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Evans M, Tang PY, Bhushan N, Fisher EB, Dreyer Valovcin D, Castellano C. Standardization and adaptability for dissemination of telephone peer support for high-risk groups: general evaluation and lessons learned. Transl Behav Med 2021; 10:506-515. [PMID: 32542342 DOI: 10.1093/tbm/ibaa047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Beyond demonstrated effectiveness, research needs to identify how peer support can be implemented in real-world settings. Telephone peer support offers one approach to this. The purpose of this study is to evaluate telephone peer support provided by trained peer staff for high-risk groups, implemented according to key tasks or functions of the Reciprocal Peer Support model (RPS) providing both standardization and adaptability. The methods used in the study include the review of contact data for years 2015-2016 from telephone peer support services of Rutgers Health University Behavioral Health Care, serving veterans, police, mothers of children with special needs, and child protection workers; structured interviews with peer supporters and clients; and audit of case notes. Across 2015-2016, peer supporters made 64,786 contacts with a total of 5,616 callers. Adaptability was apparent in 22% of callers' relationships lasting ≤1 month and 43% ≥1 year, voicemails valued as communicating presence, 92% of callers receiving support with psychosocial issues, 65% with concrete problems, such as medical or other services, 88% receiving social support, and 88% either resolving an issue (e.g., finding employment) or making documented progress (e.g., getting professional treatment, insurance, or children's services). With the balance of standardization and adaptability provided by the RPS, telephone peer support can address diverse needs and provide diverse contact patterns, assistance, support, and benefits.
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Affiliation(s)
- Megan Evans
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Patrick Y Tang
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Nivedita Bhushan
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Edwin B Fisher
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Dawn Dreyer Valovcin
- Rutgers University Behavioral Health Care National Call Center for Peer Support, Rutgers University, Piscataway, NJ, USA
| | - Cherie Castellano
- Rutgers University Behavioral Health Care National Call Center for Peer Support, Rutgers University, Piscataway, NJ, USA
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Talk to PAPA: A Systematic Review of Patient/Participant (PAPA) Feedback on Interactions With Community Health Workers Using a Depth Analysis Approach. J Ambul Care Manage 2020; 43:55-70. [PMID: 31770186 DOI: 10.1097/jac.0000000000000309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because of their shared backgrounds, community health workers' (CHWs) care of patients/program participants (PAPAs) is assumed to be acceptable, and often not evaluated empirically. Using PRISMA guidelines, we reviewed 9560 articles from 5 databases, selected 37 articles for full-text review, and developed a 5-dimensional depth analysis (focus, context, meaning, range, and voices) to characterize quality/quantity of PAPA feedback. Depth analyses clarified a spectrum of PAPA responses from extremely positive to ambivalence to outright distrust and frustration with perceived CHW limitations. Designing evaluations with 5-dimensional depth analysis can enhance PAPA feedback quality and improve evidence-based, patient-centered, CHW care delivery.
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Hearst MO, Adelli R, Hepperlen R, Biggs J, DeGracia D, Ngulube E, Maluskiku-Mwewa B, Johnson DE, Rabaey P. Community-based intervention to reduce stigma for children with disabilities in Lusaka, Zambia: a pilot. Disabil Rehabil 2020; 44:2295-2304. [DOI: 10.1080/09638288.2020.1829105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Mary O. Hearst
- Public Health, Henrietta Schmoll School of Health, St. Catherine University, Saint Paul, MN, USA
| | - Rakesh Adelli
- Public Health, Henrietta Schmoll School of Health, St. Catherine University, Saint Paul, MN, USA
| | | | - Jennifer Biggs
- Physical Therapy, Henrietta Schmoll School of Health, St. Catherine University, Saint Paul, MN, USA
| | - Donna DeGracia
- Physician Assistant Studies, Henrietta Schmoll School of Health, St. Catherine University, Saint Paul, MN, USA
| | | | | | - Dana E. Johnson
- Division of Neonatology and Global Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Paula Rabaey
- Occupational Therapy, Henrietta Schmoll School of Health, St. Catherine University, Saint Paul, MN, USA
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Ellis DA, Carcone AI, Naar-King S, Rajkumar D, Palmisano G, Moltz K. Adaptation of an Evidence-Based Diabetes Management Intervention for Delivery in Community Settings: Findings From a Pilot Randomized Effectiveness Trial. J Pediatr Psychol 2020; 44:110-125. [PMID: 29186562 DOI: 10.1093/jpepsy/jsx144] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/09/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To adapt an evidence-based intervention targeting diabetes management in adolescents with poorly controlled type 1 diabetes for use in a community setting by community health workers (CHWs) and to conduct pilot testing of the new intervention, REACH for Control (RFC). The study was conducted as a collaboration between university researchers and a federally qualified health center. Methods In a pilot effectiveness trial, feasibility and acceptability of RFC were evaluated based on participant enrollment, treatment dose, and consumer satisfaction. RFC effects on adolescent adherence, health outcomes, and quality of life were also assessed. The trial used a parallel group design. Families were randomized to 6 months of RFC plus standard medical care (n = 26) or standard care (SC) only (n = 24). Data were collected at baseline and 7-month posttest. A mixed-methods approach was used to analyze data. Results Qualitative analyses suggested that caregivers viewed RFC and delivery of a home-based intervention by CHWs positively. Furthermore, adolescents who received RFC had statistically significant (p = .05) and clinically meaningful improvements in hemoglobin A1c (HbA1c) (0.7%) and reported significant improvements in quality of life from baseline to follow-up (p = .001). No significant changes were found for adolescents in standard medical care. However, while dose of primary intervention session delivered was acceptable, dose of follow-up sessions used for skills practice was low. Conclusions Results provide preliminary support for RFC's acceptability and effectiveness to improve health status and quality of life when used in community settings serving high-risk, low-income families. Additional testing in a full-scale effectiveness trial appears warranted.
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Affiliation(s)
- Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University
| | | | - Sylvie Naar-King
- Center for Translational Behavioral Research, Florida State University
| | - Dixy Rajkumar
- Department of Family Medicine and Public Health Sciences, Wayne State University
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Hsu C, Cruz S, Placzek H, Chapdelaine M, Levin S, Gutierrez F, Standish S, Maki I, Carl M, Orantes MR, Newman D, Cheadle A. Patient Perspectives on Addressing Social Needs in Primary Care Using a Screening and Resource Referral Intervention. J Gen Intern Med 2020; 35:481-489. [PMID: 31792864 PMCID: PMC7018904 DOI: 10.1007/s11606-019-05397-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Interest is growing in interventions to address social needs in clinical settings. However, little is known about patients' perceptions and experiences with these interventions. OBJECTIVE To evaluate patients' experiences and patient-reported outcomes of a primary care-based intervention to help patients connect with community resources using trained volunteer advocates. DESIGN Qualitative telephone interviews with patients who had worked with the volunteer advocates. Sample and recruitment targets were equally distributed between patients who had at least one reported success in meeting an identified need and those who had no reported needs met, based on the database used to document patient encounters. PARTICIPANTS One hundred two patients. INTERVENTIONS Patients at the study clinic were periodically screened for social needs. If needs were identified, they were referred to a trained volunteer advocate who further assessed their needs, provided them with resource referrals, and followed up with them on whether their need was met. APPROACH Thematic analysis was used to code the data. KEY RESULTS Interviewed patients appreciated the services offered, especially the follow-up. Patients' ability to access the resource to which they were referred was enhanced by assistance with filling out forms, calling community resources, and other types of navigation. Patients also reported that interacting with the advocates made them feel listened to and cared for, which they perceived as noteworthy in their lives. CONCLUSIONS This patient-reported information provides key insights into a human-centered intervention in a clinical environment. Our findings highlight what works in clinical interventions addressing social needs and provide outcomes that are difficult to measure using existing quantitative metrics. Patients experienced the intervention as a therapeutic relationship/working alliance, a type of care that correlates with positive outcomes such as treatment adherence and quality of life. These insights will help design more patient-centered approaches to providing holistic patient care.
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Affiliation(s)
- Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Stephanie Cruz
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | - Hilary Placzek
- Data Science, Clarify Health Solutions, San Francisco, CA, USA.,Health Leads, Boston, MA, USA
| | | | - Sara Levin
- Contra Costa Health Services, Martinez, CA, USA
| | | | | | - Ian Maki
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | | | - Allen Cheadle
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Barriers and Facilitators in Implementing Non-Face-to-Face Chronic Care Management in an Elderly Population with Diabetes: A Qualitative Study of Physician and Health System Perspectives. J Clin Med 2018; 7:jcm7110451. [PMID: 30463310 PMCID: PMC6262419 DOI: 10.3390/jcm7110451] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023] Open
Abstract
The burden of illness related to diabetes and its complications is exceedingly high and growing globally. Systematic approaches to managing chronic care are needed to address the complex nature of the disease, taking into account health system structures. This study presents data collected from interviews with physicians, health system administrators, and other healthcare staff about chronic care management for elderly people with diabetes co-morbid with other chronic conditions in light of new programs intended to reduce barriers by incentivizing care encounters that take place through telephone and electronic communications (non-face-to-face care). Results indicate that health system personnel view non-face-to-face care as potentially providing value for patients and addressing systemic needs, yet challenging to implement in practice. Barriers and facilitators to this approach for managing diabetes and chronic care management for its complications are presented, with consideration to different types of health systems, and recommendations are provided for implementation.
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Egbujie BA, Delobelle PA, Levitt N, Puoane T, Sanders D, van Wyk B. Role of community health workers in type 2 diabetes mellitus self-management: A scoping review. PLoS One 2018; 13:e0198424. [PMID: 29856846 PMCID: PMC5983553 DOI: 10.1371/journal.pone.0198424] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/19/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally the number of people with Type 2 diabetes mellitus (T2DM) has risen significantly over the last few decades. Aligned to this is a growing use of community health workers (CHWs) to deliver T2DM self-management support with good clinical outcomes especially in High Income Countries (HIC). Evidence and lessons from these interventions can be useful for Low- and Middle-Income countries (LMICs) such as South Africa that are experiencing a marked increase in T2DM prevalence. OBJECTIVES This study aimed to examine how CHW have been utilized to support T2DM self-management globally, their preparation for and supervision to perform their functions. METHOD The review was guided by a stepwise approach outlined in the framework for scoping reviews developed by Arksey and O'Malley. Peer reviewed scientific and grey literature was searched using a string of keywords, selecting English full-text articles published between 2000 and 2015. Articles were selected using inclusion criteria, charted and content analyzed. RESULTS 1008 studies were identified of which 54 full text articles were selected. Most (53) of the selected studies were in HIC and targeted mostly minority populations in low resource settings. CHWs were mostly deployed to provide education, support, and advocacy. Structured curriculum based education was the most frequently reported service provided by CHWs to support T2DM self-management. Support services included informational, emotional, appraisal and instrumental support. Models of CHW care included facility linked nurse-led CHW coordination, facility-linked CHW led coordination and standalone CHW interventions without facility interaction. CONCLUSION CHWs play several roles in T2DM self-management, including structured education, ongoing support and health system advocacy. Preparing and coordinating CHWs for these roles is crucial and needs further research and strengthening.
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Affiliation(s)
| | - Peter Arthur Delobelle
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Chronic Disease Initiative for Africa, Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Perales J, Reininger BM, Lee M, Linder SH. Participants' perceptions of interactions with community health workers who promote behavior change: a qualitative characterization from participants with normal, depressive and anxious mood states. Int J Equity Health 2018; 17:19. [PMID: 29402278 PMCID: PMC5800056 DOI: 10.1186/s12939-018-0729-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 01/16/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs). CHWs can effectively advocate for healthier lifestyles and may be pivotal in addressing such mental health conditions as depression and anxiety. The goal of this study was to characterize the relationship dynamics between Latino participants and CHWs, from the participant's perspective. We aimed to determine if CHW-delivered community interventions effected behavior change, especially among participants who reported anxiety and depression. METHODS Semi-structured interviews were conducted with a purposive sample of 28 Latino participants that was based on a mental health scoring strata. Participants completed a lifestyle intervention that included multiple home visits from CHWs to promote physical activity and healthful food choice. Interviews were conducted in the participant's preferred language (English or Spanish). Transcribed interviews were analyzed using a grounded theory approach until concept saturation was achieved. RESULTS The sample was primarily female (82%), lower socioeconomic status (64%), and mean age of 50 years. Participants discussed the rapport building and professionalism of CHWs as a feature that facilitated strong, positive relationships and lifestyle behavior changes. Participants described how CHWs patterned their change approaches, which were similar to commonly used therapeutic techniques in the treatment of anxiety and depression. While anxiety and depression were described as having an impact on behavior change, most, but not all, participants who reported negative mood states said that the CHW relationship helped in changing that state to some extent. CONCLUSIONS Participants' perceptions indicated that positive personal changes were influenced by CHWs. Only participants who reported consistently poor scores for depression, anxiety or both reported negative or neutral experiences with the CHWs. This study lends qualitative support to the use of CHWs as extenders of care, particularly in areas that have a shortage of primary and mental health care providers.
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Affiliation(s)
- Joseph Perales
- La Clínica - Casa del Sol, 1501 Fruitvale Ave, Oakland, California, 94601, USA
| | - Belinda M Reininger
- UT Health School of Public Health in Brownsville, Division of Health Promotion & Behavioral Sciences and Hispanic Health Research Center, One West University Blvd, Brownsville, TX, 78520, USA. .,Michael & Susan Dell Center for Healthy Living, UT School of Public Health, Austin Regional Campus, University of Texas Administration Building (UTA), 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA. .,University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.
| | - MinJae Lee
- University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.,University of Texas Health Science Center at Houston, Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA
| | - Stephen H Linder
- UT Health School of Public Health, Institute for Health Policy, Division of Management, Policy and Community Health, 6410 Fannin, Houston, TX, 77030, USA
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Falbe J, Friedman LE, Sokal-Gutierrez K, Thompson HR, Tantoco NK, Madsen KA. "She Gave Me the Confidence to Open Up": Bridging Communication by Promotoras in a Childhood Obesity Intervention for Latino Families. HEALTH EDUCATION & BEHAVIOR 2017; 44:728-737. [PMID: 28851237 DOI: 10.1177/1090198117727323] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Childhood obesity is a public health threat that disproportionally affects Latino youth in the United States. Active and Healthy Families (AHF) is a culturally tailored, family-based program for addressing obesity disparities in a predominantly immigrant Latino population. AHF was the first primary care, culturally tailored intervention for Latino children to significantly reduce BMI in a randomized controlled trial. The 10-week AHF intervention reduced BMI (kg/m2) among overweight or obese children by 0.5, compared with an increase of 0.3 in the control group, yielding a -0.8 difference ( p < .01). A unique aspect of the program is its provider team: a physician, dietitian, and promotora. Because early feedback from families highlighted the importance of promotoras specifically, we sought to understand the unique mechanisms of promotora effectiveness in AHF. We conducted in-depth, semistructured interviews with the AHF providers ( n = 5) and parent participants ( n = 23) by phone between November 2012 and May 2013. In a grounded theory analysis, three main categories encompassing five themes emerged: (a) bridging communication by promotoras; (b) promotoras' personal qualities, including themes of kindness and caring and shared experiences with patients; and (c) impactful task performance, including themes of motivation, positive environment, and self-efficacy. Together, the themes serve as the basis of a conceptual model illustrating the process through which promotoras may enhance the impact of team-based obesity programs for the Latino community. Because this study identifies the specific ways through which promotoras can bridge cultural, linguistic, and other divides, it may inform development and dissemination of evidence-based approaches for obesity prevention in the Latino community.
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Kowitt SD, Ayala GX, Cherrington AL, Horton LA, Safford MM, Soto S, Tang TS, Fisher EB. Examining the Support Peer Supporters Provide Using Structural Equation Modeling: Nondirective and Directive Support in Diabetes Management. Ann Behav Med 2017; 51:810-821. [DOI: 10.1007/s12160-017-9904-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bossy D, Knutsen IR, Rogers A, Foss C. Group affiliation in self-management: support or threat to identity? Health Expect 2016; 20:159-170. [PMID: 26868829 PMCID: PMC5217888 DOI: 10.1111/hex.12448] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Self-management is considered important in chronic illness, and contemporary health policy recommends participation in support groups for individuals with chronic conditions. Although withdrawal from or non-participation in support groups is an important problem, there is limited knowledge about individuals' own motivation for participation in or withdrawal from self-management support groups. OBJECTIVES To investigate how individuals with type 2 diabetes perceive participation in group-based self-management support. DESIGN This is a qualitative focus group study using a semi-structured interview guide. SETTING AND PARTICIPANTS Sixteen participants diagnosed with type 2 diabetes were included in the study. Individuals with and without group affiliations were mixed in three focus groups to trigger discussions. In the analysis, reoccurring themes of engagement and discussions between participants were focused within a theoretical frame of institutional logic. The focus groups are seen as social spaces where participants construct identity. RESULTS Both participation and non-participation in group-based self-management support are associated with dealing with the stigma of having type 2 diabetes. Negotiations contribute to constructing an illness dignity as a response to the logic of moral responsibility for the disease. DISCUSSION AND CONCLUSION Contemporary policy contributes to societal understandings of individuals with type 2 diabetes as morally inadequate. Our study shows that group-based self-management support may counteract blame and contribute in negotiations of identity for individuals with type 2 diabetes. This mechanism makes participation in groups beneficial for some but stigma inducing for others.
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Affiliation(s)
- Dagmara Bossy
- Norwegian National Advisory Unit on Learning and Mastery in Health, Aker Sykehus, Universitetssykehus HF, Oslo, Norway.,Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Ruud Knutsen
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Rogers
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Hampshire, UK
| | - Christina Foss
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway
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Simmons D, Bunn C, Nakwagala F, Safford MM, Ayala GX, Riddell M, Graffy J, Fisher EB. Challenges in the Ethical Review of Peer Support Interventions. Ann Fam Med 2015; 13 Suppl 1:S79-86. [PMID: 26304976 PMCID: PMC4648134 DOI: 10.1370/afm.1803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 04/09/2015] [Accepted: 04/20/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Ethical review processes have become increasingly complex. We have examined how 8 collaborating diabetes peer-support clinical trials were assessed by ethics committees. METHODS The ethical reviews from the 8 peer-support studies were collated and subjected to a thematic analysis. We mapped the recommendations of local Institutional Review Boards and ethics committees onto the "4+1 ethical framework" (autonomy, beneficence, non-maleficence, and justice, along with concern for their scope of application). RESULTS Ethics committees did not consistently focus on tasks within the 4+1 framework: many conducted reviews of scientific, organizational, and administrative activities. Of the 20 themes identified across the ethical reviews, only 4 fell within the scope of the 4+1 framework. Variation in processes and requirements for ethics committees were particularly evident between study countries. Some of the consent processes mandated by ethical review boards were disproportionate for peer support, increased participant burden, and reduced the practicality of testing an ethical intervention. Across the 8 studies, ethics committees' reviews included the required elements to ensure participant safety; however, they created a range of hurdles that in some cases delayed the research and required consent processes that could hinder the spontaneity and/or empathy of peer support. CONCLUSION Ethics committees should avoid repeating the work of other trusted agencies and consider the ethical validity of "light touch" consent procedures for peer-support interventions. The investigators propose an ethical framework for research on peer support.
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Affiliation(s)
- David Simmons
- School of Medicine, University of Western Sydney, Sydney, Australia Institute of Metabolic Science, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, England
| | - Christopher Bunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Fred Nakwagala
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Monika M Safford
- Department of Medicine, School of Medicine, University of Alabama, Birmingham, Alabama
| | - Guadalupe X Ayala
- San Diego State University College of Health and Human Services and the Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | - Michaela Riddell
- Global Health and Society Unit, SPHPM, Monash University, Melbourne, Australia
| | - Jonathan Graffy
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation, Leawood, Kansas Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Qi L, Liu Q, Qi X, Wu N, Tang W, Xiong H. Effectiveness of peer support for improving glycaemic control in patients with type 2 diabetes: a meta-analysis of randomized controlled trials. BMC Public Health 2015; 15:471. [PMID: 25943398 PMCID: PMC4425885 DOI: 10.1186/s12889-015-1798-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/22/2015] [Indexed: 12/16/2022] Open
Abstract
Background To assess the effects of peer support at improving glycemic control in patients with type 2 diabetes. Methods Relevant electronic databases were sought for this investigation up to Dec 2014. Randomized controlled trials involving patients with type 2 diabetes that evaluated the effect of peer support on glycated hemoglobin (HbA1c) concentrations were included. The pooled mean differences (MD) between intervention and control groups with 95% confidence interval (CI) were calculated using random-effects model. The Cochrane Collaboration’s tool was used to assess the risk of bias. Results Thirteen randomized controlled trials met the inclusion criteria. Peer support resulted in a significant reduction in HbA1c (MD −0.57 [95% CI: −0.78 to −0.36]). Programs with moderate or high frequency of contact showed a significant reduction in HbA1c levels (MD −0.52 [95% CI: −0.60 to −0.44] and −0.75 [95% CI: −1.21 to −0.29], respectively), whereas programs with low frequency of contact showed no significant reduction (MD −0.32 [95% CI: −0.74 to 0.09]). The reduction in HbA1c were greater among patients with a baseline HbA1c ≥ 8.5% (MD −0.78 [95% CI: −1.06 to −0.51]) and between 7.5 ~ 8.5% (MD −0.76 [95% CI: −1.05 to −0.47]), than patients with HbA1c < 7.5% (MD −0.08 [95% CI: −0.32 to 0.16]). Conclusions Peer support had a significant impact on HbA1c levels among patients with type 2 diabetes. Priority should be given to programs with moderate or high frequency of contact for target patients with poor glycemic control rather than programs with low frequency of contact that target the overall population of patients. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1798-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Li Qi
- Department of Military Epidemiology, College of Military Prevention, Third Military Medical University, Chongqing, China. .,Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China.
| | - Qin Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China.
| | - Xiaoling Qi
- Department of Dental Medicine, Sichuan University, Chengdu, China.
| | - Na Wu
- Department of Military Epidemiology, College of Military Prevention, Third Military Medical University, Chongqing, China.
| | - Wenge Tang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China.
| | - Hongyan Xiong
- Department of Military Epidemiology, College of Military Prevention, Third Military Medical University, Chongqing, China.
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Katigbak C, Van Devanter N, Islam N, Trinh-Shevrin C. Partners in health: a conceptual framework for the role of community health workers in facilitating patients' adoption of healthy behaviors. Am J Public Health 2015; 105:872-80. [PMID: 25790405 PMCID: PMC4386525 DOI: 10.2105/ajph.2014.302411] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 11/04/2022]
Abstract
We formulated a conceptual framework that begins to answer the national call to improve health care access, delivery, and quality by explaining the processes through which community health workers (CHWs) facilitate patients' adoption of healthy behaviors. In September 2011 to January 2012, we conducted a qualitative study that triangulated multiple data sources: 26 in-depth interviews, training documents, and patient charts. CHWs served as partners in health to immigrant Filipinos with hypertension, leveraging their cultural congruence with intervention participants, employing interpersonal communication techniques to build trust and rapport, providing social support, and assisting with health behavior change. To drive the field forward, this work can be expanded with framework testing that may influence future CHW training and interventions.
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Affiliation(s)
- Carina Katigbak
- At the time of the study, Carina Katigbak and Nancy Van Devanter were with the College of Nursing, and Nadia Islam and Chau Trinh-Shevrin were with the Department of Population Health, School of Medicine, New York University, New York, NY
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Kowitt SD, Urlaub D, Guzman-Corrales L, Mayer M, Ballesteros J, Graffy J, Simmons D, Cummings DM, Fisher EB. Emotional support for diabetes management: an international cross-cultural study. DIABETES EDUCATOR 2015; 41:291-300. [PMID: 25722064 DOI: 10.1177/0145721715574729] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to explore how emotional support emerged in interactions between peer supporters (PSs) and adults living with type 2 diabetes. METHODS Qualitative data were analyzed from 22 semistructured interviews with PSs in 3 settings: low-income Latinos in Chicago, middle-class Caucasians in the United Kingdom, and low-income African American women in North Carolina. Emotional support was defined as expressions of empathy, trust, and caring. RESULTS Across all sites, emotional support gradually emerged over time, was often combined with informational support, and was conveyed both implicitly (through nonverbal actions connoting emotional acceptance; eg, a walk together without discussion of problems) and explicitly (eg, by reassurance or discussion of stressors). Cross-site differences did appear regarding the strategies to address barriers to diabetes management (eg, PSs in North Carolina and Chicago reported providing support for social stressors) and the role of PSs (eg, PSs in Chicago reported providing directive support). CONCLUSIONS Across different settings and populations, emotional support for diabetes management evolved over time, was often integrated with informational support, and emerged through both implicit and explicit strategies that addressed varied context-specific stressors.
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Affiliation(s)
- Sarah D Kowitt
- Peers for Progress, American Academy of Family Physicians Foundation, and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina (Ms Kowitt, Ms Urlaub, Ms Guzman-Corrales, Ms Mayer, Dr Fisher),Alivio Medical Center, Chicago, Illinois (Ms Ballesteros)
| | - Diana Urlaub
- Peers for Progress, American Academy of Family Physicians Foundation, and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina (Ms Kowitt, Ms Urlaub, Ms Guzman-Corrales, Ms Mayer, Dr Fisher)
| | - Laura Guzman-Corrales
- Peers for Progress, American Academy of Family Physicians Foundation, and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina (Ms Kowitt, Ms Urlaub, Ms Guzman-Corrales, Ms Mayer, Dr Fisher)
| | - Melissa Mayer
- Peers for Progress, American Academy of Family Physicians Foundation, and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina (Ms Kowitt, Ms Urlaub, Ms Guzman-Corrales, Ms Mayer, Dr Fisher)
| | | | - Jonathan Graffy
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (Dr Graffy)
| | - David Simmons
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (Dr Simmons)
| | - Doyle M Cummings
- Departments of Family Medicine and Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina (Dr Cummings)
| | - Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation, and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina (Ms Kowitt, Ms Urlaub, Ms Guzman-Corrales, Ms Mayer, Dr Fisher)
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Nelson K, Drain N, Robinson J, Kapp J, Hebert P, Taylor L, Silverman J, Kiefer M, Lessler D, Krieger J. Peer Support for Achieving Independence in Diabetes (Peer-AID): design, methods and baseline characteristics of a randomized controlled trial of community health worker assisted diabetes self-management support. Contemp Clin Trials 2014; 38:361-9. [PMID: 24956324 DOI: 10.1016/j.cct.2014.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND & OBJECTIVES Community health workers (CHWs) may be an important mechanism to provide diabetes self-management to disadvantaged populations. We describe the design and baseline results of a trial evaluating a home-based CHW intervention. METHODS & RESEARCH DESIGN Peer Support for Achieving Independence in Diabetes (Peer-AID) is a randomized, controlled trial evaluating a home-based CHW-delivered diabetes self-management intervention versus usual care. The study recruited participants from 3 health systems. Change in A1c measured at 12 months is the primary outcome. Changes in blood pressure, lipids, health care utilization, health-related quality of life, self-efficacy and diabetes self-management behaviors at 12 months are secondary outcomes. RESULTS A total of 1438 patients were identified by a medical record review as potentially eligible, 445 patients were screened by telephone for eligibility and 287 were randomized. Groups were comparable at baseline on socio-demographic and clinical characteristics. All participants were low-income and were from diverse racial and ethnic backgrounds. The mean A1c was 8.9%, mean BMI was above the obese range, and non-adherence to diabetes medications was high. The cohort had high rates of co-morbid disease and low self-reported health status. Although one-third reported no health insurance, the mean number of visits to a physician in the past year was 5.7. Trial results are pending. CONCLUSIONS Peer-AID recruited and enrolled a diverse group of low income participants with poorly controlled type 2 diabetes and delivered a home-based diabetes self-management program. If effective, replication of the Peer-AID intervention in community based settings could contribute to improved control of diabetes in vulnerable populations.
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Affiliation(s)
- Karin Nelson
- VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, United States; VA Puget Sound Healthcare System, General Internal Medicine Service, United States; University of Washington, School of Medicine, Department of Medicine, United States; University of Washington, School of Public Health, United States.
| | - Nathan Drain
- Public Health - Seattle & King County, United States
| | - June Robinson
- Public Health - Seattle & King County, United States
| | - Janet Kapp
- Public Health - Seattle & King County, United States
| | - Paul Hebert
- VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, United States; University of Washington, School of Medicine, Department of Medicine, United States
| | - Leslie Taylor
- VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, United States
| | - Julie Silverman
- VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, United States; VA Puget Sound Healthcare System, General Internal Medicine Service, United States; University of Washington, School of Medicine, Department of Medicine, United States
| | - Meghan Kiefer
- VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, United States; VA Puget Sound Healthcare System, General Internal Medicine Service, United States; University of Washington, School of Medicine, Department of Medicine, United States
| | - Dan Lessler
- University of Washington, School of Medicine, Department of Medicine, United States
| | - James Krieger
- University of Washington, School of Medicine, Department of Medicine, United States; University of Washington, School of Public Health, United States; Public Health - Seattle & King County, United States
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Philis-Tsimikas A, Gallo LC. Implementing community-based diabetes programs: the scripps whittier diabetes institute experience. Curr Diab Rep 2014; 14:462. [PMID: 24390404 PMCID: PMC3946451 DOI: 10.1007/s11892-013-0462-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diabetes affects a large and growing segment of the US population. Ethnic and racial minorities are at disproportionate risk for diabetes, with Hispanics and non-Hispanic Blacks showing a near doubling of risk relative to non-Hispanic Whites. There is an urgent need to identify low cost, effective, and easily implementable primary and secondary prevention approaches, as well as tertiary strategies that delay disease progression, complications, and associated deterioration in function in patients with diabetes. The Chronic Care Model provides a well-accepted framework for improving diabetes and chronic disease care in the community and primary care medical home. A number of community-based diabetes programs have incorporated this model into their infrastructure. Diabetes programs must offer accessible information and support throughout the community and must be delivered in a format that is understood, regardless of literacy and socioeconomic status. This article will discuss several successful, culturally competent community-based programs and the key elements needed to implement the programs at a community or health system level. Health systems together with local communities can integrate the elements of community-based programs that are effective across the continuum of the care to enhance patient-centered outcomes, enable patient acceptability and ultimately lead to improved patient engagement and satisfaction.
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Affiliation(s)
- Athena Philis-Tsimikas
- Scripps Whittier Diabetes Institute, 9894 Genesee Ave, Suite 316, La Jolla, CA 92037, Telephone : 858-626-5628, Fax : 858-626-5680
| | - Linda C. Gallo
- San Diego State University, Department of Psychology, 9245 Sky Park Court Suite 115, San Diego, CA 92123, Telephone: (619) 594-4833, Fax: (619) 594-6780
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Goldman ML, Ghorob A, Eyre SL, Bodenheimer T. How do peer coaches improve diabetes care for low-income patients?: a qualitative analysis. DIABETES EDUCATOR 2013; 39:800-10. [PMID: 24168838 DOI: 10.1177/0145721713505779] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the study was to explore the perspectives and roles of peer coaches, who are patients with diabetes trained to provide diabetes self-management support (DSMS) to other patients. METHODS A focus group and 17 qualitative semi-structured interviews were conducted with community-based peer coaches in San Francisco in order to better understand the process by which these coaches engaged with their patients. Transcripts were coded and analyzed using methods based on grounded theory to develop a theoretical model of peer coach roles. RESULTS Peer coaches play 3 principal roles in providing DSMS: advisor, supporter, and role model. While working with patients, peer coaches had different approaches to setting emotional boundaries and to allocating responsibility for implementing health behavior changes. Peer coaches were more consistent in how they sought resources from providers. Peer coaches also became empowered to better manage their own diabetes. CONCLUSION Peer coaches are a highly motivated potential workforce uniquely positioned to teach and empower patients by building trust through shared experiences. The variability in coaching styles suggests an inherent diversity among peer coaches that must be accounted for in future strategies for design, recruitment, training, and oversight of peer coaching programs.
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Affiliation(s)
- Matthew L Goldman
- The University of California Berkeley–University of California San Francisco Joint Medical Program, Berkeley, California (Mr Goldman, Dr Eyre)
| | - Amireh Ghorob
- The Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, California (Ms Ghorob, Dr Bodenheimer)
| | - Stephen L Eyre
- The University of California Berkeley–University of California San Francisco Joint Medical Program, Berkeley, California (Mr Goldman, Dr Eyre)
| | - Thomas Bodenheimer
- The Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, California (Ms Ghorob, Dr Bodenheimer)
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Collinsworth AW, Vulimiri M, Schmidt KL, Snead CA. Effectiveness of a community health worker-led diabetes self-management education program and implications for CHW involvement in care coordination strategies. DIABETES EDUCATOR 2013; 39:792-9. [PMID: 24052203 DOI: 10.1177/0145721713504470] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of a Community Health Worker (CHW)-led diabetes self-management education (DSME) program and to understand how CHWs and primary care providers (PCPs) work together to provide comprehensive diabetes care. METHODS A quantitative pre- and postassessment of change in patients' blood glucose levels (A1C), blood pressure, and body mass index was performed to determine the clinical effectiveness of the program. Qualitative, semi-structured interviews with 5 CHWs and 7 PCPs were conducted to assess how CHWs were incorporated into clinical teams and their impact on care delivery and diabetes-related outcomes. RESULTS Patients who participated in the program experienced a statistically significant decrease in mean A1C levels and systolic blood pressure readings 1 year post baseline. CHWs provided high-quality care and bridged the gap between patients and care providers through diabetes management support and education, medication assistance, access to community resources, and social support. CONCLUSIONS CHWs play a variety of roles in helping patients overcome barriers to diabetes control and can be successfully integrated into a health care system's care coordination strategy.
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Affiliation(s)
- Ashley W Collinsworth
- Ashley W. Collinsworth, MPH, ELS, Director of Health Care Research, Baylor Health Care System
- Institute for Health Care Research and Improvement, 8080 North Central Expressway, Suite 500, Dallas, TX 75206, USA.
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Brownson CA, Heisler M. The role of peer support in diabetes care and self-management. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 2:5-17. [PMID: 22273055 DOI: 10.2165/01312067-200902010-00002] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In light of the growing prevalence and healthcare costs of diabetes mellitus, it is critically important for healthcare providers to improve the efficiency and effectiveness of their diabetes care. A key element of effective disease management for diabetes is support for patient self-management. Barriers to care exist for both patients and healthcare systems. As a result, many people with diabetes do not get the care and support needed to successfully manage their diabetes.Disease management approaches that incorporate peer support may be a promising way to help provide self-management support to patients with diabetes. Trained peers provide emotional support, instrumental (tangible or material) support, education, and skills training to those they serve, and outreach and care coordination for provider systems. They play a unique role that complements and supports clinical care.To describe how peers are currently supporting diabetes care, a number of databases were searched for studies describing the roles of peers using relevant key words. This paper reviews current literature that describes the roles and duties of peers in interventions to improve diabetes care, with a focus on their contributions to six essential elements of self-management support: (i) access to regular, high-quality clinical care; (ii) an individualized approach to assessment and treatment; (iii) patient-centered collaborative goal setting; (iv) education and skills training; (v) ongoing follow-up and support; and (vi) linkages to community resources.Peers worked under a variety of titles, which did not define their duties. The scope of their work ranged from assisting health professionals to playing a central role in care. Providing education and follow-up support were the two most common roles. In all but one study, these roles were carried out during face-to-face contact, most frequently in community sites.A growing body of literature supports the value of peer models for diabetes management. Additional research can answer remaining questions related to such issues as cost effectiveness, sustainability, integration of peers into health and social service delivery systems, and recruitment, training, and support of peers. Continuing to develop and evaluate innovative models for more effectively mobilizing and integrating peers into diabetes care has great potential for improving diabetes outcomes worldwide.
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Affiliation(s)
- Carol A Brownson
- 1 Division of Health Behavior Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA 2 Veterans Affairs Center for Clinical Practice Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA 3 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA 4 Michigan Diabetes Research and Training Center, Ann Arbor, Michigan, USA
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Marrero DG, Ard J, Delamater AM, Peragallo-Dittko V, Mayer-Davis EJ, Nwankwo R, Fisher EB. Twenty-first century behavioral medicine: a context for empowering clinicians and patients with diabetes: a consensus report. Diabetes Care 2013; 36:463-70. [PMID: 23349150 PMCID: PMC3554311 DOI: 10.2337/dc12-2305] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- David G Marrero
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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Lemay CA, Ferguson WJ, Hargraves JL. Community health worker encounter forms: a tool to guide and document patient visits and worker performance. Am J Public Health 2012; 102:e70-5. [PMID: 22594753 DOI: 10.2105/ajph.2011.300416] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored the benefits of using community health worker (CHW) encounter forms to collect data on patient interactions and assessed the effectiveness of these forms in guiding and directing interactions. METHODS A 1-page standardized encounter form was developed to document topics discussed during visits with diabetes patients. A portion of the form was designed to be used as a script to guide the interaction and assist patients in setting appropriate self-management goals. Data were also collected via CHW work logs and interviews with CHWs and their supervisors to validate findings. RESULTS Data were collected for 1198 interactions with 540 patients at 6 community health centers. Self-management goals were set during 62% of encounters. With respect to the most recent self-management goal set, patients who had set a challenging goal were more likely to be in the action stage of change than in other stages. Work logs revealed that CHWs engaged in a number of activities not involving direct patient interactions and thus not captured on encounter forms. CONCLUSIONS Evaluating and monitoring CHWs' daily activities has been challenging. Encounter forms have great potential for documenting the work of CHWs with patients.
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Affiliation(s)
- Celeste A Lemay
- University of Massachusetts Medical School, Worcester, MA 01605, USA.
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Ruggiero L, Castillo A, Quinn L, Hochwert M. Translation of the diabetes prevention program's lifestyle intervention: role of community health workers. Curr Diab Rep 2012; 12:127-37. [PMID: 22350806 DOI: 10.1007/s11892-012-0254-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Approximately 8.3% of the US population has diabetes and estimates indicate that 79 million adults have prediabetes and 33.8% are obese, increasing their risk of diabetes. The national Diabetes Prevention Program (DPP) and subsequent translation studies have demonstrated the efficacy of the DPP lifestyle intervention (DPPLI) on lowering weight and reducing risk of type 2 diabetes over 10 years. Innovative strategies are needed to translate the DPPLI to reach people at risk of diabetes. Community health workers represent a group of individuals poised to play a role in supporting the translation of the DPPLI, especially in underserved populations. This article aims to 1) describe community health workers in general; 2) describe their role and impact on diabetes care in general; and 3) provide a detailed overview of studies involving community health workers in the translation of the DPPLI.
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Affiliation(s)
- Laurie Ruggiero
- University of Illinois at Chicago, Institute for Health Research and Policy, School of Public Health, Chicago, IL 60608, USA.
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Walton JW, Snead CA, Collinsworth AW, Schmidt KL. Reducing diabetes disparities through the implementation of a community health worker-led diabetes self-management education program. FAMILY & COMMUNITY HEALTH 2012; 35:161-171. [PMID: 22367263 DOI: 10.1097/fch.0b013e31824651d3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Disparities in prevalence of type 2 diabetes and complications in underserved populations have been linked to poor quality of care including lack of access to diabetes management programs. Interventions utilizing community health workers (CHWs) to assist with diabetes management have demonstrated improvements in patient outcomes. Use of CHWs may be an effective model for providing care coordination and reducing disparities, but there is limited knowledge on how to implement this model on a large scale. This article describes how an integrated health care system implemented a CHW-led diabetes self-management education program targeting Hispanic patients and reports lessons learned from the first 18 months of operation.
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Affiliation(s)
- James W Walton
- Office of Health Equity, Baylor Health Care System, Dallas, Texas 75246, USA.
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Community health workers and integrated primary health care teams in the 21st century. J Ambul Care Manage 2012; 34:354-61. [PMID: 21914991 DOI: 10.1097/jac.0b013e31822cbcd0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Community health workers are an integral part of many healthcare systems. Their roles vary and include both the socially oriented tasks of natural helpers and specific constrained tasks of health extenders. As natural helpers, community health workers play an important role in connecting public and primary care to the communities that they serve. As primary health care becomes more patient-centered and community-oriented, the natural helper roles that include trust, rapport, understanding, and the ability to communicate with the community take on an increased significance. Community health workers are effective and make the health care system more efficient. In some states, the community health worker has become a more formal member of the integrated primary health care team, and it is in this role that she or he provides structured linkages between the community, the patient, and the health care system. The effective community health workers are strongly embedded in the communities that they serve; they have clear supervision within the health care system; they have clearly defined roles in the health care system; and they are well trained and have a defined system of advancing their education and roles within the health care system.
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Brown N, Vaughn NA, Lin AJ, Browne R, White M, Smith P. Healthy families Brooklyn: working with health advocates to develop a health promotion program for residents living in New York City housing authority developments. J Community Health 2011; 36:864-73. [PMID: 21400120 DOI: 10.1007/s10900-011-9388-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Decreasing health disparities must increase access to care, improve health education and ease navigating the health care system. Community Health Workers (CHW) take on these tasks in professional and culturally competent manners. The Healthy Families Brooklyn (HFB) Program serves residents in two public housing developments in Brooklyn, NY. Healthy Families Advocates (HFA), a type of CHW, are at the core of HFB. Curriculum development for, training of and services provided by the 10 HFA over 19 months are described. Pre and post knowledge assessments of HFAs are analyzed. Data from HFA surveys regarding training were analyzed using grounded theory methods. HFA served 172 unique clients at 222 visits. Services offered include accessing public benefits, health education, and connection to hospitals. There was a significant increase between pre and post assessment knowledge scores (P < 0.01). Taking temperature, building trust, and communicating care and connection emerged as themes related to interpersonal skills used by the HFA. The HFA are committed to moving clients forward in their health knowledge and behaviors. Themes from the HFA survey closely mirrored the HFA training curriculum. Lessons learned pertaining to training needs, data collection, and supervision are explored. The HFB program is a model way of working in communities in New York City and expansion with faith-based groups and other housing development communities is underway. Engaging communities to improve access, screening, prevention and treatment is paramount to the nation's health and the success of the 2010 Affordable Care Act. CHW's role in this mission is integral.
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Affiliation(s)
- Necole Brown
- Healthy Families Brooklyn, Brooklyn, NY 11201, USA.
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Piette JD, Holtz B, Beard AJ, Blaum C, Greenstone CL, Krein SL, Tremblay A, Forman J, Kerr EA. Improving chronic illness care for veterans within the framework of the Patient-Centered Medical Home: experiences from the Ann Arbor Patient-Aligned Care Team Laboratory. Transl Behav Med 2011; 1:615-23. [PMID: 24073085 PMCID: PMC3717663 DOI: 10.1007/s13142-011-0065-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
While key components of the Patient-Centered Medical Home (PCMH) have been described, improved patient outcomes and efficiencies have yet to be conclusively demonstrated. We describe the rationale, conceptual framework, and progress to date as part of the VA Ann Arbor Patient-Aligned Care Team (PACT) Demonstration Laboratory, a clinical care-research partnership designed to implement and evaluate PCMH programs. Evidence and experience underlying this initiative is presented. Key components of this innovation are: (a) a population-based registry; (b) a navigator system that matches veterans to programs; and (c) a menu of self-management support programs designed to improve between-visit support and leverage the assistance of patient-peers and informal caregivers. This approach integrates PCMH principles with novel implementation tools allowing patients, caregivers, and clinicians to improve disease management and self-care. Making changes within a complex organization and integrating programmatic and research goals represent unique opportunities and challenges for evidence-based healthcare improvements in the VA.
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Affiliation(s)
- John D Piette
- />VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 300 N. Ingalls Bldg., Room 7E10, Ann Arbor, MI 48109-5429 USA
- />Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Bree Holtz
- />VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 300 N. Ingalls Bldg., Room 7E10, Ann Arbor, MI 48109-5429 USA
| | - Ashley J Beard
- />VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 300 N. Ingalls Bldg., Room 7E10, Ann Arbor, MI 48109-5429 USA
- />Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Caroline Blaum
- />VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 300 N. Ingalls Bldg., Room 7E10, Ann Arbor, MI 48109-5429 USA
- />Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
- />Ann Arbor VA Geriatric Research Education and Clinical Center, Ann Arbor, MI USA
| | - C Leo Greenstone
- />Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
- />VA Ann Arbor Health Care System, Ann Arbor, MI USA
| | - Sarah L Krein
- />VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 300 N. Ingalls Bldg., Room 7E10, Ann Arbor, MI 48109-5429 USA
- />Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Adam Tremblay
- />Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
- />VA Ann Arbor Health Care System, Ann Arbor, MI USA
| | - Jane Forman
- />VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 300 N. Ingalls Bldg., Room 7E10, Ann Arbor, MI 48109-5429 USA
| | - Eve A Kerr
- />VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 300 N. Ingalls Bldg., Room 7E10, Ann Arbor, MI 48109-5429 USA
- />Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - on behalf of the Ann Arbor PACT Steering Committee
- />VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 300 N. Ingalls Bldg., Room 7E10, Ann Arbor, MI 48109-5429 USA
- />Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
- />Ann Arbor VA Geriatric Research Education and Clinical Center, Ann Arbor, MI USA
- />VA Ann Arbor Health Care System, Ann Arbor, MI USA
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Ndumele CD, Russell BE, Ayanian JZ, Landon BE, Keegan T, O'Malley AJ, Hicks LS. Strategies to improve chronic disease management in seven metro Boston community health centers. Prog Community Health Partnersh 2011; 3:203-11. [PMID: 19802379 DOI: 10.1353/cpr.0.0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Community, Health Center, and Academic Medicine Partnership Project (CHAMPP) is a partnership between medical researchers, community health centers (CHCs), and a community advisory committee focused on reducing cardiovascular morbidity related to hypertension and diabetes for non-Hispanic Black and Hispanic populations in Boston, Massachusetts. OBJECTIVE We conducted site visits at seven participating CHCs, located in Boston. The visits were to solicit health center staff opinions about site-specific barriers and enabling factors for optimum preventative cardiovascular care for racial/ethnic minority patients receiving hypertension and diabetes care at their centers. METHODS Site visits included a tour of each health center and a series of directed interviews with center personnel. Site visit notes were reviewed to identify themes that emerged during the course of each site visit. A summary matrix was developed for each health center, which included information regarding the most salient and persistent themes of the visit. RESULTS Site visits uncovered several patient-, provider-, CHC-, and community-based factors that either facilitate or hinder optimal care of chronic disease patients. Commonly referenced barriers included the need for improved patient adherence to provider recommendations; insufficient time for providers to address complex health issues presented by patients and the need for a broader range of healthier food options in surrounding communities. Interactive patient groups and community health workers (CHWs) have been well received when implemented. CONCLUSION Recommendations included adopting case management as a part of usual care for chronic disease patients; additionally, widespread implementation of CHWs may to provide a platform for more comprehensive care for patients.
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Affiliation(s)
- Chima D Ndumele
- Department of Community Health, Warren Alpert Medical School, Brown University, USA
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Ferrer RL, Carrasco AV. Capability and clinical success. Ann Fam Med 2010; 8:454-60. [PMID: 20843888 PMCID: PMC2939422 DOI: 10.1370/afm.1163] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 03/02/2010] [Accepted: 03/15/2010] [Indexed: 11/09/2022] Open
Abstract
Better outcomes for chronic diseases remain elusive because success depends on events outside the control of the health care system: patients' ability to mange their health behaviors and chronic diseases. Among the most powerful influences on self-management are the social and environmental constraints on healthy living, yet the clinical response to these environmental determinants is poorly developed. A potential approach for addressing social determinants in practice, as well as planning and evaluating community responses, is the capability framework. Defined as the real opportunity to achieve a desired lifestyle, capability focuses attention on the material conditions that constrain real opportunity and how opportunity emerges from the interaction between personal resources and the social environment. Using examples relevant to chronic disease and behavior change, we discuss the clinical application of the capability framework.
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Affiliation(s)
- Robert L Ferrer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA.
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Abstract
Peer support may improve self-management among the millions of people with diabetes around the world. A major challenge to international promotion of peer support is allowing for tailoring to population, cultural, health system and other features of specific settings, while also ensuring congruence with standards for what peer support entails. One strategy to address this challenge was used in the Robert Wood Johnson Foundation Diabetes Initiative. Key functions of self-management-Resources and Supports for Self-Management-were identified. Individual programmes were then encouraged to implement these resources and support in ways that were feasible in their settings and responsive to the needs and perspectives of those they serve. Extending this to peer support, three Key functions are (i) assistance in managing and living with diabetes in daily life; (ii) social and emotional support and (iii) linkage to clinical care. International promotion may be advanced by emphasizing these key functions and then encouraging local variation in the specific ways they are addressed. Similarly, evaluation of the general benefits of peer support across several individual programmes may rest on measurement of implementation of the key functions, participants' reports of receipt of them and common end points. Challenges to promoting peer support include integrating peers amidst others in the health care system, harmonizing peers with family and other social networks, maintaining the engagement of peer supporters and those they assist and preventing training, quality improvement and professionalism from distorting the fundamental benefits of support from a peer.
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Deitrick LM, Paxton HD, Rivera A, Gertner EJ, Biery N, Letcher AS, Lahoz LM, Maldonado E, Salas-Lopez D. Understanding the role of the promotora in a Latino diabetes education program. QUALITATIVE HEALTH RESEARCH 2010; 20:386-399. [PMID: 20133505 DOI: 10.1177/1049732309354281] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We explore the role of the promotora de salud (health promoter) who provided diabetes self-management education to Puerto Rican diabetics in her community. The education program was developed as a hospital and community-based organization partnership. Information from both Spanish-language focus groups with 35 class participants and an in-depth interview with the promotora indicated patients appreciated having the classes taught in Spanish by a Latina promotora from their community. Respondents reported satisfaction with the program, increased ability to self-manage diabetes, and strengthened connections with other Latino diabetics. Terms patients used for the promotora included comadre, hijita, and buena profesora. Some of these words denote almost kinship-level connections, suggesting that patients were forming strong connections with the promotora. Specific promotora roles were identified but varied among patients, promotora, and the literature. This hospital and community-based organization partnership promotora model appears to be effective for providing chronic disease self-management education in an urban community setting.
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Affiliation(s)
- Lynn M Deitrick
- Lehigh Valley Health Network, Allentown, Pennsylvania 18105, USA.
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Swider SM, Martin M, Lynas C, Rothschild S. Project MATCH: training for a promotora intervention. DIABETES EDUCATOR 2009; 36:98-108. [PMID: 20008279 DOI: 10.1177/0145721709352381] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Adequate training and support are critical for community health workers (promotoras de salud in Spanish) to work effectively. Current literature on promotora training is limited by a focus on promotoras' knowledge and satisfaction immediately after training. The relevance of training to subsequent work performance and the need for ongoing training are rarely addressed. This article describes the training and evaluation components of a promotora intervention focused on diabetes self-management. Training Methods Project MATCH (the Mexican American Trial of Community Health Workers) is a clinical trial designed to test the effectiveness of an intensive, promotora-based intervention to improve disease self-management for Mexican Americans with diabetes. The MATCH investigators designed a multicomponent promotora training program that provided both initial and ongoing training. The investigators used multiple methods to determine promotoras' knowledge levels, initial competency in intervention delivery, and changes in this competency over time. Evaluation Methods and Results The evaluation results show that although the initial training provided a solid knowledge and skills base for the promotoras, the ongoing training was critical in helping them deal with both intervention-related and personal challenges. CONCLUSIONS The experiences of the MATCH study suggest that in addition to strong initial training, promotora interventions benefit from ongoing training and evaluation to ensure success.
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Affiliation(s)
- Susan M Swider
- Rush University Medical Center, Department of Preventive Medicine, Chicago, Illinois
| | - Molly Martin
- Rush University Medical Center, Department of Preventive Medicine, Chicago, Illinois
| | - Carmen Lynas
- Rush University Medical Center, Department of Preventive Medicine, Chicago, Illinois
| | - Steven Rothschild
- Rush University Medical Center, Department of Preventive Medicine, Chicago, Illinois
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Comellas M, Walker EA, Movsas S, Merkin S, Zonszein J, Strelnick H. Training community health promoters to implement diabetes self-management support programs for urban minority adults. DIABETES EDUCATOR 2009; 36:141-51. [PMID: 19966071 DOI: 10.1177/0145721709354606] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To develop, implement, and evaluate a peer-led diabetes self-management support program in English and Spanish for a diverse, urban, low-income population. The program goals and objectives were to improve diabetes self-management behaviors, especially becoming more physically active, healthier eating, medication adherence, problem solving, and goal setting. METHODS After a new training program for peers led by a certified diabetes educator (CDE) was implemented with 5 individuals, this pilot evaluation study was conducted in 2 community settings in the East and South Bronx. Seventeen adults with diabetes participated in the new peer-led 5-session program. Survey data were collected pre- and postintervention on diabetes self-care activities, quality of well-being, and number of steps using a pedometer. RESULTS This pilot study established the acceptance and feasibility of both the peer training program and the community-based, peer-led program for underserved, minority adults with diabetes. Significant improvements were found in several physical activity and nutrition activities, with a modest improvement in well-being. Feedback from both peer facilitators and participants indicated that a longer program, but with the same educational materials, was desirable. CONCLUSIONS To reduce health disparities in urban communities, it is essential to continue program evaluation of the critical elements of peer-led programs for multiethnic adults with diabetes to promote self-management support in a cost-effective and culturally appropriate manner. Practice Implications A diabetes self-management support program can be successfully implemented in the community by peers, within a model including remote supervision by a CDE.
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Affiliation(s)
| | - Elizabeth A Walker
- Albert Einstein College of Medicine, Bronx, New York (Dr Walker, Dr Zonszein)
| | - Sharon Movsas
- Montefiore Medical Center, Bronx, New York (Ms Movsas, Ms Merkin, Dr Strelnick)
| | - Sheryl Merkin
- Montefiore Medical Center, Bronx, New York (Ms Movsas, Ms Merkin, Dr Strelnick)
| | - Joel Zonszein
- Albert Einstein College of Medicine, Bronx, New York (Dr Walker, Dr Zonszein)
| | - Hal Strelnick
- Montefiore Medical Center, Bronx, New York (Ms Movsas, Ms Merkin, Dr Strelnick)
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Heisler M, Spencer M, Forman J, Robinson C, Shultz C, Palmisano G, Graddy-Dansby G, Kieffer E. Participants' assessments of the effects of a community health worker intervention on their diabetes self-management and interactions with healthcare providers. Am J Prev Med 2009; 37:S270-9. [PMID: 19896029 PMCID: PMC3782259 DOI: 10.1016/j.amepre.2009.08.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 07/24/2009] [Accepted: 08/05/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The specific ways in which community health worker (CHW) programs affect participants' healthcare behaviors and interactions with their healthcare providers, as well as mechanisms by which CHW programs influence these outcomes, are poorly understood. A qualitative descriptive study of participants in a successful CHW diabetes self-management program was designed to examine: (1) what gaps in diabetes care, with a focus on patient-doctor interactions, participants identify; (2) how the program influences participants' diabetes care and interactions with healthcare providers, and what gaps, if any, it addresses. METHODS From November 2005 to December 2006, semi-structured interviews with 40 African- American and Latino adults were conducted and analyzed. Participants had diabetes and had completed or were active in a CHW-led diabetes self-management program developed and implemented using community-based participatory research principles in Detroit. Interviews were audiotaped, transcribed, and coded through a consensual and iterative process. RESULTS Participants reported that prior to the intervention they had received inadequate information from healthcare providers for effective diabetes self-management, had had low expectations for help from their providers, and had not felt comfortable asking questions or making requests of their healthcare providers. Key ways participants reported that the program improved their ability to manage their diabetes were by providing (1) clear and detailed information on diabetes and diabetes care; (2) education and training on specific strategies to meet diabetes care goals; (3) sustained and nonjudgmental assistance to increase their motivation and confidence; and (4) social and peer support that enabled them to better manage their diabetes. The knowledge and confidence gained through the CHW intervention increased participants' assertiveness in asking questions to and requesting necessary tests and results from their providers. CONCLUSIONS Study findings suggest ways that CHW programs that provide both one-on-one support and group self-management training sessions may be effective in promoting more effective diabetes care and patient-doctor relationships among Latino and African-American adults with diabetes. Through these mechanisms, such interventions may help to mitigate racial and ethnic disparities in diabetes care and outcomes.
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Affiliation(s)
- Michele Heisler
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan 48113, USA.
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Brownson CA, Hoerger TJ, Fisher EB, Kilpatrick KE. Cost-effectiveness of Diabetes Self-management Programs in Community Primary Care Settings. DIABETES EDUCATOR 2009; 35:761-9. [DOI: 10.1177/0145721709340931] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study is to estimate the cost-effectiveness of diabetes self-management programs in real-world community primary care settings. Estimates incorporated lifetime reductions in disease progression, costs of adverse events, and increases in quality of life. Methods Clinical results and costs were based on programs of the Diabetes Initiative of the Robert Wood Johnson Foundation, implemented in primary care and community settings in disadvantaged areas with notable health disparities. Program results were used as inputs to a Markov simulation model to estimate the long-term effects of self-management interventions. A health systems perspective was adopted. Results The simulation model estimates that the intervention does reduce discounted lifetime treatment and complication costs by $3385, but this is more than offset by the $15 031 cost of implementing the intervention and maintaining its effects in subsequent years. The intervention is estimated to reduce long-term complications, leading to an increase in remaining life-years and quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio is $39 563/QALY, well below a common benchmark of $50 000/QALY. Sensitivity analyses tested the robustness of the model’s estimates under various alternative assumptions. The model generally predicts acceptable cost-effectiveness ratios. Conclusions Self-management programs for type 2 diabetes are cost-effective from a health systems perspective when the cost savings due to reductions in long-term complications are recognized. These findings may justify increased reimbursement for effective self-management programs in diverse settings.
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Affiliation(s)
- Carol A. Brownson
- National Program Office of the Robert Wood Johnson Foundation
Diabetes Initiative, Division of Health Behavior Research, Washington University
School of Medicine in St Louis, St Louis, Missouri,
| | - Thomas J. Hoerger
- Research Triangle Institute International (RTI), RTI-University
of North Carolina Center of Excellence in Health Promotion Economics, Research
Triangle Park, North Carolina
| | - Edwin B. Fisher
- National Program Office of the Robert Wood Johnson Foundation
Diabetes Initiative and Peers for Progress, Department of Health Behavior
and Health Education, Gillings School of Global Public Health, University
of North Carolina at Chapel Hill
| | - Kerry E. Kilpatrick
- Department of Health Policy and Management, Gillings
School of Global Public Health, University of North Carolina at Chapel Hill
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Fisher EB, Brownson CA, O'Toole ML, Anwuri VV, Shetty G. Perspectives on self-management from the Diabetes Initiative of the Robert Wood Johnson Foundation. DIABETES EDUCATOR 2007; 33 Suppl 6:216S-224S. [PMID: 17620404 DOI: 10.1177/0145721707304124] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE AND METHOD Review and highlight findings from the projects of the Diabetes Initiative of the Robert Wood Johnson Foundation described in this special supplemental issue. RESULTS The broad framework for self-management around which these programs were developed, "Resources and Supports for Self Management," includes individualized assessment, collaborative goal setting, building skills for self-management, ongoing follow-up and support, community resources, and continuity of quality clinical care. Lessons learned include the central role of community health workers in self-management, the importance of ongoing follow-up and support to sustain self-management, varied program approaches to depression and negative emotion, the importance of organizational infrastructure to support self-management programs, and the contributions of clinic-community partnerships. Several emergent themes include the value of providing choices among "good practices" as opposed to one best practice, the role of the physician as part of the self-management team, and the importance of broad efforts in promoting dissemination of self-management programs. Finally, self-management will benefit from replacing categorical distinctions, like good and bad control, proven and unproven treatment, with thinking in terms of key dimensions, like level of control and continued quality improvement. CONCLUSIONS Diabetes Initiative projects have shown that diabetes self-management can be promoted in the "real worlds" of community agencies and primary care settings serving diverse and disadvantaged populations.
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Affiliation(s)
- Edwin B Fisher
- The School of Public Health, University of North Carolina at Chapel Hill (Dr Fisher)
| | - Carol A Brownson
- The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri, Ms Shetty)
| | - Mary L O'Toole
- The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri, Ms Shetty)
| | - Victoria V Anwuri
- The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri, Ms Shetty)
| | - Gowri Shetty
- The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri, Ms Shetty)
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