most promising modalities given the largest scientific coverage on T2D outcomes. Face-to-face self-management programs were the most preferred by ethnic minority groups. Unlike peer supporters, healthcare professionals had mixed views about T2D peer support interventions. Managers of peer support programs perceived cultural competency as a cornerstone for peer support implementation. Care must be taken in recruiting, training and retaining peer supporters for sustainable practice. CONCLUSIONS Various T2D peer support models lie at the interface between primary care and community-based settings. PRACTICE IMPLICATIONS Fostering the role of peer support beyond healthcare organizations should be encouraged to engage the hardly reached, and to leverage community support to complement the health system.
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Affiliation(s)
- Sonia Lu
- University of Montreal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Canada.
| | - Nicole Leduc
- University of Montreal, School of Public Health, Department of Health Management, Evaluation and Policy, Montreal, Canada
| | - Grégory Moullec
- University of Montreal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Canada
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Wen MJ, Maurer M, Schwerer L, Sarkarati N, Egbujor UM, Nordin J, Williams SD, Liu Y, Shiyanbola OO. Perspectives on a Novel Culturally Tailored Diabetes Self-Management Program for African Americans: A Qualitative Study of Healthcare Professionals and Organizational Leaders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12814. [PMID: 36232115 PMCID: PMC9566600 DOI: 10.3390/ijerph191912814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is an urgent need for culturally tailored diabetes self-management education to improve health outcomes in African Americans, especially given the disproportionate prevalence of diabetes and medication non-adherence. Stakeholder engagement can guide and enrich the development of these interventions by integrating content directly addressing barriers to African Americans' adherence with existing community-based diabetes self-management education programs. The aim of this study is to explore stakeholder perspectives on a novel culturally tailored diabetes self-management program for African Americans. METHODS Thirteen semi-structured individual interviews were conducted in a large Midwestern U.S. city with healthcare professionals and organizational leaders serving African American communities and/or providing diabetes education. Transcripts were analyzed using directed content analysis with the Consolidated Framework for Implementation Research and inductive content analysis. RESULTS Five overarching themes were identified: (1) fulfill needs among stakeholders, (2) creating a supportive and trusting environment to address distrust, (3) building relationships and empowering peers, (4) logistical organization barriers to program implementation and (5) challenges to program acceptance by participants. CONCLUSION Stakeholders delineated how the new culturally tailored diabetes self-management program aligned with the needs of African American patients. Perceived challenges and corresponding strategies to address barriers to participation were identified to inform program implementation and sustainability.
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Affiliation(s)
- Meng-Jung Wen
- School of Pharmacy, University of Wisconsin, Madison, WI 53705, USA
| | - Martha Maurer
- School of Pharmacy, University of Wisconsin, Madison, WI 53705, USA
| | - Luke Schwerer
- School of Pharmacy, University of Wisconsin, Madison, WI 53705, USA
| | - Nassim Sarkarati
- School of Pharmacy, University of Wisconsin, Madison, WI 53705, USA
| | | | - Jenna Nordin
- School of Pharmacy, University of Wisconsin, Madison, WI 53705, USA
| | - Sharon D. Williams
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
| | - Yao Liu
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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Price A, de Bell S, Shaw N, Bethel A, Anderson R, Coon JT. What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1264. [PMID: 36909883 PMCID: PMC9316011 DOI: 10.1002/cl2.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Peer support interventions involve people drawing on shared personal experience to help one another improve their physical or mental health, or reduce social isolation. If effective, they may also lessen the demand on health and social care services, reducing costs. However, the design and delivery of peer support varies greatly, from the targeted problem or need, the setting and mode of delivery, to the number and content of sessions. Robust evidence is essential for policymakers commissioning peer support and practitioners delivering services in health care and community settings. This map draws together evidence on different types of peer support to support the design and delivery of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent, high quality evidence on the effectiveness and cost-effectiveness of the use of peer support in health and social care. Search Methods We searched MEDLINE, seven further bibliographic databases, and Epistemonikos for systematic reviews (in October 2020), randomised controlled trials (in March 2021) and economic evaluations (in May 2021) on the effectiveness of peer support interventions in health and social care. We also conducted searches of Google Scholar, two trial registers, PROSPERO, and completed citation chasing on included studies. Selection Criteria Systematic reviews, randomised controlled trials and economic evaluations were included in the map. Included studies focused on adult populations with a defined health or social care need, were conducted in high-income countries, and published since 2015. Any measure of effectiveness was included, as was any form of peer support providing the peer had shared experience with the participant and a formalised role. Data Collection and Analysis Data were extracted on the type of peer support intervention and outcomes assessed in included studies. Standardised tools were used to assess study quality for all studies: assessing the methodological quality of systematic reviews 2 for systematic reviews; Cochrane risk of bias tool for randomised controlled trials; and consensus health economic criteria list for economic evaluations. Main Results We included 91 studies: 32 systematic reviews; 52 randomised controlled trials; and 7 economic evaluations. Whilst most included systematic reviews and economic evaluations were assessed to be of low or medium quality, the majority of randomised controlled trials were of higher quality. There were concentrations of evidence relating to different types of peer support, including education, psychological support, self-care/self-management and social support. Populations with long-term health conditions were most commonly studied. The majority of studies measured health-related indicators as outcomes; few studies assessed cost-effectiveness. Studies were unevenly distributed geographically, with most being conducted in the USA. Several gaps were evident regarding the delivery of peer support, particularly the integration of peers and professionals in delivering support and interventions of longer duration. Authors' Conclusions Although there is evidence available to inform the commissioning and delivery of peer support in health and social care, there are also clear gaps that need to be addressed to further support provision, particularly regarding cost-effectiveness. The effectiveness of peer support in different countries, with varying health and social care systems, is a priority for future research, as is the integration of peers with professionals in delivering peer support.
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Affiliation(s)
- Anna Price
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Siân de Bell
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
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Topping KJ. Peer Education and Peer Counselling for Health and Well-Being: A Review of Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106064. [PMID: 35627601 PMCID: PMC9140904 DOI: 10.3390/ijerph19106064] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023]
Abstract
Peer education and peer counselling for health and wellbeing have been recognized as complementary approaches to professional intervention for over 50 years, but it is relatively recently that research into effects has become adequate. Potentially, they have advantages in reaching where professionals cannot, but it has not been clear if that potential is fulfilled, although the measurement of effects is difficult. The present paper examines 58 narrative and systematic reviews and meta-analyses on the topic. In peer education, there were many reviews of sexual health and of HIV/AIDS interventions, followed by reviews of various medical conditions and in the context of prisons. More general reviews covered a wider field. In peer counselling, there were several reviews of breast-feeding and mental health. Many early reviews complained of the lack of evaluation; then, later reviews found knowledge gains but not behavior gains; then, still later reviews found both knowledge and behavior gains. Thus, peer education and counselling appear effective but only if organizational factors are well managed and the cultural context of the country respected. The implications for future practice, policy and research were outlined.
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12
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Höld E, Grüblbauer J, Wiesholzer M, Wewerka-Kreimel D, Stieger S, Kuschei W, Kisser P, Gützer E, Hemetek U, Ebner-Zarl A, Pripfl J. Improving glycemic control in patients with type 2 diabetes mellitus through a peer support instant messaging service intervention (DiabPeerS): study protocol for a randomized controlled trial. Trials 2022; 23:308. [PMID: 35422003 PMCID: PMC9009500 DOI: 10.1186/s13063-022-06202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/26/2022] [Indexed: 12/15/2022] Open
Abstract
Background Diabetes mellitus is one of the four priority non-communicable diseases worldwide. It can lead to serious long-term complications and produces significant costs. Due to the chronicle character of the disease, it requires continuous medical treatment and good therapy adherence of those suffering. Therefore, diabetes self-management education (DSME) (and support DSMES) plays a significant role to increase patient’s self-management capacity and improve diabetes therapy. Research indicates that these outcomes might be difficult to maintain. Consequently, effective strategies to preserve the positive effects of DSMES are needed. Preliminary results show that peer support, which means support from a person who has experiential knowledge of a specific behavior or stressor and similar characteristics as the target population, is associated with better outcomes in terms of HbA1c, cardiovascular disease risk factors or self-efficacy at a lower cost compared to standard therapy. Peer-supported instant messaging services (IMS) approaches have significant potential for diabetes management because support can be provided easily and prompt, is inexpensive, and needs less effort to attend compared to standard therapy. The major objective of the study is to analyze the impact of a peer-supported IMS intervention in addition to a standard diabetes therapy on the glycemic control of type 2 diabetic patients. Methods A total of 205 participants with type 2 diabetes mellitus will be included and randomly assigned to an intervention or control group. Both groups will receive standard therapy, but the intervention group will participate in the peer-supported IMS intervention, additionally. The duration of the intervention will last for 7 months, followed by a follow-up of 7 months. Biochemical, behavioral, and psychosocial parameters will be measured before, in the middle, and after the intervention as well as after the follow-up. Discussion Type 2 diabetes mellitus and other non-communicable diseases put healthcare systems worldwide to the test. Peer-supported IMS interventions in addition to standard therapy might be part of new and cost-effective approaches to support patients independent from time and place. Trial registration ClinicalTrials.govNCT04797429. Registered on 15 March 2021.
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Affiliation(s)
- Elisabeth Höld
- Institute of Health Sciences, St. Pölten University of Applied Sciences, St. Pölten, Austria.
| | - Johanna Grüblbauer
- Institute of Creative\Media/Technologies, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Martin Wiesholzer
- Department of Internal Medicine I, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Daniela Wewerka-Kreimel
- Bachelor Degree Program Dietetics, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Stefan Stieger
- Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Werner Kuschei
- Department of Internal Medicine I, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Philip Kisser
- Fachbereich Versorgungsmanagement 3, Austrian Health Insurance Fund, St. Pölten, Austria
| | - Elisabeth Gützer
- Fachbereich Versorgungsmanagement 3, Austrian Health Insurance Fund, St. Pölten, Austria
| | - Ursula Hemetek
- Bachelor Degree Program Dietetics, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Astrid Ebner-Zarl
- Institute of Creative\Media/Technologies, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Jürgen Pripfl
- Institute of Health Sciences, St. Pölten University of Applied Sciences, St. Pölten, Austria.,Christian Doppler Forschungsgesellschaft, Vienna, Austria
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13
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Thompson DM, Booth L, Moore D, Mathers J. Peer support for people with chronic conditions: a systematic review of reviews. BMC Health Serv Res 2022; 22:427. [PMID: 35361215 PMCID: PMC8973527 DOI: 10.1186/s12913-022-07816-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/08/2022] [Indexed: 01/23/2023] Open
Abstract
Background People with chronic conditions experience functional impairment, lower quality of life, and greater economic hardship and poverty. Social isolation and loneliness are common for people with chronic conditions, with multiple co-occurring chronic conditions predicting an increased risk of loneliness. Peer support is a socially driven intervention involving people with lived experience of a condition helping others to manage the same condition, potentially offering a sense of connectedness and purpose, and experiential knowledge to manage disease. However, it is unclear what outcomes are important to patients across the spectrum of chronic conditions, what works and for whom. The aims of this review were to (1) collate peer support intervention components, (2) collate the outcome domains used to evaluate peer support, (3) synthesise evidence of effectiveness, and (4) identify the mechanisms of effect, for people with chronic conditions. Methods A systematic review of reviews was conducted. Reviews were included if they reported on formal peer support between adults or children with one or more chronic condition. Data were analysed using narrative synthesis. Results The search identified 6222 unique publications. Thirty-one publications were eligible for inclusion. Components of peer support were organised into nine categories: social support, psychological support, practical support, empowerment, condition monitoring and treatment adherence, informational support, behavioural change, encouragement and motivation, and physical training. Fifty-five outcome domains were identified. Quality of life, and self-efficacy were the most measured outcome domains identified. Most reviews reported positive but non-significant effects. Conclusions The effectiveness of peer support is unclear and there are inconsistencies in how peers are defined, a lack of clarity in research design and intervention reporting, and widely variable outcome measurement. This review presents a range of components of peer support interventions that may be of interest to clinicians developing new support programmes. However, it is unclear precisely what components to use and with whom. Therefore, implementation of support in different clinical settings may benefit from participatory action research so that services may reflect local need. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07816-7.
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Affiliation(s)
- Dean M Thompson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | | | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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14
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Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, Lau ESH, Eliasson B, Kong APS, Ezzati M, Aguilar-Salinas CA, McGill M, Levitt NS, Ning G, So WY, Adams J, Bracco P, Forouhi NG, Gregory GA, Guo J, Hua X, Klatman EL, Magliano DJ, Ng BP, Ogilvie D, Panter J, Pavkov M, Shao H, Unwin N, White M, Wou C, Ma RCW, Schmidt MI, Ramachandran A, Seino Y, Bennett PH, Oldenburg B, Gagliardino JJ, Luk AOY, Clarke PM, Ogle GD, Davies MJ, Holman RR, Gregg EW. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet 2021; 396:2019-2082. [PMID: 33189186 DOI: 10.1016/s0140-6736(20)32374-6] [Citation(s) in RCA: 303] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/06/2020] [Accepted: 11/05/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China.
| | - Lee-Ling Lim
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Ping Zhang
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric S H Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Björn Eliasson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Endocrinology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alice P S Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council Centre for Environment and Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| | - Carlos A Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Medicine and Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Guang Ning
- Shanghai Clinical Center for Endocrine and Metabolic Disease, Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China; Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jean Adams
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paula Bracco
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Gabriel A Gregory
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jingchuan Guo
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Xinyang Hua
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emma L Klatman
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Boon-Peng Ng
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - David Ogilvie
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jenna Panter
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Meda Pavkov
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Shao
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nigel Unwin
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Martin White
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Constance Wou
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Maria I Schmidt
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India
| | - Yutaka Seino
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan; Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan
| | - Peter H Bennett
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Brian Oldenburg
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre on Implementation Research for Prevention and Control of NCDs, University of Melbourne, Melbourne, VIC, Australia
| | - Juan José Gagliardino
- Centro de Endocrinología Experimental y Aplicada, UNLP-CONICET-CICPBA, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Edward W Gregg
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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15
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The Effect of Using Peer on Self-Care, Quality of Life, and Adherence in Elderly People with Coronary Artery Disease. ScientificWorldJournal 2021; 2021:4770721. [PMID: 34916875 PMCID: PMC8669978 DOI: 10.1155/2021/4770721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Coronary artery disease is one of the most common diseases and the cause of death among elderly people. Due to the chronic nature of this disease, regular follow-up, lifestyle changes, and adherence to recommendations can reduce the complications and improve the quality of life among elderly individuals. Given the importance of using educational methods that are based on the patient's age and disease stage, the present study aimed to investigate the effect of using a peer group on self-care, adherence, and quality of life in elderly people. Method This single-blind clinical trial was conducted on 30 old patients with coronary artery disease aged 60 years in Shiraz from March to June 2021. The patients were selected using simple random sampling and were then randomly assigned to the peer education and control groups (15 participants in each group) via permuted block randomization. The patients in the peer education group received the necessary education about medications, lifestyle, daily activities, self-care, and adherence through three educational clips by educated peer. The patients in the control group received routine education using two clips by the ward nurses. The levels of self-care, adherence, and quality of life were assessed in the intervention and control groups before and one month after the intervention. Data analysis was performed by SPSS 20 software using an independent t-test, paired sample t-test, and chi-square test. P < 0.05 was considered statistically significant. Findings. The results showed no statistically significant difference between the two groups with respect to the mean scores of self-care and quality of life before the intervention (P > 0.05). Following the educational intervention, however, a statistically significant difference was found between the two groups concerning the mean scores of self-care and adherence (P < 0.05). Moreover, the mean differences between the two groups regarding the three variables were statistically significant before and after the intervention (P < 0.05). Conclusion Education based on multimedia clips by peer was effective in increasing the mean scores of self-care, adherence, and quality of life among the elderly people with coronary artery disease. Given the low cost, high effectiveness, and decrease in the nurses' workload, this method is recommended to be used alongside other methods in order to educate elderly individuals suffering from coronary artery disease.
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16
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Garner NJ, Pond M, Auckland S, Sampson M. Trained Volunteers With Type 2 Diabetes Experience Significant Health Benefits When Providing Peer Support. HEALTH EDUCATION & BEHAVIOR 2021; 49:667-679. [PMID: 34743575 DOI: 10.1177/10901981211048823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trained lay volunteers may have value in supporting lifestyle change programs in the prevention of type 2 diabetes, but the potential health benefits (or harms) experienced by these lay volunteers have not been well described. This is important, as this is an appealing model in terms of workforce planning. The aim of the prespecified quantitative study reported here, was to examine the possible health benefits or harms experienced by these trained lay volunteers with type 2 diabetes. In a large type 2 diabetes prevention program, we recruited and trained 104 lay volunteers with type 2 diabetes themselves, to act as diabetes prevention mentors and codeliver the lifestyle intervention. Mentors made motivational telephone calls to 461 participants randomized to one of the trial arms to encourage lifestyle changes. Weight, diet, physical activity, well-being, quality of life, diabetes-specific self-efficacy, and glycaemic control were measured at baseline, 12 and 24 months. Average mentor age was 62.0 years, 57 (54.8%) were male, 92 (88.5%) were overweight or obese (BMI>30 kg/m2). At 12 months, mentor dietary behaviors (fat and fiber intake) improved significantly, sedentary time spent fell significantly, and diabetes specific self-efficacy scores significantly increased. These significant improvements, with no evidence of harms, suggest lay volunteers with type 2 diabetes codelivering a lifestyle intervention, may themselves experience health benefits from volunteering.
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Affiliation(s)
- Nikki J Garner
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - Martin Pond
- University of East Anglia, Norwich, Norfolk, UK
| | - Sara Auckland
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - Mike Sampson
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK.,University of East Anglia, Norwich, Norfolk, UK
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17
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Konerding U, Redaèlli M, Ackermann K, Altin S, Appelbaum S, Biallas B, Bödecker AW, Botzenhardt S, Chermette C, Cichocki M, Dapper I, Dehnen K, Funke C, Gawlik A, Giesen L, Goetz J, Graf C, Hagen B, Heßbrügge M, Höhne PH, Kleinert J, Könnecke H, Küppers L, Kuth N, Lehmann L, Lendt C, Majjouti K, Nacak Y, Neuhausen A, Pilic L, Schneider L, Scholl M, Simic D, Sönnichsen A, Thielmann A, Van der Arend I, Vitinius F, Weltermann B, Wild D, Wilm S, Stock S. A pragmatic randomised controlled trial referring to a Personalised Self-management SUPport Programme (P-SUP) for persons enrolled in a disease management programme for type 2 diabetes mellitus and/or for coronary heart disease. Trials 2021; 22:659. [PMID: 34579783 PMCID: PMC8475316 DOI: 10.1186/s13063-021-05636-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/15/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) are two chronic diseases that cause a tremendous burden. To reduce this burden, several programmes for optimising the care for these diseases have been developed. In Germany, so-called disease management programmes (DMPs), which combine components of Disease Management and the Chronic Care Model, are applied. These DMPs have proven effective. Nevertheless, there are opportunities for improvement. Current DMPs rarely address self-management of the disease, make no use of peer support, and provide no special assistance for persons with low health literacy and/or low patient activation. The study protocol presented here is for the evaluation of a programme that addresses these possible shortcomings and can be combined with current German DMPs for T2DM and CHD. This programme consists of four components: 1) Meetings of peer support groups 2) Personalised telephone-based health coaching for patients with low literacy and/or low patient activation 3) Personalised patient feedback 4) A browser-based web portal METHODS: Study participants will be adults enrolled in a DMP for T2DM and/or CHD and living in North Rhine-Westphalia, a state of the Federal Republic of Germany. Study participants will be recruited with the assistance of their general practitioners by the end of June 2021. Evaluation will be performed as a pragmatic randomised controlled trial with one intervention group and one waiting control group. The intervention group will receive the intervention for 18 months. During this time, the waiting control group will continue with usual care and the usual measures of their DMPs. After 18 months, the waiting control group will also receive a shortened intervention. The primary outcome is number of hospital days. In addition, the effects on self-reported health-state, physical activity, nutrition, and eight different psychological variables will be investigated. Differences between values at month 18 and at the beginning will be compared to judge the effectiveness of the intervention. DISCUSSION If the intervention proves effective, it may be included into the DMPs for T2DM and CHD. TRIAL REGISTRATION The study was registered in the German Clinical Trials Registry (Deutsches Register Klinischer Studien (DRKS)) in early 2019 under the number 00020592. This registry has been affiliated with the WHO Clinical Trials Network ( https://www.drks.de/drks_web/setLocale_EN.do ) since 2008. It is based on the WHO template, but contains some additional categories for which information has to be given ( https://www.drks.de/drks_web/navigate.do?navigationId=entryfields&messageDE=Beschreibung%20der%20Eingabefelder&messageEN=Description%20of%20entry%20fields ). A release and subsequent number assignment only take place when information for all categories has been given.
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Affiliation(s)
- Uwe Konerding
- Trimberg Research Academy, University of Bamberg, D-96045 Bamberg, Germany
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, D-58448 Witten, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Karolin Ackermann
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne (Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln), Weyertal 76, 50931 Köln, Germany
| | - Sibel Altin
- General Local Health Insurance, Rheinland/Hamburg (Allgemeine Ortskrankenkasse, Rheinland/Hamburg), Kasernenstraße 61, D-40213 Düsseldorf, Germany
| | - Sebastian Appelbaum
- Trimberg Research Academy, University of Bamberg, D-96045 Bamberg, Germany
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, D-58448 Witten, Germany
| | - Bianca Biallas
- Institute of Movement Therapy and Movement-oriented Prevention and Rehabilitation, German Sport University Cologne (Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - August-Wilhelm Bödecker
- Teaching Unit of General Practice, University Hospital Cologne (Schwerpunkt Allgemeinmedizin, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Suzan Botzenhardt
- Institute of General Practice, University Duisburg-Essen (Institut für Allgemeinmedizin, Universität Duisburg-Essen), Hufelandstr. 55, D-45122 Essen, Germany
| | - Chloé Chermette
- Institute of Psychology, German Sport University Cologne (Institut für Psychologie, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - Martin Cichocki
- Department of General Practice and Family Medicine, Medical University of Vienna (Abteilung für Allgemeinmedizin und Familienmedizin, Medizinischen Universität Wien), Kinderspitalgasse 15/1.Stock, A-1090 Wien, Austria
| | - Iris Dapper
- Teaching Unit of General Practice, University Hospital Cologne (Schwerpunkt Allgemeinmedizin, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Katja Dehnen
- Institute of General Practice, University Duisburg-Essen (Institut für Allgemeinmedizin, Universität Duisburg-Essen), Hufelandstr. 55, D-45122 Essen, Germany
| | - Christian Funke
- Institute of General Practice, Heinrich Heine University Düsseldorf (Institut für Allgemeinmedizin, Heinrich-Heine-Universität Düsseldorf), Post Office Box 10 10 07, D-40001 Düsseldorf, Germany
| | - Angeli Gawlik
- Institute of Psychology, German Sport University Cologne (Institut für Psychologie, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - Lisa Giesen
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Johannes Goetz
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Christian Graf
- Barmer Health Insurance (Barmer Krankenversicherung), BARMER, Heerdter Lohweg 35, D-40549 Düsseldorf, Germany
| | - Bernd Hagen
- Central Research Institute of Ambulatory Health Care in Germany (Zentralinstitut für die Kassenärztliche Versorgung in Deutschland), Salzufer 8, D-10587 Berlin, Germany
| | - Martina Heßbrügge
- Institute of General Practice, University Duisburg-Essen (Institut für Allgemeinmedizin, Universität Duisburg-Essen), Hufelandstr. 55, D-45122 Essen, Germany
| | - Phillip Hendrick Höhne
- General Local Health Insurance, Rheinland/Hamburg (Allgemeine Ortskrankenkasse, Rheinland/Hamburg), Kasernenstraße 61, D-40213 Düsseldorf, Germany
| | - Jens Kleinert
- Institute of Psychology, German Sport University Cologne (Institut für Psychologie, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - Helene Könnecke
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Lucas Küppers
- Institute of Family Medicine and General Practice, University of Bonn (Institut für Hausarztmedizin, Universität Bonn), Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Nicole Kuth
- Teaching Area of General Practice, University Hospital RWTH Aachen (Lehrgebiet für Allgemeinmedizin Uniklinik RWTH Aachen), Pauwelsstraße 30, D-52074 Aachen, Germany
| | - Lion Lehmann
- Teaching Unit of General Practice, University Hospital Cologne (Schwerpunkt Allgemeinmedizin, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Claas Lendt
- Institute of Movement Therapy and Movement-oriented Prevention and Rehabilitation, German Sport University Cologne (Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - Khalid Majjouti
- Institute of Family Medicine and General Practice, University of Bonn (Institut für Hausarztmedizin, Universität Bonn), Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Yeliz Nacak
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne (Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln), Weyertal 76, 50931 Köln, Germany
| | - Aliza Neuhausen
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne (Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln), Weyertal 76, 50931 Köln, Germany
| | - Larisa Pilic
- Teaching Unit of General Practice, University Hospital Cologne (Schwerpunkt Allgemeinmedizin, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Lara Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne (Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln), Weyertal 76, 50931 Köln, Germany
| | - Maximilian Scholl
- Institute of Movement Therapy and Movement-oriented Prevention and Rehabilitation, German Sport University Cologne (Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - Dusan Simic
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Medical University of Vienna (Abteilung für Allgemeinmedizin und Familienmedizin, Medizinischen Universität Wien), Kinderspitalgasse 15/1.Stock, A-1090 Wien, Austria
| | - Anika Thielmann
- Institute of Family Medicine and General Practice, University of Bonn (Institut für Hausarztmedizin, Universität Bonn), Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Ines Van der Arend
- Teaching Area of General Practice, University Hospital RWTH Aachen (Lehrgebiet für Allgemeinmedizin Uniklinik RWTH Aachen), Pauwelsstraße 30, D-52074 Aachen, Germany
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne (Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln), Weyertal 76, 50931 Köln, Germany
| | - Birgitta Weltermann
- Institute of Family Medicine and General Practice, University of Bonn (Institut für Hausarztmedizin, Universität Bonn), Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Dorothea Wild
- Institute of Family Medicine and General Practice, University of Bonn (Institut für Hausarztmedizin, Universität Bonn), Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Stefan Wilm
- Institute of General Practice, Heinrich Heine University Düsseldorf (Institut für Allgemeinmedizin, Heinrich-Heine-Universität Düsseldorf), Post Office Box 10 10 07, D-40001 Düsseldorf, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
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Sampson M, Clark A, Bachmann M, Garner N, Irvine L, Howe A, Greaves C, Auckland S, Smith J, Turner J, Rea D, Rayman G, Dhatariya K, John WG, Barton G, Usher R, Ferns C, Pascale M. Effects of the Norfolk diabetes prevention lifestyle intervention (NDPS) on glycaemic control in screen-detected type 2 diabetes: a randomised controlled trial. BMC Med 2021; 19:183. [PMID: 34407811 PMCID: PMC8375190 DOI: 10.1186/s12916-021-02053-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/06/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of this trial was to test if the Norfolk Diabetes Prevention Study (NDPS) lifestyle intervention, recently shown to reduce the incidence of type 2 diabetes in high-risk groups, also improved glycaemic control in people with newly diagnosed screen-detected type 2 diabetes. METHODS We screened 12,778 participants at high risk of type 2 diabetes using a fasting plasma glucose and glycosylated haemoglobin (HbA1c). People with screen-detected type 2 diabetes were randomised in a parallel, three-arm, controlled trial with up to 46 months of follow-up, with a control arm (CON), a group-based lifestyle intervention of 6 core and up to 15 maintenance sessions (INT), or the same intervention with additional support from volunteers with type 2 diabetes trained to co-deliver the lifestyle intervention (INT-DPM). The pre-specified primary end point was mean HbA1c compared between groups at 12 months. RESULTS We randomised 432 participants (CON 149; INT 142; INT-DPM 141) with a mean (SD) age of 63.5 (10.0) years, body mass index (BMI) of 32.4 (6.4) kg/m2, and HbA1c of 52.5 (10.2) mmol/mol. The primary outcome of mean HbA1c at 12 months (CON 48.5 (9.1) mmol/mol, INT 46.5 (8.1) mmol/mol, and INT-DPM 45.6 (6.0) mmol/mol) was significantly lower in the INT-DPM arm compared to CON (adjusted difference -2.57 mmol/mol; 95% CI -4.5, -0.6; p = 0.007) but not significantly different between the INT-DPM and INT arms (-0.55 mmol/mol; 95% CI -2.46, 1.35; p = 0.57), or INT vs CON arms (-2.14 mmol/mol; 95% CI -4.33, 0.05; p = 0.07). Subgroup analyses showed the intervention had greater effect in participants < 65 years old (difference in mean HbA1c compared to CON -4.76 mmol/mol; 95% CI -7.75, -1.78 mmol/mol) than in older participants (-0.46 mmol/mol; 95% CI -2.67, 1.75; interaction p = 0.02). This effect was most significant in the INT-DPM arm (-6.01 mmol/mol; 95% CI -9.56, -2.46 age < 65 years old and -0.22 mmol/mol; 95% CI -2.7, 2.25; aged > 65 years old; p = 0.007). The use of oral hypoglycaemic medication was associated with a significantly lower mean HbA1c but only within the INT-DPM arm compared to CON (-7.0 mmol/mol; 95% CI -11.5, -2.5; p = 0.003). CONCLUSION The NDPS lifestyle intervention significantly improved glycaemic control after 12 months in people with screen-detected type 2 diabetes when supported by trained peer mentors with type 2 diabetes, particularly those receiving oral hypoglycaemics and those under 65 years old. The effect size was modest, however, and not sustained at 24 months. TRIAL REGISTRATION ISRCTN34805606 . Retrospectively registered 14.4.16.
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Affiliation(s)
- Michael Sampson
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK.
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Max Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nikki Garner
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Lisa Irvine
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Colin Greaves
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Sara Auckland
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Jane Smith
- University of Exeter Medical School, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Jeremy Turner
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Dave Rea
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Gerry Rayman
- Department of Diabetes and Endocrinology, Ipswich General Hospital NHS Trust, Ipswich, UK
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - W Garry John
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department Clinical Biochemistry, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Rebecca Usher
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Clare Ferns
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Melanie Pascale
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
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19
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Bagonza A, Kitutu FE, Peterson S, Mårtensson A, Mutto M, Awor P, Mukanga D, Wamani H. Effectiveness of peer-supervision on pediatric fever illness treatment among registered private drug sellers in East-Central Uganda: An interrupted time series analysis. Health Sci Rep 2021; 4:e284. [PMID: 33977166 PMCID: PMC8103081 DOI: 10.1002/hsr2.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/19/2021] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
RATIONALE AIMS AND OBJECTIVES Appropriate treatment of pediatric fever in rural areas remains a challenge and maybe partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer-supervision among drug sellers on the appropriate treatment of pneumonia symptoms, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age in the intervention (Luuka) and comparison (Buyende) districts, in East-Central Uganda. METHODS Data on pneumonia symptoms, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age was abstracted from drug shop sick child registers over a 12-month period; 6 months before and 6 months after the introduction of peer-supervision. Interrupted time series were applied to determine the effectiveness of the peer-supervision intervention on the appropriate treatment of pneumonia, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age attending drug shops in East Central Uganda. RESULTS The proportion of children treated appropriately for pneumonia symptoms was 10.84% (P < .05, CI = [1.75, 19.9]) higher, for uncomplicated malaria was 1.46% (P = .79, CI = [-10.43, 13.36]) higher, and for non-bloody diarrhea was 4.00% (P < .05, CI = [-7.95, -0.13]) lower in the intervention district than the comparison district, respectively.Post-intervention trend results showed an increase of 1.21% (P = .008, CI = [0.36, 2.05]) in the proportion appropriately treated for pneumonia symptoms, no difference in appropriate treatment for uncomplicated malaria, and a reduction of 1% (P < .06, CI = [-1.95, 0.02]) in the proportion of children appropriately treated for non-bloody diarrhea, respectively. CONCLUSIONS Peer-supervision increased the proportion of children less than 5 years of age that received appropriate treatment for pneumonia symptoms but not for uncomplicated malaria and non-bloody diarrhea. Implementation of community-level interventions to improve pediatric fever management should consider including peer-supervision among drug sellers.
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Affiliation(s)
- Arthur Bagonza
- Department of Community Health and Behavioural SciencesMakerere University College of Health Sciences, School of Public HealthKampalaUganda
| | - Freddy Eric Kitutu
- Department of Pharmacy, School of Health SciencesMakerere University College of Health SciencesKampalaUganda
| | - Stefan Peterson
- Department of Health Policy Planning and ManagementMakerere University College of Health Sciences, School of Public HealthKampalaUganda
- International Maternal and Child Health Unit, Department of Women's and Children's HealthUppsala UniversitySweden
| | - Andreas Mårtensson
- International Maternal and Child Health Unit, Department of Women's and Children's HealthUppsala UniversitySweden
| | - Milton Mutto
- Department of Disease Control and Environmental HealthMakerere University College of Health Sciences, School of Public HealthKampalaUganda
| | - Phyllis Awor
- Department of Community Health and Behavioural SciencesMakerere University College of Health Sciences, School of Public HealthKampalaUganda
| | | | - Henry Wamani
- Department of Community Health and Behavioural SciencesMakerere University College of Health Sciences, School of Public HealthKampalaUganda
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20
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Alexandre K, Campbell J, Bugnon M, Henry C, Schaub C, Serex M, Elmers J, Desrichard O, Peytremann-Bridevaux I. Factors influencing diabetes self-management in adults: an umbrella review of systematic reviews. JBI Evid Synth 2021; 19:1003-1118. [PMID: 33741836 DOI: 10.11124/jbies-20-00020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this review was to identify and describe the factors influencing diabetes self-management in adults by summarizing the available evidence concerning their types, categories, and relative importance. INTRODUCTION A wide range of factors, acting simultaneously, influence diabetes self-management and interfere with its actual application by patients. There is a variety of systematic reviews of these factors; however, a more thorough examination of their influences was lacking. INCLUSION CRITERIA Systematic reviews of qualitative or quantitative literature focusing on factors influencing adult diabetes self-management in general or on individual behaviors (ie, management of oral antidiabetic medication and insulin injections, self-monitoring of blood glucose, foot care, healthy eating, regular exercise, and smoking cessation) will be included. METHODS We performed an extensive search of 11 bibliographic databases, including gray literature, up to June 2019. Quantitative and qualitative findings were summarized separately and labeled according to their types (eg, facilitator/barrier, strength and direction of association), categories (eg, demographic, social), and frequency of occurrence. RESULTS We identified 51 types of factors within 114 systematic reviews, which mostly addressed medication-taking behavior. Thirty-two (62.7%) factors were reported in both qualitative and quantitative literature. The predominant influences were psychological factors and behavioral attributes/skills factors. The most frequently reported facilitators of diabetes self-management were motivation to diabetes self-management, a favorable attitude to diabetes self-management, knowledge about the disease, medication and behaviors associated with diabetes self-management, skills, and self-efficacy/perceived behavioral control. The predominant barriers were the presence of depression, and polypharmacy or drug regimen complexity. The demographic factor of female sex was frequently reported for its negative influence on diabetes self-management, whereas older age was a positive factor. The social/cultural and physical environment were the least-studied categories. Other factors such as social support from family, friends, or networks; interventions led by health professionals; and a strong community environment with good social services favoring diabetes self-management were reported as major facilitators of diabetes self-management. CONCLUSIONS Essential components of interventions to promote effective diabetes self-management should aim to help adults manage the effects of specific factors related to their psychological and practical self-management experience. Screening for depression, in particular, should become an integral part of the support for adult diabetes self-management, as depression is a particular obstacle to the effectiveness of diabetes self-management. Future studies should more deeply examine the influence of factors identified in the sociocultural and physical environment categories. Research should properly consider and invest efforts in strengthening social support and innovative community care approaches, including pharmacist- and nurse-led care models for encouraging and improving adult diabetes self-management. Finally, researchers should examine non-modifiable factors - age, sex, or socioeconomic status - in the light of factors from other categories in order to deepen understanding of their real-world patterns of action on adult diabetes self-management. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018084665.
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Affiliation(s)
- Ketia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Joan Campbell
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Marie Bugnon
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
| | - Cristina Henry
- Association Vaudoise d'Aide et de Soins À Domicile (AVASAD), Lausanne, Switzerland
| | - Corinne Schaub
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Magali Serex
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Jolanda Elmers
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Olivier Desrichard
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
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21
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Rawal L, Sahle BW, Smith BJ, Kanda K, Owusu-Addo E, Renzaho AMN. Lifestyle interventions for type 2 diabetes management among migrants and ethnic minorities living in industrialized countries: a systematic review and meta-analyses. BMJ Open Diabetes Res Care 2021; 9:e001924. [PMID: 33879514 PMCID: PMC8061857 DOI: 10.1136/bmjdrc-2020-001924] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/06/2021] [Accepted: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
The objective of this systematic review was to determine the effectiveness of lifestyle interventions to improve the management of type 2 diabetes mellitus (T2DM) among migrants and ethnic minorities. Major searched databases included MEDLINE (via PubMed), EMBASE (via Ovid) and CINAHL. The selection of studies and data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the meta-analysis, significant heterogeneity was detected among the studies (I2 >50%), and hence a random effects model was used. Subgroup analyses were performed to compare the effect of lifestyle interventions according to intervention approaches (peer-led vs community health workers (CHWs)-led). A total of 17 studies were included in this review which used interventions delivered by CHWs or peer supporters or combination of both. The majority of the studies assessed effectiveness of key primary (hemoglobin (HbA1c), lipids, fasting plasma glucose) and secondary outcomes (weight, body mass index, blood pressure, physical activity, alcohol consumption, tobacco smoking, food habits and healthcare utilization). Meta-analyses showed lifestyle interventions were associated with a small but statistically significant reduction in HbA1c level (-0.18%; 95% CI -0.32% to -0.04%, p=0.031). In subgroup analyses, the peer-led interventions showed relatively better HbA1c improvement than CHW-led interventions, but the difference was not statistically significant (p=0.379). Seven studies presented intervention costs, which ranged from US$131 to US$461 per participant per year. We conclude that lifestyle interventions using either CHWs or peer supporters or a combination of both have shown modest effectiveness for T2DM management among migrants of different background and origin and ethnic minorities. The evidence base is promising in terms of developing culturally appropriate, clinically sound and cost-effective intervention approaches to respond to the growing and diverse migrants and ethnic minorities affected by diabetes worldwide.
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Affiliation(s)
- Lal Rawal
- School of Health Medical and Applied Sciences, Collage of Science and Sustainability, Central Queensland University-Sydney Campus, Sydney, New South Wales, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, South Australia, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
- School of Social Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Berhe W Sahle
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research (QPS), Alfred Health Partnership, Melbourne, Victoria, Australia
| | - Ben J Smith
- Prevention and Health Promotion, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Kie Kanda
- School of Nursing and Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
| | - Ebenezer Owusu-Addo
- Bureau of Integrated Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Andre M N Renzaho
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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22
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Pienaar M, Reid M. Self-management in face-to-face peer support for adults with type 2 diabetes living in low- or middle-income countries: a systematic review. BMC Public Health 2020; 20:1834. [PMID: 33256687 PMCID: PMC7706053 DOI: 10.1186/s12889-020-09954-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Peer support has been recognised as a promising strategy to improve self-management in patients living with chronic conditions, such as Type 2 diabetes (T2D). The purpose of the review was to synthesise the best available evidence on face-to-face peer support models for adults with T2D in low and middle-income countries (LMICs). Methods We searched Medline, Cumulative Index to Nursing and Allied Health, Literature Academic Search Ultimate, PsycINFO, CAB Abstracts, Health Source: Nursing/Academic Edition, SPORTDiscus, Africa-Wide Information, MasterFILE Premier, SocINDEX, ERIC, PsycARTICLES, Open Dissertations, Communication & Mass Media Complete, Health Source-Consumer Edition and Google Scholar for the period January 2000 to December 2017. Reference list checking and contact with authors were additional sources of data. Screening of papers, critical appraisal and data extraction were carried out independently by at least two reviewers. Results From 3092 abstracts retrieved from database searches, data was extracted from 12 papers. There was no consistency in design, setting, outcomes or measurement instruments amongst the papers. The papers were associated with improvements in various clinical and behavioural outcomes. Diabetic patients and community health workers (CHWs) were identified as two common face-to-face peer support models. The recruitment and selection of diabetic patients as peer supporters focused on patients from the community, with good glycaemic control and/or leadership skills, who were recommended by healthcare professionals. Recruitment of CHWs as peer supporters was done from an existing infrastructure of CHWs in the community and, thus, selection criteria were poorly described. The training of peer supporters featured as an important component, highlighting who provided training and the duration and content covered in training. Motivational interviewing was the most common theory basis of training used in the peer support interventions. Face-to-face, group and/or individual-based peer support was often supplemented by other peer support methods. The supervision of peer supporters was generally poorly described. Conclusions The comprehensive synthesis of the best available evidence has led to new insights regarding face-to-face peer support as a self-management strategy for patients with T2D in LMICs. Face-to-face peer support may be implemented in innovative ways to improve the quality of life of patients with T2D. Trial registration PROSPERO trial registry number, CRD 42018103261. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09954-1.
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Affiliation(s)
- Melanie Pienaar
- University of Free State, 205 Nelson Mandela Drive, Park West, Bloemfontein, 9301, South Africa.
| | - Marianne Reid
- University of Free State, 205 Nelson Mandela Drive, Park West, Bloemfontein, 9301, South Africa
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23
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Seah SJ, Zheng H, Lim RBT. Efficacy of community-based self-care interventions to improve biophysical, psychosocial or behavioural outcomes among community-dwelling older adults with type 2 diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2020; 169:108411. [PMID: 32898575 DOI: 10.1016/j.diabres.2020.108411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/23/2020] [Accepted: 08/27/2020] [Indexed: 01/04/2023]
Abstract
AIMS This review assessed the efficacy of self-care interventions to improve biophysical, psychosocial or behavioural outcomes among older adults with diabetes. METHODS Computerised and manual searches were performed. A total of 18 randomised control trials were included in the review, of which eight were subsequently included in the meta-analysis. RESULTS Most studies were from the United States of America and adopted a collaborative approach with participants. The specific needs of older adults were often not considered, and there was a predominance of biophysical measures. Meta-analysis revealed that among intervention condition participants, there were improvements in HbA1c (pooled weighted mean difference (WMD) -0.33, 95%CI -0.48 to -0.17), systolic blood pressure (WMD -1.55, 95%CI -2.93 to -0.18), diastolic blood pressure (WMD -1.41 95%CI -2.08 to -0.20), triglyceride (WMD -13.25, 95%CI -23.31 to -3.20), high-density lipoprotein (WMD 2.05, 95%CI 1.04 to 3.06) and Diabetes Self-Care Activities score (mean 4.10, 95%CI 3.11 to 5.10) compared to the control group. There was no significant change for low-density lipoprotein (WMD -5.93, 95%CI -12.08 to 0.22). CONCLUSIONS While continuing to adopt a collaborative approach, future self-care interventions should incorporate psychosocial and behavioural outcomes, consider the specific needs of older adults, and focus on more ethnically diverse populations.
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Affiliation(s)
- Siang Joo Seah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore City, Singapore.
| | - Huili Zheng
- Health Promotion Board, Singapore, 3 Second Hospital Ave, Singapore 168937, Singapore City, Singapore.
| | - Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore City, Singapore.
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Bagonza A, Peterson S, Mårtensson A, Mutto M, Awor P, Kitutu F, Gibson L, Wamani H. 'I know those people will be approachable and not mistreat us': a qualitative study of inspectors and private drug sellers' views on peer supervision in rural Uganda. Global Health 2020; 16:106. [PMID: 33109214 PMCID: PMC7590471 DOI: 10.1186/s12992-020-00636-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peer supervision improves health care delivery by health workers. However, in rural Uganda, self-supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than 5 years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self-supervision currently practiced by drug sellers at district level in rural Uganda. METHODS In this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with 130 drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management. RESULTS A model with four dimensions defining an appropriate peer supervisor was developed. The dimensions included; incentives, clearly defined roles, mediation and role model peer supervisor. While all dimensions were regarded as being important, all participants interviewed agreed that incentives for peer supervisors were the most crucial. Overall, an appropriate peer supervisor was described as being exemplary to other drug sellers, operated within a defined framework, well facilitated to do their role and a good go-between drug sellers and government inspectors. CONCLUSION Four central contributions advance literature by the model developed by our study. First, the model fills a supervision gap for rural private drug sellers. Second, it highlights the need for terms of reference for peer supervisors. Third, it describes who an appropriate peer supervisor should be. Lastly, it elucidates the kind of resources needed for peer supervision.
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Affiliation(s)
- Arthur Bagonza
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
| | - Stefan Peterson
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
- Department of Women's and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
| | - Milton Mutto
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Freddy Kitutu
- Department of Pharmacy, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Linda Gibson
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Henry Wamani
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
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Love KR, Karin E, Morogo D, Toroitich F, Boit JM, Tarus A, Barasa FA, Goldstein NE, Koech M, Vedanthan R. "To Speak of Death Is to Invite It": Provider Perceptions of Palliative Care for Cardiovascular Patients in Western Kenya. J Pain Symptom Manage 2020; 60:717-724. [PMID: 32437947 DOI: 10.1016/j.jpainsymman.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/02/2023]
Abstract
CONTEXT Cardiovascular disease (CVD) is the leading cause of death globally and a significant health burden in Kenya. Despite improved outcomes in CVD, palliative care has limited implementation for CVD in low-income and middle-income countries. This may be partly because of providers' perceptions of palliative care and end-of-life decision making for patients with CVD. OBJECTIVES Our goal was to explore providers' perceptions of palliative care for CVD in Western Kenya to inform its implementation. METHODS We conducted eight focus group discussions and five key informant interviews. These were conducted by moderators using structured question guides. Qualitative analysis was performed using the constant comparative method. A coding scheme was developed and agreed on by consensus by two investigators, each of whom then independently coded each transcript. Relationships between codes were formulated, and codes were grouped into distinct themes. New codes were iteratively added with successive focus group or interview until thematic saturation was reached. RESULTS Four major themes emerged to explain the complexities of integrating of palliative care for patients with CVD in Kenya: 1) stigma of discussing death and dying, 2) mismatch between patient and clinician perceptions of disease severity, 3) the effects of poverty on care, and 4) challenges in training and practice environments. All clinicians expressed a need for integrating palliative care for patients with CVD. CONCLUSION These results suggest that attainable interventions supported by local providers can help improve CVD care and quality of life for patients living with advanced heart disease in low-resource settings worldwide.
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Affiliation(s)
- Keith R Love
- Yale New Haven Hospital, New Haven, Connecticut, USA.
| | - Elizabeth Karin
- Tacoma Family Medicine, University of Washington, Tacoma, Washington, USA
| | - Daniel Morogo
- Living Room Ministries International, Eldoret, Kenya
| | | | - Juli M Boit
- Living Room Ministries International, Eldoret, Kenya
| | - Allison Tarus
- Living Room Ministries International, Eldoret, Kenya
| | | | - Nathan E Goldstein
- The Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Myra Koech
- Department of Pediatrics, MUSOM, MUCHS, Eldoret, Kenya
| | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York, New York, USA
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Effectiveness of lay-led, group-based self-management interventions to improve glycated hemoglobin (HbA1c), self-efficacy, and emergency visit rates among adults with type 2 diabetes: A systematic review and meta-analysis. Int J Nurs Stud 2020; 113:103779. [PMID: 33080479 DOI: 10.1016/j.ijnurstu.2020.103779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Diabetes is a debilitating health condition that is rapidly increasing in prevalence globally. Diabetes self-management is known as an important aspect of diabetes care, and group-based self-management interventions led by lay leaders have been explored previously. However, the effects of such an interventional approach to improve glycated hemoglobin (HbA1c) levels, self-efficacy, and emergency visit rates among adults with type 2 diabetes remains inconclusive. OBJECTIVES To review and perform a meta-analysis systematically of the effectiveness of lay-led, group-based self-management interventions to improve HbA1c levels, self-efficacy, and frequency of emergency visit rates in adults with type 2 diabetes. METHODS A systematic literature search was conducted through the following seven databases: PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, SCOPUS, and Web of Science. Screening and assessment for risk of bias were conducted by two independent reviewers. Meta-analyses were performed for HbA1c levels, self-efficacy, and frequency of emergency visits, using RevMan 5.3 software. RESULTS Sixteen randomized controlled trials were included in this review. Meta-analyses results indicated significant effects on HbA1c (pooled MD = 0.23, 95% CI [-0.41, -0.05], p = 0.01) self-efficacy (d = 0.27; 95% CI [0.19, 0.36]; p <0.00001), and frequency of emergency visits (pooled MD = 0.15; 95% CI [-0.26, -0.05]; p = 0.004], favoring the intervention groups. However, possible publication bias was detected. Significant heterogeneity was observed for HbA1c but not for self-efficacy or frequency of emergency visits. CONCLUSIONS Possible effects of lay-led, group-based self-management interventions on improving HbA1c, self-efficacy, and frequency of emergency visits among adults with type 2 diabetes were demonstrated in this review. Although possible publication bias and heterogeneity were detected for HbA1c, the results point toward a potentially feasible and effective treatment for adults with type 2 diabetes, allowing them to manage and sustain self-care behaviors.
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Chen Z, Zhang C, Fan G. Interrelationship between Interpersonal Interaction Intensity and Health Self-Efficacy in People with Diabetes or Prediabetes on Online Diabetes Social Platforms: An In-Depth Survey in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155375. [PMID: 32722561 PMCID: PMC7432193 DOI: 10.3390/ijerph17155375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 02/05/2023]
Abstract
Objective: The peer interaction-based online model has been influential in the recent development of diabetes management. This model "extends and innovates" the traditional mode of doctor-patient guidance, transforming it into a mode in which both doctor-patient guidance and patient-patient interaction coexist; this new mode has the added advantage of offering "extended continual intervention." This study contributes to research on extending diabetes management models by investigating how patients with diabetes or prediabetes interact in online health communities, focusing on the interrelationship between self-efficacy characteristics and online participation during patient-patient interactions. Methods: In this cross-sectional study, participants with diabetes of various severities completed an electronic questionnaire, which was formulated with a revised classical scale. The questionnaire was disseminated through diabetes online health communities. Its content covered the respondent's general condition, self-evaluation of their self-efficacy, and participation in online health communities, specifically with respect to factors such as the time spent in online information each day, the number of groups joined, and the extent of interaction in diabetes online health communities, etc. The main observation indicators were the participants' self-efficacy, their extent of online participation, and the characteristics of online health communities. Descriptive statistics, chi-square test, linear trend estimation, and ordinal logistic regression were used to explore the relationship between the three indicators. Results: The self-efficacy scores ( x ¯ ± s) were 51.9 ± 9.12, and 59.1% of interviewed participants had self-efficacy scores greater than the mean. Overall, most participants (96%) considered online diabetes social platforms to be helpful. Groups differed with respect to interaction mode, which indicated that people with high self-efficacy tend to employ various modes of interaction. Participants with high self-efficacy were also more likely to live in cities (p < 0.05) and be married (p < 0.05) and tended to spend more time paying attention to group information (p < 0.05), spend more time viewing group information (p < 0.05), and have a greater degree of interaction with group members (p < 0.05). Information sources for the different grades of participants was primarily obtained from social media. Conclusion: Among people with diabetes, the frequency and intensity of online interaction might positively affect self-efficacy and, by implication, diabetes self-management. Diabetics with high self-efficacy also tend to have positive online interaction and adopt different ways of interaction. In addition, the diabetes information sources of the respondents mainly come from social networks, most of the respondents think that online social networking sites have a positive impact on diabetes self-management, which shows that social network plays an important role in diabetes information source of diabetics. However, the design of online health communities has room for improvement, specifically with respect to the provision of information that patients require. As an interesting side note, among people with diabetes or prediabetes, those who lived in urban area and were married, those who paid more attention to group information, and those who actively participated in interactions tended to have relatively high self-efficacy. The results suggest that people with diabetes have higher-quality self-care when they engage in online health community interactions; such benefits cannot be obtained from treatment in a hospital. In general, enhanced self-efficacy in people with diabetes enables them to more readily acquire diabetes-related knowledge. Online interaction with diabetics, who has the same experience, can not only get more information, but also have a sense of identity and belonging, which enhances self-efficacy and further urges them to actively participate in online interaction. Therefore, online health communities are an important supplement to the clinical treatment of diabetes mellitus and clinicians can take advantage of the educational function of online diabetes groups in their provision of tailored diabetes interventions and take into account the factors that affect the self-efficacy of diabetics (including the frequency and intensity of online interaction, age, marital status, residential area, etc.), to provide tailored diabetes interventions for diabetics. Such a use of online diabetes groups can strengthen diabetes self-management.
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Litchman ML, Oser TK, Hodgson L, Heyman M, Walker HR, Deroze P, Rinker J, Warshaw H. In-Person and Technology-Mediated Peer Support in Diabetes Care: A Systematic Review of Reviews and Gap Analysis. DIABETES EDUCATOR 2020; 46:230-241. [PMID: 32321370 DOI: 10.1177/0145721720913275] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE The purpose of this study is to report a systematic review of reviews of evidence and gaps focused on in-person and technology-mediated diabetes peer support and its impact on clinical, behavioral, and psychosocial outcomes. METHODS We conducted a systematic review of reviews in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Reviews published in English from December 1978 through December 2018 examining clinical, behavioral, and psychosocial outcomes were included. The search yielded 167 reviews that were examined for inclusion/exclusion criteria. RESULTS Nine systematic reviews and meta-analyses meeting criteria were included. Findings suggest peer support interventions can have a positive impact on clinical (A1C, blood pressure, cholesterol, weight), behavioral (diabetes knowledge, being active, healthy eating, medication management, self-management, self-efficacy, empowerment), and psychosocial (social support, health and diabetes distress, depression, quality of life) outcomes. Research gaps exist related to understanding the effects of emerging technology-mediated peer support modalities and the effects of peer support on gestational diabetes. CONCLUSION Many clinical, behavioral, and psychosocial benefits related to in-person and technology-mediated peer support exist. Diabetes care and education specialists should incorporate and recommend peer support resources for people with diabetes.
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Affiliation(s)
- Michelle L Litchman
- University of Utah College of Nursing, Salt Lake City, Utah and Utah Diabetes and Endocrinology Center, Salt Lake City, Utah
| | - Tamara K Oser
- Department of Family Medicine, University of Colorado School of Medicine, Colorado
| | | | - Mark Heyman
- Center for Diabetes and Mental Health, San Diego, California
| | | | - Phyllisa Deroze
- Department of English, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Joanne Rinker
- American Association of Diabetes Educators, Chicago, Illinois
| | - Hope Warshaw
- Hope Warshaw Associates, LLC, Asheville, North Carolina
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Hussein M, Dibaba B, Wondu Y. Factors Influencing Effectiveness of Peer Education Against Nonadherence to Antiretroviral Therapy Among Adult People Living with HIV/AIDS: A Pre-Post Intervention Study in Arsi Zone, Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:1-7. [PMID: 32021482 PMCID: PMC6957001 DOI: 10.2147/hiv.s228330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/20/2019] [Indexed: 11/23/2022]
Abstract
Background Nonadherence to antiretroviral therapy (ART) among people with HIV/AIDS can lead to drug resistance and death. Different studies have defined nonadherence, and it denotes at least one missed dose of ART within 28 days. One of the strategies to prevent nonadherence to ART could be peer education. However, published studies which test out whether or not peer education is effective for prevention of nonadherence to ART among adults living with HIV were not available. Moreover, published studies on factors discussing the success of peer education against nonadherence to ART were not available, so we conducted this study. Objectives To determine effectiveness of peer education against nonadherence to ART and identify factors influencing the effectiveness of peer education for prevention of nonadherence to ART among people living with HIV/AIDS in Arsi zone, Ethiopia. Methods An institution based pre-post intervention study was conducted. The intervention was giving peer education for three months. Frequencies and percentages were used to describe the data. Binary and multivariate logistic regressions were used to assess the variables. Results The data was collected from 355 and 319 people with HIV/AIDS at pre- and post-intervention stages, respectively. Experiencing an ART side effect, reminder to take ART, gender, marital status and monthly income were associated with nonadherence. More study participants who had not useda reminder to take ART service missed at least one dose of ART when compared to those who used a reminder to take ART service (adjusted odds ratio (AOR) =6.21; 95% CI=2.12–18.20). Conclusion Experiencing a side effect of ART influenced effectiveness of peer education negatively while using reminder to take ART influenced effectiveness positively. Peer education is effective for reduction of nonadherence to ART if it is used with reminder to take ART. This study can be a base for further studies that should be conducted in various areas, since peer education can be influenced by sociodemographic and economic factors.
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Affiliation(s)
- Mohammed Hussein
- Department of Pharmacy, College of Health Sciences, Arsi University, Asella, Oromia Regional State, Ethiopia
| | - Bekele Dibaba
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Oromia Regional State, Ethiopia
| | - Yirga Wondu
- Department of Midwifery, College of Health Sciences, Arsi University, Asella, Oromia Regional State, Ethiopia
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Warshaw H, Hodgson L, Heyman M, Oser TK, Walker HR, Deroze P, Rinker J, Litchman ML. The Role and Value of Ongoing and Peer Support in Diabetes Care and Education. DIABETES EDUCATOR 2019; 45:569-579. [PMID: 31617467 DOI: 10.1177/0145721719882007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Increasing attention is being given to the challenges and emotional toll of managing diabetes. This Perspectives in Practice details the specialty's guiding documents for initial and ongoing support. It also defines various types of social support, including peer support, for optimal diabetes care. Focusing on peer support, this paper provides a review of the body of evidence demonstrating the value of peer support to improve clinical and behavioral outcomes. To achieve positive outcomes, it is optimal for people with diabetes to have access to ongoing support from their health care provider, including diabetes care and education specialists. They should also be made aware of, and given referral to options and opportunities for peer support. This Perspectives in Practice concludes with a call to action for diabetes care and education specialists to deliver to integrate and promote the value of peer support in the care they provide. CONCLUSION Managing diabetes during the stages and ages of life is chronically challenging and complex. Various types of support offered by health care providers, including diabetes care and education specialists and others in the person's social support milieu, can positively affect emotional well-being. Health care providers should routinely assess their client's social supports and refer the person with diabetes and/or their caregivers to evidence-based types of peer support mutually determined to be of most value. Diabetes care and education specialists should increase their awareness of opportunities to integrate the value of and referral to peer support in their counseling and to gain greater insight into the diabetes-lived experience.
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Affiliation(s)
- Hope Warshaw
- Hope Warshaw Associates, LLC, Asheville, North Carolina
| | | | - Mark Heyman
- Center for Diabetes and Mental Health, San Diego, California
| | - Tamara K Oser
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Phyllisa Deroze
- Department of English, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Joanne Rinker
- American Association Diabetes Educators, Chicago, Illinois
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Coghlan N, Copley J, Aplin T, Strong J. The experience of wearing compression garments after burn injury: “On the inside it is still me”. Burns 2019; 45:1438-1446. [DOI: 10.1016/j.burns.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/27/2018] [Accepted: 08/07/2018] [Indexed: 10/26/2022]
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How to improve compression garment wear after burns: Patient and therapist perspectives. Burns 2019; 45:1447-1455. [DOI: 10.1016/j.burns.2019.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/25/2019] [Accepted: 04/16/2019] [Indexed: 11/20/2022]
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Pérez-Panero AJ, Ruiz-Muñoz M, Cuesta-Vargas AI, Gónzalez-Sánchez M. Prevention, assessment, diagnosis and management of diabetic foot based on clinical practice guidelines: A systematic review. Medicine (Baltimore) 2019; 98:e16877. [PMID: 31464916 PMCID: PMC6736276 DOI: 10.1097/md.0000000000016877] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/26/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023] Open
Abstract
AIM Diabetic foot complications are the main reason for hospitalization and amputation in people with diabetes and have a prevalence of up to 25%. Clinical practice guidelines are recommendations based on evidence with the aim of improving health care. The main aim of this study was to carry out a systematic review of the levels of the evaluation and treatment strategies that appear in the clinical practice guidelines focus on diabetic foot or diabetes with diabetic foot section. Another objective of this study was to perform an analysis of the levels of evidence in support of the recommendations made by the selected clinical practice guidelines. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and a quality assessment by the Appraisal of Guidelines for Research and Evaluation (AGREE II) were performed. The databases checked were "NICE", "Cinahl", "Health Guide", "RNAO", "Sign", "PubMed", "Scopus" and "NCG". The search terms included were "diabetic foot", "guideline(s)", "practice guideline(s)" and "diabetes." RESULTS Twelve articles were selected after checked inclusion criteria and quality assessment. A summary and classification of the recommendations was completed. CONCLUSIONS The heterogeneity of levels of evidence and grades of recommendation of the CPGs included regarding the management, approach and treatment of DF makes it difficult to interpret and assume them in clinical practice in order to select the most correct procedures. Despite this and according to the detailed study of the guidelines included in this work, it can be concluded that the highly recommendable interventions for DF management are debridement (very high level of evidence and strongly recommended), foot evaluation (moderate level of evidence and fairly recommended) and therapeutic footwear (moderate level of evidence and fairly recommended).
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Affiliation(s)
| | | | - Antonio I. Cuesta-Vargas
- Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos 29071, Málaga, Spain
| | - Manuel Gónzalez-Sánchez
- Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos 29071, Málaga, Spain
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Kodama S, Morikawa S, Horikawa C, Ishii D, Fujihara K, Yamamoto M, Osawa T, Kitazawa M, Yamada T, Kato K, Tanaka S, Sone H. Effect of family-oriented diabetes programs on glycemic control: A meta-analysis. Fam Pract 2019; 36:387-394. [PMID: 30423118 DOI: 10.1093/fampra/cmy112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Efficacy of programs for patients with diabetes mellitus (DM) that have promoted family members to help with patients' self-care activities has been largely inconsistent. This meta-analysis aims to assess the effect of family-oriented diabetes programs for glycemic control (GC). METHODS Electronic literature searches were conducted for clinical trials with a parallel design wherein there were two groups according to whether family members were included (intervention group) or not included (control group) and changes in glycohemoglobin A1C (A1C) were assessed as a study outcome. Each effect size (i.e. difference in A1C change between the intervention and control group) was pooled with a random-effects model. RESULTS There were 31 eligible trials consisting of 1466 and 1415 patients in the intervention and control groups, respectively. Pooled A1C change [95% confidence interval (CI)] was -0.45% (-0.64% to -0.26%). Limiting analyses to 21 trials targeted at patients with type 1 DM or 9 trials targeted at patients with type 2 DM, the pooled A1C changes (95% CI) were -0.35% (-0.55% to -0.14%) and -0.71% (-1.09% to -0.33%), respectively. CONCLUSION This meta-analysis suggests that focusing on the family as well as the individual patient in self-management diabetes programs to improve the performance of self-care activities of patients with DM is effective in terms of proper GC.
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Affiliation(s)
- Satoru Kodama
- Department of Laboratory Medicine and Clinical Epidemiology for Prevention of Noncommunicable Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Sakiko Morikawa
- Department of Food Science and Dietetics, Faculty of Human Life Studies, Takushima Bunri University, Tokushima
| | - Chika Horikawa
- Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture, Niigata
| | - Dai Ishii
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Masahiko Yamamoto
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Taeko Osawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Masaru Kitazawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Takaho Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Kiminori Kato
- Department of Laboratory Medicine and Clinical Epidemiology for Prevention of Noncommunicable Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Shiro Tanaka
- Department of Clinical Trial, Design & Management, Translational Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
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Bluml BM, Kolb LE, Lipman R. Evaluating the Impact of Year-Long, Augmented Diabetes Self-Management Support. Popul Health Manag 2019; 22:522-528. [PMID: 30668228 PMCID: PMC6885759 DOI: 10.1089/pop.2018.0175] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This was a randomized controlled study to test a scalable intervention model addressing the need for ongoing diabetes support. The study included individuals receiving care in a Federally Qualified Health Center (FQHC) with HbA1c >8. The aim of this project was to determine whether augmenting diabetes self-management education (DSME) with support for an economically vulnerable population might better meet patient needs and reduce morbidity and premature mortality. The intervention utilized pre and post comparisons and was designed to test the efficacy of a telephonic diabetes support intervention to increase patient engagement in self-care and with the health care system as a means to improve clinical outcomes. There were significant improvements in HbA1c, body mass index, low-density lipoprotein cholesterol, triglycerides, and depression screening scores in the year following DSME. However, there was no statistically significant difference between the 2 groups. This randomized controlled study demonstrated that comprehensive face-to-face care with consistent assessment and documentation over time in FQHCs produce clinically significant and predictable improvement for people with diabetes. The addition of structured provision of telephonic support overlapping in time with the comprehensive face-to-face process of care in this environment did not produce statistically significant clinical or behavioral care improvement.
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Affiliation(s)
- Benjamin M Bluml
- American Pharmacists Association Foundation, Washington, District of Columbia
| | - Leslie E Kolb
- American Association of Diabetes Educators, Chicago, Illinois
| | - Ruth Lipman
- American Dental Association, Chicago, Illinois
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Peer support interventions for breast cancer patients: a systematic review. Breast Cancer Res Treat 2019; 174:325-341. [PMID: 30600413 DOI: 10.1007/s10549-018-5033-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/27/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Due to the clear efficacy of peer support as a means of improving emotional well-being and healthy behaviors in a highly cost-effective manner, this program is widely used. Controversy remains, however, with regard to its efficacy in breast cancer patients. Given the heterogeneity of peer support interventions, this review aimed to categorize, assess, and synthesize the existing evidence from randomized controlled trials (RCTs) to clarify the effects of different types of peer support on breast cancer patients. METHODS We searched Pubmed, EMBase, CENTRAL, CINAHL, PsychINFO, Chinese National Knowledge Infrastructure (CNKI) and Wanfang Data for English and Chinese language RCTs. The Cochrane Collaboration 'risk of bias' tool for systematic reviews was used to assess the methodological quality of each RCT. RESULTS Of the 1494 studies screened, 15 studies met eligibility criteria for inclusion, comprising 1695 breast cancer patients. Overall, there were more positive effects than invalid or negative effects across peer interventions, with notable exceptions: unmoderated and unstructured group peer support interventions as well as Internet-based models without peer training had no effect or adverse effects on proximal and distal outcomes. However, adding other peer roles to the peer support structure or using one-on-one models could significantly improve the patients' negative emotions. Peer education showed promising effects on stress management, quality of life, and healthy behaviors. CONCLUSIONS This systematic review found that different types of peer support have different effects on outcomes for breast cancer patients. Web-based group peer support without peer training must be avoided or used with caution in the future. Peer education is recommended for breast cancer patient support models, given its excellent results and cost-effectiveness.
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Garner NJ, Pascale M, France K, Ferns C, Clark A, Auckland S, Sampson M. Recruitment, retention, and training of people with type 2 diabetes as diabetes prevention mentors (DPM) to support a healthcare professional-delivered diabetes prevention program: the Norfolk Diabetes Prevention Study (NDPS). BMJ Open Diabetes Res Care 2019; 7:e000619. [PMID: 31245004 PMCID: PMC6557468 DOI: 10.1136/bmjdrc-2018-000619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 04/21/2019] [Accepted: 04/26/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Intensive lifestyle interventions reduce the risk of type 2 diabetes in populations at highest risk, but staffing levels are usually unable to meet the challenge of delivering effective prevention strategies to a very large at-risk population. Training volunteers with existing type 2 diabetes to support healthcare professionals deliver lifestyle interventions is an attractive option. METHODS We identified 141 973 people at highest risk of diabetes in the East of England, screened 12 778, and randomized 1764 into a suite of type 2 diabetes prevention and screen detected type 2 diabetes management trials. A key element of the program tested the value of volunteers with type 2 diabetes, trained to act as diabetes prevention mentors (DPM) when added to an intervention arm delivered by healthcare professionals trained to support participant lifestyle change. RESULTS We invited 9951 people with type 2 diabetes to become DPM and 427 responded (4.3%). Of these, 356 (83.3%) were interviewed by phone, and of these 131 (36.8%) were interviewed in person. We then appointed 104 of these 131 interviewed applicants (79%) to the role (mean age 62 years, 55% (n=57) male). All DPMs volunteered for a total of 2895 months, and made 6879 telephone calls to 461 randomized participants. Seventy-six (73%) DPMs volunteered for at least 6 months and 66 (73%) for at least 1 year. DISCUSSION Individuals with type 2 diabetes can be recruited, trained and retained as DPM in large numbers to support a group-based diabetes prevention program delivered by healthcare professionals. This volunteer model is low cost, and accesses the large type 2 diabetes population that shares a lifestyle experience with the target population. This is an attractive model for supporting diabetes prevention efforts.
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Affiliation(s)
- Nikki J Garner
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Melanie Pascale
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Kalman France
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Clare Ferns
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sara Auckland
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Michael Sampson
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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Zhao X, Yu X, Zhang X. The Role of Peer Support Education Model in Management of Glucose and Lipid Levels in Patients with Type 2 Diabetes Mellitus in Chinese Adults. J Diabetes Res 2019; 2019:5634030. [PMID: 31886280 PMCID: PMC6893247 DOI: 10.1155/2019/5634030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 11/18/2022] Open
Abstract
AIMS To investigate the effect of peer support education model on the levels of glucose and lipids in patients with type 2 diabetes mellitus in China. METHODS 120 type 2 diabetes mellitus patients (T2DM) were assigned to two groups randomly from December 2016 to October 2017. Group 1 was trained on basic diabetic medical knowledge by a professional medical staff. After 8 weeks of studying, these specially trained patients then trained the patients of Group 2. RESULTS It was found that after 3 months of intervention, the levels of fasting blood glucose, triglycerides, glycosylated hemoglobin, total cholesterol, and low-density lipoprotein cholesterol were significantly decreased for the two groups (p < 0.05). However, with the prolongation of time, there were no significant changes in the two groups in the above indices (p > 0.05) after 6 months, and the result was the same after strafing sex, age, and education level. Meanwhile, there was no significant difference in decreasing glucose and lipid level between the two groups' participants (p > 0.05). CONCLUSION It was found that both the peer support education model and medical staff education model have a better short-term effect on blood glucose and lipid levels in patients with type 2 diabetes. As there is no difference of effect between the two methods of training, the peer support education model can be widely used in diabetes education.
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Affiliation(s)
- Xin Zhao
- Endocrinology Department, Peking University International Hospital, Beijing, China
| | - Xiaofeng Yu
- Endocrinology Department, Peking University International Hospital, Beijing, China
| | - Xiaomei Zhang
- Endocrinology Department, Peking University International Hospital, Beijing, China
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Kong L, Hu P, Yang L, Cui D. The effectiveness of peer support on self‐efficacy and quality of life in adults with type 2 diabetes: A systematic review and meta‐analysis. J Adv Nurs 2018; 75:711-722. [PMID: 30289552 DOI: 10.1111/jan.13870] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/30/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Ling‐Na Kong
- School of Nursing Chongqing Medical University Chongqing China
- The first Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Ping Hu
- The first Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Li Yang
- School of Nursing Harbin Medical University Harbin China
| | - Dan Cui
- School of Nursing Harbin Medical University Harbin China
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