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Robertson M, Parè G, Costa I, Alvarado B, Duhn L, Plazas PC. “I Could Have Stood a Little More Education Rather than Just: ‘Hey, you’re Diabetic Man, Make the Best out of It’”: Revisioning Diabetes Self-Management Education for Older Adults. Res Aging 2022:1640275221138968. [DOI: 10.1177/01640275221138968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: Providing diabetes self-management education (DSME) in an evidence-based format that is accessible and tailored to the population needs is crucial for individuals living with diabetes mellitus. Our qualitative study explores the experiences of older adults living with diabetes while residing in a rural setting. Methods: Adults aged 65 or older and residing in a rural area of Ontario completed a photovoice activity and semi-structured interviews to illustrate their experience of living with diabetes and accessing DSME. Results: Fourteen participants (11 males; mean age = 74 years) completed the photovoice activity and interview. Four main themes were identified pertaining to learning about diabetes education, the depth and breadth of learning, applying knowledge to daily life, and engaging older adults in DSME. Discussion: Diabetes self-management education should account for older adults’ preferences in learning about diabetes and self-management to promote access to evidence-based information, bolster knowledge and self-management efficacy, and improve disease control.
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Affiliation(s)
| | - Geneviéve Parè
- School of Nursing, Queen’s University, Kingston, ON, Canada
| | - Idevania Costa
- School of Nursing, Lakehead University, Thunder Bay, ON, Canada
| | - Beatriz Alvarado
- Department of Public Health Sciences, Queen’s University,Kingston, ON, Canada
| | - Lenora Duhn
- School of Nursing, Queen’s University, Kingston, ON, Canada
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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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The Effect of Using Peer on Self-Care, Quality of Life, and Adherence in Elderly People with Coronary Artery Disease. ScientificWorldJournal 2021; 2021:4770721. [PMID: 34916875 PMCID: PMC8669978 DOI: 10.1155/2021/4770721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Coronary artery disease is one of the most common diseases and the cause of death among elderly people. Due to the chronic nature of this disease, regular follow-up, lifestyle changes, and adherence to recommendations can reduce the complications and improve the quality of life among elderly individuals. Given the importance of using educational methods that are based on the patient's age and disease stage, the present study aimed to investigate the effect of using a peer group on self-care, adherence, and quality of life in elderly people. Method This single-blind clinical trial was conducted on 30 old patients with coronary artery disease aged 60 years in Shiraz from March to June 2021. The patients were selected using simple random sampling and were then randomly assigned to the peer education and control groups (15 participants in each group) via permuted block randomization. The patients in the peer education group received the necessary education about medications, lifestyle, daily activities, self-care, and adherence through three educational clips by educated peer. The patients in the control group received routine education using two clips by the ward nurses. The levels of self-care, adherence, and quality of life were assessed in the intervention and control groups before and one month after the intervention. Data analysis was performed by SPSS 20 software using an independent t-test, paired sample t-test, and chi-square test. P < 0.05 was considered statistically significant. Findings. The results showed no statistically significant difference between the two groups with respect to the mean scores of self-care and quality of life before the intervention (P > 0.05). Following the educational intervention, however, a statistically significant difference was found between the two groups concerning the mean scores of self-care and adherence (P < 0.05). Moreover, the mean differences between the two groups regarding the three variables were statistically significant before and after the intervention (P < 0.05). Conclusion Education based on multimedia clips by peer was effective in increasing the mean scores of self-care, adherence, and quality of life among the elderly people with coronary artery disease. Given the low cost, high effectiveness, and decrease in the nurses' workload, this method is recommended to be used alongside other methods in order to educate elderly individuals suffering from coronary artery disease.
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Lavender EC, Dusabe-Richards E, Anderson AM, Antcliff D, McGowan L, Conaghan PG, Kingsbury SR, McHugh GA. Exploring the feasibility, acceptability and value of volunteer peer mentors in supporting self-management of osteoarthritis: a qualitative evaluation. Disabil Rehabil 2021; 44:6314-6324. [PMID: 34498993 PMCID: PMC9590401 DOI: 10.1080/09638288.2021.1964625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hip and knee osteoarthritis (OA) affect a large and growing proportion of the population. Treatment options are typically conservative making self-management a priority. Using trained peers to support individuals with OA has potential to improve self-management. PURPOSE To explore the process of engaging and training volunteers to become peer mentors; and to qualitatively evaluate the feasibility, acceptability and value of being a peer mentor to support others' self-management of OA. MATERIALS AND METHODS A qualitative evaluation of a peer mentorship support intervention reporting the processes of recruitment and training; and semi-structured interviews conducted with nine active peer mentors. Transcribed interviews were coded and analysed using framework analysis. RESULTS It was possible to recruit, train and retain volunteers with OA to become peer mentors. The peer mentors benefitted from their training and felt equipped to deliver the intervention. They enjoyed social elements of the mentorship intervention and gained satisfaction through delivering valued support to mentees. Peer mentors perceived the mentorship intervention to have a positive impact on self-management of OA for mentees. CONCLUSION Training volunteers with OA to become peer mentors was feasible and acceptable. Peer mentors perceived their support benefitted others with OA. They positively rated their experience of providing mentorship support.IMPLICATIONS FOR REHABILITATIONThis study demonstrates that it is possible to recruit, train and engage older volunteers to become peer mentors for people with osteoarthritis.Training should highlight the significance of employing key self-management techniques such as goal-setting.Peer mentors acknowledged that they benefitted from training and delivering the mentorship intervention, and this impacted positively on their own osteoarthritis self-management.Careful consideration of matching mentors and mentees appears to enhance the success of mentorship support.Recognising the impact of mentorship support on mentees' self-management is central to peer mentors' sustained engagement with the intervention.
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Affiliation(s)
| | | | - Anna M Anderson
- School of Healthcare, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK.,Physiotherapy Department, Bury & Rochdale Care Organisation, Northern Care Alliance NHS Group, Salford, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
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Walshe C, Roberts D, Calman L, Appleton L, Croft R, Perez Algorta G, Skevington S, Lloyd-Williams M, Grande G. Peer Mentors for People with Advanced Cancer: Lessons Learnt from Recruiting and Training Peer Mentors for a Feasibility Randomized Controlled Trial. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:710-718. [PMID: 31994006 PMCID: PMC8328854 DOI: 10.1007/s13187-020-01692-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Peer mentors may offer distinctive forms of support to people with advanced cancer. Whilst peer mentor programmes are known, little is understood about recruiting and training peer mentors to support those with advanced cancer. The purpose of this study is to determine the feasibility of recruiting and training peer mentors for a novel peer mentor intervention to promote well-being in people with advanced cancer. Feasibility study testing proactive introduction to a trained peer mentor for 12 weeks in the context of a randomized controlled two-arm trial and nested qualitative process evaluation was used. Peer mentors have/had cancer, recruited via an open call. Two-day training included a new bespoke module on coping with cancer. Descriptive recruitment and training data were captured, supplemented by qualitative interviews, analysed thematically. Forty-eight people expressed interest, mostly female (69%), with breast cancer (32%), and recruited via social media (49%). Twelve people completed training, with attrition often due to availability or mentors' own health; many had advanced cancer themselves. They wanted to 'give something back', but also formed supportive bonds with fellow mentors. It is feasible to recruit and train people with lived experience of cancer to be peer mentors, but those with particular characteristics may predominate. Broad social media based recruitment may have merit in widening the pool of potential peer mentors.
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Affiliation(s)
- Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Bailrigg, Lancaster, UK.
| | - Diane Roberts
- Division of Nursing, Midwifery and Social Work, Manchester University, Manchester, UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, School of Health Sciences, Southampton University, Southampton, UK
| | - Lynda Appleton
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | | | | | - Suzanne Skevington
- Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester University, Manchester, UK
| | | | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, Manchester University, Manchester, UK
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Anderson AM, Lavender EC, Dusabe-Richards E, Mebrahtu TF, McGowan L, Conaghan PG, Kingsbury SR, Richardson G, Antcliff D, McHugh GA. Peer mentorship to improve self-management of hip and knee osteoarthritis: a randomised feasibility trial. BMJ Open 2021; 11:e045389. [PMID: 34290063 PMCID: PMC8296761 DOI: 10.1136/bmjopen-2020-045389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine the feasibility of conducting a randomised controlled trial (RCT) of a peer mentorship intervention to improve self-management of osteoarthritis (OA). DESIGN Six-month parallel group non-blinded randomised feasibility trial. SETTING One secondary care and one primary care UK National Health Service Trust. PARTICIPANTS Fifty adults aged ≥55 years old with hip and/or knee OA. INTERVENTIONS Participants were allocated 1:1 to the intervention or control group using an online randomisation service. Intervention group participants received usual care (information resources) and up to eight community-based self-management support sessions delivered by a peer mentor (trained volunteer with hip and/or knee OA). Control group participants received usual care only. OUTCOME MEASURES Key feasibility outcomes were participant and peer mentor recruitment and attrition, intervention completion and the sample size required for a definitive RCT. Based on these feasibility outcomes, four success criteria for proceeding to a definitive RCT were prespecified. Patient-reported outcomes were collected via questionnaires at baseline, 8 weeks and 6 months. RESULTS Ninety-six individuals were screened, 65 were eligible and 50 were randomised (25 per group). Of the 24 participants who commenced the intervention, 20 completed it. Four participants did not complete the 6-month questionnaire. Twenty-one individuals were eligible for the peer mentor role, 15 were trained and 5 withdrew prior to being matched with a participant. No intervention-related harms occurred. Allowing for 20% attrition, the sample size required for a definitive RCT was calculated as 170 participants. The intervention group showed improvements in self-management compared with the control group. CONCLUSIONS The feasibility outcomes achieved the prespecified criteria for proceeding to an RCT. The exploratory analyses suggest peer mentorship may improve OA self-management. An RCT of the OA peer mentorship intervention is therefore warranted with minor modifications to the intervention and trial procedures. TRIAL REGISTRATION NUMBER ISRCTN:50675542.
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Affiliation(s)
- Anna M Anderson
- School of Healthcare, University of Leeds, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, UK
| | | | | | | | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, UK
- NIHR Research Design Service for Yorkshire and the Humber, York, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK
- Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, UK
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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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Khiyali Z, Ghasemi A, Toghroli R, Ziapour A, Shahabi N, Dehghan A, Yari A. The effect of peer group on self-care behaviors and glycemic index in elders with type II diabetes. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:197. [PMID: 34250131 PMCID: PMC8249984 DOI: 10.4103/jehp.jehp_990_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/21/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Diabetes is one of the most expensive and chronic diseases of elderly age. Knowledge and self-care behaviors play an important role in treating diabetes and preventing its side effects. This study aimed to investigate the effect of peer group on self-care behaviors and glycemic index in the elderly with type II diabetes mellitus in Fasa city, Fars province. MATERIALS AND METHODS This quasi-experimental study was conducted on 100 elderly patients with type II diabetes (50 patients in the intervention group and 50 in control group) referred to the diabetes center. Among the elderly, the intervention group was selected as a trainer based on the checklist of the peer group and was trained by the researcher. In addition to the usual care of the diabetes clinic, the patients in the intervention group received training from their peers for 8 weeks during 8-45 min of training sessions. Data were collected using a valid self-reported questionnaire including demographic variables, awareness, and diabetes self-care behaviors (Summary of Diabetes Self-care Activities), as well as free practice (fasting blood sugar [FBS] and hemoglobin A1c [HbA1c]), which was completed by both groups before and 2 months after the intervention. Then, the data were entered into the SPSS statistical software, version 22 and were analyzed using Chi-square test, independent t-test, and descriptive statistical methods. P < 0.05 was considered statistically significant. RESULTS The results showed that the two groups of intervention and test were identical in terms of demographic information. In the intervention group, before and after 2 months of educational intervention, there was a significant difference in increasing awareness and self-care behavior in diet, physical activity, blood sugar testing, foot care, and medication (P < 0.001). However, this difference was not significant in the control group (P < 0.05). In the intervention group, the mean FBS and quarterly (HbA1c) index decreased significantly (P < 0.05). CONCLUSION This study showed that teaching self-care program, in the same way, has been effective in improving self-care behavior and blood sugar index in the elderly with diabetes and suggested that this educational method be used in other chronic diseases.
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Affiliation(s)
- Zahra Khiyali
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Afsaneh Ghasemi
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Razie Toghroli
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Arash Ziapour
- Health Education and Health Promotion, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nahid Shahabi
- Student Research Committee, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Asiyeh Yari
- Ph.D Candidate of Health Education and Health Promotion, School of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Kumah E, Abuosi AA, Ankomah SE, Anaba C. Self-management Education Program: The Case of Glycemic Control of Type 2 Diabetes. Oman Med J 2021; 36:e225. [PMID: 33585046 PMCID: PMC7868594 DOI: 10.5001/omj.2021.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/28/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives Self-management education (SME) is recognized globally as a tool that enables patients to achieve optimal glucose control. While factors influencing the effectiveness of self-management interventions have been studied extensively, the impact of program length on clinical endpoints of patients diagnosed with diabetes is underdeveloped. This paper synthesized information from the existing literature to understand the effect of program length on glycated hemoglobin (HbA1C) in adults with type 2 diabetes mellitus. Methods We searched Web of Science, PubMed, Scopus, MEDLINE, EMBASE, PsychINFO, and the Cochrane Central Register of Controlled Trials to identify relevant English language publications on diabetes self-management education published between January 2000 and April 2019. Results The review included 25 randomized controlled trials, with 64.0% reporting significant changes in HbA1C. The studies classified as long-term (lasting one year and above) were associated with the greatest number of interventions achieving statistically significant (87.5% significant vs. 12.5% non-significant) differences in changes in HbA1C between the intervention and the control subjects, recording an overall between-group HbA1C mean difference of 0.6±0.3% (range = 0.2–1.2). Conclusions Our findings suggest that program length may change the effectiveness of educational interventions. Achieving sustained improvements in patients’ HbA1C levels will require long-term, ongoing SME, and support.
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Affiliation(s)
- Emmanuel Kumah
- Policy, Planning, Monitoring, and Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | | | - Cynthia Anaba
- Department of Administration, St. Dominic Hospital, Akwatia, Eastern Region, Ghana
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Kravitz N, Levanon Y, Cukierman-Yaffe T, Nota A, Kizony R, Rand D. Sensorimotor and Cognitive Abilities Associated With Touchscreen Tablet App Performance to Support Self-Management of Type 2 Diabetes. Am J Occup Ther 2021; 75:7501205080p1-7501205080p9. [PMID: 33399056 DOI: 10.5014/ajot.2021.040600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Self-management programs (facilitated by mobile devices) may improve health and prevent secondary complications for older adults with diabetes. However, older adults may have difficulties using mobile devices because of neuropathy or cognitive dysfunction. OBJECTIVE To identify sensorimotor and cognitive abilities associated with touchscreen tablet app performance to support self-management of diabetes in older adults. DESIGN Cross-sectional study. SETTING Outpatient Center for Successful Aging With Diabetes. PARTICIPANTS Forty-five older adults with Type 2 diabetes. OUTCOMES AND MEASURES Dexterity (Purdue Pegboard Test), touch sensation (Semmes-Weinstein monofilaments), pinch strength (pinch gauge), cognition (Montreal Cognitive Assessment), and executive functioning (Trail Making Test) were assessed. Two apps were then used: Dexteria and SuCare. Demographic data, prior mobile device use, and diabetes severity (hemoglobin A1C [HbA1C]) were collected. RESULTS Age and HbA1C accounted for 29.8% and 9.7%, respectively, of the total variance of Dexteria performance time (dominant hand). Dexterity (dominant hand) accounted for an additional 5.4% of the total variance of 45.1%, F(4, 40) = 10.021, p < .001. Prior mobile device use, age, and diabetes severity accounted for 6.4%, 11.8%, and 26.4%, respectively, of the total variance of SuCare performance time. Executive functioning and dominant-hand dexterity accounted for an additional 9.5% and 9.4%, respectively, of the total variance of 61.0%, F(5, 39) = 14.75, p < .001. CONCLUSIONS AND RELEVANCE Beyond age and diabetes severity, executive functioning and dominant-hand dexterity contributed to app performance, highlighting the importance of diabetes self-management. These findings may help determine suitable candidates for tablet use for self-management. WHAT THIS ARTICLE ADDS App performance is explained by the executive functioning and dexterity of older adults with Type 2 diabetes. These factors, in addition to age and diabetes severity, should be taken into consideration by occupational therapy practitioners in future mobile self-management programs.
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Affiliation(s)
- Neta Kravitz
- Neta Kravitz, OT, MSc, is Occupational Therapist, Department of Hand Rehabilitation, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. At the time of the study, Kravitz was Master's Student, Department of Occupational Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yafi Levanon
- Yafi Levanon, OT, PhD, is Teacher, Department of Occupational Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Deputy, Occupational Therapy Services, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Tali Cukierman-Yaffe, MSc, MD, is Head Physician, Center for Successful Aging With Diabetes, Division of Endocrinology, Diabetes and Metabolism, Gertner Institute, Sheba Medical Center, Ramat Gan, Israel; Senior Lecturer, Epidemiology Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and Researcher, Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | - Ayala Nota
- Ayala Nota, OT, MSc, is Occupational Therapist and Head of Occupational Therapy Services, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Rachel Kizony
- Rachel Kizony, OT, PhD, is Senior Lecturer, Department of Occupational Therapy, University of Haifa, Haifa, Israel, and Occupational Therapist, Occupational Therapy Services, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Debbie Rand
- Debbie Rand, OT, PhD, is Senior Lecturer, Department of Occupational Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
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Yu D, Cai Y, Graffy J, Holman D, Zhao Z, Simmons D. Association Between Systolic Blood Pressure and Cardiovascular Inpatient Cost Moderated by Peer-Support Intervention Among Adult Patients With Type 2 Diabetes: A 2-Cohort Study. Can J Diabetes 2020; 45:179-185.e1. [PMID: 33046400 DOI: 10.1016/j.jcjd.2020.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/08/2020] [Accepted: 07/31/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES People with type 2 diabetes and increased systolic blood pressure (SBP) are at high risk of cardiovascular disease (CVD). In this study, we aimed to investigate the association between CVD-related hospital payments and SBP and tested whether this association is influenced by diabetes peer support. METHODS Two cohorts comprising people with type 2 diabetes were included in the study. The first cohort comprised 4,704 patients with type 2 diabetes assessed between 2008 and 2009 from 18 general practices in Cambridgeshire and followed up to 2009-2011. The second cohort comprised 1,121 patients with type 2 diabetes from post-trial follow-up data, recruited between 2011 and 2012 and followed up to 2015. SBP was measured at baseline. Inpatient payments for CVD hospitalization within 2 years since baseline was the main outcome. The impact of 1:1, group or combined diabetes peer support and usual care were investigated in the second cohort. Adjusted mean CVD inpatient payments per person were estimated using a 2-part model after adjusting for baseline characteristics. RESULTS A "hockey-stick" relationship between baseline SBP and estimated CVD inpatient payment was identified in both cohorts, with a threshold at 133 to 141 mmHg, suggesting increased payments for patients with SBP below and above the threshold. The combined peer-support intervention altered the aforementioned association, with no increased payment with SBP above the threshold, and payment slightly decreased with SBP beyond the threshold. CONCLUSIONS SBP maintained between 133 and 141 mmHg is associated with the lowest CVD disease management costs for patients with type 2 diabetes. Combined peer-support intervention could significantly decrease CVD-related hospital payments.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China; Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Yamei Cai
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Jonathan Graffy
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
| | - Daniel Holman
- Department of Sociological Studies, University of Sheffield, Sheffield, United Kingdom
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China.
| | - David Simmons
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China; Western Sydney University, Campbelltown, Sydney New South Wales, Australia.
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12
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Thuita AW, Kiage BN, Onyango AN, Makokha AO. Effect of a nutrition education programme on the metabolic syndrome in type 2 diabetes mellitus patients at a level 5 Hospital in Kenya: "a randomized controlled trial". BMC Nutr 2020; 6:30. [PMID: 32774875 PMCID: PMC7401230 DOI: 10.1186/s40795-020-00355-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 06/02/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2D), is a life-threatening condition of global public health concern. It worsens in the presence of the metabolic syndrome (MetS), a complex disorder characterized by co-occurrence of at least three of such factors as hypertension, obesity, dyslipidemia and insulin resistance. However, lifestyle interventions reduce the risk of both MetS and T2D, and nutrition education can empower individuals on the appropriate, lifestyle changes. The aim of the current study was to evaluate the effect of a nutrition education programme, with and without inclusion of peer to peer support, on MetS in T2D patients. METHODS This was a randomized controlled trial with two intervention groups and one control. One of the intervention groups involved a nutrition education programme with peer-to-peer support (NEP); the other involved only the education program, while the control received standard care. Each group had 51 participants. The nutrition education programme was conducted for 2 h per week for 8 weeks. In addition, the NEP had weekly peer-to-peer interactions for 8 weeks. All groups had follow-up sessions for 6 months. Data on MetS risk factors as well as food intake patterns and physical activity levels were taken at baseline and at different time points during the study. Analysis of Co-variance and regression were used in the analysis. RESULTS The MetS prevalence improved in the NEP (90 to 52%) and NE (86 to 69%), while it worsened in C (88 to 91%). There was improvement in the mean values of the anthropometric parameters in the NEP and NE which worsened in the control group. There was a general improvement in mean values of blood lipids, fasting blood glucose and HbA1c in all the groups, with NEP showing the greatest improvements, followed by NE, except for triglycerides and HDL where the control group had better improvement than the NE. Changes in the anthropometric and metabolic indicators mirrored the changes in food intake patterns and physical activity, where the greatest improvements occurred in the NEP. CONCLUSIONS Nutrition education with inclusion of peer to peer support was of clinical benefit in improving metabolic outcomes and reducing MetS in T2DM patients. TRIAL REGISTRATION The study has been registered retrospectively by Pan African Clinical Trial Registry; Registration No: PACTR201910518676391.
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Affiliation(s)
- Ann Watetu. Thuita
- School of Food and Nutrition Sciences, Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Beatrice Nyanchama Kiage
- School of Food and Nutrition Sciences, Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Arnold N. Onyango
- School of Food and Nutrition Sciences, Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Anselimo O. Makokha
- School of Food and Nutrition Sciences, Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
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13
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Surey J, Menezes D, Francis M, Gibbons J, Sultan B, Miah A, Abubakar I, Story A. From peer-based to peer-led: redefining the role of peers across the hepatitis C care pathway: HepCare Europe. J Antimicrob Chemother 2019; 74:v17-v23. [PMID: 31782500 PMCID: PMC6883389 DOI: 10.1093/jac/dkz452] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND HCV infection disproportionately affects underserved populations such as homeless individuals, people who inject drugs and prison populations. Peer advocacy can enable active engagement with healthcare services and increase the likelihood of favourable treatment outcomes. OBJECTIVES This observational study aims to assess the burden of disease in these underserved populations and describe the role of peer support in linking these individuals to specialist treatment services. METHODS Services were identified if they had a high proportion of individuals with risk factors for HCV, such as injecting drug use or homelessness. Individuals were screened for HCV using point-of-care tests and a portable FibroScan. All positive cases received peer support for linkage to specialist care. Information was gathered on risk factors, demographics and follow-up information regarding linkage to care and treatment outcomes. RESULTS A total of 461 individuals were screened, of which 197 (42.7%) were chronically infected with HCV. Referral was made to secondary care for 176 (89.3%) and all received peer support, with 104 (52.8%) individuals engaged with treatment centres. Of these, 89 (85.6%) started treatment and 76 (85.4%) had a favourable outcome. Factors associated with not being approved for treatment were recent homelessness, younger age and current crack cocaine injecting. CONCLUSIONS Highly trained peer support workers working as part of a specialist outreach clinical team help to identify a high proportion of individuals exposed to HCV, achieve high rates of engagement with treatment services and maintain high rates of treatment success amongst a population with complex needs.
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Affiliation(s)
- Julian Surey
- Institute of Global Health, University College London, London, UK
- Find and Treat, University College London Hospitals NHS Trust, London, UK
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Dee Menezes
- Institute of Health Informatics, University College London, London, UK
| | - Marie Francis
- Institute of Global Health, University College London, London, UK
- Find and Treat, University College London Hospitals NHS Trust, London, UK
| | - John Gibbons
- Find and Treat, University College London Hospitals NHS Trust, London, UK
- Groundswell, London, UK
| | - Binta Sultan
- Institute of Global Health, University College London, London, UK
| | | | - Ibrahim Abubakar
- Institute of Global Health, University College London, London, UK
| | - Alistair Story
- Find and Treat, University College London Hospitals NHS Trust, London, UK
- Collaborative Centre for Inclusion Health, UCL, London, UK
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Harris J, Haltbakk J, Dunning T, Austrheim G, Kirkevold M, Johnson M, Graue M. How patient and community involvement in diabetes research influences health outcomes: A realist review. Health Expect 2019; 22:907-920. [PMID: 31286639 PMCID: PMC6803418 DOI: 10.1111/hex.12935] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/30/2022] Open
Abstract
Background Patient and public involvement in diabetes research is an international requirement, but little is known about the relationship between the process of involvement and health outcomes. Objective This realist review identifies who benefits from different types of involvement across different contexts and circumstances. Search strategies Medline, CINAHL and EMBASE were searched to identify interventions using targeted, embedded or collaborative involvement to reduce risk and promote self‐management of diabetes. People at risk/with diabetes, providers and community organizations with an interest in addressing diabetes were included. There were no limitations on date, language or study type. Data extraction and synthesis Data were extracted from 29 projects using elements from involvement frameworks. A conceptual analysis of involvement types was used to complete the synthesis. Main results Projects used targeted (4), embedded (8) and collaborative (17) involvement. Productive interaction facilitated over a sufficient period of time enabled people to set priorities for research. Partnerships that committed to collaboration increased awareness of diabetes risk and mobilized people to co‐design and co‐deliver diabetes interventions. Cultural adaptation increased relevance and acceptance of the intervention because they trusted local delivery approaches. Local implementation produced high levels of recruitment and retention, which project teams associated with achieving diabetes health outcomes. Discussion and Conclusions Achieving understanding of community context, developing trusting relationships across sectors and developing productive partnerships were prerequisites for designing research that was feasible and locally relevant. The proportion of diabetes studies incorporating these elements is surprisingly low. Barriers to resourcing partnerships need to be systematically addressed.
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Affiliation(s)
- Janet Harris
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Johannes Haltbakk
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Trisha Dunning
- Centre for Quality and Patient Safety Research, Deakin University and Barwon Health Partnership, Geelong, Victoria, Australia
| | - Gunhild Austrheim
- Library, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marit Kirkevold
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marit Graue
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Yu D, Cai Y, Graffy J, Holman D, Zhao Z, Simmons D. Derivation and external validation of risk algorithms for cerebrovascular (re)hospitalisation in patients with type 2 diabetes: Two cohorts study. Diabetes Res Clin Pract 2018; 144:74-81. [PMID: 30114459 DOI: 10.1016/j.diabres.2018.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/25/2018] [Accepted: 08/09/2018] [Indexed: 11/26/2022]
Abstract
AIMS Cerebrovascular disease is one of more typical reasons for hospitalisation and re-hospitalisation in people with type 2 diabetes. We aimed to derive and externally validate two risk prediction algorithms for cerebrovascular hospitalisation and re-hospitalisation. METHODS Two independent cohorts were used to derive and externally validate the two risk scores. The development cohort comprises 4704 patients with type 2 diabetes registered in 18 general practices across Cambridgeshire. The validation cohort includes 1121 type 2 patients from a post-trial cohort data. Outcomes were cerebrovascular hospitalisation within two years and cerebrovascular re-hospitalisation within ninety days of the previous cerebrovascular hospitalisation. Logistic regression was applied to derive the two risk scores for cerebrovascular hospitalisation and re-hospitalisation from development cohort, which were externally validated in the validation cohort. RESULTS The incidence of cerebrovascular hospitalisation and re-hospitalisation was 3.76% and 1.46% in the development cohort, and 4.99% and 1.87% in the external validation cohort. Age, gender, body mass index, blood pressures, and lipid profiles were included in the final model. Model discrimination was similar in both cohorts, with all C-statistics > 0.70, and very good calibration of observed and predicted individual risks. CONCLUSION Two new risk scores that quantify individual risks of cerebrovascular hospitalisation and re-hospitalisation have been well derived and externally validated. Both scores are on the basis of a few of clinical measurements that are commonly available for patients with type 2 diabetes in primary care settings and could work as tools to identify individuals at high risk of cerebrovascular hospitalisation and re-hospitalisation.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China; Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele ST5 5BG, United Kingdom
| | - Yamei Cai
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Jonathan Graffy
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire CB2 0SR, United Kingdom
| | - Daniel Holman
- Department of Sociological Studies, University of Sheffield, Sheffield S10 2TU, United Kingdom
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - David Simmons
- Western Sydney University, Campbelltown, Sydney, NSW 2760, Australia.
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Yu D, Cai Y, Qin R, Graffy J, Holman D, Zhao Z, Simmons D. Total/high density lipoprotein cholesterol and cardiovascular disease (re)hospitalization nadir in type 2 diabetes. J Lipid Res 2018; 59:1745-1750. [PMID: 29959181 DOI: 10.1194/jlr.p084269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/26/2018] [Indexed: 11/20/2022] Open
Abstract
Total cholesterol to HDL cholesterol ratio (TC/HDL) is an important prognostic factor for CVD. This study used restricted cubic spline modeling to investigate the dose-response associations between TC/HDL and both CVD hospitalization and CVD rehospitalization in two independent prospective cohorts. The East Cambridgeshire and Fenland cohort includes 4,704 patients with T2D from 18 general practices in Cambridgeshire. The Randomized controlled trial of Peer Support In type 2 Diabetes cohort comprises 1,121 patients with T2D with posttrial follow-up data. TC/HDL and other demographic and clinical measurements were measured at baseline. Outcomes were CVD hospitalization over 2 years and CVD rehospitalization after 90 days of the prior CVD hospitalization. Modeling showed nonlinear relationships between TC/HDL and risks of CVD hospitalization and rehospitalization consistently in both cohorts (all P < 0.001 for linear tests). The lowest risks of CVD hospitalization and rehospitalization were consistently found for TC/HDL at 2.8 (95% CI: 2.6-3.0) in both cohorts and both overall and by gender. This is lower than the current lipid control target, 4.0 of TC/HDL. Reducing the TC/HDL target to 2.8 would include a further 33-44% patients with TC/HDL in the 2.8-4.0 range. Studies are required to assess the effectiveness and cost-effectiveness of the earlier introduction of, and more intensive, lipid-lowering treatment needed to achieve this new lower TC/HDL target.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China; Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele ST5 5BG, United Kingdom
| | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Rui Qin
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Jonathan Graffy
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire CB2 0SR, United Kingdom
| | - Daniel Holman
- Department of Sociological Studies, University of Sheffield, Sheffield S10 2TU, United Kingdom
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - David Simmons
- Western Sydney University, Campbelltown, Sydney NSW 2751, Australia.
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17
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Yu D, Graffy J, Holman D, Robins P, Cai Y, Zhao Z, Simmons D. Impact of peer support on inpatient and outpatient payments among people with Type 2 diabetes: a prospective cohort study. Diabet Med 2018; 35:789-797. [PMID: 29575010 DOI: 10.1111/dme.13624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 12/29/2022]
Abstract
AIM To investigate the impact of a low-cost diabetes peer-support intervention, aimed at reducing inpatient and outpatient care utilization and healthcare payments, by conducting a cohort study that followed up a randomized controlled trial. METHODS A total of 1121 adults with Type 2 diabetes were recruited through general practices in Cambridgeshire and Hertfordshire, UK, and were followed up for 3.25 financial years after 8-12 months of one-to-one, group or combined diabetes peer support and usual care. Use of, and payments for inpatient and outpatient services were fully recorded in the follow-up. Adjusted mean inpatient and outpatient payments per person were estimated using a two-part model after adjusting for baseline characteristics. RESULTS The mean age of the recruited adults was 65.6±11.4 years, 60.4% were male, and 16.8% were insulin-treated. Compared with the control group, less healthcare utilization (especially non-elective inpatient care and outpatient consultations) was observed in each of the intervention groups, particularly the combined intervention group. Over the course of 3.25 financial years, significant reductions of 41% (£909.20 per head) were observed for overall inpatient payments (P<0.0001), 51% (£514.67 per head) for non-elective inpatient payments (P=0.005) in the combined intervention group, and 34% (£413.30 per head) and 32% (£388.99 per head) for elective inpatient payments in the one-to-one (P=0.029) and combined intervention (P=0.048) groups, respectively. CONCLUSIONS Type 2 diabetes peer support, whether delivered using a one-to-one, group or combined approach was associated with reduced inpatient care utilization (particularly non-elective admissions) and payments over 3.25 years.
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Affiliation(s)
- D Yu
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Arthritis Research UK, Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - J Graffy
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - D Holman
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - P Robins
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Y Cai
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Z Zhao
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - D Simmons
- Western Sydney University, Campbelltown, Sydney, NSW, Australia
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House A, Latchford G, Russell AM, Bryant L, Wright J, Graham E, Stansfield A, Ajjan R. Development of a supported self-management intervention for adults with type 2 diabetes and a learning disability. Pilot Feasibility Stud 2018; 4:106. [PMID: 29862037 PMCID: PMC5975532 DOI: 10.1186/s40814-018-0291-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/09/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although supported self-management is a well-recognised part of chronic disease management, it has not been routinely used as part of healthcare for adults with a learning disability. We developed an intervention for adults with a mild or moderate learning disability and type 2 diabetes, building on the principles of supported self-management with reasonable adjustments made for the target population. METHODS In five steps, we:Clarified the principles of supported self-management as reported in the published literatureIdentified the barriers to effective self-management of type 2 diabetes in adults with a learning disabilityReviewed existing materials that aim to support self-management of diabetes for people with a learning disabilitySynthesised the outputs from the first three phases and identified elements of supported self-management that were (a) most relevant to the needs of our target population and (b) most likely to be acceptable and useful to themImplemented and field tested the intervention. RESULTS The final intervention had four standardised components: (1) establishing the participant's daily routines and lifestyle, (2) identifying supporters and their roles, (3) using this information to inform setting realistic goals and providing materials to the patient and supporter to help them be achieved and (4) monitoring progress against goals.Of 41 people randomised in a feasibility RCT, thirty five (85%) completed the intervention sessions, with over three quarters of all participants (78%) attending at least three sessions.Twenty-three out of 40 (58%) participants were deemed to be very engaged with the sessions and 12/40 (30%) with the materials; 30 (73%) participants had another person present with them during at least one of their sessions; 15/41 (37%) were reported to have a very engaged main supporter, and 18/41 (44%) had a different person who was not their main supporter but who was engaged in the intervention implementation. CONCLUSIONS The intervention was feasible to deliver and, as judged by participation and engagement, acceptable to participants and those who supported them. TRIAL REGISTRATION Current Controlled Trials ISRCTN41897033 (registered 21/01/2013).
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Affiliation(s)
- Allan House
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Amy M. Russell
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Louise Bryant
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Elizabeth Graham
- Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | | | - Ramzi Ajjan
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
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Yu D, Cai Y, Graffy J, Holman D, Zhao Z, Simmons D. Development and External Validation of Risk Scores for Cardiovascular Hospitalization and Rehospitalization in Patients With Diabetes. J Clin Endocrinol Metab 2018; 103:1122-1129. [PMID: 29319819 DOI: 10.1210/jc.2017-02293] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/03/2018] [Indexed: 02/12/2023]
Abstract
CONTEXT Cardiovascular disease (CVD) is a common and costly reason for hospitalization and rehospitalization among patients with type 2 diabetes. OBJECTIVE This study aimed to develop and externally validate two risk-prediction models for cardiovascular hospitalization and cardiovascular rehospitalization. DESIGN Two independent prospective cohorts. SETTING The derivation cohort includes 4704 patients with type 2 diabetes from 18 general practices in Cambridgeshire. The validation cohort comprises 1121 patients with type 2 diabetes from post-trial follow-up data. MAIN OUTCOME MEASURE Cardiovascular hospitalization over 2 years and cardiovascular rehospitalization after 90 days of the prior CVD hospitalization. RESULTS The absolute rate of cardiovascular hospitalization and rehospitalization was 12.5% and 6.7% in the derivation cohort and 16.3% and 7.0% in the validation cohort. Discrimination of the models was similar in both cohorts, with C statistics above 0.70 and excellent calibration of observed and predicted risks. CONCLUSION Two prediction models that quantify risks of cardiovascular hospitalization and rehospitalization have been developed and externally validated. They are based on a small number of clinical measurements that are available for patients with type 2 diabetes in many developed countries in primary care settings and could serve as the tools to screen the population at high risk of cardiovascular hospitalization and rehospitalization.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Yamei Cai
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Jonathan Graffy
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire0SR, United Kingdom
| | - Daniel Holman
- Department of Sociological Studies, University of Sheffield, Sheffield, United Kingdom
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - David Simmons
- Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
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20
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Wingate L, Graffy J, Holman D, Simmons D. Can peer support be cost saving? An economic evaluation of RAPSID: a randomized controlled trial of peer support in diabetes compared to usual care alone in East of England communities. BMJ Open Diabetes Res Care 2017; 5:e000328. [PMID: 29225890 PMCID: PMC5706488 DOI: 10.1136/bmjdrc-2016-000328] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 06/22/2017] [Accepted: 07/11/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diabetes peer support, where one person with diabetes helps others, may improve diabetes management. The objective of this study was to perform a cost analysis of peer support strategies used in RAndomized controlled trial of Peer Support in type 2 Diabetes. METHODS We performed a 2×2 factorial randomized cluster controlled trial in England. People with type 2 diabetes were invited to participate as either 'peer' or 'peer support facilitator' (PSF) through postal invitation predominantly from general practice. Clusters, based on local communities, were each randomly assigned to one arm of group, 1:1, both group and 1:1 or control interventions. The intervention was delivered over 8-12 months by trained PSFs, supported by monthly meetings with a diabetes nurse. Out-of-pocket expenses/service utilization were self-reported at baseline, midpoint and on trial completion. Intervention costs were collated. Non-hospital costs used National Health Service (NHS) reference costs. Hospital payments were obtained from one local commissioning group and mean payments calculated. The analysis employed a societal perspective. Costs were evaluated at the conclusion of the trial. RESULTS Participants (n=1299) were recruited across 130 clusters. The four arms were well balanced and matched (60% male, mean diabetes duration 9.5 years, mean glycated haemoglobin (HbA1c) 7.4+/-1.3%, 17% insulin treated). Implementation costs at 2013 rates were £13.84/participant/annum, participant out-of-pocket expenses for any intervention were £11.41/participant/annum and the NHS-incurred costs were reduced by £138.38/participant/annum. Savings for the 1:1, group and any intervention were £233.65, £90.52 and £113.13/participant/annum, respectively. CONCLUSIONS We conclude that both 1:1 and group diabetes peer support over 8-12 months are cost saving in this setting, although much of the benefit is largely derived by differences in self-reported healthcare utilization. Long-term benefits should be investigated. TRIAL REGISTRATION NUMBER ISRCTN66963621.
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Affiliation(s)
- La’Marcus Wingate
- Department of Clinical and Administrative Pharmacy, Howard University, Washington DC, Washington, USA
| | - Jonathan Graffy
- Department of Public Health and Primary Care, Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Daniel Holman
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - David Simmons
- MacArthur Clinical School, Western Sydney University, Campbelltown, Australia
- Wolfson Diabetes and Endocrinology Clinic, Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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21
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The relationship between diabetes attitudes and treatment among free clinic patients and volunteers. J Community Health 2016; 39:1186-92. [PMID: 24756836 DOI: 10.1007/s10900-014-9875-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Free clinics provide free primary care to the under or uninsured and have been playing an important role in serving the socio-economically disadvantaged. Free clinic patients represent a group of people who experience significant barriers to receiving diabetes prevention and intervention. This study examined diabetes attitudes among free clinic patients and volunteers. English or Spanish speaking patients and volunteers (N = 384), aged 18 years or older completed a self-administered survey. Diabetic patients and volunteers shared similar levels of diabetes attitudes compared to non-diabetic patients. Among patients, ethnicity, education level, diabetes education, and family history affected diabetes attitudes. Among volunteers, diabetes education was an important factor associated with positive diabetes attitudes. Whether the volunteer is a healthcare professional or student was related only to one aspect of diabetes attitudes, seriousness of type 2 diabetes. The results, indicating free clinic diabetic patients and volunteers shared similar levels of diabetes attitudes, were positive for maintaining and developing diabetes education programs at a free clinic. Unfortunately, the average length of volunteering at this free clinic was short and student volunteers likely leave the clinic upon graduation. Future research should examine issues of volunteer retention in free clinics. Diabetes education for patients may need to be diversified according to ethnicity, family history of diabetes, and educational level. Finally, non-healthcare professional volunteers could potentially be involved in diabetes education at a free clinic.
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Gómez-Pardo E, Fernández-Alvira JM, Vilanova M, Haro D, Martínez R, Carvajal I, Carral V, Rodríguez C, de Miguel M, Bodega P, Santos-Beneit G, Peñalvo JL, Marina I, Pérez-Farinós N, Dal Re M, Villar C, Robledo T, Vedanthan R, Bansilal S, Fuster V. A Comprehensive Lifestyle Peer Group-Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program. J Am Coll Cardiol 2015; 67:476-85. [PMID: 26562047 DOI: 10.1016/j.jacc.2015.10.033] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 10/22/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cardiovascular diseases stem from modifiable risk factors. Peer support is a proven strategy for many chronic illnesses. Randomized trials assessing the efficacy of this strategy for global cardiovascular risk factor modification are lacking. OBJECTIVES This study assessed the hypothesis that a peer group strategy would help improve healthy behaviors in individuals with cardiovascular risk factors. METHODS A total of 543 adults 25 to 50 years of age with at least 1 risk factor were recruited; risk factors included hypertension (20%), overweight (82%), smoking (31%), and physical inactivity (81%). Subjects were randomized 1:1 to a peer group-based intervention group (IG) or a self-management control group (CG) for 12 months. Peer-elected leaders moderated monthly meetings involving role-play, brainstorming, and activities to address emotions, diet, and exercise. The primary outcome was mean change in a composite score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT score, 0 to 15). Multilevel models with municipality as a cluster variable were applied to assess differences between groups. RESULTS Participants' mean age was 42 ± 6 years, 71% were female, and they had a mean baseline Fuster-BEWAT score of 8.42 ± 2.35. After 1 year, the mean scores were significantly higher in the IG (n = 277) than in the CG (n = 266) (IG mean score: 8.84; 95% confidence interval (CI): 8.37 to 9.32; CG mean score: 8.17; 95% CI: 7.55 to 8.79; p = 0.02). The increase in the overall score was significantly larger in the IG compared with the CG (difference: 0.75; 95% CI: 0.32 to 1.18; p = 0.02). The mean improvement in the individual components was uniformly greater in the IG, with a significant difference for the tobacco component. CONCLUSIONS The peer group intervention had beneficial effects on cardiovascular risk factors, with significant improvements in the overall score and specifically on tobacco cessation. A follow-up assessment will be performed 1 year after the final assessment reported here to determine long-term sustainability of the improvements associated with peer group intervention. (Peer-Group-Based Intervention Program [Fifty-Fifty]; NCT02367963).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jose Luis Peñalvo
- Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Iñaki Marina
- Internal Medicine Department, Catalan Health Institute, Viladecans, Spain
| | | | - Marian Dal Re
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition
| | - Carmen Villar
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition
| | - Teresa Robledo
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition
| | | | | | - Valentin Fuster
- SHE Foundation, Barcelona, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York.
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Simmons D, Bunn C, Nakwagala F, Safford MM, Ayala GX, Riddell M, Graffy J, Fisher EB. Challenges in the Ethical Review of Peer Support Interventions. Ann Fam Med 2015; 13 Suppl 1:S79-86. [PMID: 26304976 PMCID: PMC4648134 DOI: 10.1370/afm.1803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 04/09/2015] [Accepted: 04/20/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Ethical review processes have become increasingly complex. We have examined how 8 collaborating diabetes peer-support clinical trials were assessed by ethics committees. METHODS The ethical reviews from the 8 peer-support studies were collated and subjected to a thematic analysis. We mapped the recommendations of local Institutional Review Boards and ethics committees onto the "4+1 ethical framework" (autonomy, beneficence, non-maleficence, and justice, along with concern for their scope of application). RESULTS Ethics committees did not consistently focus on tasks within the 4+1 framework: many conducted reviews of scientific, organizational, and administrative activities. Of the 20 themes identified across the ethical reviews, only 4 fell within the scope of the 4+1 framework. Variation in processes and requirements for ethics committees were particularly evident between study countries. Some of the consent processes mandated by ethical review boards were disproportionate for peer support, increased participant burden, and reduced the practicality of testing an ethical intervention. Across the 8 studies, ethics committees' reviews included the required elements to ensure participant safety; however, they created a range of hurdles that in some cases delayed the research and required consent processes that could hinder the spontaneity and/or empathy of peer support. CONCLUSION Ethics committees should avoid repeating the work of other trusted agencies and consider the ethical validity of "light touch" consent procedures for peer-support interventions. The investigators propose an ethical framework for research on peer support.
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Affiliation(s)
- David Simmons
- School of Medicine, University of Western Sydney, Sydney, Australia Institute of Metabolic Science, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, England
| | - Christopher Bunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Fred Nakwagala
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Monika M Safford
- Department of Medicine, School of Medicine, University of Alabama, Birmingham, Alabama
| | - Guadalupe X Ayala
- San Diego State University College of Health and Human Services and the Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | - Michaela Riddell
- Global Health and Society Unit, SPHPM, Monash University, Melbourne, Australia
| | - Jonathan Graffy
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation, Leawood, Kansas Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Simmons D, Prevost AT, Bunn C, Holman D, Parker RA, Cohn S, Donald S, Paddison CAM, Ward C, Robins P, Graffy J. Impact of community based peer support in type 2 diabetes: a cluster randomised controlled trial of individual and/or group approaches. PLoS One 2015; 10:e0120277. [PMID: 25785452 PMCID: PMC4364716 DOI: 10.1371/journal.pone.0120277] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/16/2015] [Indexed: 11/19/2022] Open
Abstract
Background Diabetes peer support, where one person with diabetes helps guide and support others, has been proposed as a way to improve diabetes management. We have tested whether different diabetes peer support strategies can improve metabolic and/or psychological outcomes. Methods People with type 2 diabetes (n = 1,299) were invited to participate as either ‘peer’ or ‘peer support facilitator’ (PSF) in a 2x2 factorial randomised cluster controlled trial across rural communities (130 clusters) in England. Peer support was delivered over 8–12 months by trained PSFs, supported by monthly meetings with a diabetes educator. Primary end point was HbA1c. Secondary outcomes included quality of life, diabetes distress, blood pressure, waist, total cholesterol and weight. Outcome assessors and investigators were masked to arm allocation. Main factors were 1:1 or group intervention. Analysis was by intention-to-treat adjusting for baseline. Results The 4 arms were well matched (Group n = 330, 1:1(individual) n = 325, combined n = 322, control n = 322); 1035 (79•7%) completed the mid-point postal questionnaire and 1064 (81•9%) had a final HbA1c. A limitation was that although 92.6% PSFs and peers were in telephone contact, only 61.4% of intervention participants attended a face to face session. Mean baseline HbA1c was 57 mmol/mol (7•4%), with no significant change across arms. Follow up systolic blood pressure was 2•3mm Hg (0.6 to 4.0) lower among those allocated group peer-support and 3•0mm Hg (1.1 to 5.0) lower if the group support was attended at least once. There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication. Conclusions Group diabetes peer support over 8–12 months was associated with a small improvement in blood pressure but no other significant outcomes. Long term benefits should be investigated. Trial Registration ISRCTN.com ISRCTN6696362166963621
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Affiliation(s)
- David Simmons
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, England
- * E-mail:
| | - A. Toby Prevost
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England
| | - Chris Bunn
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, England
| | - Daniel Holman
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England
| | - Richard A. Parker
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England
| | - Simon Cohn
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England
| | - Sarah Donald
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, England
| | - Charlotte A. M. Paddison
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England
| | - Candice Ward
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, England
| | - Peter Robins
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, England
| | - Jonathan Graffy
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England
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Kowitt SD, Urlaub D, Guzman-Corrales L, Mayer M, Ballesteros J, Graffy J, Simmons D, Cummings DM, Fisher EB. Emotional support for diabetes management: an international cross-cultural study. DIABETES EDUCATOR 2015; 41:291-300. [PMID: 25722064 DOI: 10.1177/0145721715574729] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to explore how emotional support emerged in interactions between peer supporters (PSs) and adults living with type 2 diabetes. METHODS Qualitative data were analyzed from 22 semistructured interviews with PSs in 3 settings: low-income Latinos in Chicago, middle-class Caucasians in the United Kingdom, and low-income African American women in North Carolina. Emotional support was defined as expressions of empathy, trust, and caring. RESULTS Across all sites, emotional support gradually emerged over time, was often combined with informational support, and was conveyed both implicitly (through nonverbal actions connoting emotional acceptance; eg, a walk together without discussion of problems) and explicitly (eg, by reassurance or discussion of stressors). Cross-site differences did appear regarding the strategies to address barriers to diabetes management (eg, PSs in North Carolina and Chicago reported providing support for social stressors) and the role of PSs (eg, PSs in Chicago reported providing directive support). CONCLUSIONS Across different settings and populations, emotional support for diabetes management evolved over time, was often integrated with informational support, and emerged through both implicit and explicit strategies that addressed varied context-specific stressors.
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Affiliation(s)
- Sarah D Kowitt
- Peers for Progress, American Academy of Family Physicians Foundation, and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina (Ms Kowitt, Ms Urlaub, Ms Guzman-Corrales, Ms Mayer, Dr Fisher),Alivio Medical Center, Chicago, Illinois (Ms Ballesteros)
| | - Diana Urlaub
- Peers for Progress, American Academy of Family Physicians Foundation, and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina (Ms Kowitt, Ms Urlaub, Ms Guzman-Corrales, Ms Mayer, Dr Fisher)
| | - Laura Guzman-Corrales
- Peers for Progress, American Academy of Family Physicians Foundation, and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina (Ms Kowitt, Ms Urlaub, Ms Guzman-Corrales, Ms Mayer, Dr Fisher)
| | - Melissa Mayer
- Peers for Progress, American Academy of Family Physicians Foundation, and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina (Ms Kowitt, Ms Urlaub, Ms Guzman-Corrales, Ms Mayer, Dr Fisher)
| | | | - Jonathan Graffy
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (Dr Graffy)
| | - David Simmons
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (Dr Simmons)
| | - Doyle M Cummings
- Departments of Family Medicine and Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina (Dr Cummings)
| | - Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation, and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina (Ms Kowitt, Ms Urlaub, Ms Guzman-Corrales, Ms Mayer, Dr Fisher)
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Carey ME, Mandalia PK, Daly H, Gray LJ, Hale R, Martin Stacey L, Taub N, Skinner TC, Stone M, Heller S, Khunti K, Davies MJ. Increasing capacity to deliver diabetes self-management education: results of the DESMOND lay educator non-randomized controlled equivalence trial. Diabet Med 2014; 31:1431-8. [PMID: 24798205 DOI: 10.1111/dme.12483] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/10/2014] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
Abstract
AIM To develop and test a format of delivery of diabetes self-management education by paired professional and lay educators. METHODS We conducted an equivalence trial with non-randomized participant allocation to a Diabetes Education and Self Management for Ongoing and Newly Diagnosed Type 2 diabetes (DESMOND) course, delivered in the standard format by two trained healthcare professional educators (to the control group) or by one trained lay educator and one professional educator (to the intervention group). A total of 260 people with Type 2 diabetes diagnosed within the previous 12 months were referred for self-management education as part of routine care and attended either a control or intervention format DESMOND course. The primary outcome measure was change in illness coherence score (derived from the Diabetes Illness Perception Questionnaire-Revised) between baseline and 4 months after attending education sessions. Secondary outcome measures included change in HbA1c level. The trial was conducted in four primary care organizations across England and Scotland. RESULTS The 95% CI for the between-group difference in positive change in coherence scores was within the pre-set limits of equivalence (difference = 0.22, 95% CI 1.07 to 1.52). Equivalent changes related to secondary outcome measures were also observed, including equivalent reductions in HbA1c levels. CONCLUSION Diabetes education delivered jointly by a trained lay person and a healthcare professional educator with the same educator role can provide equivalent patient benefits. This could provide a method that increases capacity, maintains quality and is cost-effective, while increasing access to self-management education.
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Affiliation(s)
- M E Carey
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
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Schinckus L, Van den Broucke S, Housiaux M. Assessment of implementation fidelity in diabetes self-management education programs: a systematic review. PATIENT EDUCATION AND COUNSELING 2014; 96:13-21. [PMID: 24795074 DOI: 10.1016/j.pec.2014.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 03/19/2014] [Accepted: 04/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE As diabetes requires extensive self-care, self-management education is widely recommended to enhance the effectiveness and reduce the costs of treatment. While a variety of diabetes self-management (DSM) programs are available, the conditions for their effective implementation are not well documented. This paper reviews the literature on implementation fidelity (IF), the degree to which programs are delivered as intended, as a factor influencing the effectiveness of diabetes education. METHODS Medical, psychological and educational research databases were searched to identify published studies on diabetes education describing the implementation process. Studies detailing the intervention adherence/fidelity/integrity were included to assess the way key elements of IF were addressed. RESULTS From an initial 418 abstracts, 20 published papers were retained for an in-depth analysis focusing on the components of IF. Intervention content was mainly assessed through observation, whereas intervention dose was more often assessed through self-report measures. Only one study addressed the relationship between IF and intervention effectiveness. CONCLUSION Despite the importance of IF to achieve program outcomes, IF of DSM programs remains largely under-investigated. PRACTICE IMPLICATIONS The results of this review suggest that reports on DSM education should systematically describe how the program was implemented. The impact of IF on program outcomes needs further investigation.
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Affiliation(s)
- Louise Schinckus
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium.
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Marie Housiaux
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
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Wong EY, Jennings CA, Rodgers WM, Selzler AM, Simmonds LG, Hamir R, Stickland MK. Peer educator vs. respiratory therapist support: which form of support better maintains health and functional outcomes following pulmonary rehabilitation? PATIENT EDUCATION AND COUNSELING 2014; 95:118-125. [PMID: 24447522 DOI: 10.1016/j.pec.2013.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 10/24/2013] [Accepted: 12/09/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study examined if ongoing support delivered by telephone following pulmonary rehabilitation (PR) assisted chronic obstructive pulmonary disease (COPD) patients to maintain health outcomes. METHODS Phase one (n=79) compared post-rehabilitation telephone-based support delivered by peers compared to usual care (UC). The second phase (n=168) compared post-rehabilitation support from peer educators, respiratory therapists (RT), or UC. Primary outcome variables were St. George's Respiratory Questionnaire (SGRQ) total score and the six minute walk test (6MWT). Measures were obtained at baseline, immediately following PR, and six-months post PR. RESULTS Six-month follow-up data for phase one was collected for 66 COPD patients (n=35 peer support, n=31 UC) and 142 for phase two (n=42 peer support, n=52 RT support, n=48 UC). Per-protocol and intention to treat (ITT) analysis in both phases found no significant group by time differences for SGRQ or 6MWT. CONCLUSION Providing peer or RT support via telephone following PR was not more effective than UC for maintaining health outcomes. PRACTICE IMPLICATIONS There are concerns with using peers to provide ongoing support to COPD patients. Additionally, COPD patients require a higher level of care than telephone support can provide.
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Affiliation(s)
- Eric Y Wong
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Centre for Lung Health (Covenant Health), Edmonton General Continuing Care Centre, Edmonton, Alberta, Canada
| | - Cally A Jennings
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - Wendy M Rodgers
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Anne-Marie Selzler
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsay G Simmonds
- Centre for Lung Health (Covenant Health), Edmonton General Continuing Care Centre, Edmonton, Alberta, Canada
| | - Rashida Hamir
- Centre for Lung Health (Covenant Health), Edmonton General Continuing Care Centre, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Centre for Lung Health (Covenant Health), Edmonton General Continuing Care Centre, Edmonton, Alberta, Canada
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