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Ewen AM, Hawkins JM, Kloss KA, Nwankwo R, Funnell MM, Sengupta S, Jean Francois N, Piatt G. The Michigan Men's Diabetes Project Randomized Clinical Control Trial: A Pilot/Feasibility Study of a Peer-Led Diabetes Self-Management and Support Intervention for Black Men With Type 2 Diabetes. Am J Mens Health 2024; 18:15579883241258318. [PMID: 38879823 PMCID: PMC11181889 DOI: 10.1177/15579883241258318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 06/19/2024] Open
Abstract
Black men are disproportionately affected by type 2 diabetes (T2D) and experience higher diabetes-related complications than non-Hispanic White men. To address the complex barriers in diabetes self-management for Black men, we implemented a 3-month peer-led and empowerment-based Diabetes Self-Management Education (DSME) and Support (DSMS) intervention in Metro Detroit. Twenty-five Black men ≥55 years of age with self-reported T2D were randomized to the intervention group (n=12)-10 hr of DSME and 9 hr of DSMS-or enhanced usual care (EUC) group (n=13)-10 hr of DSME. Peer leaders (n = 3) were trained by certified diabetes care and education specialists (CDCESs) to cofacilitate the support sessions. Outcomes (hemoglobin A1c [HbA1c], diabetes self-care activities, and diabetes distress) were assessed preintervention and postintervention. In the intervention and EUC groups, mean HbA1c decreased by 0.20% (p = .52, SD = 0.99) and 0.13% (p = .68), respectively. General diet (p = .03, M change: 1.32, SD = 1.71) and blood glucose monitoring (p < .05, M change: 0.50, SD = 0.74) scores improved among those in the intervention group. General diet scores also improved in the EUC group: mean change: 1.77, p = .08, although changes were not statistically significant. Changes in diabetes distress scores differed based on the number of sessions attended, with a significant decrease in those attending 7 to 12 sessions (n = 7), >50%, (p = .003, M change: -5.71, SD = 3.20). Implementing a peer-led DSMS program for Black men was feasible, adopted, and led to positive changes in outcomes. Scaling up the intervention and assessing sustainability is warranted.
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Affiliation(s)
- Alana M. Ewen
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Robin Nwankwo
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Martha M. Funnell
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Srijani Sengupta
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | - Gretchen Piatt
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, USA
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Park M, Choi E, Jeong M, Seo HJ, Kim J, Seo E. Interprofessional Educational Needs for Shared Governance of Integrated Care. Int J Integr Care 2024; 24:15. [PMID: 38736721 PMCID: PMC11086590 DOI: 10.5334/ijic.7674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 04/17/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction This study investigated the educational needs of integrated care among professionals in the public sector of healthcare and social care services in South Korea. Methods A cross-sectional secondary data analysis was performed. Original data were obtained from 10 metropolitan communities with a convenience sample of 210 integrated care professionals. The Borich Needs Assessment Model and the Locus for Focus Model were used to examine the priority educational needs of each integrated care professional. Results This study analyzed the key details of educational needs in integrated care by focusing on the competencies of integrated care approaches for person-centered care, interprofessional collaboration, and community involvement. The core educational needs of community care administrators, care coordinators, healthcare and social care providers, and community health champions, which are common to all professionals, and the specific educational needs for each type of professional were demonstrated, which contained specific content to implement integrated care. Conclusion This study provides an opportunity to comprehensively understand the educational needs of integrated care professionals based on their competencies. They want better interprofessional cooperation through networking and collaborative strategies. The results of this study may be utilized as fundamental data by future instructors to provide evidence-based education programs.
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Affiliation(s)
- Myonghwa Park
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Eunjeong Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Miri Jeong
- Department of nursing, Joongbu University, Geumsan-gun, Chungnam-do, Republic of Korea
| | - Hyun-Ju Seo
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Jahyeon Kim
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
- Chung-ang University Gwangmyeong Hospital, Gwangmyeong-si, Gyeonggi-do, Republic of Korea
| | - Eunkyung Seo
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
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Hassan S, Rac VE, Hodges B, Leake P, Cobbing S, Gray CM, Bartley N, Etherington A, Abdulwasi M, Cheung HCK, Anderson M, Woods NN. Upskilling programmes for unregulated care providers to provide diabetic foot screening for systematically marginalised populations: how, why and in what contexts do they work? A realist review. BMJ Open 2024; 14:e081006. [PMID: 38262651 PMCID: PMC10806612 DOI: 10.1136/bmjopen-2023-081006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE We aimed to understand how, why and in what context upskilling programmes for unregulated care providers (UCPs) to provide foot screening for systematically marginalised groups living with diabetes were implemented. DESIGN We used realist synthesis based on Realist And Meta-narrative Evidence Syntheses: Evolving Standards guidance. DATA SOURCES We searched the Medline, Embase, PsycINFO, CINAHL, ERIC, Web of Science Core Collection, and Scopus databases and the grey literature (Google Scholar, ProQuest Dissertations and Theses) up to November 2022. ELIGIBILITY CRITERIA We included experimental and non-experimental articles in English that either described mechanisms or discussed expected outcomes for educational interventions for patients and family caregivers or healthcare providers, both regulated and unregulated. We also included articles that evaluated the impact of foot care programmes if the UCPs' training was described. DATA EXTRACTION AND SYNTHESIS The lead author extracted, annotated and coded uploaded relevant data to identify contexts, mechanisms and outcome configurations using MAXQDA (a qualitative data analysis software). We used deductive and inductive coding to structure the process. Our team members double-reviewed and appraised a random sample of 20% of articles at all stages to ensure consistency. RESULTS Our search identified 52 articles. Evidence suggested the necessity of developing upskilling foot screening programmes within the context of preventive care programmes that also provide education in diabetes, and early referrals for appropriate interventions. Multidisciplinary programmes created an ideal context facilitating coordination between UCPs and their regulated counterparts. Engaging patients and community partners, using a competency-based model, and incorporating cultural competencies were determinants of success for these programmes. CONCLUSION This review provides a realistic programme theory for the mechanisms used, the context in which these programmes were developed, and the expected outcomes to train UCPs to provide preventive foot care for systematically marginalised populations. PROSPERO REGISTRATION NUMBER CRD42022369208.
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Affiliation(s)
- Samah Hassan
- University Health Network, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
| | - Valeria E Rac
- University Health Network, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Diabetes Action Canada, CIHR SPOR Network, Toronto, Ontario, Canada
| | - Brian Hodges
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patti Leake
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Saul Cobbing
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa
| | - Catharine Marie Gray
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Nicola Bartley
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Andrea Etherington
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Munira Abdulwasi
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Hei-Ching Kristy Cheung
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Melanie Anderson
- University Health Network, Toronto, Ontario, Canada
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Nicole N Woods
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
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Mallaiah J, Leon RD, Williams O, Allegrante JP. Cardiovascular Disease and Stroke-Focused Competency Assessment Tools for Community Health Workers in the United States: A Scoping Review. Health Promot Pract 2023; 24:1183-1195. [PMID: 36062599 DOI: 10.1177/15248399221120809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease (CVD) and stroke are major contributors to chronic disease burden in the United States. Despite the high prevalence of stroke, 90% of all stroke events are preventable and can be attributed to seven key modifiable risk factors (MRFs)-high blood pressure (BP), high cholesterol, diabetes mellitus (DM), smoking, obesity, unhealthy diet, and physical inactivity. In the United States, stroke prevention interventions led by community health workers (CHWs) have been proven to be highly effective in preventing the onset of MRFs. We conducted a scoping review of the competency assessment methods used in CVD and stroke-focused CHW training programs. We searched six online databases: PubMed, Cochrane, CINAHL, Embase, Web of Science, and HaPI, from all available years until January 2021. Of the 1,774 initial articles found, we identified 30 eligible articles to be included in the review. Nine of these studies used previously validated instruments, whereas the remaining 21 studies used tools from the training curriculum or independently developed instruments. Only five of these validated tools reported psychometric properties; none of them were designed for the CHW population. Our scoping review of literature revealed that CHW-specific competency assessment methods were limited, with few or no domain-referenced tools on CVD or stroke risk factors that complied with established measurement standards. We conclude that there is an urgent need for the development of a comprehensive and valid assessment instrument in CVD and stroke prevention to evaluate CHW performance and optimize their credibility, representing important first steps toward integrating CHWs into health care systems.
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Jabri A, Domínguez Páez Y, Brown M, Lui G, Hui WK, Hernandez N, Parks ML, Gonzalez Della Valle A, Goodman SM, Banerjee S, Safford MM, Navarro-Millán I. A single-center, open-label, randomized, parallel-group trial to pilot the effectiveness of a peer coach behavioral intervention versus an active control in reducing anxiety and depression in patients scheduled for total knee replacement. BMC Musculoskelet Disord 2023; 24:353. [PMID: 37147587 PMCID: PMC10160708 DOI: 10.1186/s12891-023-06460-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Moving Well is a behavioral intervention for patients with knee osteoarthritis (KOA) scheduled for a total knee replacement (TKR). The objective of this intervention is to help patients with KOA mentally and physically prepare for and recover from TKR. METHODS This is an open-label pilot randomized clinical trial that will test the feasibility and effectiveness of the Moving Well intervention compared to an attention control group, Staying Well, to reduce symptoms of anxiety and depression in patients with KOA undergoing TKR. The Moving Well intervention is guided by Social Cognitive Theory. During this 12-week intervention, participants will receive 7 weekly calls before surgery and 5 weekly calls after surgery from a peer coach. During these calls, participants will be coached to use principles of cognitive behavioral therapy (CBT), stress reduction techniques, and will be assigned an online exercise program, and self-monitoring activities to complete on their own time throughout the program. Staying Well participants will receive weekly calls of similar duration from research staff to discuss a variety of health topics unrelated to TKR, CBT, or exercise. The primary outcome is the difference in levels of anxiety and/or depression between participants in the Moving Well and Staying Well groups 6 months after TKR. DISCUSSION This study will pilot test the feasibility and effectiveness of Moving Well, a peer coach intervention, alongside principles of CBT and home exercise, to help patients with KOA mentally and physically prepare for and recover from TKR. TRIAL REGISTRATION Clinicaltrials.gov. NCT05217420; Registered: January 31, 2022.
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Affiliation(s)
- Assem Jabri
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Mackenzie Brown
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Geyanne Lui
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Wai-Kwong Hui
- Department of Physical Therapy, Hospital for Special Surgery, New York, NY, USA
| | - Noelia Hernandez
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael L Parks
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Susan M Goodman
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Iris Navarro-Millán
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA.
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA.
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Hawkins J, Sengupta S, Kloss K, Kurnick K, Ewen A, Nwawkwo R, Funnell M, Mitchell J, Jones L, Piatt G. Michigan men's diabetes project II: Protocol for peer-led diabetes self-management education and long-term support in Black men. PLoS One 2023; 18:e0277733. [PMID: 36862648 PMCID: PMC9980828 DOI: 10.1371/journal.pone.0277733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/06/2023] [Indexed: 03/03/2023] Open
Abstract
Previous literature has indicated that Black men are twice as likely to develop type 2 diabetes compared to their non-Hispanic White counterparts and are also more likely to have associated complications. Furthermore, Black men have lower access to quality health care, and masculinity norms have been shown to hinder them from seeking the limited care that is available. In this study, we aim to investigate the effect of peer-led diabetes self-management education and long-term ongoing support on glycemic management. The first phase of our study will consist of modification of existing diabetes education content to be more appropriate for the population of interest, Then, in the second phase, we will conduct a randomized controlled trial to test the intervention. Participants randomized to the intervention arm will receive diabetes self-management education, structured diabetes self-management support, and a more flexible ongoing support period. Participants randomized to the control arm will receive diabetes self-management education. Diabetes self-management education will be taught by certified diabetes care and education specialists, while the diabetes self-management support and ongoing support period will be facilitated by fellow Black men with diabetes who will be trained in group facilitation, patient-provider communication strategies, and empowerment techniques. The third phase of this study will consist of post-intervention interviews and dissemination of findings to the academic community. The primary goal of our study is to determine whether long-term peer-led support groups in conjunction with diabetes self-management education are a promising solution to improve self-management behaviors and decrease A1C levels. We will also evaluate the retention of participants throughout the study, which has historically been an issue in clinical studies focused on the Black male population. Finally, the results from this trial will determine whether we can proceed to a fully-powered R01 trial or if other modifications of the intervention are necessary. Trial registration: Registered at ClinicalTrials.gov with an ID of NCT05370781 on May 12, 2022.
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Affiliation(s)
- Jaclynn Hawkins
- School of Social Work, University of Michigan, Ann Arbor, MI, United States of America
| | - Srijani Sengupta
- School of Social Work, University of Michigan, Ann Arbor, MI, United States of America
| | - Katherine Kloss
- School of Social Work, University of Michigan, Ann Arbor, MI, United States of America
| | - Katie Kurnick
- School of Social Work, University of Michigan, Ann Arbor, MI, United States of America
| | - Alana Ewen
- School of Public Health, University of Maryland, College Park, MD, United States of America
| | - Robin Nwawkwo
- Medical School, University of Michigan, Ann Arbor, MI, United States of America
| | - Martha Funnell
- Medical School, University of Michigan, Ann Arbor, MI, United States of America
| | - Jamie Mitchell
- School of Social Work, University of Michigan, Ann Arbor, MI, United States of America
| | - Lenette Jones
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Gretchen Piatt
- Medical School, University of Michigan, Ann Arbor, MI, United States of America
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Afshar R, Askari AS, Sidhu R, Cox S, Sherifali D, Camp PG, Tang TS. Out of the mouths of Peer Leaders: Perspectives on how to improve a telephone-based peer support intervention in type 2 diabetes. Diabet Med 2022; 39:e14853. [PMID: 35437815 DOI: 10.1111/dme.14853] [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: 10/21/2021] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the experiences of peer leaders with respect to delivering core components of a 12-month, telephone-based peer support intervention in type 2 diabetes within a tertiary-care setting. METHODS Seventeen peer leaders were recruited and interviewed. Interviews lasted approximately 20 to 45 min, were audio-taped, and transcribed verbatim. The transcripts were analysed by two team members using the qualitative descriptive approach. FINDINGS Peer leaders reported mutually beneficial and reciprocal relationships with participants. They encountered challenges in maintaining regular contact with participants and in motivating them to make lifestyle changes. To improve the programme, peer leaders suggested having more frequent - but shorter - training sessions and reducing the diabetes education component of the training programme. To enhance the intervention fidelity and retention rate, they recommended matching peer leaders to participants on more meaningful variables (e.g. diabetes-related commonalities, personality, life experiences, etc.) beyond just gender, geographic proximity and availability. They also requested more frequent face-to-face contacts with participants (Modality of Contact), and additional ongoing support from the research team. CONCLUSION Peer leaders were satisfied with the intervention design. However, future studies may consider more comprehensive peer leader-matching algorithms and increased opportunities for in-person communication modalities. CLINICALTRIALS gov Identifier: NCT02804620.
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Affiliation(s)
- Rowshanak Afshar
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Amir S Askari
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rawel Sidhu
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Susan Cox
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Pat G Camp
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Tricia S Tang
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada
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Wan X, Chau JPC, Wu Y, Xu L, Gong W. Effects of a nurse-led peer support intervention for stroke survivors: protocol for a randomised controlled trial. BMJ Open 2022; 12:e062531. [PMID: 35688588 PMCID: PMC9189841 DOI: 10.1136/bmjopen-2022-062531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Many stroke survivors have unmet psychosocial needs during the recovery phase following a stroke. There is emerging evidence that peer support interventions may play a valuable role in managing stroke. However, evidence regarding the effectiveness of peer support interventions on the psychosocial outcomes of stroke survivors is uncertain. This study aims to develop a nurse-led peer support intervention for stroke survivors based on the Person-Environment-Occupation-Performance Model and evaluate its effects on the psychosocial outcomes of stroke survivors. METHODS AND ANALYSIS This is an assessor-blinded two-arm randomised controlled trial. A convenience sample of 120 stroke survivors will be recruited from two community centres and one rehabilitation unit in Yangzhou, a medium-sized city in eastern China, with 60 participants each in the intervention and control groups. The participants allocated to the intervention group will receive the nurse-led peer support intervention, which includes 6 weekly peer support sessions facilitated by a nurse and at least one peer facilitator. Participants randomised to the control group will receive the same dose of interpersonal interaction as intervention participants, including weekly individual face-to-face session for 6 weeks. The primary outcomes are social participation and participation self-efficacy. The secondary outcomes are psychosocial distress, social support, stigma towards disease, self-efficacy in managing chronic conditions and quality of life. Data will be collected at baseline, immediately after the intervention and 3 months after the intervention. A process evaluation will be conducted qualitatively and quantitively to examine the mechanism by which the intervention impacts the psychosocial outcomes of stroke survivors. All outcomes will be analysed following the intention to treat principle. Generalised Estimation Equation models will be used to assess the intervention effect. ETHICS AND DISSEMINATION This protocol was approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No.: 2021.196-T). All participants will be required to provide written informed consent. Results of the study will be disseminated through publication in peer-reviewed journals and presentation at local or international conferences. TRIAL REGISTRATION NUMBER ChiCTR2100050853.
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Affiliation(s)
- Xiaojuan Wan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ying Wu
- Yangzhou Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Yangzhou, China
| | - Limei Xu
- Outpatient Pharmacy, Wenfeng Community Health Service Centre, Yangzhou, China
| | - Weijuan Gong
- Department of Medicine, Yangzhou University, Yangzhou, China
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Weiner J, Lui G, Brown M, Páez YD, Fritz S, Sydnor-Campbell T, Allen A, Jabri A, Venkatachalam S, Gavigan K, Nowell WB, Curtis JR, Fraenkel L, Safford M, Navarro-Millán I. Protocol for the pilot randomized trial of the CArdiovascular Risk assEssment for Rheumatoid Arthritis (CARE RA) intervention: a peer coach behavioral intervention. Pilot Feasibility Stud 2022; 8:84. [PMID: 35428359 PMCID: PMC9011938 DOI: 10.1186/s40814-022-01041-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the most common cause of death among people with rheumatoid arthritis (RA), with an estimated increased risk of 50–60% compared to the general population. Lipid-lowering strategies have been shown to lower CVD risk significantly in people with RA and hyperlipidemia. Thus, CVD risk assessment has an important role to play in reducing CVD among people with RA. Yet currently only 37 to 45% of this population are receiving primary lipids screening. This paper describes the CArdiovascular Risk assEssment for RA (CARE RA) intervention, which is designed to address this issue. CARE RA is a peer coach intervention, that is, an intervention in which a person with RA coaches another person with RA, which is designed to educate people with RA about the relation between RA and CVD risk and to help them obtain evidence-based CVD risk assessment and treatment. Methods This is an open-label pilot study that will test if the participants assigned to complete the CARE RA curriculum with a peer coach will receive a cardiovascular risk assessment more frequently compared to those that complete the CARE RA curriculum by themselves. The CARE RA intervention is guided by Social Cognitive Theory. Participants in the peer coach intervention arm will receive the assistance of a peer coach who will call the participants once a week for 5 weeks to go over the CARE RA curriculum and train them on how to obtain CVD risk assessment. The control arm will complete the CARE RA curriculum without any assistance. Participants will be randomized 1:1 either to the control arm or to the peer coach intervention arm. The primary outcome is a participant’s having a CVD risk assessment or initiating a statin, if indicated. Secondary outcomes include patient activation and RA medication adherence. The RE-AIM implementation framework guides the implementation and evaluation of the intervention. Discussion This pilot study will test the feasibility of the peer coach intervention in anticipation of a larger trial. CARE RA pioneers the use of peer coaches to facilitate the implementation of evidence-based treatment guidelines among people with RA. Trial registration ClinicalTrials.gov NCT04488497. Registered on July 28, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01041-z.
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Schwei RJ, Hetzel S, Kim K, Mahoney J, DeYoung K, Frumer J, Lanzafame RP, Madlof J, Simpson A, Zambrano-Morales E, Jacobs EA. Peer-to-Peer Support and Changes in Health and Well-being in Older Adults Over Time. JAMA Netw Open 2021; 4:e2112441. [PMID: 34129024 PMCID: PMC8207241 DOI: 10.1001/jamanetworkopen.2021.12441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Literature on peer-to-peer (P2P) programs suggests they improve health and well-being of older adults. Analysis from a previous study showed P2P to be associated with higher rates of hospitalization and no significant differences in rates of emergency department or urgent care visits; however, it is not known whether measures of health and well-being varied by group over time. OBJECTIVE To compare the association between receiving P2P support and secondary outcomes (ie, health status, quality of life, and depressive and anxiety symptoms) with receiving standard community services (SCS) over time. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among a volunteer sample of older adults (≥65 years) who were new to P2P or were already receiving P2P and a corresponding control group. Participants were matched between groups on age, sex, and race/ethnicity. The study was conducted from March 2015 to December 2017 at 3 community-based organizations that delivered P2P in California, Florida, and New York. Data analysis was performed from October 2018 through May 2020. EXPOSURES P2P support, provided by trained older adult volunteers. MAIN OUTCOMES AND MEASURES Mental and physical components of the health status and quality of life measure and depressive and anxiety symptoms were collected over 12 months. The hypothesis was that older adults receiving P2P support would maintain higher health status and quality of life than the SCS group. RESULTS A total of 503 participants were screened, 456 participants were enrolled and had baseline data, and 8 participants only had baseline information with no follow-up data, leaving 448 participants (231 [52%] in the SCS group; 217 [48%] in the P2P group; 363 [81%] women; mean [SD] age, 80 [9] years). The P2P group had improvements in mental health (change at 12 months, 1.1 points; 95% CI, -0.8 to 3.0 points) and physical health (change at 12 months, 1.0 points; 95% CI, -0.7 to 2.8 points). However, the difference of differences between the 2 groups did not differ significantly from baseline to 12 months (mental health: 0.2 points; 95% CI -2.3 to 2.7 points; physical health: 1.7 points; 95% CI, -0.6 to 3.9 points). The P2P and SCS groups had a statistically significant difference of differences in anxiety symptoms of 0.36 points (95% CI, 0.04 to 0.61 points). There were no significant differences in depressive symptoms or mental and physical components of the health status and quality of life. CONCLUSIONS AND RELEVANCE These findings suggest that receiving P2P support did not slow the decline of health and well-being in older adults compared with those who received SCS. Baseline imbalance in key characteristics, even after adjusting for the imbalance using the propensity score method, may explain the results. Randomized trials are needed.
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Affiliation(s)
- Rebecca J. Schwei
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, Madison
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin Madison School of Medicine and Public Health, Madison
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin Madison School of Medicine and Public Health, Madison
| | - Jane Mahoney
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Jenni Frumer
- Next Generation of Holocaust Survivors Inc, Boynton Beach, Florida
| | | | - Jenny Madlof
- Alpert Jewish Family Service of West Palm Beach, West Palm Beach, Florida
| | - Alis Simpson
- Brockport Research Institute, Brockport, New York
| | | | - Elizabeth A. Jacobs
- Department of Medicine and Population Health, University of Texas at Austin Dell Medical School, Austin
- now with Maine Medical Center Research Institute, Scarborough
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Hawkins J, Kloss K, Funnell M, Nwankwo R, Schwenzer C, Smith F, Piatt G. Michigan Men's diabetes project (MenD): protocol for a peer leader diabetes self-management education and support intervention. BMC Public Health 2021; 21:562. [PMID: 33752609 PMCID: PMC7983198 DOI: 10.1186/s12889-021-10613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background Black men are more likely to be diagnosed with type 2 diabetes (T2D) compared to non-Hispanic White men, and this disparity increases among men over the age of 55. A growing body of literature demonstrates the critical role of gender in the management of health behaviors such as T2D and shows that male gender norms can conflict with healthy behaviors. These studies suggest that tailoring diabetes self-management interventions to address the needs of Black men may be critical to helping them to achieve optimal health outcomes. Further, our own research on Blacks with T2D found gender disparities in participation in diabetes interventions, with males participating at significantly lower rates than females. Peer leaders are trained lay individuals who are used to provide ongoing diabetes self-management support to people with diabetes, particularly in minority communities. However, despite studies showing that diabetes management interventions using peer leaders have been successful, the majority of peer leaders as well as the participants in those studies are women. The limited studies to date suggest that Black men with T2D prefer peer-led, male-to-male T2D programs, however, this research consists primarily of nonrandomized, small sample feasibility studies calling for additional studies to establish the efficacy of these approaches. The proposed study will develop and preliminarily validate the effectiveness of an adapted peer leader diabetes self-management support (PLDSMS) intervention designed to improve diabetes-related lifestyle and self-management behaviors in Black men (over 55) with T2D. Method We propose to tailor an existing intervention by 1) our using male peers and 2) modifying the peer leader training content to focus on material appropriate for men. The proposed study includes a developmental phase (development of the intervention with expert feedback, followed by feasibility testing with Black men) and a validation phase [randomized clinical trial (RCT)]. Discussion If successful, this study will lead to the development and dissemination of an intervention that will address the unique needs of Black men with T2D, helping them to achieve optimal diabetes self-management and health outcomes. Trial registration Registered at ClinicalTrials.gov with an ID NCT04760444 on February 17, 2021
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Affiliation(s)
- Jaclynn Hawkins
- University of Michigan, School of Social Work, 1080 S. University, Ann Arbor, MI, 48109, USA.
| | - Katherine Kloss
- Department of Learning Health Sciences, University of Michigan, 1111 E. Catherine, Ann Arbor, MI, 48109, USA
| | - Martha Funnell
- Department of Learning Health Sciences, University of Michigan, 1111 E. Catherine, Ann Arbor, MI, 48109, USA
| | - Robin Nwankwo
- Department of Learning Health Sciences, University of Michigan, 1111 E. Catherine, Ann Arbor, MI, 48109, USA
| | - Claudia Schwenzer
- University of Michigan, School of Social Work, 1080 S. University, Ann Arbor, MI, 48109, USA
| | - Fonda Smith
- University of Michigan, School of Social Work, 1080 S. University, Ann Arbor, MI, 48109, USA
| | - Gretchen Piatt
- Department of Learning Health Sciences, University of Michigan, 1111 E. Catherine, Ann Arbor, MI, 48109, USA
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12
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Chen WC, Kuo CC, Lin CC, Wu CC. A preliminary study on the effects of the Peer-Led Self-Management (PLSM) program on self-efficacy, self-management, and physiological measures in older adults with diabetes: A block randomized controlled trial. Geriatr Nurs 2021; 42:386-396. [DOI: 10.1016/j.gerinurse.2021.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 02/08/2023]
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13
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Chen WC, Lin CC, Kuo CC, Wu CC, Liu TJ, Chen MT. A Theory-Based Self-Management Training Program for Older Adult Peer Leaders with Diabetes: A Feasibility Assessment. J Multidiscip Healthc 2021; 14:33-44. [PMID: 33442261 PMCID: PMC7800687 DOI: 10.2147/jmdh.s286186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To improve the quality of peer leader training, this study developed a theory-based self-management training program for older adult peer leaders with diabetes and assessed its feasibility. Background Current self-management programs are designed mainly to be implemented by healthcare professionals, but healthcare staff may not fully perceive the needs and obstacles of older adults in disease management due to a lack of similar illness experience. To target this problem, peer leaders with successful self-management experiences, similar cultural backgrounds and languages, and related illness experiences are trained to guide and mentor peer patients in self-management programs. Study Design and Methods This study was conducted in two stages. In stage 1, a peer leader training program was developed based on experiential learning theory as the framework and self-regulation theory as the activity design strategy. In stage 2, program feasibility was assessed via participants’ feedback toward the training program by three indicators: attendance, future willingness to lead the peer-led self-management program, and leadership skills evaluated by a peer leader training assessment tool. Results In this study, peer leaders demonstrated good leadership skills by expressing active willingness to lead self-management programs in the community. Peer leaders’ feedback indicated that the program’s training content was helpful in preparing peer leaders to guide older adults in learning self-management skills and in improving the abilities and confidence of peer leaders in mentoring self-management. Conclusion Findings in this study showed that peer leader training can impact the effectiveness and success of self-management in older adults with diabetes. Even in a small-scale study, the impact was evident, which demonstrated the feasibility of the program. More large-scale studies on the effectiveness of various peer leader training programs in diverse disciplines are recommended. Clinical Trials Registry ClinicalTrials.gov Identifier: NCT04298424 (the Peer-Led Self-Management Program).
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Affiliation(s)
- Wen-Chun Chen
- Department of Community Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan.,School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Chang Jung University of Science and Technology, Chiayi Campus, Tainan, Taiwan
| | - Chiu-Chu Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Chi Kuo
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Nursing, Chang Jung Christian University, Tainan, Taiwan
| | - Chia-Chen Wu
- School of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Tz-Jie Liu
- Health Management Center, St. Martin De Porres Hospital, Chiayi, Taiwan
| | - Mei-Tsu Chen
- Health Management Center, St. Martin De Porres Hospital, Chiayi, Taiwan
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14
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Heisler M, Kullgren J, Richardson C, Stoll S, Alvarado Nieves C, Wiley D, Sedgwick T, Adams A, Hedderson M, Kim E, Rao M, Schmittdiel JA. Study protocol: Using peer support to aid in prevention and treatment in prediabetes (UPSTART). Contemp Clin Trials 2020; 95:106048. [PMID: 32497783 PMCID: PMC8059966 DOI: 10.1016/j.cct.2020.106048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is an urgent need to develop and evaluate effective and scalable interventions to prevent or delay the onset of type 2 diabetes mellitus (T2DM). METHODS In this randomized controlled pragmatic trial, 296 adults with prediabetes will be randomized to either a peer support arm or enhanced usual care. Participants in the peer support arm meet face-to-face initially with a trained peer coach who also is a patient at the same health center to receive information on locally available wellness and diabetes prevention programs, discuss behavioral goals related to diabetes prevention, and develop an action plan for the next week to meet their goals. Over six months, peer coaches call their assigned participants weekly to provide support for weekly action steps. In the final 6 months, coaches call participants at least once monthly. Participants in the enhanced usual care arm receive information on local resources and periodic updates on available diabetes prevention programs and resources. Changes in A1c, weight, waist circumference and other patient-centered outcomes and mediators and moderators of intervention effects will be assessed. RESULTS At least 296 participants and approximately 75 peer supporters will be enrolled. DISCUSSION Despite evidence that healthy lifestyle interventions can improve health behaviors and reduce risk for T2DM, engagement in recommended behavior change is low. This is especially true among racial and ethnic minority and low-income adults. Regular outreach and ongoing support from a peer coach may help participants to initiate and sustain healthy behavior changes to reduce their risk of diabetes. TRIAL REGISTRATION The ClinicalTrials.gov registration number is NCT03689530.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America.
| | - Jeffrey Kullgren
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States of America; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States of America.
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Shelley Stoll
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Cristina Alvarado Nieves
- University of Michigan, Department of Internal Medicine- Metabolism, Endocrinology and Diabetes, United States of America.
| | - Deanne Wiley
- Kaiser Permanente Northern California, United States of America.
| | - Tali Sedgwick
- Kaiser Permanente Northern California Division of Research, United States of America.
| | - Alyce Adams
- Kaiser Permanente Northern California, United States of America.
| | | | - Eileen Kim
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Megan Rao
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Julie A Schmittdiel
- Kaiser Permanente Northern California Division of Research, United States of America.
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15
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Navarro-Millán I, Young SR, Shurbaji S, McDavid C, Cornelius-Schecter A, Johnson B, Cherrington AL, Fraenkel L, Goodman SM, Curtis JR, Venkatachalam S, Safford MM. Barriers and facilitators for screening and treatment of hyperlipidemia among patients with inflammatory arthritis. BMC Rheumatol 2020; 4:26. [PMID: 32514493 PMCID: PMC7265623 DOI: 10.1186/s41927-020-00123-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with inflammatory arthritis (IA), defined as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), are at increased risk for cardiovascular disease (CVD). The frequency of screening and treatment of hyperlipidemia, a modifiable CVD risk factor, is low in these patients. The reasons for low screening and treatment rates in this population are poorly understood. Our objective was to elicit the barriers and facilitators for screening and treatment of hyperlipidemia from the perspective of patients with IA. METHODS We conducted a qualitative study using focus groups of patients with IA, guided by Bandura's Social Cognitive Theory. We recruited patients with IA aged 40 years and older from a single academic center. Data were analyzed thematically. RESULTS We conducted three focus groups with 17 participants whose mean age was 56 (range 45-81) years; 15 were women. Four themes emerged as barriers: 1) need for more information about arthritis, prognosis, and IA medications prior to discussing additional topics like CVD risk; 2) lack of knowledge about how IA increases CVD risk; 3) lifestyle changes to reduce overall CVD risk rather than medications; and 4) the need to improve doctor-patient communication about IA, medications, and CVD risk. One theme emerged as a facilitator: 5) potential for peer coaches (patients with IA who are trained about concepts of CVD risk and IA) to help overcome barriers to screening and treatment of hyperlipidemia to lower CVD risk. CONCLUSION Patients with IA identified educational needs about IA, increased CVD risk in IA and the need for improved doctor-patient communication about screening for hyperlipidemia and its treatment. Patients were receptive to working with peer coaches to facilitate achievement of these goals.
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Affiliation(s)
- Iris Navarro-Millán
- Weill Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 420 East 70yth Street – LH -363, New York, NY 10021 USA
- Division of Rheumatology, Hospital for Special Surgery, 535 East 70yth Street – LH -363, New York, NY 10021 USA
| | - Sarah R. Young
- Department of Social Work, Binghamton University, Binghamton, NY USA
| | - Sally Shurbaji
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Chastity McDavid
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Anna Cornelius-Schecter
- Weill Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 420 East 70yth Street – LH -363, New York, NY 10021 USA
| | - Bernadette Johnson
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Andrea L. Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Liana Fraenkel
- Yale University, New Haven, USA
- Berkshire Health Systems, Pittsfield, MA USA
| | - Susan M. Goodman
- Division of Rheumatology, Hospital for Special Surgery, 535 East 70yth Street – LH -363, New York, NY 10021 USA
| | - Jeffrey R. Curtis
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Monika M. Safford
- Weill Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 420 East 70yth Street – LH -363, New York, NY 10021 USA
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16
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Yao J, Wang H, Yin J, Shao D, Guo X, Sun Q, Yin X. Factors associated with the utilization of community-based diabetes management care: A cross-sectional study in Shandong Province, China. BMC Health Serv Res 2020; 20:407. [PMID: 32393254 PMCID: PMC7212576 DOI: 10.1186/s12913-020-05292-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 05/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background Community-based diabetes management is known to be an important strategy for global diabetes control. In China, community-based diabetes management care, including regular blood glucose tests and guidance on medicine use, dietary control, and physical exercise provided by primary health institutions (PHIs), as one of the key contents of the national essential public health services (EPHS), was implemented since 2009 when the new round of health system reform was initiated. This study aimed to investigate the utilization of community-based diabetes management care services, and explore the factors influencing utilization from both patients’ and providers’ points of view. Methods In total, 2520 type-2 diabetes mellitus (DM) patients registered for EPHS were selected from 63 PHIs in eight counties of Shandong province, China, using multi-stage stratified sampling. Of those, 2166 patients (response rate: 85.4%) completed face-to-face structured questionnaires on their utilization of community-based diabetes management care services. Further, 63 PHIs were surveyed on diabetes care delivery, and 444 primary healthcare providers were purposively sampled from those PHIs to measure their knowledge of diabetes management care delivery, using a self-developed questionnaire. Descriptive statistics were used to analyze the delivery and utilization of diabetes management care services. Multilevel logistic regression models were used to analyze the factors associated with patients’ utilization of diabetes management services. Results All 63 PHIs reported that all the required four diabetes management services were provided through EPHS. However, only 49.6% of the patients reported they fully used these services, with no statistically significant difference between urban and rural patients. Patients who had higher knowledge of diabetes and better self-efficacy in controlling the condition, were more likely to fully utilize diabetes management care. A larger number of PHI health staff per 1000 population was associated with better utilization of care. Conclusion Although community-based diabetes management services are well available to Chinese DM patients under the framework of EPHS, the actual utilization of diabetes management services among the patients was poor. The size of the PHI workforce, patients’ knowledge and self-efficacy in controlling diabetes, were important predictors of utilization, and could be enhanced to improve control of diabetes.
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Affiliation(s)
- Jingjing Yao
- School of Health Care Management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - Haipeng Wang
- School of Health Care Management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - Jia Yin
- School of Health Care Management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - Di Shao
- School of Health Care Management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - Xiaolei Guo
- Shandong Centers for Disease Control and Prevention, Jingshi Road, Lixia District, Jinan, 250012, China
| | - Qiang Sun
- School of Health Care Management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Wenhuaxi Road, Lixia District, Jinan, 250012, China.
| | - Xiao Yin
- Shandong University Affliated Jinan Center Hospital, Jiefang Road, Lixia District, Jinan, 250012, China.
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Dolovich L, Gaber J, Valaitis R, Ploeg J, Oliver D, Richardson J, Mangin D, Parascandalo F, Agarwal G. Exploration of volunteers as health connectors within a multicomponent primary care-based program supporting self-management of diabetes and hypertension. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:734-746. [PMID: 31777125 DOI: 10.1111/hsc.12904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/30/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
Volunteers support health and social care worldwide, yet there is little research on integrating these unpaid community members into primary care. 'Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management' (Health TAPESTRY-HC-DM) integrates volunteer 'health connectors' into a community- and primary care-based program supporting client self-management in Hamilton, Canada. Volunteers supported clients through goal setting, motivation, education and connections to community resources and primary care. This study aimed to create and apply a volunteer program evaluation framework to explore: (a) volunteer training effectiveness (learning online content, in-person training, self-efficacy in role tasks, training overall); (b) feasibility of program implementation (process measures, reflections on client encounters, understanding of volunteer roles/responsibilities, client perspectives on volunteer program); and (c) effects of volunteering on volunteers (health outcomes, self-efficacy, value of volunteering). A concurrent triangulation, mixed-methods design was used. Data were collected in 2016, sources included: volunteer online training quizzes, focus groups, self-efficacy survey, Veterans RAND 12-Item (VR-12) survey, in-person training feedback forms and narratives of client visits; client interviews; and quantitative implementation data. Quantitative data analysis included descriptive statistics, paired samples t tests, and effect size (Cohen's d). Qualitative data used descriptive thematic analysis. Nineteen volunteers and 12 clients participated in this evaluation. Findings demonstrate the volunteer program evaluation framework in action. Online training increased knowledge. In-person training received largely positive evaluations. Self-efficacy was high post-training and higher after volunteering. VR-12 sub-scale means increased descriptively. Volunteers understood themselves as healthcare system connectors, feeling fulfilled with their contributions and learning new skills. They identified barriers including not having the resources and skills of healthcare professionals. Clients found volunteers were a major program strength, appreciating their company and regular goals follow-up. Using a volunteer program evaluation framework generated rich and comprehensive data demonstrating the feasibility of bringing volunteers into primary care.
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Affiliation(s)
- Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Leslie Dan Faculty of Pharmacy University of Toronto, Toronto, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jessica Gaber
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Ruta Valaitis
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Doug Oliver
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Fiona Parascandalo
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Yao J, Wang H, Yin X, Yin J, Guo X, Sun Q. The association between self-efficacy and self-management behaviors among Chinese patients with type 2 diabetes. PLoS One 2019; 14:e0224869. [PMID: 31710631 PMCID: PMC6844544 DOI: 10.1371/journal.pone.0224869] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022] Open
Abstract
Background Self-management is the cornerstone of diabetes care, however, despite the numerous recommendations available for self-management, type-2 diabetes mellitus (T2DM) patients’ performance is suboptimal in China. This study aimed to explore the association between self-efficacy and self-management behaviors among Chinese T2DM patients, which might provide evidence to inform effective self-management interventions for these patients. Methods A cross-sectional survey was conducted using a multi-stage stratified randomized sampling in Shandong Province, China. The Diabetes Empowerment Scale-Short Form (DES-SF) was used to measure patients’ self-efficacy to manage diabetes. Latent class analysis (LCA) was used to explore the observed classes of self-management behaviors (dietary control, physical exercise, regular medication and self-monitoring of blood glucose). A two-class solution for self-management behaviors was tested to be the fittest based on LCA; we labelled active and inactive self-management groups. Univariate and multivariate logistic regression analysis were used to examine the associations between self-efficacy and self-management behaviors. Results A total of 2166 T2DM patients were included in the analysis. The mean DES-SF score was 31.9 (standard deviation: 5.2). The estimated proportions of T2DM in the active and inactive groups were 54.8% and 45.2%, respectively. The multivariate logistic regression showed that higher DES-SF score was significantly associated with higher possibility of active self-management behaviors (odds ratio = 1.06; 95% confidence interval: 1.04–1.08). Conclusions Self-efficacy in managing diabetes is associated with self-management behaviors among Chinese T2DM patients. To improve self-management behaviors, multiple strategies should be conducted to improve patients’ self-efficacy.
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Affiliation(s)
- Jingjing Yao
- School of Health Care management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Haipeng Wang
- School of Health Care management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiao Yin
- Jinan Central Hospital, Jinan, China
| | - Jia Yin
- School of Health Care management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Qiang Sun
- School of Health Care management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
- * E-mail:
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Cheng L, Sit JWH, Choi KC, Chair SY, Li X, Wu Y, Long J, Yang H. The effects of an empowerment-based self-management intervention on empowerment level, psychological distress, and quality of life in patients with poorly controlled type 2 diabetes: A randomized controlled trial. Int J Nurs Stud 2019; 116:103407. [PMID: 31679744 DOI: 10.1016/j.ijnurstu.2019.103407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is considerable interest in advocating empowerment in diabetes care. Health professionals, however, often fail to realize empowerment in clinical practice, especially in patients with poorly controlled type 2 diabetes. OBJECTIVES To evaluate the effectiveness of an empowerment-based intervention on empowerment level, psychological distress, and quality of life among patients with poorly controlled type 2 diabetes. DESIGN An analysis of secondary outcomes of a prospective multi-center, randomized, parallel, investigator-blinded controlled trial. METHODS A total of 242 adult patients with poorly controlled type 2 diabetes [Hemoglobin A1c (HbA1c)≥ 58 mmol/mol in the recent six months] were randomly allocated to either intervention (n = 121) or attentional control (n = 121) groups. The design of the intervention was based on the Empowerment Process Model. The intervention group received a 6-week empowerment-based transitional care program, with significant emphasis on establishing personally meaningful goals, facilitating collaborative partnership and shared decision-making, resolving life-disease conflicts via situational reflection. Participants in the attentional control group received two general health education classes and post-discharge social calls on top of routine care. Outcomes of interest include empowerment level, diabetes distress, and quality of life. Participants were invited to complete a set of questionnaires before randomization, one-week, and three-month post-intervention. Statistical analyses were performed using the generalized estimating equations based on the intention-to-treat principle. RESULTS Comparing with the attention control group, participants in the intervention group showed significant improvements on empowerment level [(β= 0.163; 95% confidence interval (CI): 0.011 to 0.316, p = 0.036) at one-week post-intervention and (β= 0.176; 95% CI: 0.020 to 0.331, p = 0.027) at three-month post-intervention, respectively]. This group of patients also displayed significant reduction in terms of emotional-distress (β= -0.424, 95% CI: -0.798 to -0.049, p = 0.027) and regimen-distress (β= -0.397, 95% CI: -0.702 to -0.091, p = 0.011) at three-month post-intervention and physician-related distress (β= -0.236, 95% CI: -0.466 to -0.006, p = 0.044) at one-week post-intervention. Significant improvement in quality of life (β= 4.151, 95% CI: 1.291, 7.012, p = 0.004) at three-month post-intervention was also observed in the intervention group. CONCLUSIONS Findings provide empirical evidence for the values of an empowerment-based intervention program for patients with poorly controlled type 2 diabetes in increasing the empowerment level and perceived quality of life and reducing diabetes distress. Long-term effects of the intervention and its underlying mechanisms need further investigation.
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Affiliation(s)
- Li Cheng
- School of Nursing, Sun Yat-Sen University, Guangzhou, China.
| | - Janet W H Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Kai-Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Sek-Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Xiaomei Li
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, China.
| | - Yuning Wu
- The Department of Endocrinology, The Ninth Affiliated Hospital of Xi'an Jiaotong University, China.
| | - Junhong Long
- The Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, China.
| | - Hui Yang
- The Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, China.
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Tang TS, Afshar R, Elliott T, Kong J, Gill S. Study protocol and baseline sample characteristics: From clinic to community: Using peer support as a transition model for improving long-term diabetes-related health outcomes. Contemp Clin Trials 2019; 79:104-110. [PMID: 30739001 DOI: 10.1016/j.cct.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The objective of this randomized controlled trial is to examine the effects of a 12-month telephone-based peer-led diabetes self-management support (DSMS) intervention on long-term diabetes-related health outcomes. METHODS In total, 197 participants with type 2 diabetes were recruited from specialty care settings (diabetes and endocrinology clinics). They were randomly assigned to 1) a 12-month Peer-Led, Empowerment-based Approach to Self-management Efforts in Diabetes (PLEASED) program where they received 12 weekly contacts from their peer supporter (PS) in the first 3 months, followed by 18 biweekly telephone support contacts over the last 9 months, or 2) usual care. The primary clinical and psychosocial outcomes were HbA1c and diabetes distress (DD), respectively. Secondary outcomes were cardiovascular risk factors. Assessments were conducted at baseline, 3 months, and 12 months. RESULT Of 197 recruited participants, 49.7% were female. The majority of participants were married/partnered, well-educated, employed, and Caucasian, with a mean HbA1c of 8.09 ± 1.7. Forty-two percent of participants reported little or no distress. There was no significant difference between the two groups. DISCUSSION Despite evidence showing that individuals with poor glycemic control benefit the most from peer support interventions, the majority of such interventions have been designed for and implemented in community and primary care-based settings. The present study investigates a 12-month peer support model to help patients initiate and sustain effective self-management behaviors while transitioning from specialty care to a community setting. The study was completed in November 2018. The outcome data analyses are currently underway. TRIAL REGISTRATION The study was registered on clinicaltrials.gov (NT02804620). PROTOCOL VERSION The protocol version is 3.5.
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, The University of British Columbia, Gordon and Leslie Diamond Center, 2775 Laurel Street, Room 102011, Vancouver, BC V5Z 1M, Canada.
| | - Rowshanak Afshar
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Canada.
| | - Thomas Elliott
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Canada.
| | - Jason Kong
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Canada.
| | - Sabrina Gill
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Canada.
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Ishikawa T, Sato Y, Kurimoto K, Sone Y, Akamatsu R, Fujiwara Y. Curricular evaluation of "SHOKUIKU program" as a postgraduate minor course of food and nutrition education using a text-mining procedure. BMC Nutr 2018; 4:38. [PMID: 32153899 PMCID: PMC7050726 DOI: 10.1186/s40795-018-0246-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background "SHOKUIKU", food and nutrition education, is a national promotion to enable people to acquire an adequate knowledge of SHOKU (which include food, nutrition, dietary habits, etc.) in Japanese society and to allow people to make appropriate SHOKU choices in Japan. In order to educate SHOKUIKU experts who can promote evidence-based SHOKUIKU with advanced professional knowledge and skills, an original "SHOKUIKU program" was established. To evaluate this program, a short answer questionnaire was given to students. Results were objectively analyzed by text mining procedures. Methods Five hundred forty four comment papers submitted by a total of 52 consenting students after each lecture in the 12 omnibus-style lectures were examined as cross-sectional data. A total of 2507 sentences were decomposed into words, and word classes of morpheme in Japanese were properly specified. Subsequently, on the basis of a constructed keyword data base, 123 morphemes with high frequency were investigated with co-occurrence network analysis. Furthermore, multivariate network analyses according to the student's major were performed. Results Students majoring in food and nutritional sciences recognized that evidence-based SHOKUIKU is "difficult" but "necessary" to "convey" reliable information at "actual" SHOKUIKU sites. On the other hand, students studying other majors not only got an "interesting" opportunity to "learn" "nutrition" and "eating habits" but also thought about their own SHOKUIKU promotion in relation to their major. Conclusions These results suggest that the students of the Food Course assumed that they would practice the evidence-based SHOKUIKU themselves, while the students of other courses learned new knowledge more passively. The results also confirmed that students comprehensively grasped the 12 omnibus-style lectures and understood the significance of evidence-based SHOKUIKU regardless of their major. Our original educational program could be valuable for postgraduate students to promote SHOKUIKU.
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Affiliation(s)
- Tomoko Ishikawa
- 1Institute for Human Life Innovation, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610 Japan
| | - Yoko Sato
- 2Natural Science Division, Faculty of Core Research, Ochanomizu University, Tokyo, 112-8610 Japan
| | - Kyoko Kurimoto
- 1Institute for Human Life Innovation, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610 Japan
| | - Yasuko Sone
- 3Faculty of Health & Nutrition, Takasaki University of Health and Welfare, 37-1 Nakaorui-machi, Takasaki-shi, Gunma 370-0033 Japan
| | - Rie Akamatsu
- 2Natural Science Division, Faculty of Core Research, Ochanomizu University, Tokyo, 112-8610 Japan
| | - Yoko Fujiwara
- 1Institute for Human Life Innovation, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610 Japan.,2Natural Science Division, Faculty of Core Research, Ochanomizu University, Tokyo, 112-8610 Japan
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Piatt GA, Rodgers EA, Xue L, Zgibor JC. Integration and Utilization of Peer Leaders for Diabetes Self-Management Support: Results From Project SEED (Support, Education, and Evaluation in Diabetes). DIABETES EDUCATOR 2018; 44:373-382. [PMID: 29806788 DOI: 10.1177/0145721718777855] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose The purpose of the study was to evaluate the effectiveness of a peer leader-led (PL) diabetes self-management support (DSMS) group in achieving and maintaining improvements in A1C, self-monitoring of blood glucose (SMBG), and diabetes distress in individuals with diabetes. Diabetes self-management support is critical; however, effective, sustainable support models are scarce. Methods The study was a cluster randomized controlled trial of 221 people with diabetes from 6 primary care practices. Practices and eligible participants (mean age: 63.0 years, 63.8% female, 96.8% white, 28.5% at or below poverty level, 32.5% using insulin, A1C ≥7%: 54.2%) were randomized to diabetes self-management education (DSME) + PL DSMS (n = 119) or to enhanced usual care (EUC) (DSME + traditional DSMS with no PL; n = 102). Data were collected at baseline, after DSME (6 weeks), after DSMS (6 months), and after telephonic DSMS (12 months). Results Decreases in A1C occurred between baseline and post-DSME in both groups. Both groups sustained improvements during DSMS, but A1C levels increased during telephonic DSMS. Improvements in self-monitoring of blood glucose were observed in both groups following DSME and were sustained throughout. At study end, the intervention group was 4.3 times less likely to have diabetes regimen-related distress compared to EUC. Conclusions PL DSMS is as effective as traditional DSMS in helping participants to maintain glycemic control and self-monitoring of blood glucose (SMBG) and more effective at improving distress. With increasing diabetes prevalence and shortage of diabetes educators, it is important to integrate and use low-cost interventions in high-risk communities that build on available resources.
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Affiliation(s)
- Gretchen A Piatt
- University of Michigan School of Medicine, Department of Learning Health Sciences, Ann Arbor, MI, USA
| | - Elizabeth A Rodgers
- Gateway Health Plan, Pittsburgh, PA.,University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA
| | - Lingshu Xue
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA
| | - Janice C Zgibor
- University of South Florida, College of Public Health, Tampa, FL, USA
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Goldstein KM, Zullig LL, Oddone EZ, Andrews SM, Grewe ME, Danus S, Heisler M, Bastian LA, Voils CI. Understanding women veterans' preferences for peer support interventions to promote heart healthy behaviors: A qualitative study. Prev Med Rep 2018; 10:353-358. [PMID: 29868391 PMCID: PMC5984244 DOI: 10.1016/j.pmedr.2018.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/23/2018] [Accepted: 04/21/2018] [Indexed: 11/25/2022] Open
Abstract
Peer support may be an effective strategy to improve heart healthy behaviors among populations who have a strong communal identity, such as women veterans. Women veterans are a particularly important group to target as they are the fastest growing sub-population within the Veterans Affairs healthcare system. Our goal was to identify aspects of peer support and modalities for providing peer support that are preferred by women veterans at risk for cardiovascular disease (CVD). In 2016, we conducted 25 semi-structured individual interviews with women veterans from the Durham VA Healthcare System aged 35–64 who were at risk of CVD, defined as presence of at least one of the following: hypertension, hyperlipidemia, obesity (BMI ≥ 30), non-insulin dependent diabetes or prediabetes, or current smoking. Interview guide design and data analysis involved conventional content analysis. Important themes for effective peer partnerships included sharing a common behavior change goal, the need for trust between peers, compatibility around level of engagement, maintaining a positive attitude, and the need for accountability. Peer support interventions may prove beneficial to address the burden of common and preventable conditions such as CVD. Among women veterans, peer support interventions should account for individual preferences in peer matching and provide opportunities for peers to engage in relationship building in-person initially through trust-building activities. Women veterans endorsed peer support to promote heart healthy behaviors. Women Veterans prefer peers with similar health goals and level of engagement. Developing trust is key to facilitate emotional support with peers.
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Affiliation(s)
- Karen M Goldstein
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, USA
| | - Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA.,Department of Population Health Sciences, Duke University, 2200 West Main Street, Suite 720A, Durham, NC 27707, USA
| | - Eugene Z Oddone
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, USA
| | - Sara M Andrews
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA
| | - Mary E Grewe
- Cooperative Studies Program Epidemiology Center - Durham, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA
| | - Susanne Danus
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Healthcare System, 508 Fulton Street, Durham, NC 27705, USA
| | - Michele Heisler
- Ann Arbor VA Medical Center, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48015, USA.,University of Michigan, Institute for Healthcare Policy & Innovation, 2800 Plymouth Road, Ann Arbor, MI 48019, USA
| | - Lori A Bastian
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA.,Department of Medicine, Yale University, 330 Cedar Street, New Haven, CT 06520, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace (151), Madison, WI 53705, USA.,Department of Surgery, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, K6/100 CSC, Madison, WI 53792-1690, USA
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Grant RW, Altschuler A, Uratsu CS, Sanchez G, Schmittdiel JA, Adams AS, Heisler M. Primary care visit preparation and communication for patients with poorly controlled diabetes: A qualitative study of patients and physicians. Prim Care Diabetes 2017; 11:148-153. [PMID: 27916628 PMCID: PMC5340584 DOI: 10.1016/j.pcd.2016.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/09/2016] [Accepted: 11/16/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to examine how patients with diabetes and their primary care physicians identify and discuss visit priorities prior to and during visits. METHODS We conducted a qualitative study involving patients with diabetes (4 focus groups, n=29) and primary care physicians (6 provider practice meeting discussions, n=67). RESULTS Four key themes related to prioritization were identified: 1) the value of identifying visit priorities before the visit; 2) challenges to negotiating priorities during the time-limited visit; 3) the importance of "non-medical" priorities; and 4) the need for strategies to help patients prepare for visits. Both patients and physicians felt that identifying a concise list of key priorities in advance of the visit could help establish collaborative visit agendas and treatment plans. CONCLUSIONS Identifying and communicating mutually agreed upon priorities for discussion is a key challenge for time-limited primary care visits. PRACTICE IMPLICATIONS Communication between primary care physicians and their patients with diabetes could be improved by strategies that help patients identify their top visit priorities before the visit.
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Affiliation(s)
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Connie Si Uratsu
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Gabriela Sanchez
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | | | - Alyce Sophia Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Michele Heisler
- University of Michigan Department of Internal Medicine, Ann Arbor, USA
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Davis S, Keep S, Edie A, Couzens S, Pereira K. A Peer-led Diabetes Education Program in a Homeless Community to Improve Diabetes Knowledge and Empowerment. J Community Health Nurs 2016; 33:71-80. [DOI: 10.1080/07370016.2016.1159435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Baumann LC, Frederick N, Betty N, Jospehine E, Agatha N. A demonstration of peer support for Ugandan adults with type 2 diabetes. Int J Behav Med 2015; 22:374-83. [PMID: 24733698 DOI: 10.1007/s12529-014-9412-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND By 2030, 80% of people with diabetes will be living in developing countries. PURPOSE The purpose of this pre-post quasi-experimental study was to test the feasibility of a peer intervention to improve the following: (1) diabetes self-care behaviors, (2) glycemic control, (3) social support and emotional well-being, (4) linkages to health care providers, and (5) to assess the sustainability of the intervention 18 months later. METHOD Participants were adults with type 2 diabetes who resided in rural Uganda. Participants (n = 46) attended a 1-day diabetes education program and agreed to make weekly contacts over 4 months with each other by phone or in person to assist with daily management, provide social and emotional support, and encourage appropriate contact with health care providers. RESULTS Results indicated improvement in glycosylated hemoglobin (A1C), diastolic blood pressure, and eating behaviors. CONCLUSIONS A short-term peer support program was a feasible intervention to improve diabetes care in rural Uganda. Participants were successfully recruited and retained, and they experienced positive behavioral and physiologic outcomes. Elements of the intervention were sustained 18 months after the intervention.
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Affiliation(s)
- Linda C Baumann
- School of Nursing, University of Wisconsin-Madison, Madison, WI, 53792-2455, USA,
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Abstract
BACKGROUND A 2.5-month diabetes education training for community health workers (CHWs) was developed, implemented, and evaluated. METHODS Training methods used included case studies, role-playing, and lectures. Exams were used throughout the training for its evaluation. Teaching was delivered by different ways: a one day American Diabetes Association (ADA) course; a five day Diabetes Self-Management Program (DSMP); Conversation Maps; and a series of seven National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) diabetes education booklets. RESULTS Qualitative and quantitative evaluative methods were used during and after the training. The CHWs' diabetes knowledge was evaluated by a pre- and post-test Diabetes Knowledge Questionnaire (DKQ). The post-test was conducted one week after completing the training. The findings showed that the diabetes knowledge of the CHWs increased. CONCLUSIONS Diabetes competencies and evaluative tools need to be developed specific for CHWs as a way to standardize all CHW diabetes trainings.
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Affiliation(s)
- Judith Aponte
- Hunter College, Hunter-Bellevue School of Nursing, New York, New York, USA
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Picture Good Health: A Church-Based Self-Management Intervention Among Latino Adults with Diabetes. J Gen Intern Med 2015; 30:1481-90. [PMID: 25920468 PMCID: PMC4579235 DOI: 10.1007/s11606-015-3339-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/04/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Churches may provide a familiar and accessible setting for chronic disease self-management education and social support for Latinos with diabetes. OBJECTIVE We assessed the impact of a multi-faceted church-based diabetes self-management intervention on diabetes outcomes among Latino adults. DESIGN This was a community-based, randomized controlled, pilot study. SUBJECTS One-hundred adults with self-reported diabetes from a Midwestern, urban, low-income Mexican-American neighborhood were included in the study. INTERVENTIONS Intervention participants were enrolled in a church-based diabetes self-management program that included eight weekly group classes led by trained lay leaders. Enhanced usual care participants attended one 90-minute lecture on diabetes self-management at a local church. OUTCOME MEASURES The primary outcome was change in glycosylated hemoglobin (A1C). Secondary outcomes included changes in low-density lipoproteins (LDL), blood pressure, weight, and diabetes self-care practices. KEY RESULTS Participants' mean age was 54 ± 12 years, 81 % were female, 98 % were Latino, and 51 % were uninsured. At 3 months, study participants in both arms decreased their A1C from baseline (-0.32 %, 95 % confidence interval [CI]: -0.62, -0.02 %). The difference in change in A1C, LDL, blood pressure and weight from baseline to 3-month and 6-month follow-up was not statistically significant between the intervention and enhanced usual care groups. Intervention participants reported fewer days of consuming high fat foods in the previous week (-1.34, 95 % CI: -2.22, -0.46) and more days of participating in exercise (1.58, 95 % CI: 0.24, 2.92) compared to enhanced usual care from baseline to 6 months. CONCLUSIONS A pilot church-based diabetes self-management intervention did not reduce A1C, but resulted in decreased high fat food consumption and increased participation in exercise among low-income Latino adults with diabetes. Future church-based interventions may need to strengthen linkages to the healthcare system and provide continued support to participants to impact clinical outcomes.
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Goldman ML, Ghorob A, Hessler D, Yamamoto R, Thom DH, Bodenheimer T. Are Low-Income Peer Health Coaches Able to Master and Utilize Evidence-Based Health Coaching? Ann Fam Med 2015; 13 Suppl 1:S36-41. [PMID: 26304970 PMCID: PMC4648140 DOI: 10.1370/afm.1756] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE A randomized controlled trial found that patients with diabetes had lower HbA1c levels after 6 months of peer health coaching than patients who did not receive coaching. This paper explores whether the peer coaches in that trial, all low-income patients with diabetes, mastered and utilized an evidence-based health coaching training curriculum. The curriculum included 5 core features: ask-tell-ask, closing the loop, know your numbers, behavior-change action plans, and medication adherence counseling. METHODS This paper includes the results of exams administered to trainees, exit surveys performed with peer coaches who completed the study and those who dropped out, observations of peer coaches meeting with patients, and analysis of in-depth interviews with peer coaches who completed the study. RESULTS Of the 32 peer coach trainees who completed the training, 71.9% lacked a college degree; 25.0% did not graduate from high school. The 26 trainees who passed the exams attended 92.7% of training sessions compared with 80.6% for the 6 trainees who did not pass. Peer coaches who completed the study wanted to continue peer coaching work and had confidence in their abilities despite their not consistently employing the coaching techniques with their patients. Quotations describe coaches' perceptions of the training. CONCLUSIONS Of low-income patients with diabetes who completed the evidenced-based health coaching training, 81% passed written and oral exams and became effective peer health coaches, although they did not consistently use the techniques taught.
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Affiliation(s)
- Matthew L Goldman
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Amireh Ghorob
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Danielle Hessler
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Russell Yamamoto
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - David H Thom
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Thomas Bodenheimer
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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Ammerlaan J, van Os-Medendorp H, Scholtus L, de Vos A, Zwier M, Bijlsma H, Kruize AA. Feasibility of an online and a face-to-face version of a self-management program for young adults with a rheumatic disease: experiences of young adults and peer leaders. Pediatr Rheumatol Online J 2014; 12:10. [PMID: 24666817 PMCID: PMC3986975 DOI: 10.1186/1546-0096-12-10] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 03/20/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Based on the self-efficacy theory, an online and a face-to-face self-management programs 'Challenge your Arthritis' for young adults with a rheumatic disease have recently been developed. These two courses are led by young peer leaders. The objective of this study was to test the feasibility of the online and face-to-face self-management program. METHODS Feasibility was evaluated on items of perceived usefulness, perceived ease of use, user-acceptance, and adherence to both programs in young adults and peer leaders. Additional analyses of interactions on the e-Health applications, discussion board and chat board, were conducted. RESULTS Twenty-two young adults with a diagnosed rheumatic disease participated in the study: 12 young adults followed the online program and 10 followed the face-to-face program. Both programs appeared to be feasible, especially in dealing with problems in daily life, and the participants indicated the time investment as 'worthwhile'. In using the online program, no technical problems occurred. Participants found the program easy to use, user friendly, and liked the 'look and feel' of the program. CONCLUSIONS Both the online and the face-to-face versions of a self-management program. 'Challenge your arthritis' were found to be feasible and well appreciated by young adults with a rheumatic disease. Because these programs are likely to be a practical aid to health practices, a randomized controlled study to investigate the effects on patient outcomes is planned.
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Affiliation(s)
- Judy Ammerlaan
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands.
| | | | - Lieske Scholtus
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - André de Vos
- Dutch Rheumatism Patient League (Dutch Arthritis Association), Amsterdam, Netherlands
| | - Matthijs Zwier
- CBO (TNO Company), Dutch Institute for Healthcare Improvement, Utrecht, Netherlands
| | - Hans Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Aike A Kruize
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
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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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Tang TS, Sohal PS, Garg AK. Evaluating a diabetes self-management support peer leader training programme for the English- and Punjabi-speaking South-Asian community in Vancouver. Diabet Med 2013; 30:746-52. [PMID: 23506520 DOI: 10.1111/dme.12179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2013] [Indexed: 11/26/2022]
Abstract
AIMS The purpose of this single-cohort study was to implement and evaluate a programme that trains peers to deliver a diabetes self-management support programme for South-Asian adults with Type 2 diabetes and to assess the perceived efficacy of and satisfaction with this programme. METHODS We recruited eight South-Asian adults who completed a 20-h peer-leader training programme conducted over five sessions (4 h per session). The programme used multiple instructional methods (quizzes, group brainstorming, skill building, group sharing, role-play and facilitation simulation) and provided communication, facilitation, and behaviour change skills training. To graduate, participants were required to achieve the pre-established competency criteria in four training domains: active listening, empowerment-based facilitation, five-step behavioural goal-setting, and self-efficacy. Participants were given three attempts to pass each competency domain. RESULTS On the first attempt six (75%), eight (100%), five (63%) and five (63%) participants passed active listening, empowerment-based facilitation, five-step behavioural goal-setting, and self-efficacy, respectively. Those participants who did not pass a competency domain on the first attempt were successful in passing on the second attempt. As a result, all eight participants graduated from the training programme and became peer leaders. Satisfaction ratings for programme length, balance between content and skills development, and preparation for leading support activities were uniformly high. Ratings for the instructional methods ranged between effective and very effective. CONCLUSION Findings suggest it is feasible to train and graduate peer leaders with the necessary skills to facilitate a diabetes self-management support intervention.
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Affiliation(s)
- T S Tang
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Henderson VA, Barr KL, An LC, Guajardo C, Newhouse W, Mase R, Heisler M. Community-based participatory research and user-centered design in a diabetes medication information and decision tool. Prog Community Health Partnersh 2013; 7:171-84. [PMID: 23793248 PMCID: PMC4117400 DOI: 10.1353/cpr.2013.0024] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Together, community-based participatory research (CBPR), user-centered design (UCD), and health information technology (HIT) offer promising approaches to improve health disparities in low-resource settings. OBJECTIVES This article describes the application of CBPR and UCD principles to the development of iDecide/Decido, an interactive, tailored, web-based diabetes medication education and decision support tool delivered by community health workers (CHWs) to African American and Latino participants with diabetes in Southwest and Eastside Detroit. The decision aid is offered in English or Spanish and is delivered on an iPad in participants' homes. METHODS The overlapping principles of CBPR and UCD used to develop iDecide/Decido include a user-focused or community approach, equitable academic and community partnership in all study phases, an iterative development process that relies on input from all stakeholders, and a program experience that is specified, adapted, and implemented with the target community. RESULTS Collaboration between community members, researchers, and developers is especially evident in the program's design concept, animations, pictographs, issue cards, goal setting, tailoring, and additional CHW tools. CONCLUSIONS The principles of CBPR and UCD can be successfully applied in developing health information tools that are easy to use and understand, interactive, and target health disparities.
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Abstract
AIM There is increasing interest in the role that peers may play to support positive health behaviours in diabetes, but there is limited evidence to inform policy and practice. The aim of this study was to systematically review evidence of the impact and effectiveness of peer support in adults living with diabetes. METHODS We searched the Cochrane Library, MEDLINE, PubMed, EMBASE and CINHAL for the period 1966-2011, together with reference lists of articles for eligible studies. Data were synthesized in a narrative review. RESULTS Twenty-five studies, including fourteen randomized, controlled or comparative trials, met the inclusion criteria. There was considerable heterogeneity in the design, setting, outcomes and measurement tools. Peer support was associated with statistically significant improvements in glycaemic control (three out of 14 trials), blood pressure (one out of four trials), cholesterol (one out of six trials), BMI/weight (two out of seven trials), physical activity (two out of five trials), self-efficacy (two out of three trials), depression (four out of six trials) and perceived social support (two out of two trials). No consistent pattern of effect related to any model of peer support emerged. CONCLUSIONS Peer support appears to benefit some adults living with diabetes, but the evidence is too limited and inconsistent to support firm recommendations. There remains a need for further well-designed evaluations of its effectiveness and impact. Key questions remain over its suitability to the needs of particular individuals, populations and settings, how best to implement its specific components and the sustainability of its effects.
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Affiliation(s)
- J R Dale
- Warwick Medical School, University of Warwick, UK.
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Ferguson WJ, Lemay CA, Hargraves JL, Gorodetsky T, Calista J. Developing community health worker diabetes training. HEALTH EDUCATION RESEARCH 2012; 27:755-765. [PMID: 21926065 DOI: 10.1093/her/cyr080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We designed, implemented and evaluated a 48-hour training program for community health workers (CHWs) deployed to diabetes care teams in community health centers (CHCs). The curriculum included core knowledge/skills with diabetes content to assist CHWs in developing patient self-management goals. Our qualitative evaluation included pre/post-knowledge outcomes and encounter data from the field. CHWs and their supervisors were interviewed providing qualitative outcome data of the training process and program implementation. There were statistically significant increases in the scores of CHWs' self-reported knowledge in 8 of 15 curricular domains. Qualitative analysis revealed that CHWs preferred skill-based and case-based teaching, shorter training days but more contact hours. CHWs reported that pre-deployment training alone is insufficient for successful integration into care teams. CHW supervisors reported that CHC's readiness to accept CHWs as members of the care team was as important to successful deployment as training. With respect to implementation, supervision by social workers was deemed more successful than nursing supervision. Field data showed that patient encounters lasted less than 30 min and self-management goals focused on appointment keeping, diet, exercise and glucose testing. Integration and analysis of qualitative and descriptive field data provide an opportunity to continuously evaluate the effectiveness of implementation.
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Affiliation(s)
- W J Ferguson
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA 01605, USA.
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Paice E, Hasan S. Educating for integrated care. LONDON JOURNAL OF PRIMARY CARE 2012; 5:52-5. [PMID: 25949668 DOI: 10.1080/17571472.2013.11493374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 01/15/2013] [Indexed: 10/23/2022]
Abstract
In September 2012 the North West London Integrated Care Plot held a conference for clinical educators. The aim was to reach a consensus about what learning clinical staff needed in order to contribute to an integrated care system. The conference was attended by 81 clinical educators from a range of backgrounds. The participants decided that competence in the following three domains was essential: 1. Patient and user engagement and empowerment. 2. Collaboration with other health and social care professionals. 3. Leading improvement in the system of care. Educational interventions to facilitate learning should wherever possible be interprofessional, team based and experiential. The views of patients, carers and users should inform the education. Assessment should take into account real-life performance through multi-source feedback and observed practice. Evaluation of the educational intervention should take into account any impact on the patient and user experience as well as clinical outcome measures.
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Affiliation(s)
| | - Samia Hasan
- GP Lead, Imperial College Healthcare Trust; GP and GP Training Programme Director, NHS Hammersmith and Fulham
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Tang TS, Funnell MM, Gillard M, Nwankwo R, Heisler M. Training peers to provide ongoing diabetes self-management support (DSMS): results from a pilot study. PATIENT EDUCATION AND COUNSELING 2011; 85:160-8. [PMID: 21292425 PMCID: PMC3783215 DOI: 10.1016/j.pec.2010.12.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 10/22/2010] [Accepted: 12/14/2010] [Indexed: 05/23/2023]
Abstract
OBJECTIVE This study determined the feasibility of training adults with diabetes to lead diabetes self-management support (DSMS) interventions, examined whether participants can achieve the criteria required for successful graduation, and assessed perceived efficacy of and satisfaction with the peer leader training (PLT) program. METHODS We recruited nine African-American adults with diabetes for a 46-h PLT pilot program conducted over 12 weeks. The program utilized multiple instructional methods, reviewed key diabetes education content areas, and provided communication, facilitation, and behavior change skills training. Participants were given three attempts to achieve the pre-established competency criteria for diabetes knowledge, empowerment-based facilitation, active listening, and self-efficacy. RESULTS On the first attempt 75%, 75%, 63%, and 75% passed diabetes knowledge, empowerment-based facilitation, active listening, and self-efficacy, respectively. Those participants who did not pass on first attempt passed on the second attempt. Participants were highly satisfied with the program length, balance between content and skills development, and preparation for leading support activities. CONCLUSION Findings suggest that it is feasible to train and graduate peer leaders with the necessary knowledge and skills to facilitate DSMS interventions. PRACTICAL IMPLICATIONS With proper training, peer support may be a viable model for translating and sustaining DSMS interventions into community-based settings.
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Affiliation(s)
- Tricia S Tang
- Department of Medical Education and the Michigan Diabetes Research and Training Center, University of Michigan Medical School, Ann Arbor, USA.
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