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Williams LB, Abu Farsakh B, Karle ER, Almogheer ZS, Coughlin S, Kim Yeary KH. How effective are church-based weight-loss interventions among Black adults? A systematic review. Obesity (Silver Spring) 2024. [PMID: 39199014 DOI: 10.1002/oby.24115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/18/2024] [Accepted: 06/10/2024] [Indexed: 09/01/2024]
Abstract
OBJECTIVE Churches are frequently used to reach Black adults to effect weight loss. However, there has been no recent review, to our knowledge, inclusive of solely Black adults in church settings. We sought to comprehensively examine the methodological approaches and weight-loss outcomes of church-based weight-loss lifestyle interventions conducted among Black adults to provide insights on literature gaps and offer suggestions for future research. METHODS Google Scholar, PubMed, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched for trials conducted in churches that reported weight outcomes at any time point. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guided manuscript development. RESULTS A total of 15 studies (N = 2285) from 2007 to 2023 met inclusion criteria, and 33% were high-quality randomized trials. The majority were pilot studies (60%) conducted in the Southern United States. Most reported significant postintervention weight loss. The follow-up time points varied from 2 to 12 months. Methodological approaches included the following: cultural adaptations (93%); theory-guided (93%); delivered by community health workers (80%); and delivered in person in a group format (100%). Only one study offered individual-level attention beyond texts/emails. Most participants were well-educated female individuals. CONCLUSIONS Weight-loss interventions among Black church settings effect statistically significant weight loss, albeit in a small way. Limitations include pilot studies and small samples. More rigorously designed studies are warranted.
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Affiliation(s)
| | | | - Erika R Karle
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | | | - Steven Coughlin
- College of Allied Health Sciences, Augusta University, Augusta, Georgia, USA
| | - Karen H Kim Yeary
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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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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Ayala GX, Chan JCN, Cherrington AL, Elder J, Fisher EB, Heisler M, Howard AG, Ibarra L, Parada H, Safford M, Simmons D, Tang TS. Predictors and Effects of Participation in Peer Support: A Prospective Structural Equation Modeling Analysis. Ann Behav Med 2022; 56:909-919. [PMID: 35830356 DOI: 10.1093/abm/kaab114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Peer support provides varied health benefits, but how it achieves these benefits is not well understood. PURPOSE Examine a) predictors of participation in peer support interventions for diabetes management, and b) relationship between participation and glycemic control. METHODS Seven peer support interventions funded through Peers for Progress provided pre/post data on 1,746 participants' glycemic control (hemoglobin A1c), contacts with peer supporters as an indicator of participation, health literacy, availability/satisfaction with support for diabetes management from family and clinical team, quality of life (EQ-Index), diabetes distress, depression (PHQ-8), BMI, gender, age, education, and years with diabetes. RESULTS Structural equation modeling indicated a) lower levels of available support for diabetes management, higher depression scores, and older age predicted more contacts with peer supporters, and b) more contacts predicted lower levels of final HbA1c as did lower baseline levels of BMI and diabetes distress and fewer years living with diabetes. Parallel effects of contacts on HbA1c, although not statistically significant, were observed among those with baseline HbA1c values > 7.5% or > 9%. Additionally, no, low, moderate, and high contacts showed a significant linear, dose-response relationship with final HbA1c. Baseline and covariate-adjusted, final HbA1c was 8.18% versus 7.86% for those with no versus high contacts. CONCLUSIONS Peer support reached/benefitted those at greater disadvantage. Less social support for dealing with diabetes and higher PHQ-8 scores predicted greater participation in peer support. Participation in turn predicted lower HbA1c across levels of baseline HbA1c, and in a dose-response relationship across levels of participation.
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Affiliation(s)
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Andrea L Cherrington
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Elder
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Edwin B Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Michele Heisler
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Annie Green Howard
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Leticia Ibarra
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Humberto Parada
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Monika Safford
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - David Simmons
- Campbelltown Hospital Endocrinology Department, Western Sydney University Macarthur Clinical School, Campbelltown, New South Wales, Australia
| | - Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Ye W, Kuo S, Kieffer EC, Piatt G, Sinco B, Palmisano G, Spencer MS, Herman WH. Cost-Effectiveness of a Diabetes Self-Management Education and Support Intervention Led by Community Health Workers and Peer Leaders: Projections From the Racial and Ethnic Approaches to Community Health Detroit Trial. Diabetes Care 2021; 44:1108-1115. [PMID: 33958424 PMCID: PMC8132331 DOI: 10.2337/dc20-0307] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To simulate the long-term cost-effectiveness of a peer leader (PL)-led diabetes self-management support (DSMS) program following a structured community health worker (CHW)-led diabetes self-management education (DSME) program in reducing risks of complications in people with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS The trial randomized 222 Latino adults with T2D to 1) enhanced usual care (EUC); 2) a CHW-led, 6-month DSME program and 6 months of CHW-delivered monthly telephone outreach (CHW only); or 3) a CHW-led, 6-month DSME program and 12 months of PL-delivered weekly group sessions with telephone outreach to those unable to attend (CHW + PL). Empirical data from the trial and the validated Michigan Model for Diabetes were used to estimate cost and health outcomes over a 20-year time horizon from a health care sector perspective, discounting both costs and benefits at 3% annually. The primary outcome measure was the incremental cost-effectiveness ratio (ICER). RESULTS Over 20 years, the CHW + PL intervention had an ICER of $28,800 and $5,900 per quality-adjusted life-year (QALY) gained compared with the EUC and CHW-only interventions, respectively. The CHW-only intervention had an ICER of $430,600 per QALY gained compared with the EUC intervention. In sensitivity analyses, the results comparing the CHW + PL with EUC and CHW-only interventions were robust to changes in intervention effects and costs. CONCLUSIONS The CHW + PL-led DSME/DSMS intervention improved health and provided good value compared with the EUC intervention. The 6-month CHW-led DSME intervention without further postintervention CHW support was not cost effective in Latino adults with T2D.
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Affiliation(s)
- Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Shihchen Kuo
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | | | - Gretchen Piatt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Brandy Sinco
- University of Michigan School of Social Work, Ann Arbor, MI
| | | | | | - William H Herman
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
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Reed M, Wilbur J, Tangney CC, Miller AM, Schoeny ME, Webber-Ritchey KJ. Development and Feasibility of an Obesity Prevention Intervention for Black Adolescent Daughters and Their Mothers. JOURNAL OF HEALTHY EATING AND ACTIVE LIVING 2021; 1:94-107. [PMID: 37789909 PMCID: PMC10544921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Black female adolescents and women have disproportionately higher rates of obesity than their racial/ethnic counterparts. There is an urgent need to address obesity prevention in Black adolescent females through interventions that enhance lifestyle physical activity and improve dietary behaviors. Middle adolescence presents an important opportunity to strengthen the daughter-mother bond and improve healthy behaviors such as physical activity and dietary intake. Because of the intersection of adolescent development, culture and structural racism, it is essential to include mothers; however, this approach is understudied in the literature. This pre-pilot proof of concept study, Black Girls Move, was conducted using a 12-week pre-post within-subjects design to assess feasibility of conducting and delivering the BGM intervention, program satisfaction, and ability to obtain outcome measures in Black ninth and tenth grade daughters and their mothers. Twenty-two dyads were recruited and 14 dyads completed baseline assessments; however, only eight daughters and their mothers attended the first session and remained for the entire study. All dyads had valid objective and self-reported physical activity data. However, two of eight daughters and one mother provided self-reported dietary data that were considered invalid. All individual sessions were rated highly. Excellent attendance, retention, and satisfaction among participants suggest that we succeeded in developing an accepted, culturally relevant intervention. This lifestyle intervention would be strengthened by modifications to recruitment and retention, as well as incorporation of a computerized dietary assessment tool, a tailored dietary app for self-monitoring, and increased photo-based and group homework activities.
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Abbey EL, Keogh George SM. Our Bodies are Temples: Health Programming in Christian Church Communities. JOURNAL OF RELIGION AND HEALTH 2020; 59:1958-1981. [PMID: 31493214 DOI: 10.1007/s10943-019-00905-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This exploratory research considers the ways in which Christian churches provide health and wellness programming to their congregations and the surrounding community. We investigated one community in the Pacific Northwest region of the USA. Here we examined the types of health-related programs promoted by the church community, to whom these programs are directed, and the theological motivations for providing such services. We also analyzed the sociocultural dynamics of each congregation that may lead some churches to promote health and wellness more than others. Findings suggest that many churches focus primarily on providing services to the community at large, rather than promoting healthy living within their own communities.
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Affiliation(s)
- Elizabeth L Abbey
- Department of Health Sciences, Whitworth University, 300 W Hawthorne Rd., Spokane, WA, 99251, USA.
| | - Stacy M Keogh George
- Department of Sociology, Whitworth University, 300 W Hawthorne Rd., Spokane, WA, 99251, USA
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7
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Religious Faith and Diabetes Health Beliefs in a Homeless Population: A Qualitative Study. J Christ Nurs 2019; 36:228-235. [PMID: 31490877 DOI: 10.1097/cnj.0000000000000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This participatory action research project explored the perspectives and challenges of homeless persons living with, or at risk for, type 2 diabetes. Because these persons were sheltered in and served by a church, their perspectives provide understanding about how religious faith may influence diabetes self-management.
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Interventions to Reduce Ethnic and Racial Disparities in Dyslipidemia Management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:24. [DOI: 10.1007/s11936-019-0725-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Spencer MS, Kieffer EC, Sinco B, Piatt G, Palmisano G, Hawkins J, Lebron A, Espitia N, Tang T, Funnell M, Heisler M. Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self-Management Program for Latino Adults. Diabetes Care 2018; 41:1414-1422. [PMID: 29703724 PMCID: PMC6014532 DOI: 10.2337/dc17-0978] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 04/07/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA1c and other clinical and patient-centered outcomes over 18 months. RESEARCH DESIGN AND METHODS The study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1) a CHW-led, 6-month DSME program or 2) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA1c. Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months. RESULTS Participants in the CHW intervention at the 6-month follow-up had greater decreases in HbA1c (-0.45% [95% CI -0.87, -0.03]; P < 0.05) and in diabetes distress (-0.3 points [95% CI -0.6, -0.03]; P < 0.05) compared with EUC. CHW+PL participants maintained HbA1c improvements at 12 and 18 months, and CHW-only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (-2.2 points [95% CI -4.1, -0.3]; P < 0.05). Participants in CHW-led DSME had significant improvements in diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months. CONCLUSIONS This study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tricia Tang
- University of British Columbia, Vancouver, British Columbia, Canada
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10
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Using Exploratory Focus Groups to Inform the Development of a Peer-Supported Pulmonary Rehabilitation Program: DIRECTIONS FOR FURTHER RESEARCH. J Cardiopulm Rehabil Prev 2017; 37:57-64. [PMID: 27798508 DOI: 10.1097/hcr.0000000000000213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE There has been limited research on the role of peer support in self-management for patients with chronic obstructive pulmonary disease (COPD) attending pulmonary rehabilitation (PR) programs. This research explored patient acceptability of "peer supporters" in promoting sustained self-management practices after PR and to assess their perceived self-efficacy to manage their disease. METHODS This qualitative study used focus groups and individual interviews to identify perspectives of peer supporters and benefits of participation in a PR program. The analysis included systematically reading and reviewing transcripts of the sessions, establishing themes, and sorting responses into thematic categories. RESULTS A total of 28 patients with COPD (15 males) participated in either a focus group or interview. The majority of participants considered peer supporters to be good facilitators for motivating ongoing exercise after completing PR. Exercise sessions were viewed as extremely beneficial for disease management, and many were satisfied with the care they had received. Most subjects wanted to receive followup sessions with either a professional or peer after the intensive phase of PR. Overall, the concept of having a peer supporter involved in ongoing maintenance of self-management efforts after PR was generally viewed as positive. CONCLUSIONS Integrating a peer support model into PR programs may improve better long-term health outcomes for COPD management as many participants endorsed the need for continued support after the program. It also improved our understanding of the role of "peer supports" in exercise and self-care maintenance after PR. The selection of peers and the specific model used warrants further investigation in a randomized controlled trial.
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Flórez KR, Payán DD, Derose KP, Aunon FM, Bogart LM. Process Evaluation of a Peer-Driven, HIV Stigma Reduction and HIV Testing Intervention in Latino and African American Churches. Health Equity 2017; 1:109-117. [PMID: 30283840 PMCID: PMC6071886 DOI: 10.1089/heq.2017.0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: Faith-based organizations may be effective in addressing HIV-related disparities, but few interventions have been implemented across diverse churches. The Facilitating Awareness to Increase Testing for HIV (FAITH) intervention harnessed peer leadership to decrease HIV stigma and promote HIV testing in African American and Latino congregations. A pilot study found more consistent effects among Latino congregations. This process evaluation evaluates implementation of FAITH to better understand the pilot study's findings. Methods: Data sources included HIV education and peer leader workshop evaluation forms, participant views of the community's perspective of HIV, and peer leader follow-up interviews. Data were triangulated with systematic observation notes and analyzed using process-related themes of recruitment, reach, context, implementation, dose-delivered, and fidelity. Results: At the Latino churches (compared to the African American church), facilitators spent more time addressing community-based misconceptions about HIV. The peer leader model was well received, especially among Latino participants, and most said that after the workshop they felt comfortable speaking with others about HIV-related topics. Latino peer leaders reported speaking with up to 20 people within their social networks (particularly with family members); African Americans reported up to 4. Implementation challenges at the African American church may have contributed to the limited intervention effects. Nevertheless, we found the peer motivator model feasible and acceptable across diverse faith settings. Conclusion: Peer-based models within faith settings are promising for addressing HIV. However, differences among groups in HIV knowledge, social network characteristics and norms, and church preferences may influence overall effectiveness.
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Affiliation(s)
- Karen R Flórez
- CUNY Graduate School of Public Health and Health Policy, New York, New York.,RAND Corporation, Santa Monica, California
| | - Denise D Payán
- RAND Corporation, Santa Monica, California.,UCLA Fielding School of Public Health, Los Angeles, California
| | | | - Frances M Aunon
- Department of Psychology, University of Washington, Seattle, Washington
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Abstract
PURPOSE OF REVIEW The aim of this current narrative review is to critique the scope and value of recent studies with a focus on obesity-related health promotion in faith organizations. RECENT FINDINGS Electronic database searches, scanning of the reference lists of identified articles, and hand searching of journals for articles written in English and published in 2013-2016 revealed 16 studies. Half of the studies involved African-Americans, in churches and with predominantly female participants. Research among other ethnic groups was more likely to be exploratory. All of the 11 studies reporting the impact of programmes on weight-related measures showed favourable outcomes. However, due to study limitations (small sample size, short duration, attrition), significant unbiased effects cannot yet be concluded for most of the interventions reviewed. Study strengths included application of theory in community engagement and detailed description of cultural tailoring. Faith organizations show promise as settings for obesity prevention among high-risk groups, particularly African-Americans. Support for progressing formative work to adequately powered, randomized controlled trials is vital. Wider involvement of diverse faith settings and targeting obesity in men and childhood would be valuable developments.
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Affiliation(s)
- Maria J Maynard
- School of Clinical & Applied Sciences, Leeds Beckett University, City Campus, CL 413, Calverley Building, Leeds, LS1 3HE, UK.
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13
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Sun Y, You W, Almeida F, Estabrooks P, Davy B. The Effectiveness and Cost of Lifestyle Interventions Including Nutrition Education for Diabetes Prevention: A Systematic Review and Meta-Analysis. J Acad Nutr Diet 2017; 117:404-421.e36. [PMID: 28236962 PMCID: PMC5330213 DOI: 10.1016/j.jand.2016.11.016] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 11/28/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Type 2 diabetes is a significant public health concern. With the completion of the Diabetes Prevention Program, there has been a proliferation of studies attempting to translate this evidence base into practice. However, the cost, effectiveness, and cost-effectiveness of these adapted interventions is unknown. OBJECTIVE The purpose of this systematic review was to conduct a comprehensive meta-analysis to synthesize the effectiveness, cost, and cost-effectiveness of lifestyle diabetes prevention interventions and compare effects by intervention delivery agent (dietitian vs non-dietitian) and channel (in-person vs technology-delivered). METHODS English and full-text research articles published up to July 2015 were identified using the Cochrane Library, PubMed, Education Resources Information Center, CAB Direct, Science Direct, and Google Scholar. Sixty-nine studies met inclusion criteria. Most employed both dietary and physical activity intervention components (four of 69 were diet-only interventions). Changes in weight, fasting and 2-hour blood glucose concentration, and hemoglobin A1c were extracted from each article. Heterogeneity was measured by the I2 index, and study-specific effect sizes or mean differences were pooled using a random effects model when heterogeneity was confirmed. RESULTS Participants receiving intervention with nutrition education experienced a reduction of 2.07 kg (95% CI 1.52 to 2.62; P<0.001; I2=90.99%, 95% CI 88.61% to 92.87%) in weight at 12 months with effect sizes over time ranging from small (0.17, 95% CI 0.04 to 0.30; P=0.012; I2= 86.83%, 95% CI 80.42% to 91.14%) to medium (0.65, 95% CI 0.49 to 0.82; P<0.001; I2=98.75%, 95% CI 98.52% to 98.94). Effect sizes for 2-hour blood glucose and hemoglobin A1c level changes ranged from small to medium. The meta-regression analysis revealed a larger relative weight loss in dietitian-delivered interventions than in those delivered by nondietitians (full sample: -1.0 kg; US subsample: -2.4 kg), and did not find statistical evidence that the delivery channel was an important predictor of weight loss. The average cost per kilogram weight loss ranged from $34.06 over 6 months to $1,005.36 over 12 months. The cost of intervention per participant delivered by dietitians was lower than interventions delivered by non-dietitians, although few studies reported costs. CONCLUSIONS Lifestyle interventions are effective in reducing body weight and glucose-related outcomes. Dietitian-delivered interventions, compared with those delivered by other personnel, achieved greater weight reduction. No consistent trend was identified across different delivery channels.
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Riddell MA, Dunbar JA, Absetz P, Wolfe R, Li H, Brand M, Aziz Z, Oldenburg B. Cardiovascular risk outcome and program evaluation of a cluster randomised controlled trial of a community-based, lay peer led program for people with diabetes. BMC Public Health 2016; 16:864. [PMID: 27558630 PMCID: PMC4995663 DOI: 10.1186/s12889-016-3538-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 08/17/2016] [Indexed: 02/06/2023] Open
Abstract
Background The 2013 Global Burden of Disease Study demonstrated the increasing burden of diabetes and the challenge it poses to the health systems of all countries. The chronic and complex nature of diabetes requires active self-management by patients in addition to clinical management in order to achieve optimal glycaemic control and appropriate use of available clinical services. This study is an evaluation of a “real world” peer support program aimed at improving the control and management of type 2 diabetes (T2DM) in Australia. Methods The trial used a randomised cluster design with a peer support intervention and routine care control arms and 12-month follow up. Participants in both arms received a standardised session of self-management education at baseline. The intervention program comprised monthly community-based group meetings over 12 months led by trained peer supporters and active encouragement to use primary health care and other community resources and supports related to diabetes. Clinical, behavioural and other measures were collected at baseline, 6 and 12 months. The primary outcome was the predicted 5 year cardiovascular disease risk using the United Kingdom Prospective Diabetes Study (UKPDS) Risk Equation at 12 months. Secondary outcomes included clinical measures, quality of life, measures of support, psychosocial functioning and lifestyle measures. Results Eleven of 12 planned groups were successfully implemented in the intervention arm. Both the usual care and the intervention arms demonstrated a small reduction in 5 year UKPDS risk and the mean values for biochemical and anthropometric outcomes were close to target at 12 months. There were some small positive changes in self-management behaviours. Conclusions The positive changes in self-management behaviours among intervention participants were not sufficient to reduce cardiovascular risk, possibly because approximately half of the study participants already had quite well controlled T2DM at baseline. Future research needs to address how to enhance community based programs so that they reach and benefit those most in need of resources and supports to improve metabolic control and associated clinical outcomes. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12609000469213. Registered 16 June 2009. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3538-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M A Riddell
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - J A Dunbar
- Deakin Population Health Strategic Research Centre, Deakin University, Melbourne, Australia
| | - P Absetz
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - R Wolfe
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - H Li
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.,Institute of Chronic Disease Control, Beijing Centers for Disease Control and Prevention, Beijing, People's Republic of China
| | - M Brand
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Z Aziz
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - B Oldenburg
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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15
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Mudaliar U, Zabetian A, Goodman M, Echouffo-Tcheugui JB, Albright AL, Gregg EW, Ali MK. Cardiometabolic Risk Factor Changes Observed in Diabetes Prevention Programs in US Settings: A Systematic Review and Meta-analysis. PLoS Med 2016; 13:e1002095. [PMID: 27459705 PMCID: PMC4961455 DOI: 10.1371/journal.pmed.1002095] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/17/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The Diabetes Prevention Program (DPP) study showed that weight loss in high-risk adults lowered diabetes incidence and cardiovascular disease risk. No prior analyses have aggregated weight and cardiometabolic risk factor changes observed in studies implementing DPP interventions in nonresearch settings in the United States. METHODS AND FINDINGS In this systematic review and meta-analysis, we pooled data from studies in the United States implementing DPP lifestyle modification programs (focused on modest [5%-7%] weight loss through ≥150 min of moderate physical activity per week and restriction of fat intake) in clinical, community, and online settings. We reported aggregated pre- and post-intervention weight and cardiometabolic risk factor changes (fasting blood glucose [FBG], glycosylated hemoglobin [HbA1c], systolic or diastolic blood pressure [SBP/DBP], total [TC] or HDL-cholesterol). We searched the MEDLINE, EMBASE, Cochrane Library, and Clinicaltrials.gov databases from January 1, 2003, to May 1, 2016. Two reviewers independently evaluated article eligibility and extracted data on study designs, populations enrolled, intervention program characteristics (duration, number of core and maintenance sessions), and outcomes. We used a random effects model to calculate summary estimates for each outcome and associated 95% confidence intervals (CI). To examine sources of heterogeneity, results were stratified according to the presence of maintenance sessions, risk level of participants (prediabetes or other), and intervention delivery personnel (lay or professional). Forty-four studies that enrolled 8,995 participants met eligibility criteria. Participants had an average age of 50.8 years and body mass index (BMI) of 34.8 kg/m2, and 25.2% were male. On average, study follow-up was 9.3 mo (median 12.0) with a range of 1.5 to 36 months; programs offered a mean of 12.6 sessions, with mean participant attendance of 11.0 core sessions. Sixty percent of programs offered some form of post-core maintenance (either email or in person). Mean absolute changes observed were: weight -3.77 kg (95% CI: -4.55; -2.99), HbA1c -0.21% (-0.29; -0.13), FBG -2.40 mg/dL (-3.59; -1.21), SBP -4.29 mmHg (-5.73, -2.84), DBP -2.56 mmHg (-3.40, 1.71), HDL +0.85 mg/dL (-0.10, 1.60), and TC -5.34 mg/dL (-9.72, -0.97). Programs with a maintenance component achieved greater reductions in weight (additional -1.66kg) and FBG (additional -3.14 mg/dl). Findings are subject to incomplete reporting and heterogeneity of studies included, and confounding because most included studies used pre-post study designs. CONCLUSIONS DPP lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements. Together, these data suggest that additional value is gained from these programs, reinforcing that they are likely very cost-effective.
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Affiliation(s)
- Uma Mudaliar
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Azadeh Zabetian
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ann L. Albright
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Edward W. Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mohammed K. Ali
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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16
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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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Evaluation of physical activity reporting in community Diabetes Prevention Program lifestyle intervention efforts: A systematic review. Prev Med 2015; 77:191-9. [PMID: 26051204 DOI: 10.1016/j.ypmed.2015.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The Diabetes Prevention Program (DPP) lifestyle intervention has been translated to community settings using the DPP goals of 7% weight loss and 150min of moderate physical activity (PA) per week. Given that PA is a primary lifestyle goal and has been linked to improvements in metabolic health in the DPP, it is important to understand the role that PA plays in translation effort success. The purpose of this review is to thoroughly evaluate the reporting of PA methodology and results in DPP-based translations in order to guide future prevention efforts. METHODS PubMed and Ovid databases were searched to identify peer-reviewed original research articles on DPP-based translations for adults at-risk for developing diabetes or cardiovascular disease, limited to English language publications from January 2002-March 2015. RESULTS 72 original research articles describing 57 translation studies met eligibility criteria. All 57 study interventions included a PA goal, 47 studies (82%) collected participant PA information, and 34 (60%) provided PA results. CONCLUSIONS Despite PA being a primary intervention goal, PA methodology and results are under-reported in published DPP translation studies. This absence and inconsistency in reporting PA needs addressed in order to fully understand translation efforts' impact on participant health.
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Fisher EB, Ayala GX, Ibarra L, Cherrington AL, Elder JP, Tang TS, Heisler M, Safford MM, Simmons D. Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress. Ann Fam Med 2015; 13 Suppl 1:S2-8. [PMID: 26304968 PMCID: PMC4648132 DOI: 10.1370/afm.1852] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
SUBSTANTIAL: evidence documents the benefits of peer support provided by community health workers, lay health advisors, promotores de salud, and others. The papers in this supplement, all supported by the Peers for Progress program of the American Academy of Family Physicians Foundation, contribute to the growing body of literature addressing the efficacy, effectiveness, feasibility, reach, sustainability, and adoption of peer support for diabetes self-management. They and additional papers supported by Peers for Progress contribute to understanding how peer support can be implemented in real world settings. Topics include examination of the peers who provide peer support, reaching the hardly reached, success factors in peer support interventions, proactive approaches, attention to emotions, peer support in behavioral health, dissemination models and their application in China, peer support in the patient-centered medical home, research challenges, and policy implications.
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Affiliation(s)
- Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation, Leawood, Kansas Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Guadalupe X Ayala
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | | | - Andrea L Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - John P Elder
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | - Tricia S Tang
- University of British Columbia Department of Medicine, Vancouver, British Columbia
| | - Michele Heisler
- University of Michigan Department of Internal Medicine, Ann Arbor, Michigan
| | - Monika M Safford
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David Simmons
- School of Medicine, University of Western Sydney, Australia Institute of Metabolic Science, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, England
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Tang TS, Sohal PS, Garg AK. Rethinking peer support for diabetes in Vancouver's South-Asian community: a feasibility study. Diabet Med 2015; 32:1077-84. [PMID: 25472598 DOI: 10.1111/dme.12655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
AIM To examine the feasibility and potential health impact of a diabetes self-management education and support intervention involving peer support on glycaemic control and diabetes distress. METHODS A total of 41 South-Asian adults with Type 2 diabetes were recruited for a 24-week diabetes self-management education and support pilot intervention involving peer support. The intervention consisted of six weekly education sessions co-facilitated by a certified diabetes educator and two peer leaders, followed by 18 weekly support sessions facilitated by two peer leaders. Education sessions were guided entirely by participants' self-management questions and also emphasized goal setting and action planning. Support sessions were based on empowerment principles and participants discussed self-management challenges, shared emotions, asked self-management questions, problem-solved in a group, set goals, and developed and evaluated action plans. Feasibility outcomes included recruitment and retention. Primary health-related outcomes included HbA1c levels and diabetes distress (measured at baseline, 6 and 24 weeks). Programme satisfaction was also assessed. RESULTS Pre-established criteria for recruitment and retention were met. Paired t-tests showed no changes in HbA1c and diabetes distress at 6 weeks. At 24 weeks, HbA1c levels deteriorated [54 mmol/mol (7.1%) vs 61 mmol/mol (7.7%)] while diabetes distress scores improved (2.0 vs 1.7). CONCLUSIONS Although feasible, findings suggest this peer-support model may have a positive impact on diabetes distress, but not on HbA1c levels. Culturally responsive modifications (e.g. intervention location) to the pilot model are needed and could lead to more favourable health outcomes for this community. Such a re-designed peer-support model will require further investigation.
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Affiliation(s)
- T S Tang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - P S Sohal
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - A K Garg
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Sanders Thompson VL, Johnson-Jennings M, Bauman AA, Proctor E. Use of culturally focused theoretical frameworks for adapting diabetes prevention programs: a qualitative review. Prev Chronic Dis 2015; 12:E60. [PMID: 25950567 PMCID: PMC4436044 DOI: 10.5888/pcd12.140421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Diabetes disproportionately affects underserved racial/ethnic groups in the United States. Diabetes prevention interventions positively influence health; however, further evaluation is necessary to determine what role culture plays in effective programming. We report on the status of research that examines cultural adaptations of diabetes prevention programs. Methods We conducted database searches in March and April 2014. We included studies that were conducted in the United States and that focused on diabetes prevention among African Americans, American Indians/Alaska Natives, Asian Americans/Pacific Islanders, and Latinos. Results A total of 58 studies were identified for review; 29 were excluded from evaluation. Few adaptations referenced or followed recommendations for cultural adaptation nor did they justify the content modifications by providing a rationale or evidence. Cultural elements unique to racial/ethnic populations were not assessed. Conclusion Future cultural adaptations should use recommended processes to ensure that culture’s role in diabetes prevention–related behavioral changes contributes to research.
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Affiliation(s)
- Vetta L Sanders Thompson
- Washington University in St. Louis, Brown School, One Brookings Dr, CB 1196, St. Louis, MO, 63130.
| | | | - Ana A Bauman
- Washington University in St. Louis, Brown School, St. Louis, Missouri
| | - Enola Proctor
- Washington University in St. Louis, Brown School, St. Louis, Missouri
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